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Anatomy Exam 2 > Kidneys, Diaphragm and Posterior Abdominal Wall > Flashcards

Kidneys, Diaphragm and Posterior Abdominal Wall Flashcards

1
Q

Describe the fat & fascia surrounding the kidneys

A
  • kidney are encapsulated by
    • perirenal fat
    • renal fascia
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2
Q

Describe the structure of the kidneys

A
  • Fibrous capsule
  • Renal cortex
    • outer 1/3
  • Renal medulla
    • inner 2/3 contains renal pyramids
  • Renal papillae
    • receive apex of pyramids
  • Minor calyces
  • Major calyces
  • Renal pelvis Ureter
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3
Q

Describe the position of the kidneys

A
  • located lateral to vertebral column T12-L3
    • superior pole of L kidney at 11th rib
    • superior pole of R kidney at 12th rib
  • kidneys ascend from pelvis during development (ectopic pelvic – remains ant. to sacrum; horseshoe – below IMA; transplanted – placed in lower abdomen)
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4
Q

Describe the drainage of the kidneys

A
  • Renal papillae receive tips of pyramids (urine)
    • to Minor Calyces
      • to Major Calyces
        • to Renal pelvis
          • to Ureter to Urinary bladder
            • to Urethra
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5
Q

Describe the course of the ureters

A
  • Cross psoas major mm to enter bladder
  • Run obliquely posterior to gonadal vessels
  • Anterior to Ext. Iliac a.
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6
Q

Describe the common variations of the ureters

A
  • Bifid renal pelvis & ureters
    • fairly common
  • Retrocaval ureters
    • occasional
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7
Q

Explain the referred pain relative to kidney stones

A
  • Waves of contraction force kidney stone down thru ureter
  • Rhythmic pain occurs & is referred with descent of stone
  • Region of referred pain changes with level of obstruction
  • Gradually moves inferoanteriorly toward groin
    • from side & back between ribs to pelvis to inguinal
      • area of cutaneous innervation T11-12
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8
Q

Describe the structure and location of the adrenal glands

A
  • Fibrous capsule
  • Adrenal cortex
    • outer produces adrenal steroids
  • Adrenal medulla
    • inner portion that acts as sympathetic ganglion
  • Two glands
  • R gland
    • roughly triangular
    • Lies superior to R kidney
    • posterior to IVC
  • L gland
    • more semilunar
    • Lies superomedial to L kidney
    • near hilum
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9
Q

Describe the structure of the diaphragm

A
  • Dome shaped sheet of muscle and tendon
  • Vena Cava foramen T8
    • IVC
  • Esophageal Hiatus T10
    • Esophagus
  • Aortic Hiatus T12
    • Aorta
  • Consists of Arcuate Ligaments or Lumbocostal arches
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10
Q

Describe the function of the diaphragm

A
  • separates the thoracic cavity from the abdominal cavity
  • important for respiration
    • inhale as diaphragm contracts
    • exhale as diaphragm relaxes
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11
Q

Describe the neurovascular supply of the diaphragm

A
  • Phrenic nerve
    • motor & sensory components
  • Pericardiacophrenic & superior phrenic vessels
  • Inferior phrenic vessels
  • Musculophrenic vessels
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12
Q

Describe the musculature of the posterior abdominal wall

A
  • Transversus abdominus m.
  • Quadratus lumborum m.
  • Psoas major m
  • Iliacus m.
  • Psoas minor m.
  • Diaphragm
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13
Q

Describe the vasculature of the posterior abdominal wall

A
  • Lumbar aa 4 pairs aa
    • brs of Abd aorta (sup to bifurcation)

Note: Aorta bifurcates at L4 level of umbilicus

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14
Q

Describe the composition & innervation pattern of the lumbar plexus of nerves

A
  • Ventral rami T12-L4
    • subcostal is T12
    • iliohypogastric L1
    • ilioinguinal L2
  • Lumbar plexus of nn.
    • located beneath fascia of posterior abd. mm.
    • note positions of the nerves relative to psoas major m.

Note: Symp. trunks posterior as well continuous with thoracic portions

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15
Q

Describe the vasculature of the kidneys

A
  • Renal Arteries
    • R longer
    • R passes post to IVC
  • Each divides at hilum into segmental aa
    • end arteries
  • Renal veins to IVC
    • anterior to arteries
    • L is longer
    • L passes anterior to aorta
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16
Q

Describe the vasculature of the ureters

A
  • Ureter Arteries – arise from 3-4 sources
    • renal a.
    • testicular or ovarian a.
    • abdominal aorta
    • internal iliac a. (Pelvic cavity)
  • Veins of ureters drain into similarly named vv.
17
Q

Describe kidney stones (calculi)

A
  • Form in kidney & progress to renal pelvis
  • May spontaneously pass thru ureter into bladder
  • Usually associated with considerable pain
  • Larger stones my have to be surgically removed
    • (~1cm)
  • May be subjected to ultrasonic crushing via lithotripsy
18
Q

Describe the vasculature of the adrenal glands

A
  • Richly vascularized due to endocrine function
  • Suprarenal aa – 3 sources
    • Sup. suprarenal aa (6-8)
      • Inferior phrenic a
    • Middle suprarenal aa (1+)
      • Abdominal aa
    • Inf. suprarenal aa (1+)
      • Renal aa
19
Q

Describe the nerves of the posterior wall

A
  • Ventral rami T12-L4
  • Lumbar plexus of nn.
    • located beneath fascia of posterior abd. mm.
20
Q

Describe the Subcostal n

A
  • T 12
  • ~1cm inferior to 12th rib
  • Supplies sensory to
    • ant./lat. abd. wall
  • Supplies motor to abdominal mm.
    • EO, IO, TA, pyramidalis, RA, QL
21
Q

Describe the Iliohypogastric & Ilioinguinal Nn

A
  • L1
  • Can arise from common trunk
  • descend ant. to QL
  • Both also supply abd. mm.
  • Iliohypogastric n.
    • supplies skin of suprapubic region
  • Ilioinguinal n.
    • runs thru inguinal call to supply it
22
Q

Describe the genitofemoral n

A
  • L1-L2
  • Pierces psoas major m.
  • descends along ant. surface
  • Splits to
    • femoral br.
    • genital br.
  • Supplies skin inf. & med. to inguinal ligament
  • Supplies cremaster m. (of spermatic cord)
23
Q

Describe the Lateral Femoral Cutaneous n

A
  • L2-L3
  • Descends ant. to iliacus m.
  • Passes deep to inguinal ring
  • Inferior to ASIS
  • Supplies ant./lat. skin of thigh
24
Q

Describe the femoral n

A
  • L2-L4
  • Runs between iliacus & psoas major mm.
  • Passes deep to inguinal ligament
  • Inferior to ASIS
  • Supplies sensory & motor to anterior thigh
25
Q

Describe the obturator n

A
  • L2-L4
  • Runs medial to psoas major mm.
  • Passes thru obturator foramen
  • Supplies sensory & motor to medial thigh
26
Q

Compare and contrast femoral and obturator nn

A
  • both are L2-L4
  • Femoral N.
    • Supplies sensory & motor to anterior thigh
  • Obturator N.
    • Supplies sensory & motor to medial thigh
27
Q

Describe the lumbosacral trunk

A
  • L4-L5
  • Large n. trunk crosses over ala of sacrum
  • Descends into pelvis to help form sacral plexus
  • Provides general contributions to both plexuses
28
Q

Describe the pericardiacophrenic & superior phrenic vessels

A
  • arteries supply superior surface of diaphragm
    • pericadiacophrenic a: branch of int. thoracic a
    • sup. phrenic a : branch of thoracic aorta
  • veins drain to IVC
29
Q

Describe the Inferior phrenic vessels

A
  • 2 of them
  • artery supplies inferior surface or diaphragm
    • branch of abdominal aorta
  • vein drain to IVC
30
Q

Describe the musculophrenic vessels

A
  • arteries supply periphery of diaphram (lateral part)
    • branch of int. thoracic aa.
  • vein drains to IVC
31
Q

Describe the arcuate ligaments or lumbocostal arches

A
  • 1 median arcuate lig.
    • arches over aorta
  • 2 medial arcuate ligs.
    • arch over psoas mm.
  • 2 lateral arcuate ligs.
    • arch over quadratus lumborum mm.
32
Q

Phrenic n clinical notes

A
  • Originate from C3-C5 spinal segments
  • Explains paralysis from cervical cord injuries
    • paralysis of diaphragmatic respiration
  • Paralyzed hemidiaphragm cannot contract (descend) unilateral damage
    • remains high in thorax
    • recognizable on radiographic chest films

Note : expiratory film doesn’t reveal paralysis, only evident on inspiratory film

33
Q

Describe the Arcuate Ligaments or Lumbocostal arches

A
  • 1 median arcuate lig
    • arches over aorta
  • 2 medial arcuate ligs.
    • arch over psoas mm.
  • 2 lateral arcuate ligs.
    • arch over quadratus lumborum mm.
34
Q

Subclavian artery overview

A

subclavian a

  • comes off thoracic aorta
  • gives off internal thoracic a
    • branches
      • pericardiophrenic a
      • bifurcates
        • sup. epigastric a
        • musculophrenic a
35
Q

throacic aorta overview

A

branches

  • subclavian a
  • superior phrenic a

covered by median arcuate ligament

enters diaphragm via aortic hiatus at T12

then refered to as abdominal aorta

36
Q

Abdominal aorta overview

A

below the arcuate ligaments of the diaphragm

branches

  • inferior phrenic
  • celiac trunk
  • renal a.a
  • SMA
  • IMA

bifurcates into common iliac aa

Anatomy Exam 2 (13 decks)

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