Kidneys, Diaphragm and Posterior Abdominal Wall Flashcards
Describe the fat & fascia surrounding the kidneys
- kidney are encapsulated by
- perirenal fat
- renal fascia
Describe the structure of the kidneys
- 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

Describe the position of the kidneys
- 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)

Describe the drainage of the kidneys
- Renal papillae receive tips of pyramids (urine)
- to Minor Calyces
- to Major Calyces
- to Renal pelvis
- to Ureter to Urinary bladder
- to Urethra
- to Ureter to Urinary bladder
- to Renal pelvis
- to Major Calyces
- to Minor Calyces
Describe the course of the ureters
- Cross psoas major mm to enter bladder
- Run obliquely posterior to gonadal vessels
- Anterior to Ext. Iliac a.
Describe the common variations of the ureters
- Bifid renal pelvis & ureters
- fairly common
- Retrocaval ureters
- occasional
Explain the referred pain relative to kidney stones
- 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
- from side & back between ribs to pelvis to inguinal
Describe the structure and location of the adrenal glands
- 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

Describe the structure of the diaphragm
- 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

Describe the function of the diaphragm
- separates the thoracic cavity from the abdominal cavity
- important for respiration
- inhale as diaphragm contracts
- exhale as diaphragm relaxes
Describe the neurovascular supply of the diaphragm
- Phrenic nerve
- motor & sensory components
- Pericardiacophrenic & superior phrenic vessels
- Inferior phrenic vessels
- Musculophrenic vessels
Describe the musculature of the posterior abdominal wall
- Transversus abdominus m.
- Quadratus lumborum m.
- Psoas major m
- Iliacus m.
- Psoas minor m.
- Diaphragm
Describe the vasculature of the posterior abdominal wall
- Lumbar aa 4 pairs aa
- brs of Abd aorta (sup to bifurcation)
Note: Aorta bifurcates at L4 level of umbilicus

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

Describe the vasculature of the kidneys
- 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

Describe the vasculature of the ureters
- 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.

Describe kidney stones (calculi)
- 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
Describe the vasculature of the adrenal glands
- 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
- Sup. suprarenal aa (6-8)

Describe the nerves of the posterior wall
- Ventral rami T12-L4
- Lumbar plexus of nn.
- located beneath fascia of posterior abd. mm.
Describe the Subcostal n
- 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
Describe the Iliohypogastric & Ilioinguinal Nn
- 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
Describe the genitofemoral n
- 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)
Describe the Lateral Femoral Cutaneous n
- L2-L3
- Descends ant. to iliacus m.
- Passes deep to inguinal ring
- Inferior to ASIS
- Supplies ant./lat. skin of thigh
Describe the femoral n
- L2-L4
- Runs between iliacus & psoas major mm.
- Passes deep to inguinal ligament
- Inferior to ASIS
- Supplies sensory & motor to anterior thigh
