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Genitourinary MBCHB2 > Lecture 1: Posterior abdominal wall > Flashcards

Lecture 1: Posterior abdominal wall Flashcards

1
Q

Describe the origin, insertion, action and innervation of the iliacus:

A

Origin: Iliac fossa
Insertion: Lesser trochanter of femur (joins psoas to form common tendon)
Action: Hip flexion
Innervation: Femoral n. (L2-4)

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2
Q

Describe the origin, insertion, action and innervation of Psoas Major:

A

Origin: T12,L1-5 (Vertebral bodies and IV discs)
Insertion: Lesser trochanter of femur, (Joins iliacus to form common tendon)
Action: Raise body from supine position (both) / Bend trunk laterally (one) / Flex hip jt.
Innervation: L1-3 (4) (anterior rami)

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3
Q

Describe the origin, insertion, action and innervation of quadratus lumborum:

A

Origin: Iliac crest
Insertion: 12th rib and L1-4 transverse processess
Action: Both = Forced expiration and 12th rib support, One = Bend trunk to same side
Innervation: T12, L1-4 (ANTERIOR Rami)

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4
Q

What are the muscles of the posterior abdominal wall:

A

Psoas, Quadratus, Transversus, Iliacus, Diaphragm

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5
Q

Whats the arterial and venous supply of the posterior abdominal wall?

A

x5 Lumbar arteries
x5 Lumbar veins

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6
Q

Describe the urinary system:

A

Kidney
Ureter
Bladder
Urethra

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7
Q

Where are all the urinary organs located?

A

All = Retroperitoneal/infraperitoneal

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8
Q

What is the function of the urinary system:

A

Removal of waste
Electrolyte balance
pH balance
Blood pressure / volume regulation

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9
Q

Describe the surface anatomy location of the kidneys:

A
  • Post. abdomen
  • RK slightly lower than left b/c liver ~Rib12
  • Lk sits behind and below Rib 11+12
  • Ureters exit kidney @L1 transpyloric plane
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10
Q

Describe the hilums of the kidney:

A

Renal vein + Renal arteries (also lymphatics and ANS) (Veins anterior to art.)

  • Ureters+renal pelvis = posterior to renal vessels

(Note can be divided into upper and lower poles)

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11
Q

What happens to renal arteries when they enter the kidney?

A
  • Arteries branch into anterior and posterior branches before entering the kidney
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12
Q

Describe a key difference in R and L renal veins:

A

Left renal vein is much longer because the right shifted. The left renal vein also travels between aorta and SMA which can lead to compression and nutcracker syndrome.

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13
Q

Write some notes on the venous supply of the renal veins:

A

Renal veins -> Into IVC Laterally @L1/2

Left renal vein = x3 longer than right, ant. to aorta, under SMA and post. to splenic v./ body of pancreas.

Right renal vein = Runs post. to secondary duodenum

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14
Q

What is the nerve supply of the kidneys:

A

Renal plexus:

  • Symp; Complicated (T11-12)
  • Parasymp; Vagus n.

Referred pain described as flank pain

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15
Q

What is the lymphatics of the kidneys:

A

Para-aortic nodes (@L1/2)

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16
Q

What are the ureters and what do they do?

A

Ureter = Smooth muscle muscle tube

Propells urine from kidney via smooth muscle contractions (Filtration pressure from glomeruli)

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17
Q

Why is it important to know the anatomy of the ureter?

A

V imp. for surgery as they cross many important structures and are around 25cm long

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18
Q

Describe the journey of the ureter:

A
  • Exits kidney @ L1
  • Extends vertically down from hilum on surface of Psoas muscle (Roughly inline with transverse process of lumbar spine)
  • Crosses bifurcation of common iliac artery (Ant. SI joint)
  • Passes on ilium towards ischial spine
  • Enters bladder on post. surface at the trigone
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19
Q

Describe the blood supply of the ureter:

A

Sup 1/3 = Renal art
Mid 1/3 = Gonadal art. and Iliac Art.
Inf 1/3 = Sup. vesical art.

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20
Q

Describe the venous supply of the ureter:

A

Sup 1/3 = Renal vein
Mid 1/3 = Gonadal vein. and Iliac vein.
Inf 1/3 = Sup. vesical vein.

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21
Q

Describe the nervous supply of the ureter:

A

Renal plexus (Sup)

Hypogastric plexuses (Inf 1/3)

Pain referred LOIN to GROIN

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22
Q

What are the lymphatics of the ureter?

A

Para-aortic @ L1/2 to iliac nodes

23
Q

What are the three constrictions of the ureters?

A
  • Pelvi-ureteric junction
  • Ureters crossing pelvic brim
  • As they enter the wall of bladder - vesico-ureteric junction

Importance: Most common sites of renal calculus obstruction

24
Q

Overview the bladder:

A
  • Transition epithelium and rugae
  • Muscular SM coat = Detrusor muscle
  • Neck of bladder has internal urethral sphincter (SM)
  • Apex post. to pubic symphysis
  • Bladder fills and rises to suprapubic region
  • Partial covering of peritoneum
25
Q

Ureters enter at the trigone, whats the importance of this and what is it?

A
  • Trigone: Triangular smooth area at base of bladder, mucous membrane, no rugae
  • Ureters enter and urethra exits at the points
  • B/w ureteric openings is known as the inter-ureteric crest
  • The ureteric entrance are oblique (acts as pressure valve to prevent backflow)
26
Q

What is the art., venous, nervous supply of the bladder:

A

Arterial: Sup (x2) and inf. vesical arteries on both sides (off internal iliac)
Venous: Vesical plexus (drains to internal iliac vein)
Nervous: ANS inferior hypogastric plexus
Symp: Sacral splenich nn.
Parasymp: Pelvic splanchnic nn.

Pain = Referred to suprapubic region (L1/2 dermatome)

27
Q

Describe the path of the female urethra:

A

4cm, leaves bladder and passes through deep and superficial perineal pouches.

28
Q

Describe the 4 distinct regions of the male urethra:

A

Pre-prostatic: (Assc with Int. urethral sphincter)
Prostatic: Widest, Many ducts dump
Membranous: Thinnest, Through deep perineal pouch (External urethral sphincter)
Spongy/penile: Through bulb of penis/corpus spongiosum

29
Q

Describe the lymphatics of the urinary tract:

A

Ureter: Para-aortic @L1/2, lumbar, common iliac, ext. iliac, int. iliac (as they descend towards bladder)

Bladder: Internal iliac nodes

Urethra: Internal iliac nodes

30
Q

What do the iliohypogastric and olioinguinal nerves have in common?

A

Both L1 (Motor and Sensory)

31
Q

Describe the sensory and motor function of the iliohypogastric nerve:

A

Sensory: Lateral gluteal and pubic skin
Motor: Transversus abdominus

32
Q

Describe the sensory and motor function of the ilioinguinal nerve:

A

Sensory: Skin of medial thigh and root of penis/scrotum or mons pubis/labia majora

33
Q

Describe the course of the iliohypogastric and ilioingunial nerves:

A
  • Emerge lateral border of Psoas
  • Run obliquely over Quad Lumborum (IL1iohypo sup. to IL1ioinguinal)
  • Pierce transversus abdominus

Note: Ilioinguinal will pierce internal oblique to enter inguinal canal and accompany spermatic cord through inguinal ring

34
Q

Where does the gen12ofemoral nerve originate and what are its two main branches?

A

L1 and L2 (Motor and Sensory)

Two branches:

  • Genital
  • Femoral
35
Q

What are the sensory and motor functions of the genitofemoral nerve?

A

Sensory:

  • Scrotum/Mons pubis
  • Skin of upper ant. thigh

Motor
- Cremasteric muscle

36
Q

Describe the course of the genitofemoral nerve:

A
  • Emerges through and runs on top of Psoas
  • Genital branch will pass through inguinal canal / spermatic cord to innervate cremaster muscle and give sensory to genital skin
  • Femoral branch will pass under inguinal ligament to thigh
37
Q

What is the origin and function of the lateral femoral cutaneous nerve?

A

Origin: L2 and L3

Sensory only: Skin on Anterior and lateral thigh (Above the knee)

38
Q

Describe the course of the lateral femoral cutaneous nerve:

A
  • Emerges from lateral border of Psoas
  • Descends obliquely across surface of Iliacus
  • Passes under inguinal lig. (At lateral extremity near attatchment to ASIS)
39
Q

What is a clinical condition associated with the lateral femoral cutaneous nerve?.

A

Bernhardt-Roth Syndrome (Meralgia parasthetica)
- Numbness of outer thigh due to compression of the nerve as it passes under the inguinal ligament

i.e seat belts, exercise, tight clothing

40
Q

What is the origin and function of the femoral nerve?

A

Origin: L2-4 (Its the largest)

Sensory: Skin of anterior thigh and medial leg.
Motor: Pectineus, Iliacus and Anterior compartment of thigh

41
Q

Describe the course of the femoral nerve:

A
  • Emerges from lower lateral border of Psoas
  • Runs between iliacus and Psoas
  • Passes under inguinal ligament to thigh
42
Q

Describe the origins and functions of the obturator nerve:

A

Origin: L2-4

Sensory: Skin on medial thigh
Motor: Obturator externus and Medial compartment of thigh

43
Q

What is the course of the obturator nerve?

A
  • Emerges from lower medial border of Psoas
  • Passes behind the common iliac arteries, then lateral to internal iliac and ureters
  • Runs along walls of pelvic cavity to exit via the Obturator foramen (Specifically through the obturator internus and externus)
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Genitourinary MBCHB2 (26 decks)

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