Lecture 10 (abdomen) pt 4

Question 1

1) Are the kidneys intraperitoneal or retroperitoneal?
2) What is the renal hilum (vertical cleft)?
3) What does the renal sinus contain?

Answer 1

1) Retroperitoneal
2) Entrance to the renal sinus
3) Mostly fatty tissue embedding renal pelvis, calices, vessels and nerves

Question 2

List the 7 major parts of the urine collection system in order

Answer 2

1) Renal pyramid (loops of Henle)
2) Apex of pyramid, called renal papilla indent each minor calices
3) 2-3 minor calices merge into major calices
4) 2-3 major calices merge into renal pelvis
5) Renal pelvis (expanded ureter)
6) Ureters
7) Bladder

Question 3

1) What two things traverse the renal columns?
2) What is the apex of the renal pyramid (loops of Henle) called?

Answer 3

1) Renal artery and veins
2) Renal papilla

Question 4

1) Are the ureters intraperitoneal or retroperitoneal?
2) What do they cross? Where?
3) What are its 3 important areas?

Answer 4

1) Retroperitoneal
2) Inferiorly cross external iliac just after bifurcation of common iliac and lateral wall of pelvis to bladder
3) The 3 areas of “constriction”

Question 5

List the 3 areas of “constriction”/ potential sites of obstruction of the ureters.
What is the significance of these?

Answer 5

1) Ureteropelvic junction
2) Crossing external iliac vessels at sacrum
3) Ureter traverses bladder wall
-Most likely places to find a kidney stone stuck

Question 6

1) What protects the adrenal/ supra renal glands?
2) What is the second layer of the adrenal glands? What two things does this structure secrete?
3) What is the thick inner layer of the adrenal glands called? What does this structure secrete?

Answer 6

1) Fibrous capsule
2) Cortex: secrets corticosteroids and androgens
3) Medulla: secrets catecholamines (epinephrine and norepinephrine)

Question 7

What is the unique job of the medulla of the adrenal glands?

Answer 7

Act as post-synaptic cell body for pre-synaptic sympathetic fibers

Question 8

What two things are different about the right renal artery when compared to the left one?

Answer 8

1) Longer
2) Passes posterior to IVC

Question 9

1) Superior suprarenal arteries come from where?
2) Middle suprarenal arteries come from where?
3) Inferior suprarenal arteries come from where?

Answer 9

1) Inferior phrenic artery
2) Abdominal aorta near origin of SMA
3) Renal artery

Question 10

Why is suprarenal blood supply so vast?

Answer 10

Due to endocrine function

Question 11

1) Where does the renal artery divide? Into how many things?
2) Then what do those turn into?

Answer 11

1) Close to Hilum divides into 5 segmental a.
2) End arteries

Question 12

What are the 3 ureter vascular supply sources?

Answer 12

1) Renal artery
2) Testicular or ovarian artery
3) Abdominal aorta

Question 13

What are the 3 blood supply sources for the suprarenal glands? Were does each come from?

Answer 13

1) Superior suprarenal (6-8): from inferior phrenic a.
2) Middle (1+): from aorta near origin of SMA
3) Inferior (1+): from the renal artery

Question 14

What does each renal vein of the kidneys drain into?

Answer 14

The IVC (NOT the hepatic portal)

Question 15

Describe the route of the left renal vein. Is it longer or shorter than the right?

Answer 15

Left renal vein longer, passes anterior to aorta but under the SMA

Question 16

What is the vein of suprarenal glands?

State whether the left or right one is shorter and which drains directly into the IVC

Answer 16

Large suprarenal vein;
1) Shorter right into IVC
2) Longer left into the left renal vein, then into IVC

Question 17

Renal lymphatics follow what?

Answer 17

The veins (drain midline)

Question 18

1) What type of sensation allows the kidneys to feel pain?
2) Where do renal lymphatics gather? Where do they flow to after?

Answer 18

1) Visceral sensory for pain (renal colic); sympathetic fibers retrograde T11-L5
2) Lymphatics gather paramedian and flow to thoracic duct

Question 19

Lymphatic renal drainage goes where? Then where does it go up?

Answer 19

To center (lumbar) LN, then up toward cisterna chyli

Question 20

1) Define cisterna chyli
2) What flows into here?

Answer 20

1) A dilated sac at the lower end of the thoracic duct (in most mammals)
2) Lymph from the intestinal trunk and two lumbar lymphatic trunks flow.

Question 21

1) What vertebral level are the kidneys at?
2) What about the renal arteries?
3) What about the infra renal aorta?

Answer 21

1) T12-L3 (umbilicus ~ L3)
2) ~L1/2 (RAS)
3) ~L2/3 (AAA)

Question 22

1) What vertebral level is the aortic bifurcation at?
2) Where does the right kidney go from?
3) Where is the left kidney?

Answer 22

1) Aortic bifurcation ~ L4/5
2) Lower 2nd to liver
3) 5cm from median plane

Question 23

1) Generally, kidneys not palpable; why?
2) Where are the ureters? What is the significance of this?

Answer 23

1) Retroperitoneal and under ribs except for inferior poles
2) Occupy sagittal plane that intersects tips of transverse processes of lumbar vertebrae
-important radiographic landmark

Question 24

1) Where is CVA tenderness?
2) Where is the transpyloric plane?
3) What is the scapular line?

Answer 24

1) Just below last rib
2) ~T-12: hilum of left kidney, superior pole right kidney
3) The sagittal line passing thru inferior angle of scapula

Question 25

1) Is the spleen retroperitoneal?
2) Are the kidneys retroperitoneal?

Answer 25

1) Spleen: not retroperitoneal
2) Kidneys: yes, retroperitoneal

Question 26

What are the veins of the posterior abdominal wall?

Answer 26

1) IVC (from two common iliac veins)
2) Portal venous system

Question 27

True or false: The IVC has no valves

Answer 27

True

Question 28

What does the IVC drain blood from? (4 places)

Answer 28

LE, most of the back, the abdominal walls, pelvic viscera

Question 29

1) What does the portal venous system collect blood from?
2) How?

Answer 29

1) Abdominal viscera to the liver before entering the IVC
2) Via the hepatic veins just prior to entering the diaphragm

Question 30

1) Where does the IVC begin? What two things unite to form it?
2) Where is this in relation to the aorta’s bifurcation and the rt common iliac a?

Answer 30

1) Begins anterior to L5 by union of two common iliac veins about 2.5cm right of the median plane
2) Inferior to the bifurcation of the aorta and posterior to the right common iliac a.

Question 31

Where does the IVC ascend? Where does it leave?

Answer 31

To the right of the vertebrae and aorta; leaves through the caval aperture in the diaphragm

Question 32

What are the 8 tributaries of the IVC?

Answer 32

1) Common iliac veins
2) 3rd and 4th lumbar veins
3) Right testicular or ovarian veins (left via the left renal vein)
4) Right and left renal veins
5) Ascending lumbar veins + azygos/hemi-azygos veins – connect the IVC with SVC
6) Right suprarenal vein (left via the left renal vein)
7) Inferior phrenic veins
8) Hepatic veins

Question 33

Which testicular/ ovarian veins are direct tributaries of the IVC, left or right? Where does the other one come from?

Answer 33

Right testicular or ovarian veins; left via left renal vein

Question 34

What connect the IVC with SVC?

Answer 34

Ascending lumbar veins + azygos/hemi-azygos veins

Question 35

1) Which suprarenal vein are direct tributaries of the IVC, left or right?
2) Which lumbar veins are tributaries of the IVC?

Answer 35

1) Right suprarenal vein (left via the left renal vein
2) 3rd and 4th

Question 36

What are the paired muscles of the posterior abdominal wall and what does each do?

Answer 36

1) Psoas major + Iliacus = iliopsoas m.
-Acts on hip joint = flexes
-While sitting flexes the vertebral column
2) Quadratus lumborum
-Extends and laterally flexes the vertebral column

Question 37

1) What part of what muscle is the lumbar plexus on?
2) What nerves does it come from?
3) Where does it supply motor innervation to?

Answer 37

1) Posterior part of psoas m.
2) L1-4 spinal nerves
3) Iliopsoas

Question 38

What 6 nerves come from the lumbar plexus?
(don’t think we need to know in a ton of detail)

Answer 38

1) Obturator n. L2-4, innervates the medial thigh and adductor muscles
2) Femoral n. L2-4, innervates iliacus m., anterior thigh suppling flexors of the hip and extensors of the knee
3) Lumbosacral trunk L4-5…participates in formation of sacral plexus
4+5) Ilioinguinal and iliohypogastric supply the abdominal muscles and skin of the pubic and inguinal regions
6) Genitofemoral n., divides into femoral and genital branches
Lateral cutaneous nerve of the thigh innervates skin of anterior lateral thigh

Question 39

1) Is the stomach retroperitoneal?
2) Is the pancreas retroperitoneal?

Answer 39

1) Stomach: no
2) Pancreas: yes

Question 40

1) Is the duodenum retroperitoneal?
2) Are the ileum/ jejunum retroperitoneal?

Answer 40

1) First part and last parts are not retro, most is
2) Not retroperitoneal, mesentery