Lecture 10 (abdomen) pt 4 Flashcards
1) Are the kidneys intraperitoneal or retroperitoneal?
2) What is the renal hilum (vertical cleft)?
3) What does the renal sinus contain?
1) Retroperitoneal
2) Entrance to the renal sinus
3) Mostly fatty tissue embedding renal pelvis, calices, vessels and nerves
List the 7 major parts of the urine collection system in order
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
1) What two things traverse the renal columns?
2) What is the apex of the renal pyramid (loops of Henle) called?
1) Renal artery and veins
2) Renal papilla
1) Are the ureters intraperitoneal or retroperitoneal?
2) What do they cross? Where?
3) What are its 3 important areas?
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”
List the 3 areas of “constriction”/ potential sites of obstruction of the ureters.
What is the significance of these?
1) Ureteropelvic junction
2) Crossing external iliac vessels at sacrum
3) Ureter traverses bladder wall
-Most likely places to find a kidney stone stuck
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?
1) Fibrous capsule
2) Cortex: secrets corticosteroids and androgens
3) Medulla: secrets catecholamines (epinephrine and norepinephrine)
What is the unique job of the medulla of the adrenal glands?
Act as post-synaptic cell body for pre-synaptic sympathetic fibers
What two things are different about the right renal artery when compared to the left one?
1) Longer
2) Passes posterior to IVC
1) Superior suprarenal arteries come from where?
2) Middle suprarenal arteries come from where?
3) Inferior suprarenal arteries come from where?
1) Inferior phrenic artery
2) Abdominal aorta near origin of SMA
3) Renal artery
Why is suprarenal blood supply so vast?
Due to endocrine function
1) Where does the renal artery divide? Into how many things?
2) Then what do those turn into?
1) Close to Hilum divides into 5 segmental a.
2) End arteries
What are the 3 ureter vascular supply sources?
1) Renal artery
2) Testicular or ovarian artery
3) Abdominal aorta
What are the 3 blood supply sources for the suprarenal glands? Were does each come from?
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
What does each renal vein of the kidneys drain into?
The IVC (NOT the hepatic portal)
Describe the route of the left renal vein. Is it longer or shorter than the right?
Left renal vein longer, passes anterior to aorta but under the SMA
What is the vein of suprarenal glands?
State whether the left or right one is shorter and which drains directly into the IVC
Large suprarenal vein;
1) Shorter right into IVC
2) Longer left into the left renal vein, then into IVC
Renal lymphatics follow what?
The veins (drain midline)
1) What type of sensation allows the kidneys to feel pain?
2) Where do renal lymphatics gather? Where do they flow to after?
1) Visceral sensory for pain (renal colic); sympathetic fibers retrograde T11-L5
2) Lymphatics gather paramedian and flow to thoracic duct
Lymphatic renal drainage goes where? Then where does it go up?
To center (lumbar) LN, then up toward cisterna chyli
1) Define cisterna chyli
2) What flows into here?
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.
1) What vertebral level are the kidneys at?
2) What about the renal arteries?
3) What about the infra renal aorta?
1) T12-L3 (umbilicus ~ L3)
2) ~L1/2 (RAS)
3) ~L2/3 (AAA)
1) What vertebral level is the aortic bifurcation at?
2) Where does the right kidney go from?
3) Where is the left kidney?
1) Aortic bifurcation ~ L4/5
2) Lower 2nd to liver
3) 5cm from median plane
1) Generally, kidneys not palpable; why?
2) Where are the ureters? What is the significance of this?
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
1) Where is CVA tenderness?
2) Where is the transpyloric plane?
3) What is the scapular line?
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
1) Is the spleen retroperitoneal?
2) Are the kidneys retroperitoneal?
1) Spleen: not retroperitoneal
2) Kidneys: yes, retroperitoneal
What are the veins of the posterior abdominal wall?
1) IVC (from two common iliac veins)
2) Portal venous system
True or false: The IVC has no valves
True
What does the IVC drain blood from? (4 places)
LE, most of the back, the abdominal walls, pelvic viscera
1) What does the portal venous system collect blood from?
2) How?
1) Abdominal viscera to the liver before entering the IVC
2) Via the hepatic veins just prior to entering the diaphragm
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?
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.
Where does the IVC ascend? Where does it leave?
To the right of the vertebrae and aorta; leaves through the caval aperture in the diaphragm
What are the 8 tributaries of the IVC?
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
Which testicular/ ovarian veins are direct tributaries of the IVC, left or right? Where does the other one come from?
Right testicular or ovarian veins; left via left renal vein
What connect the IVC with SVC?
Ascending lumbar veins + azygos/hemi-azygos veins
1) Which suprarenal vein are direct tributaries of the IVC, left or right?
2) Which lumbar veins are tributaries of the IVC?
1) Right suprarenal vein (left via the left renal vein
2) 3rd and 4th
What are the paired muscles of the posterior abdominal wall and what does each do?
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
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?
1) Posterior part of psoas m.
2) L1-4 spinal nerves
3) Iliopsoas
What 6 nerves come from the lumbar plexus?
(don’t think we need to know in a ton of detail)
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
1) Is the stomach retroperitoneal?
2) Is the pancreas retroperitoneal?
1) Stomach: no
2) Pancreas: yes
1) Is the duodenum retroperitoneal?
2) Are the ileum/ jejunum retroperitoneal?
1) First part and last parts are not retro, most is
2) Not retroperitoneal, mesentery
