Lecture 11 - Posterior Abdominal wall and retroperitoneal viscera

Question 1

As we move laterally from the vertebral coloum there are _ musclces, what are they?

Answer 1

4 muscles:

pair of psoas major muscle
Psoas minor (missing in 1/3 of people)
Quadratus lumborum
Iliacus below

Question 2

Where does iliacus originate?

Answer 2

iliac fossa - its tendon converges with psoas to insert into the lesser trochanter

Question 3

Psoas majors origin is from the lower border of..

Answer 3

T12 - -vertebral bodies and medial side of the transverse process

Question 4

The tendon of psoas passes ____ the inguinal ligament and attaches to..

Answer 4

The tendon of psoas passes beneath the inguinal ligament, attaches to the lesser trochanter

Question 5

Psoas major is slender (disappearing - not in 1/3 of people) - the tendon blends with the …

Answer 5

perisoteum of the pelvis

Question 6

Quadratus Lumboum (QL) has to fill what space?

Answer 6

gap inferior to the 12th rib, superior to the poster half of the iliac crest and edge to edge with psoas major - stabilises the 12th rib

Question 7

Where are the vessels, lumbar plexus, sympathetic trunk and ureter in relation to psoas major?

Answer 7

vessels 0 behind
lumbar plexus - within
sympathetic trunk and ureter - in front

Question 8

Each of iliacus and Psoas is enclosed in ..

Answer 8

their own fascial sheath

• Psoas Fascia and iliacus fascia

Question 9

QL and erector spinae are enclosed by..

Answer 9

thoracolumbar fascia

Question 10

The thoracolumbar fascia has _ layers to it

Where do each of the layers come from?

Answer 10

3

Posterior - from the tip of spinous process

middle - from the tip of transverse process

anterior - from the front of the transverse process

Question 11

The 3 layers of thoracolumbar fascia fuse along the line of the ___ rib

How many compartments does this create and what is in each one?

Answer 11

12th

2 compartments

anterior - contains QL

posterior - contains ES

Question 12

What constitutes a psoas abscess?

Answer 12

bursting into psoas by contained in the fascial envelope

Question 13

Which muscle do the kidney lie on?

Answer 13

QL

Question 14

Which vertebrae are the Kidneys adjacent to?

Answer 14

T12/L3 - but related to diaphragm also, so will move with it

Surgeons can got in from behind - take out 12th rib

Question 15

The right kidney sits a bit lower because of the ___

Answer 15

liver

Question 16

The kidney have their own fibrous capsule called..

Answer 16

the renal capsule - also surrounded by a lot of fat

Question 17

What is the organisation of the Kidney?

Answer 17

Outer cortex - continuous

inner medulla - discontinous (darker), divided into discrete pyramids with their apex pointing to the collecting system

Question 18

Once the hilum enters the Kidney they are embedded in fat know as the …

Answer 18

renal sinus

Question 19

From anterior to posterior, the Kidney hilum:

Answer 19

renal vein,
renal artery (branches of aorta)
renal pelvis

(also nerves and lymphatics)

Question 20

Just proximal to the kidney the renal artery divides into …

Answer 20

5 Segmental arteries

Question 21

The Right renal artery goes ____ the IVC to get to kidney

The left vein goes _____ of the aorta

Answer 21

The Right renal artery goes behind the IVC to get to kidney

The left vein goes in front of the aorta

Question 22

What do the vessels migrate up?

Answer 22

Because of the differential growth rate relative to the posterior wall

Question 23

Minor ____ form at the bottom of the medullar pyramids, then 2 or 3 of them form the major _____

Answer 23

Minor calyces form at the bottom of the medullar pyramids, then 2 or 3 of them form the major calyses

Question 24

How many major calyses form the renal pelvis?

Answer 24

3

Question 25

How long are the ureters in male?

Answer 25

25-30cm

Question 26

Where do the ureters travel?

Answer 26

vertical descent on the posterior wall (on psoas major)

Tracks the tip of the lumbar transverse processes over the plevis

Question 27

Where are the narrowings of the ureters path?

Answer 27

1. Where the renal pelvis narrows into the ureter
2. Where the ureter transverses over the pelvis
3. Where it enters the bladder

Question 28

true or false

The adrenal glands are asymmetrical

Answer 28

True

Question 29

What are the shapes of each adrenal gland?

Answer 29

Right - pyramidal

Left - more crescent

both very vacular