Lecture 11 RH Flashcards
Where are the kidneys located during development and what happens to them during growth?
Kidneys develop on the lower part of the posterior abdominal wall. However their position changes to a higher position due to the growth rate of surrounding structures.
What are accessory renal arteries and where do they enter the kidneys?
Accessory renal arteries either enter the hilum or penetrate the capsule directly. They are a remnant of development that stay after birth in 25% of people.
Where are renal veins located in the kidneys?
renal veins are the most anterior structure in the hilum.
Where is IVC located?
IVC sits to the right of the abdominal aorta.
Where does the renal vein run relative to the aorta?
renal vein runs anterior to abdominal aorta.
Where do the testicular veins drain into?
The left testicular vein drains into the left renal vein.
The right testicular vein drains directly into IVC
Where is the renal pelvis located within the hilum?
It is the most posterior structure of the hilum
What types of callyces does the kidney have?
Major callyces are the first branches of the renal pelvis
Minor callyces are the smallest and most distal branches of the renal pelvis.
What are the kidney’s medullary pyramids?
Pyramidal tissue in the kidney’s medulla. Their apexes feeds into the minor callyces. These feed into major callyces and then the renal pelvis.
Where are the ureters located relative to the structures of the abdomen?
ureters are muscular tubes and are 25 - 30 cm long and they initially descend on posterior abdominal wall. The ureters descend anterior to psoas major and then tips over pevic brim and into the bladder.
What blood vessels supply the ureters?
Ureter is supplied by various blood vessels along its path.
Principle of muscular tubes in anatomy:
A muscular tube is associated with a normal site of narrowing at the beginning and the end of the tube.
Where are the sites of narrowing of the ureter? What is the clinical significance of these narrowings?
Where the ureteric pelvis converges is the first site of narrowing. When it feeds into the bladder is the second site of narrowing. Over the pelvic brim it gets narrower as well. They are potential sites of obstruction (kidney stone).
What do the ureters’ pathways correspond with?
Descent of the ureters corresponds with the tips of the transverse processes.
What are the key features to look for to understand abdominal viscera?
quadrant in which viscera is located
relationship to peritoneum
Identifying features
Neurovascular supply
Where does the oesophagus begin?
oesophagus begins at the cricoid cartilage at C6
Where does the oesophagus end?
it descends through posterior mediastinum through the oesophageal hiatus which is a sling formed by the left crus of the diaphragm. (diaphragm contraction closes the oesophagus at the level of about T10)
Where does the oesophagus penetrate the stomach?
half an inch below the diaphragm. It penetrates into the middle of the stomach on the right.
What structure lines the oesophagus?
stratified squamus epithelium.
Where are the sites of narrowing of the oesophagus located?
3 sites of narrowing:
Cervical: upper oesophageal sphincter
Thoracic: aortic arch Left main bronchus
Abdominal: diaphragmatic orifice
What is the arterial supply of the oesophagus?
Supplied by 3 different arteries at 3 different locations:
Cervical: Inferior thyroid artery
Thoracic: oesophageal branches from aorta
Abdomen: Left gastric artery form the aorta
What veins drain the oesophagus?
Drained by 3 different veins at 3 different locations:
Cervical: Brachiocephalic systemic
Thoracic: azygous
Abdomen: Left gastric portal overlaps systemic
What lymphatics drain the oesophagus?
Cervical: Deep cervical nodes
Thoracic: Mediastinal nodes
Abdomen: Pre-aortic nodes
What is a hiatus hernia?
Upper part of the stomach herniates through the oesophageal hiatus of the diaphragm.
What is a paraoesophageal hernia?
In very rare cases the upper stomach slides up through the hiatus while the oesophagus remains at the hiatus. This is known as a paraoesophageal hiatal hernia.
What is the more common hiatal hernia?
Sliding hiatal hernia where the oesophagus slides upwards and protrudes through the oesophageal hiatus.
Where is the stomach located in the abdomen?
left upper quadrant
What is the name of the the orifices of the stomach?
cardiac orifice is the proximal opening of the stomach.
Pyloric orifice is the distal orifice.
What are the types of curvature the stomach has?
Greater curvature of the stomach on the left.
Lesser curvature on the right of the stomach.
What is the name of the dome shaped part of the stomach above the cardiac orifice? What happens here?
fundus; here the gas accumulates.
What are the parts of the stomach called?
fundus on top
body in the middle
pyloris on the bottom
Where does the body of the stomach extend from?
From the cardiac orifice to the angular notch.
What is the pyloric antrum?
pyloric antrum is the funnelling part of the pyloris this converges into the pyloris.
What is the pyloric sphincter?
pyloris has a thick muscular wall called the pyloric sphincter.
What is the hole through which food moves through from the stomach to the intestine?
Pyloric canal
What is the function of the pyloris?
pyloris controls output of stomach into the intestine to ensure food is digested properly.
What is the lesser omentum?
lesser curvature connects to the under surface of the liver via a double folded membrane of peritoneum called the lesser omentum.
What is the greater omentum?
mesentery connected to greater curvature of stomach and connects stomach to posterior abdominal wall is called the greater omentum.
What are the folds of the stomach called?
Rugae
What happens to rugae as you get to locations closer to the pyloris?
they get larger and more prominent
What blood vessels supply the stomach?
Stomach has a rich blood supply.
Left and right gastric arteries that supply them and anastomose on the stomach. (Aka epiploic arteries)
What blood vessels supply the stomach?
Stomach has a rich blood supply.
Left and right gastric arteries that supply them and anastomose on the stomach. (Aka epiploic arteries)
What is the first part of the small intestine?
Duodenum
What are the components of the small intestine?
duodenum
jejunem
ileum
Is the duodenum intra or retro peritoneal?
retroperitoneal. All but first inch (stomach is intra so it continues that way onto the first inch of the duodenum).
What is the function of the duodenum?
digestion and absorbtion of digested products
Why does the duodenum contain such a large surface area?
contains lots of mucosal folds with microscopic villi.
How long is the duodenum and what constitutes this length?
10 inches;
4 parts:
duodenal cap 2 inches long
Vertical duodenum 3 inches long
Lower horizontal part of the duodenum 4 inches long from right to left.
final part of the duodenum is 1 inch long
What are characteristics of the duodenal cap?
2 inches long and directed upwards and backwards and lies on right crus and right psoas. Sits adjacent to the right crus of the diaphragm and medially to the right kidney.
What structure sits on quadratus lumborum?
The kidneys
What causes peptic ulcers?
Peptic ulcers happen at the duodenum due to influx of acid into the duodenum.
What is located around the second part of the duodenum?
second part of the duodenum is 3 inches long descends next to the head of the pancreas on the right psoas. peritoneal mesentery over the front of the duodenum that supplies the transverse mesocolon.
Where is the third part of the duodenum located?
The third part of the duodenum goes from right psoas and overlies IVC and abdominal aorta and steps onto left psoas.
It crosses at the level of L3.
Where is the fourth part of the duodenum?
fourth part of the duodenum is located on left psoas. curves anteriorly and the duodenojejunal flexure is the point where duodenum becomes the intraperitoneal jejunum.
Why is the duodenum important for digestion?
Halfway down the second vertical part of the duodenum is the Major duodenal papilla. Here the common bile duct enters and also the pancreatic duct enters here meaning it is the entry point of pancreatic and liver enzymes + bicarbonate + bile.
What is the importance of the minor duodenal papilla?
Pancreas has another duct which goes through the minor duodenal papilla located a little higher.
What structure runs anteriorly to the jejunum?
the 3rd and horizontal part of the duodenum has the root of the jejunal mesentery running anterior to it.
How much of the small intestines is jejunum and ileum?
40% is jejunum and 60% is ilium
What is the difference between the jejunum and ileum?
jejunum in left upper quadrant. Ileum in right lower quadrant.
jejunum is larger in diameter than ilium.
jejunum is thicker walled with higher mucosal folds.
Jejunum mesentery has small number of arcave loops and long vasa recta leading to the intestine. Ileum has many arcaves and shorter vasa recta.
Jejunum mesentery has less fat than the ileum mesentery.
What is the intestinal mesentery called?
The mesentery
