Lecture 15: Posterior Body Wall, Diaphragm, and Autonomics Flashcards
1
Q
What are the major components of the excretory system
A
kidney
2
Q
What is the embryological derivative of kidney tissue
A
Intermediate mesoderm
3
Q
What are the names of the 3 different kidneys that are formed in the human at subsequent developmental stages?
A
Pronephric, mesonephric, adult kidney (metanephros)
4
Q
Pronephros: Will it deteriorate or remain? Percursors?
A
Will deteriorate. Becomes past of the mesonephric duct
5
Q
What does the mesonephric duct in the embryo become in the adult for males and females?
A
Males- Vas deferens and epididimus (reproductive organs)
Both sexes- Gives of ureteric bud
6
Q
Mesonephros: Does it function?
A
Yes but deteriorates with age
7
Q
What does the ureteric bud give rise to in the adult?
A
The ureter, collecting tubules of kidney, and calyx system
8
Q
Where does the adult kidney form in the embryo
A
Pelvis
9
Q
What does the undifferentiated metanephros form?
A
nephrons
10
Q
What causes the metonephros to ascend with age
A
- Growth of body in the lumbar-sacral regions
- Decrease in body curvature
11
Q
Congenital abnormality: Pelvic Kidney
A
Failure for kidney to ascend- may interfere with pregnancy
12
Q
Congenital abdnormality: Horseshoe kidney
A
Gets stuck on inferior mesenteric a. Functions but plaques and aneurisms occur within the common iliac arteries (makes surgery difficult)
13
Q
What is the location (vertebral level) of the adult kidney
A
T12-L3
14
Q
Which kidney sits lower relative to the other and why?
A
The right is lower than the left due to the massive liver
15
Q
Is the kidney retroperitoneal?
A
Yes, primarily retroparitoneal
16
Q
Where does the adult kidney lie
A
In a mass of perirenal fat ensheathed by renal fascia
17
Q
What is the renal fascia attached to superiorly, inferiorly, posteriorly, and medially?
A
Superiorly- Diaphragm
Posteriorly- psoas major m.
Medially- IVC and aorta
Inferiorly- Ureter
18
Q
How is it that kidney infections spread to the pelvis?
A
Because the renal fascia blends with the ureteric fascia
19
Q
What are the 3 muscles that come into contact with the kidneys
A
Psoas major, quadrates lumborum, and transversus abdominis
20
Q
What are the boarders of the kidney that each posterior back wall muscle contacts
A
- Psoas major- medial surface
- Quadratus laborum- Biggest (between the medial and lateral boarders)
- Tranversus abdominis- Lateral surface
21
Q
What are the two surfaces of the kidney
A
Anterior and posterior
22
Q
What are the 2 margins of the kidneys
A
medial and lateral
23
Q
Describe the medial and lateral margin of the kidney
A
Medial: indented or concave (where the hilus is).
Lateral: Convex
24
Q
What is the order (anterior to posterior) that vessels leave the hilus of the kidney
A
Renal vein –> Renal artery –> ureter
25
What are the 2 poles of the kidney
Superior and inferior
26
What sits atop of the superior pole of the kidney
Suprarenal gland (adrenaline gland)
27
What is the outermost covering of the kidney
Renal capsule
28
What are the inner and outer regions of the kidney referred to as?
- Outer= Cortex
| - Inner= Medulla
29
Within the medulla, there are triangular structures called.... which are separated by....
Renal pyramids,,,, renal columns in between each pyramid
30
Can we see structural subdivisions of the cortex?
Not without a microscope
31
The tip of each renal pyramid is called...
Renal papilla
32
Purpose of the renal papilla
Provides a route of entry for the urine into minor calyces
33
What do minor calyces unite to form
major calyces
34
Role of major calyces
Dump urine into the expanded portion of the ureter (renal pelvis)
35
Expanded portion of the ureter is called...
Renal pelvis
36
Typically, how many major calyces and minor calyces
Major- 2 or 3
| Minor- 7 to 14
37
What is the superior pole of the right kidney related to?
The inferior surface of the liver
38
What part of the duodenum passes along the hills of the right kidney
descending part of duodenum
39
What structure is close to the inferior pole of the right kidney
The hepatic flexure
40
Which kidney touches more organs the right or left?
Left
41
Since the left kidney touches many organs, what can be said about cancer in the left kidney
Metastisis is common?
42
What are the organs that surround the left kidney
Suprarenal gland, stomach, spleen, pancreas, jejunum, and descending colon
43
Where does the left kidney lie
Stomach bed- region where stomach lies
44
Where do the renal arteries arise from
Abdominal aorta inferior to the superior mesenteric a.
45
Describe the morphology of the branches given to the kidneys by the renal a.
Large anterior branch and small posterior branch
46
What are the subdivisions of the anterior artery branch to the kidney
Apical (superior), upper (anteriosuperior), middle (anterioinferior), and inferior branches
47
What supplies the entire anterior surface of the kidney?
The large anterior branch
48
What region on the kidney does the posterior artery supply
The whole posterior surface, with the exception of the superior and inferior poles
49
What supplies the blood on the posterior surface of the kidney at the superior pole
The anterior apical artery
50
What supplies the blood on the posterior surface of the kidney at the inferior pole
Anterior lower artery
51
What are the sources for accessory arteries to the kidney?
The come off as branches from the aorta
52
When do these accessory renal arteries from the aorta form?
When the kidney ascends from the pelvis
53
What sorts of issues can accessory renal arteries bring about
They can obstruct the ureter
54
What drains blood out of the kidneys and into the heart?
Right and left renal veins which flow into the inferior vena cava
55
Is innervation to the kidney sympathetic or parasympathetic? Where does it come from?
Sympathetic. The lesser and least splanchnic nerves synapse at the aorticorenal gangia which supplies the kidney
56
Which kidney has a further distance to travel to reach the IVC
Left
57
Where do the suprarenal and gonal vein ever for the left kindey
The Left renal v.
58
Where do the suprarenal and gonal vein ever for the right kindey
Directly into the IVC
59
Where does the calyx system in the kidneys derive from?
Urinteric bud
60
What does the ureter derive from
Urinteric bud
61
The urinteric bud also forms collecting tubules, can we see these in lab?
no need microscope.
62
Where does the ureter start and end
Begins at the renal pelvis and ends at the urinary trigone within the urinary bladder
63
Where are ureters commonly constricted (smaller)
- Where the renal pelvis becomes the ureter
- Where the ureter crosses the common iliac a.
- Where the ureter goes into urinary bladder
64
What normally gets stuck in the constricted regions of the ureter
kidney stones (urantitic calculi)
65
What is the arterial supply to the ureters
Renal, gonadal (testicular or ovarian) and abdominal aorta
66
Where is the pain felt for a kidney stone
Loin to groin (back to groin)
67
What spinal nerves are responsible for the loin to groin pain for a kidney stone
T11-L2 due to the marked distention of the muscular wall of the ureter.
68
Where do the suprarenal glands lie in relation to the kidney?
Superior pole of each kidney
69
What shape are the left and right suprarenal glands
Left- Semilunar
| Right- Hat
70
What makes up the urintary trigone
2 ureters and 1 urethra
71
What technique is used to reveal where kidney stones are
Pyelogram (Can see kidney outline, can see calyx system
72
How are bifid ureters formed
uranteric bud divides too early
73
Why can bifid ureters be an issue?
they are so narrow suceptible to clogging- there is one of these in the lab
74
Which suprarenal gland (right or left) extends more inferiorly
Left
75
What separates the kidney from the suprarenal gland
renal fascia
76
What envelopes each suprarenal gland
fat and renal fascia
77
Embryonically, what is the suprarenal gland derived from
mesoderm (cortex) and ectoderm (medulla)
78
What is the difference between the cortex and medulla of the suprarenal glands
Cortex- secretes and produces steroid hormones (cortisol and aldosterone)
Medulla- produces and secretes peptide hormones (epiephrine)
79
Why is it that the cortex and medulla produce different types of hormones
because they are derived from two different embryonic layers
80
What receives innervation from in the suprarenal gland
Medulla
81
Is the innervation to the medulla parasympathetic or sympathetic
Sympathetic
82
Describe the pathway of innervation
The medulla receives preganglionic fibers from the sympathetic truck via the greater splanchnic n. **These splanchnic nerves DO NOT go into the celiac ganglia. They go into the medulla directly. There are no postganglionic fibers**
83
What happens when the suprarenal gland is stimulated by a neuronal synapse
The organ secretes epinephrine during fight or flight
84
How many arterial branches supply the suprarenal gland
3
85
The three vessels that supply the suprarenal gland are...
Superior suprarenal a
Middle suprarenal a
Inferior suprarenal a
86
What are the superior, middle and inferior suprarenal arteries branches of?
Superior- Inferior phrenic a
Middle- Aorta
Inferior- Renal a
87
What are the veins that drain the suprarenal gland?
Right and left suprarenal v.
88
What are the tributaries of the right and left suprarenal veins
Right-IVC
| Left- Renal v.
89
What are the bony attachments of the diaphragm (sternal and costal portions)
Sternal portion- Typhoid process
| Costal portion- Internal surface of lower 6 ribs and costal cartilage.
90
What are the bony attachments of the diaphragm (Lumbar portion)
Lumbar portion- Arises from lumbar vertebrae by the right and left cura, which attach to L1-2 and surround aorta.
91
What ligament unites with the cura of the diaphragm
The anterior longitudinal ligament
92
Attachment to the diaphragm (central tendon)
Sheet like aponeurosis- no bony attachment
93
What gives sensory and motor innervation to the diaphragm
The phrenic nerve
94
What spinal cord levels make up the phrenic nerve
C3,4,5
95
What additional nerves provide sensory innervation to the diaphragm other than the phrenic nerve
intercostal n.
96
What are the 3 ligaments of the diaphragm
Median, Medial, and Lateral arcuate ligaments
97
Median arcuate ligament: Attachment
Unites cura opposite of T12 and L1.
98
Medial arcuate ligament: Attachment
Connects the cura of the diaphragm to transverse processes of L1
99
What goes underneath the medial arcuate ligament
Posts major m.
100
What goes under the median arcuate ligament
The aorta
101
Lateral arcuate ligament: Attachment
Attaches to the transverse process of L1 to rib 12
102
What lies superior to the lateral arcuate ligament
vertebrocostal triangle
103
What is the vertebrocostal triangle
A region where the diaphragm is so thin that it produces a potential herniation spot
104
Where do most diaphragmatic herniations occur
The vertebrocostal triangle
105
In what hole does the esophagus go through the diaphragm
Esophageal hiatus
106
In what hole does the inferior vena cava penetrate the diaphragm
The Inferior vena cala formamen
107
What muscle sits beneath the medial arcuate ligament
Posas major m.
108
What muscle sits under the lateral arcuate ligament
Quadratus laborum m.
109
What is the role of the arcuate ligaments
Anchor the diaphragm (to lumbar vertebrae)
110
At what vertebral level does the inferior vena cava go through the inferior vena naval forament
T8
111
At what vertebral levels does the esophagus penetrate the diaphragm through the esophageal hiatus?
T10
112
At what vertebral level does the aorta come off of the median arcuate ligament?
T12
113
How does the diaphragm increase the size of the thoracic cavity
Muscles pull down on the central tendon
114
What is the hole that the aorta emerges out of in the diaphragm
Aortic hiatus (again at vertebral level T12)
115
What are the arterial supplies to the diaphragm on the abdominal side
Inferior phrenic artery
116
What are the arterial supplies to the diaphragm on the thoracic side?
Pericardiophrenic a., Musculophrenic a, and branches of the thoracic aorta.
117
Where do the branches of the pericardiophrenic a that supply the diaphragm come from
internal thoracic a.
118
What is the first branch off the abdominal aorta
The inferior phrenic a.
119
What portion of the diaphragm is supplied by the arterial supplies from the thoracic and abdominal sides respectively
Thorax- superior portion
| Abdominal- Inferior
120
Embryology of the diaphragm: What cells for the muscles on the periphery
Somites (muscle cells on body wall)
121
Embryology of the diaphragm- What forms the cura of the diaphragm
The dorsal mesentery of the esophagus
122
Embryology of the diaphragm- What forms the central tendon of the diaphragm
Septum transversum
123
What are the 4 posterior body all muscles
Psoas Minor
Psoas Major
Quadratus Laborum
Iliacus
124
Proximal attachment of the posts major m.
Transverse processes of lumbar vertebrae. Bodies of discs T12-L5
125
Distal attachment of Psoas major m.
Lesser trochanter of femur
126
Innervation of Psoas major m.
Vertebral branches of lumbar nerves (ventral rami)
127
Proximal attachment of Iliacus
Iliac fossa, iliac crest, sacral ala, anterior sacroiliac ligaments
128
Distal attachment of Illiacus
Lesser trochanter of femur (same as psoas major)
129
Innervation of iliacus
femoral n.
130
Action of iliacus
Flexes thigh on hip (this action is shared by psoas major m.)
131
What is the only thing different between the psoas major m and the iliacus
Innervation
132
Why do the psoas major and iliac us have different innervations?
Because they have different embryological origins
133
Proximal attachment of Psoas minor m
Sides and bodies of vertebrae T12-L1
134
Distal attachment of Psoas minor m
Pectineal line and iliopectineal eminence
135
Innervation of the Psoas minor m.
Ventral branches from L1
136
Proximal attachment of Quadrates Laborum
12th rib and lumbar transverse process
137
Distal attachment of Quadrates Laborum
Iliolumbar ligament and internal lip of iliac crest
138
Action of Quadrates laborum
extends and laterally flexes vertebral column. Fixes 12th rib during inspiration
139
Innervation of Quadratus Laborum m
Ventral branches of T12 and L1-4
140
What muscle is where the lumbar plexus forms?
The psoas major muscle
141
What are the spinal nerves that make up the lumbar plexus
Ventral rami of L1-4
142
What are the 6 nerves in the lumbar plexus
Iliohypogastric, Ilioinguinal, Gentiofemoral, Lateral femoral cutaneous n of the thigh, Femoral, and obturator
143
Iliohypogastric spinal cord level
L1
144
Iliohypogastric innervation
Sensory for skin over buttocks and anterior abdominal wall above pubic symphysis. Motor fibers to the transverses abdomens and internal obllique muscles
145
Ilioinguinal spinal cord level
L1
146
Ilioinguinal innervation
Sensory- Passes through superficial inguinal ring and supplies groin, scrotum, and labia major. Motor- transverses abdominis and internal oblique muscles
147
Genitofemoral nerve spinal cord level
L1,2
148
Genitofemoral nerve innervation
Genital branch- Supplies cremaster muscle and scrotum in males and labia majora in females. Femoral branch- sensory to skin of femoral triangle
149
Lateral femoral cutaneous nerve of thigh spinal cord level
L2-3
150
Lateral femoral cutaneous nerve of thigh innervation
Skin over the anterior and lateral aspects of the thigh
151
Femoral nerve Spinal cord level
L2,3,4
152
Femoral n innervation
anterior compartment of the thigh
153
Obturator spinal cord level
L2,3,4
154
Obturator innervation
Supplies adductor muscles of thigh
155
2 additional nerves that are NOT a part of the lumbar plexus
Subcostal n, and lumbrosacral trunk
156
Spinal cord levels of subcostal and lumbrosacral trunk
```
Subcostal= T12
Lumbrosacral= L4-5
```
157
Do the majority of organs receive sympathetic or parasympathetic fibers
both
158
Where do the majority of the nerve fibers tend to congregate in the abdomen?
Many congregate around arteries forming nerve plexuses
159
Do synapses occur in these poleax located on the arteries?
No
160
What are the 3 poleax in the abdomen
Celiac, superior mesenteric, and inferior mesenteric pelus
161
Where does the celiac plexus sit and what organs does it innervate?
Surrounds celiac artery. Innervates stomach, liver, pancreas, gallbladder, spleen, and parts of duodenum (AKA FORGUT)
162
Where does the superior mesenteric plexus sit and what organs does it innervate?
Surrounds superior mesenteric a. innervates the midgut
163
Where does the inferior mesenteric plexus sit and what organs does it innervate?
Surrounds inferior mesenteric a. innervates the hindgut
164
Are splanchnic nerves composed of pre or postganglionic fibers
preganglionic
165
Where do the greater and lesser splanchnic nerves pierce the diaphragm?
The cura
166
Where do the least and lumbar splanchnic nerves arise in relation to the diaphragm
At the level of or below the diaphragm
167
What are the spinal cord levels of the greater splanchnic n.
T(s)6-9
168
What are the spinal cord levels of the lesser splanchnic n.
T(9)10-11
169
What are the spinal cord levels of the least splanchnic n.
T12
170
Where do the preganglionic fibers in the greater splanchnic nerve synapse
celiac ganglia
171
From the celiac ganglia- what organs are supplied by the postganglionic fibers?
Forgut organs
172
Where do the lesser and least splanchnic nerves synapse
aorticorenal ganglia
173
What organ does the aorticorenal ganglia supply?
Kidney (lesser) renal arteries and ureters (least)
174
What are the spinal cord levels of the lumbar splanchnic nerves
L1,2,3
175
Where do the lumbar splanchnic nerve synapse?
inferior mesenteric ganglia
176
What organs are supplied by the inferior mesenteric ganglia
hindgut
177
For the sympathetic fibers that enter the celiac ganglia but do not synaspe there, what do they innervate?
Suprarenal gland
178
Is the aorticorenal ganglia a part of the celiac ganglia complex?
yes
179
What does the vagus nerve provide innervation to in the abdomen
Everything up to the distal 1/3 of transverse colon (mostly forgut
180
Where do the parasympathetic pelvic splanchnic nerves arise from (spinal cord levels)
S2-4
181
What plexus contains the pelvic splanchnic nerves for the parasympathetic system
Inferior mesenteric plexus
182
What do the pelvic splanchnic nerves innervate
Parasympathetic innervation to the distal 1/3 transverse colon, large intestine, rectum, and pelvic organs
183
Referred visceral pain
Brain misdiagnoses visceral pain for abdonmial pain because the pain receptors are in the same dorsal root ganglia as the somatic afferent fibers, and somatic afferent fibers carry pain better than the visceral afferent fibers
184
What are the two main lymphatics of the abdomen
Visceral lymph nodes and lumbar lymph nodes
185
Visceral lymph noses
From abdominal viscera drain into nodes situated along the unpaired visceral branches of the aorta
186
Lumbar lymph nodes
Receive drainage from the kidneys, testes, ovaries, and posterior body wall and lower limbs through the common iliac lymph nodes
187
Where do the visceral and lumbar lymph nodes unite?
At a dilation within the abdomen called the cisterna chyli to form the thoracic duct,
188
What is the largest lymph vessel in the body
the cisterna chyli
