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Block 2 Gross > Lecture 15: Posterior Body Wall, Diaphragm, and Autonomics > Flashcards

Lecture 15: Posterior Body Wall, Diaphragm, and Autonomics Flashcards

1
Q

What are the major components of the excretory system

A

kidney

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2
Q

What is the embryological derivative of kidney tissue

A

Intermediate mesoderm

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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)

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4
Q

Pronephros: Will it deteriorate or remain? Percursors?

A

Will deteriorate. Becomes past of the mesonephric duct

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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

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6
Q

Mesonephros: Does it function?

A

Yes but deteriorates with age

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7
Q

What does the ureteric bud give rise to in the adult?

A

The ureter, collecting tubules of kidney, and calyx system

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8
Q

Where does the adult kidney form in the embryo

A

Pelvis

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9
Q

What does the undifferentiated metanephros form?

A

nephrons

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10
Q

What causes the metonephros to ascend with age

A
  • Growth of body in the lumbar-sacral regions

- Decrease in body curvature

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11
Q

Congenital abnormality: Pelvic Kidney

A

Failure for kidney to ascend- may interfere with pregnancy

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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)

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13
Q

What is the location (vertebral level) of the adult kidney

A

T12-L3

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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

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15
Q

Is the kidney retroperitoneal?

A

Yes, primarily retroparitoneal

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16
Q

Where does the adult kidney lie

A

In a mass of perirenal fat ensheathed by renal fascia

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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

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18
Q

How is it that kidney infections spread to the pelvis?

A

Because the renal fascia blends with the ureteric fascia

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19
Q

What are the 3 muscles that come into contact with the kidneys

A

Psoas major, quadrates lumborum, and transversus abdominis

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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
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21
Q

What are the two surfaces of the kidney

A

Anterior and posterior

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22
Q

What are the 2 margins of the kidneys

A

medial and lateral

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23
Q

Describe the medial and lateral margin of the kidney

A

Medial: indented or concave (where the hilus is).
Lateral: Convex

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24
Q

What is the order (anterior to posterior) that vessels leave the hilus of the kidney

A

Renal vein –> Renal artery –> ureter

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25
Q

What are the 2 poles of the kidney

A

Superior and inferior

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26
Q

What sits atop of the superior pole of the kidney

A

Suprarenal gland (adrenaline gland)

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27
Q

What is the outermost covering of the kidney

A

Renal capsule

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28
Q

What are the inner and outer regions of the kidney referred to as?

A
  • Outer= Cortex

- Inner= Medulla

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29
Q

Within the medulla, there are triangular structures called…. which are separated by….

A

Renal pyramids,,,, renal columns in between each pyramid

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30
Q

Can we see structural subdivisions of the cortex?

A

Not without a microscope

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31
Q

The tip of each renal pyramid is called…

A

Renal papilla

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32
Q

Purpose of the renal papilla

A

Provides a route of entry for the urine into minor calyces

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33
Q

What do minor calyces unite to form

A

major calyces

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34
Q

Role of major calyces

A

Dump urine into the expanded portion of the ureter (renal pelvis)

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35
Q

Expanded portion of the ureter is called…

A

Renal pelvis

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36
Q

Typically, how many major calyces and minor calyces

A

Major- 2 or 3

Minor- 7 to 14

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37
Q

What is the superior pole of the right kidney related to?

A

The inferior surface of the liver

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38
Q

What part of the duodenum passes along the hills of the right kidney

A

descending part of duodenum

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39
Q

What structure is close to the inferior pole of the right kidney

A

The hepatic flexure

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40
Q

Which kidney touches more organs the right or left?

A

Left

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41
Q

Since the left kidney touches many organs, what can be said about cancer in the left kidney

A

Metastisis is common?

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42
Q

What are the organs that surround the left kidney

A

Suprarenal gland, stomach, spleen, pancreas, jejunum, and descending colon

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43
Q

Where does the left kidney lie

A

Stomach bed- region where stomach lies

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44
Q

Where do the renal arteries arise from

A

Abdominal aorta inferior to the superior mesenteric a.

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45
Q

Describe the morphology of the branches given to the kidneys by the renal a.

A

Large anterior branch and small posterior branch

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46
Q

What are the subdivisions of the anterior artery branch to the kidney

A

Apical (superior), upper (anteriosuperior), middle (anterioinferior), and inferior branches

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47
Q

What supplies the entire anterior surface of the kidney?

A

The large anterior branch

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48
Q

What region on the kidney does the posterior artery supply

A

The whole posterior surface, with the exception of the superior and inferior poles

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49
Q

What supplies the blood on the posterior surface of the kidney at the superior pole

A

The anterior apical artery

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50
Q

What supplies the blood on the posterior surface of the kidney at the inferior pole

A

Anterior lower artery

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51
Q

What are the sources for accessory arteries to the kidney?

A

The come off as branches from the aorta

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52
Q

When do these accessory renal arteries from the aorta form?

A

When the kidney ascends from the pelvis

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53
Q

What sorts of issues can accessory renal arteries bring about

A

They can obstruct the ureter

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54
Q

What drains blood out of the kidneys and into the heart?

A

Right and left renal veins which flow into the inferior vena cava

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55
Q

Is innervation to the kidney sympathetic or parasympathetic? Where does it come from?

A

Sympathetic. The lesser and least splanchnic nerves synapse at the aorticorenal gangia which supplies the kidney

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56
Q

Which kidney has a further distance to travel to reach the IVC

A

Left

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57
Q

Where do the suprarenal and gonal vein ever for the left kindey

A

The Left renal v.

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58
Q

Where do the suprarenal and gonal vein ever for the right kindey

A

Directly into the IVC

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59
Q

Where does the calyx system in the kidneys derive from?

A

Urinteric bud

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60
Q

What does the ureter derive from

A

Urinteric bud

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61
Q

The urinteric bud also forms collecting tubules, can we see these in lab?

A

no need microscope.

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62
Q

Where does the ureter start and end

A

Begins at the renal pelvis and ends at the urinary trigone within the urinary bladder

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63
Q

Where are ureters commonly constricted (smaller)

A
  • Where the renal pelvis becomes the ureter
  • Where the ureter crosses the common iliac a.
  • Where the ureter goes into urinary bladder
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64
Q

What normally gets stuck in the constricted regions of the ureter

A

kidney stones (urantitic calculi)

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65
Q

What is the arterial supply to the ureters

A

Renal, gonadal (testicular or ovarian) and abdominal aorta

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66
Q

Where is the pain felt for a kidney stone

A

Loin to groin (back to groin)

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67
Q

What spinal nerves are responsible for the loin to groin pain for a kidney stone

A

T11-L2 due to the marked distention of the muscular wall of the ureter.

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68
Q

Where do the suprarenal glands lie in relation to the kidney?

A

Superior pole of each kidney

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69
Q

What shape are the left and right suprarenal glands

A

Left- Semilunar

Right- Hat

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70
Q

What makes up the urintary trigone

A

2 ureters and 1 urethra

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71
Q

What technique is used to reveal where kidney stones are

A

Pyelogram (Can see kidney outline, can see calyx system

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72
Q

How are bifid ureters formed

A

uranteric bud divides too early

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73
Q

Why can bifid ureters be an issue?

A

they are so narrow suceptible to clogging- there is one of these in the lab

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74
Q

Which suprarenal gland (right or left) extends more inferiorly

A

Left

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75
Q

What separates the kidney from the suprarenal gland

A

renal fascia

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76
Q

What envelopes each suprarenal gland

A

fat and renal fascia

77
Q

Embryonically, what is the suprarenal gland derived from

A

mesoderm (cortex) and ectoderm (medulla)

78
Q

What is the difference between the cortex and medulla of the suprarenal glands

A

Cortex- secretes and produces steroid hormones (cortisol and aldosterone)

Medulla- produces and secretes peptide hormones (epiephrine)

79
Q

Why is it that the cortex and medulla produce different types of hormones

A

because they are derived from two different embryonic layers

80
Q

What receives innervation from in the suprarenal gland

A

Medulla

81
Q

Is the innervation to the medulla parasympathetic or sympathetic

A

Sympathetic

82
Q

Describe the pathway of innervation

A

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
Q

What happens when the suprarenal gland is stimulated by a neuronal synapse

A

The organ secretes epinephrine during fight or flight

84
Q

How many arterial branches supply the suprarenal gland

A

3

85
Q

The three vessels that supply the suprarenal gland are…

A

Superior suprarenal a
Middle suprarenal a
Inferior suprarenal a

86
Q

What are the superior, middle and inferior suprarenal arteries branches of?

A

Superior- Inferior phrenic a
Middle- Aorta
Inferior- Renal a

87
Q

What are the veins that drain the suprarenal gland?

A

Right and left suprarenal v.

88
Q

What are the tributaries of the right and left suprarenal veins

A

Right-IVC

Left- Renal v.

89
Q

What are the bony attachments of the diaphragm (sternal and costal portions)

A

Sternal portion- Typhoid process

Costal portion- Internal surface of lower 6 ribs and costal cartilage.

90
Q

What are the bony attachments of the diaphragm (Lumbar portion)

A

Lumbar portion- Arises from lumbar vertebrae by the right and left cura, which attach to L1-2 and surround aorta.

91
Q

What ligament unites with the cura of the diaphragm

A

The anterior longitudinal ligament

92
Q

Attachment to the diaphragm (central tendon)

A

Sheet like aponeurosis- no bony attachment

93
Q

What gives sensory and motor innervation to the diaphragm

A

The phrenic nerve

94
Q

What spinal cord levels make up the phrenic nerve

A

C3,4,5

95
Q

What additional nerves provide sensory innervation to the diaphragm other than the phrenic nerve

A

intercostal n.

96
Q

What are the 3 ligaments of the diaphragm

A

Median, Medial, and Lateral arcuate ligaments

97
Q

Median arcuate ligament: Attachment

A

Unites cura opposite of T12 and L1.

98
Q

Medial arcuate ligament: Attachment

A

Connects the cura of the diaphragm to transverse processes of L1

99
Q

What goes underneath the medial arcuate ligament

A

Posts major m.

100
Q

What goes under the median arcuate ligament

A

The aorta

101
Q

Lateral arcuate ligament: Attachment

A

Attaches to the transverse process of L1 to rib 12

102
Q

What lies superior to the lateral arcuate ligament

A

vertebrocostal triangle

103
Q

What is the vertebrocostal triangle

A

A region where the diaphragm is so thin that it produces a potential herniation spot

104
Q

Where do most diaphragmatic herniations occur

A

The vertebrocostal triangle

105
Q

In what hole does the esophagus go through the diaphragm

A

Esophageal hiatus

106
Q

In what hole does the inferior vena cava penetrate the diaphragm

A

The Inferior vena cala formamen

107
Q

What muscle sits beneath the medial arcuate ligament

A

Posas major m.

108
Q

What muscle sits under the lateral arcuate ligament

A

Quadratus laborum m.

109
Q

What is the role of the arcuate ligaments

A

Anchor the diaphragm (to lumbar vertebrae)

110
Q

At what vertebral level does the inferior vena cava go through the inferior vena naval forament

A

T8

111
Q

At what vertebral levels does the esophagus penetrate the diaphragm through the esophageal hiatus?

A

T10

112
Q

At what vertebral level does the aorta come off of the median arcuate ligament?

A

T12

113
Q

How does the diaphragm increase the size of the thoracic cavity

A

Muscles pull down on the central tendon

114
Q

What is the hole that the aorta emerges out of in the diaphragm

A

Aortic hiatus (again at vertebral level T12)

115
Q

What are the arterial supplies to the diaphragm on the abdominal side

A

Inferior phrenic artery

116
Q

What are the arterial supplies to the diaphragm on the thoracic side?

A

Pericardiophrenic a., Musculophrenic a, and branches of the thoracic aorta.

117
Q

Where do the branches of the pericardiophrenic a that supply the diaphragm come from

A

internal thoracic a.

118
Q

What is the first branch off the abdominal aorta

A

The inferior phrenic a.

119
Q

What portion of the diaphragm is supplied by the arterial supplies from the thoracic and abdominal sides respectively

A

Thorax- superior portion

Abdominal- Inferior

120
Q

Embryology of the diaphragm: What cells for the muscles on the periphery

A

Somites (muscle cells on body wall)

121
Q

Embryology of the diaphragm- What forms the cura of the diaphragm

A

The dorsal mesentery of the esophagus

122
Q

Embryology of the diaphragm- What forms the central tendon of the diaphragm

A

Septum transversum

123
Q

What are the 4 posterior body all muscles

A

Psoas Minor
Psoas Major
Quadratus Laborum
Iliacus

124
Q

Proximal attachment of the posts major m.

A

Transverse processes of lumbar vertebrae. Bodies of discs T12-L5

125
Q

Distal attachment of Psoas major m.

A

Lesser trochanter of femur

126
Q

Innervation of Psoas major m.

A

Vertebral branches of lumbar nerves (ventral rami)

127
Q

Proximal attachment of Iliacus

A

Iliac fossa, iliac crest, sacral ala, anterior sacroiliac ligaments

128
Q

Distal attachment of Illiacus

A

Lesser trochanter of femur (same as psoas major)

129
Q

Innervation of iliacus

A

femoral n.

130
Q

Action of iliacus

A

Flexes thigh on hip (this action is shared by psoas major m.)

131
Q

What is the only thing different between the psoas major m and the iliacus

A

Innervation

132
Q

Why do the psoas major and iliac us have different innervations?

A

Because they have different embryological origins

133
Q

Proximal attachment of Psoas minor m

A

Sides and bodies of vertebrae T12-L1

134
Q

Distal attachment of Psoas minor m

A

Pectineal line and iliopectineal eminence

135
Q

Innervation of the Psoas minor m.

A

Ventral branches from L1

136
Q

Proximal attachment of Quadrates Laborum

A

12th rib and lumbar transverse process

137
Q

Distal attachment of Quadrates Laborum

A

Iliolumbar ligament and internal lip of iliac crest

138
Q

Action of Quadrates laborum

A

extends and laterally flexes vertebral column. Fixes 12th rib during inspiration

139
Q

Innervation of Quadratus Laborum m

A

Ventral branches of T12 and L1-4

140
Q

What muscle is where the lumbar plexus forms?

A

The psoas major muscle

141
Q

What are the spinal nerves that make up the lumbar plexus

A

Ventral rami of L1-4

142
Q

What are the 6 nerves in the lumbar plexus

A

Iliohypogastric, Ilioinguinal, Gentiofemoral, Lateral femoral cutaneous n of the thigh, Femoral, and obturator

143
Q

Iliohypogastric spinal cord level

A

L1

144
Q

Iliohypogastric innervation

A

Sensory for skin over buttocks and anterior abdominal wall above pubic symphysis. Motor fibers to the transverses abdomens and internal obllique muscles

145
Q

Ilioinguinal spinal cord level

A

L1

146
Q

Ilioinguinal innervation

A

Sensory- Passes through superficial inguinal ring and supplies groin, scrotum, and labia major. Motor- transverses abdominis and internal oblique muscles

147
Q

Genitofemoral nerve spinal cord level

A

L1,2

148
Q

Genitofemoral nerve innervation

A

Genital branch- Supplies cremaster muscle and scrotum in males and labia majora in females. Femoral branch- sensory to skin of femoral triangle

149
Q

Lateral femoral cutaneous nerve of thigh spinal cord level

A

L2-3

150
Q

Lateral femoral cutaneous nerve of thigh innervation

A

Skin over the anterior and lateral aspects of the thigh

151
Q

Femoral nerve Spinal cord level

A

L2,3,4

152
Q

Femoral n innervation

A

anterior compartment of the thigh

153
Q

Obturator spinal cord level

A

L2,3,4

154
Q

Obturator innervation

A

Supplies adductor muscles of thigh

155
Q

2 additional nerves that are NOT a part of the lumbar plexus

A

Subcostal n, and lumbrosacral trunk

156
Q

Spinal cord levels of subcostal and lumbrosacral trunk

A 
Subcostal= T12
Lumbrosacral= L4-5
157
Q

Do the majority of organs receive sympathetic or parasympathetic fibers

A

both

158
Q

Where do the majority of the nerve fibers tend to congregate in the abdomen?

A

Many congregate around arteries forming nerve plexuses

159
Q

Do synapses occur in these poleax located on the arteries?

A

No

160
Q

What are the 3 poleax in the abdomen

A

Celiac, superior mesenteric, and inferior mesenteric pelus

161
Q

Where does the celiac plexus sit and what organs does it innervate?

A

Surrounds celiac artery. Innervates stomach, liver, pancreas, gallbladder, spleen, and parts of duodenum (AKA FORGUT)

162
Q

Where does the superior mesenteric plexus sit and what organs does it innervate?

A

Surrounds superior mesenteric a. innervates the midgut

163
Q

Where does the inferior mesenteric plexus sit and what organs does it innervate?

A

Surrounds inferior mesenteric a. innervates the hindgut

164
Q

Are splanchnic nerves composed of pre or postganglionic fibers

A

preganglionic

165
Q

Where do the greater and lesser splanchnic nerves pierce the diaphragm?

A

The cura

166
Q

Where do the least and lumbar splanchnic nerves arise in relation to the diaphragm

A

At the level of or below the diaphragm

167
Q

What are the spinal cord levels of the greater splanchnic n.

A

T(s)6-9

168
Q

What are the spinal cord levels of the lesser splanchnic n.

A

T(9)10-11

169
Q

What are the spinal cord levels of the least splanchnic n.

A

T12

170
Q

Where do the preganglionic fibers in the greater splanchnic nerve synapse

A

celiac ganglia

171
Q

From the celiac ganglia- what organs are supplied by the postganglionic fibers?

A

Forgut organs

172
Q

Where do the lesser and least splanchnic nerves synapse

A

aorticorenal ganglia

173
Q

What organ does the aorticorenal ganglia supply?

A

Kidney (lesser) renal arteries and ureters (least)

174
Q

What are the spinal cord levels of the lumbar splanchnic nerves

A

L1,2,3

175
Q

Where do the lumbar splanchnic nerve synapse?

A

inferior mesenteric ganglia

176
Q

What organs are supplied by the inferior mesenteric ganglia

A

hindgut

177
Q

For the sympathetic fibers that enter the celiac ganglia but do not synaspe there, what do they innervate?

A

Suprarenal gland

178
Q

Is the aorticorenal ganglia a part of the celiac ganglia complex?

A

yes

179
Q

What does the vagus nerve provide innervation to in the abdomen

A

Everything up to the distal 1/3 of transverse colon (mostly forgut

180
Q

Where do the parasympathetic pelvic splanchnic nerves arise from (spinal cord levels)

A

S2-4

181
Q

What plexus contains the pelvic splanchnic nerves for the parasympathetic system

A

Inferior mesenteric plexus

182
Q

What do the pelvic splanchnic nerves innervate

A

Parasympathetic innervation to the distal 1/3 transverse colon, large intestine, rectum, and pelvic organs

183
Q

Referred visceral pain

A

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
Q

What are the two main lymphatics of the abdomen

A

Visceral lymph nodes and lumbar lymph nodes

185
Q

Visceral lymph noses

A

From abdominal viscera drain into nodes situated along the unpaired visceral branches of the aorta

186
Q

Lumbar lymph nodes

A

Receive drainage from the kidneys, testes, ovaries, and posterior body wall and lower limbs through the common iliac lymph nodes

187
Q

Where do the visceral and lumbar lymph nodes unite?

A

At a dilation within the abdomen called the cisterna chyli to form the thoracic duct,

188
Q

What is the largest lymph vessel in the body

A

the cisterna chyli

Block 2 Gross (11 decks)

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