Lecture 18 - Posterior Abdomen and Abdominal Arteries Flashcards
What are the posterior wall muscles?
- Diaphragm
- Quadratus lumborum
- Psoas minor
- Psoas major
- Iliacus
- Iliopsoas
What are the 3 hiatuses?
- Caval hiatus (T8)
- Esophageal hiatus (T10)
- Aortic hiatus (T12)
What are the 3 arcuate ligaments?
- Lateral arcuate ligament
- Medial arcuate ligament
- Median arcuate ligament
What does the lateral arcuate ligament create a passage for?
Quadratus lumborum
What does the medial arcuate ligament create a passage for?
Psoas major/minor
What does the median arcuate ligament create a passage for?
Aorta (aortic hiatus)
What are the kidneys?
Smooth, ovoid organs covered in a fibrous capsule
What are the margins of the kidneys?
- Medial margin
- Lateral margin
What are the poles of the kidneys?
- Superior pole
- Inferior pole
What are the structures of the kidneys?
- Hilum
- Renal artery
- Renal vein
- Ureter
- Fibrous capsule
What are the hilum on the kidneys an entrance for?
Renal sinus (on medial margin)
What is the renal pelvis?
Funnel shaped region at the superior end of the ureter
What gland is located on the superior pole of the kidneys?
Adrenal (suprarenal) gland
What are the suprarenal glands attached to?
The crura of the diaphragm by the renal fascia
What are the layers of the internal kidney?
- Outer renal cortex
- Inner renal medulla
What are the parts of the renal cortex?
- Renal capsule
- Cortex
- Renal columns
What are the renal columns?
Extensions of the renal cortex into the renal medulla
What are the parts of the renal medulla?
- Renal pyramid
- Renal papilla
What are renal pyramids?
Divisions of the renal medulla by the renal columns
What are the renal papilla?
Apical projections of renal pyramids
What are the 2 different renal calices?
- Minor calyces
- Major calyx
How many minor calyces are there?
8-12 per kidney
How many major calyx are there?
2-3 per kidney
What is the renal sinus?
Cavity containing adipose, renal pelvis + calyces, and neurovasculature
What is the nephron?
Functional unit of the kidney (average of 1M per kidney)
What are the renal connective tissues?
- Kidney’s are associated with several outer layers of connective tissues
- Kidney’s -> retroperitoneal
What are the layers of fascia?
From outside to inside:
1. Thoracolumbar fascia
2. Transversalis fascia
3. Renal fascia
4. Parietal peritoneum
What are the layers of fat?
From outside to inside:
1. Paranephric (pararenal)
2. Perinephric (perirenal)
Where is paranephric fat located?
Outside the renal fascia
Where is perinephric fat located?
Between the fibrous capsule of the kidney and renal fascia
What are ureters?
- Retroperitoneal muscular tubes that carry from kidneys to urinary bladder
- 25 to 30 cm
What are the layers of the suprarenal glands?
From outside to inside:
1. Capsule
2. Cortex
3. Medulla
What artery and vein cross over the ureter?
Gonadal a. and v.
Where do the visceral afferent nerves travel to?
T11-L2 spinal levels
Where is the referred pain of these visceral afferent nerves?
Ipsilateral lower abdomen/groin region
What are renal and ureteric calculi?
Stones/pebbles made of concentrated salts/minerals in urine
Where can calculi pass?
Into the ureter
What issues can large calculi cause in the ureter?
- Distention
- Leads to intermittent pain (as stone is passed)
- Can obstruct flow of urine
What are the treatments for calculi?
- Nephroscopic removal
- Lithotripsy
What is lithotripsy?
Shockwaves to break up calculi
What are the 3 sites of ureter constriction?
- Ureteropelvic junction
- Crossing iliac vessels at pelvic brim
- Entering the wall of the bladder
What are the retroperitoneal structures?
- Suprarenal glands
- Aorta + inferior vena cava
- Duodenum (D2 + D3)
- Pancreas (except tail)
- Ureters
- Colon (Asc. + desc.)
- Kidneys
- Esophagus
- Rectum
What are the paired parietal (segmental) arteries?
- Inferior phrenic a. (T12)
- Lumbar a. (L1-L4)
Where do the inferior phrenic arteries run?
- Branches off abdominal aorta
- Located inferior to aortic hiatus
What do the inferior phrenic arteries supply?
Supply blood to inferior diaphragm
What is a branch of the inferior phrenic arteries?
Superior suprarenal arteries
Where do the lumbar arteries run?
- Arise from posterior aorta
- Wrap laterally around vertebral bodies
What do the lumbar arteries supply?
- Parts of spinal cord
- Posterior abdominal wall
What are the paired visceral arteries?
- Middle suprarenal a. (L1)
- Renal a. (L1/L2)
- Gonadal a. (L2)
Where do the middle suprarenal arteries run?
Arises between celiac trunk and superior mesenteric a.
Where do the renal arteries run?
- Lateral branch arising between L1 and L2 vertebral levels
- Enters hilum of the kidney
What do the renal arteries supply?
Kidneys
What is a branch of the renal arteries?
Inferior suprarenal arteries
Which renal artery is longer?
Right renal artery (passes behind the inferior vena cava)
Where do the gonadal arteries run?
- Lateral branch arising around L2
- Travels anterior to the ureter
- Can be testicular or ovarian
What 3 sources supply blood to the suprarenal glands?
- Superior suprarenal a.
- Middle suprarenal a.
- Inferior suprarenal a.
What are the 3 “trunks” of the abdominal arteries?
- Celiac trunk (T12)
- Superior mesenteric a. (L1)
- Inferior mesenteric a. (L3)
What are the 3 branches of the celiac trunk?
- Left gastric artery
- Splenic artery
- Common hepatic artery
What is the branch of the splenic artery?
Left gastroepiploic a.
What are the branches of the common hepatic artery?
a) Gastroduodenal a.
c) Right gastroepiploic a.
d) Superior pancreaticoduodenal a.
e) Right gastric a.
f) Hepatic a. proper
g) Cystic a.
h) Right hepatic a.
i) Left hepatic a.
What is the anastomosis along the lesser curvature of the stomach?
Between: Left gastric + Right gastric
What is the anastomosis along the greater curvature of the stomach?
Between: Left gastroepiploic + Right gastroepiploic
What does the cystic artery supply?
Gallbladder
What does the right hepatic artery supply?
Liver
What does the left hepatic artery supply?
Liver
What are the branches of the superior mesenteric artery?
- Inferior pancreaticoduodenal a.
- Jejunal arteries
- Ileal arteries
- Ileocolic a.
- Right colic a.
- Middle colic a.
What anastomoses with the inferior pancreaticoduodenal artery?
Superior pancreaticoduodenal a.
What are the branches of the inferior mesenteric artery?
- Left colic a.
- Sigmoid arteries
- Superior rectal artery
What is the marginal artery?
An arterial arcade near the splenic flexure
What anastomosis occurs at the marginal artery?
Between: Left colic + Middle colic
