lecture 3 retroperitoneum

Question 1

retroperitoneal organs on posterior abdominal walls (SADPUCKER)

Answer 1

suprarenal glands, aorta/inferior vena cava, duodenum, pancreas, ureters, colon, kidney, oesophagus, rectum; also nerves (lumbar plexus and sympathetic trunk)

Question 2

posterior abdominal region

Answer 2

spleen is present but is intraperitoneal

Question 3

feature of primary retroperitoneal structures

Answer 3

developed outside parietal peritoneum and never had a mesentery

Question 4

what are the primary retroperitoneal structures

Answer 4

abdominal aorta (and branches), inferior vena cava (and tributaries), kidneys, ureters, adrenal glands, lumbar plexus and sympathetic trunk nerves

Question 5

what is the first “superimposed” retroperitoneal structure

Answer 5

duodenum

Question 6

levels and lengths of sections of duodenum

Answer 6

5cm long, L1 level, left (horizontal); 7-10cm long, L1-L3, down (vertical); 6-8cm, crosses L3, right (horizontal); 5cm, to L2, right and up (ascending)

Question 7

duodenum

Answer 7

first 1.5cm is intraperitoneal, rest is retroperitoneal

Question 8

first section of duodenum

Answer 8

1st 2cm has mesentery, lies anterior to bile duct, portal vein and gastroduodenal artery

Question 9

second section of duodenum

Answer 9

bile duct and pancreatic ducts open into it; root of transverse mesocolon crosses it

Question 10

third section of duodenum

Answer 10

crossed anteriorly by superior mesenteric artery and vein (can be compressed if mesenteric artery expands)

Question 11

fourth section of duodenum

Answer 11

5cm leads into jejunum

Question 12

what organs are superimposed on the background structures; of which, which are not retroperitoneal

Answer 12

duodenum, pancreas and spleen; all retroperitoneal except spleen and tail of pancreas (left side)

Question 13

what is pancreas derived from

Answer 13

buds growing into dorsal and ventral foregut mesenteries

Question 14

where does head, neck and uncinate process of pancreas lie

Answer 14

in ‘G’ of duodenum anterior to inferior vena cava

Question 15

where does body of pancreas extend to

Answer 15

left side across aorta to left kidney

Question 16

where does tail connect spleen to

Answer 16

kidney in dorsal foregut mesentery (lieno-renal or spleno-renal ligament)

Question 17

draw retroperitoneal structures

Answer 17

having removed stomach and colon

Question 18

histology of pancreas

Answer 18

endocrine and exocrine (acini are exocrine)

Question 19

blood vessels surrounding kidney (upper pole above is suprarena gland; lower pole)

Answer 19

coeliac trunk, superior mesenteric artery; ureter runs in front of transverse process of lumbar vertebrae

Question 20

macroscopic features of kidney

Answer 20

cortex, medulla (pyramids), renal papilla, renal column, medullary rays, fibrous capsule, minor calyces (medulla drains into it), renal sinus, major calyces, renal pelvis (major calyces drain into it), ureter

Question 21

kidney in situ

Answer 21

lies in perinpephric fat (well protected) within renal fascia (from transversalis fascia), with paranephric fat in between renal fasica and continuing posterior tansveralis fascia; quadratus lumborum and psoas major posterior (psoas more medial); on level of L2/3; parietal peritoneum anterior

Question 22

what is anterior to upper part of right kidney

Answer 22

liver

Question 23

what is anterior to lower part of left kidney

Answer 23

jejunum

Question 24

visceral relations of right kidney

Answer 24

right suprarenal gland, liver, descending (2nd) part of duodenum (medial), right colic flexure (lateral) - ascending colon, small intestine (anterior inferior)

Question 25

visceral relations of left kidney

Answer 25

left suprarenal gland, stomach, spleen, pancreas, left colic flexure (lateral), descending colon (lateral), jejunum (significant, anterior, inferior)

Question 26

diagram of visceral relations of kidneys

Answer 26

slide 16

Question 27

visceral relations of both kidneys

Answer 27

adrenal glands

Question 28

visceral relations of right kidney

Answer 28

liver, 2nd part of duodenum, ascending colon

Question 29

visceral relations of left kidney

Answer 29

descending colon, stomach, spleen, tail of pancreas, coils of small bowel

Question 30

surface projection of kidneys

Answer 30

hilum located at transpyloric plain (L1); right often lower; 5cm from midline; greater separation at inferior ends (upper poles closer to median plan than lower poles); below vertebral level T12 (12th rib runs diagonally across posterior surfaces of kidneys) so can only palpate from anterior abdominal wall (posterior is too thick)

Question 31

where are ureters located

Answer 31

arise from hilem at L1; descending vertically, anterior to transverse processes of lumbar vertebrae

Question 32

what 3 places do ureters narrow (kidney stones occur)

Answer 32

ureteropelvic junction, pelvic brim (common iliac vessels cross), entrance of urinary bladder

Question 33

narrowing ureter sections

Answer 33

slide 20

Question 34

posterior relations of kidneys: muscular structures

Answer 34

lies on diaphragm, psoas, quadratus lumborum and transverus abdominis muscle

Question 35

what cross between kindeys and muscles posteriorly

Answer 35

T12 (subcostal) and L1 (ilio-hypogastric and ilio-inguinal) nerves

Question 36

what is posterior approach used for

Answer 36

open surgery, renal biopsy