Lecture 5: Kidney Ureter post abdominal wall

Question 1

What are the muscles of the posterior abdominal wall?

Answer 1

• Quadratus lamborum
• Iliacus
• Psoas Major

Question 2

Quadratus lamborum

Answer 2

• Origin: Iliac Crest
• Insertion: 12th Rib & L1-4 Transverse processes
• Action:
  
  • Both = Forced expiration & 12th rib support
  • One = Bend trunk to same side​
• Innervation: T12, L1-L4 (anterior rami)

Question 3

Iliacus

Answer 3

• Origin: Iliac fossa
• Insertion: Lesser Trochanter of Femur
• Joins Psoas to form common tendon
• Action: Hip flexion
• Innervation: Femoral n. (L2-4)

Question 4

Psoas major

Answer 4

• Origin: T12, L1-L5 (Vertebral bodies &IV Discs)
• Insertion: Lesser Trochanter of Femur Joins Iliacus to form common tendon
• Action: Raise body from supine position (both) / Bend trunk laterally (one) / Flex Hip jt.
• Innervation: Lumbar plexus L1-3 (direct branches)

(Muscle on the right)

Question 5

At what level does the aorta give off the SMA?

Answer 5

• L1

Question 6

At what level do the gonal arteries branch off the aorta?

Answer 6

• L2

Question 7

At what level does the aorta bifurcate?

Answer 7

• L4

Question 8

How many arteries supply and drain the posterior abdominal wall?

Answer 8

• 5

Question 9

Where does the IVC sit relatve to the aorta, what concequences can this have?

Answer 9

• IVC sits to the right and behind the aorta
• this meaning that the left common iliac vein passes under the right common iliac artery, and hence the left common iliac vein can be compressed

Question 10

What is the surface anatomy of the kidneys and ureter?

Answer 10

• Right kidney sits behind and below rib 12
• Left kindey sits behind and below ribs 11-12
• Ureter exits kidney at the level of the transpyloric plane (L1)

Question 11

Reltionship of ureters and renal vessels?

Answer 11

• Ureters sit posterior to renal vessels
• Veins sit anterior to the arteries

Question 12

Blood nerve and lymph of kidneys

Answer 12

• Arterial: Renal Arteries (lateral @L1)
  
  • anterior & posterior branches
    
    • (into segmental branches)
  • Right Renal artery = longer than Left, Runs posterior to IVC
• Venous: Renal Veins – Into IVC laterally @L1
  
  • Left Renal vein = 3x Longer than Right
    
    • Runs Anterior to Aorta, Under SMA & Posterior to Splenic v./Body of Pancreas
  • Right Renal vein: runs posterior to 2° Duodenum
• Nerve: Renal plexus:
  
  • Sympathetic = Complicated
  • Parasympathetic = Vagus n. [CNX]
    
    • Referred pain described as “Flank” pain
• Lymph: Para-aortic nodes (@L1)

Question 13

Features of the ureters

Answer 13

• Course:
  
  • ~25cm Long
  • Exit Kidneys @L1
  • Extend vertically down from hilus on surface of Psoas muscle
• Roughly in-line with transverse processes of lumbar spine (Think radiology)
• Crosses Bifurcation of Common Iliac Artery • (@ Anterior Sacro-iliac Joint)
• Passes on lateral wall of Pelvis (Ilium) towards the Ischial Spine
• Enters Bladder on inferior surface at the Trigone

Question 14

3 constrictions of the ureters?

Answer 14

• Junction of the Ureters and the renal pelvis – Pelvi-ureteric junction (PUJ)
• Where ureters cross the pelvic brim
• As they enter the wall of the bladder

Question 15

Features of the bladder?

Answer 15

• Partial covering of peritoneum, ‘stuck’ against pubic bones (various ligaments helping to do so)
• Transitional epithelium and rugae
• Muscular coat of smooth muscle (Detrusor Muscle) and at neck of bladder smooth muscle sphincter (Sphincter Vesicae)
• As the bladder fills it rises into the suprapubic region
• Apex posterior to pubic symphysis

Question 16

What is the trigone?

Answer 16

• Triangular smooth area at base of bladder – mucous membrane , no rugae
• Ureters enter & Urethra exits at the points of the triangle

Question 17

Blood and nerve supply of the bladder?

Answer 17

• Arterial = Superior (x2) and Inferior Vesical arteries from each side
  • Off of anterior branch of Internal Iliac a.
  • ​(Inferior Vesical a. in males usually corresponds to Vaginal a.in females)
• Venous = Vesical Plexus (Drain to Internal Iliac v.)
• Nervous = ANS Inferior Hypogastric Plexus
  
  • Sympathetic: Sacral Splanchnic nerves
  • S2-4 (L1-2 Fibres)
  • Parasympathetic: Pelvic Splanchnic
  • Pain is referred to Suprapubic region (L1/2 Dermatomes)

Question 18

Features of male and female urtheras?

Answer 18

• Female
  
  • Urethra leaves bladder and passes through Deep & Superficial Perineal Pouches
• Male:
  
  • 4 Distinct regions:
    
    • Pre-Prostatic
    • Prostatic
      
      • Widest part – many ducts emptying in
    • Membranous
      
      • Thinnest part – Through deep perineal pouch
    • Spongy
      
      • Through Corpus Spongiosum

Question 19

Urinary tract lymphatics?

Answer 19

• Ureter Drains to:
  
  • Lumbar
  • CommonIliac
  • ExternalIliac
  • InternalIliac
• Urinary bladder drains to:
  
  • Internal iliac nodes
• Urethra drains to:
  
  • internal iliac nodes

Question 20

Nerves the input to lumbar plexsus?

Answer 20

• T12-L4

Question 21

Branches from JUST L1?

Answer 21

• Ilioinguinal
  
  • Sensory: Lateral Gluteal & Pubic skin
  • Motor: Transversus Abdominis & Internal Oblique
  • More superior
• Iliohypogastric
  
  • Sensory: Skin of Medial Thigh + Root of Penis/Scrotum or Mons pubis/labia majora
  • Motor: Transversus Abdominis & Internal Oblique
  • traces iliac crest
• ABOVE psoas muscle (emerge at lateral border)

Question 22

Branches from L1+L2?

Answer 22

• Genitofemoral nerve
  
  • genital nerve
    
    • motor supply to cremasteric muscle
    • sensory to Scrotum/ Mons Pubis
  • femoral nerve
• RUNS on top of psoas muscle

Question 23

Branches from L2+L3?

Answer 23

• Lateral femoral cutaneous
• Pases diagonally over iliacus and under inguinal ligament next to ASIS

Question 24

Branches from L2 + L3 + L4?

Answer 24

• Obturator nurve
  
  • Medial to psoas
• Femoral nevre
  
  • HUGE