Lecture 7 - Diaphragm, kidneys, and posterior ab wall Flashcards
what kind of plexus is the lumbar plexus?
somatic - (sensory and motor)
all fibers of diaphragm insert at
central tendon
when diaphragm is contracting what is the body doing
inspiration
innervation of diaphragm
phrenic nerve
phrenic nerves are passing through diaphragm from
thoracic cavity
phrenic nerve is coming from
ventral rami of cervical plexus of nerves (C3,C4,C4)
which nerves keep you breathing and alive
C3,C4,C5
phrenic nerve has both motor and sensory, and anatomizes with some intercostal sensory nerve at
periphery of diaphragm
the phrenic nerve is majority sensory or motor?
motor but has both
IVC passes through the diaphragm where
vena cava foramen T8
esophagus passes through diaphragm where
esophageal hiatus T10
Aorta passes through diaphragm where
aortic hiatus T12
arcuate ligaments or lumbocostal ligaments;
1; arches over aorta
2; arch over psoas mm
3; arch over quadratus lumborum mm.
1= 1 median arcuate lig.
arches over aorta
2= 2 medial arcuate ligs.
arch over psoas mm.
3= 2 lateral arcuate ligs.
arch over quadratus lumborum mm.
supply superior surface of diaphragm:
pericardiacophrenic and superior phrenic aa.
branch of internal thoracis aa that supplies superior surface of diaphragm
pericardiacophrenic aa
branch off aorta in thoracic cavity that supplies superior surface of diaphragm
superior phrenic aa
supply inferior surface of diaphragm
inferior phrenic aa (paired)
first paired branches of arteries off the abdominal aorta
paired inferior phrenic aa
supply periphery of diaphragm ( branch off what)
musculophrenic aa branch of internal thoracic a.
venous drainage is same name as artiers that supply diaphragm and dump into
IVC
paired organs but not symmetrically arranged
kidneys
where is superior pole of left kidney found
11th rib
where is superior pole of right kidney found
12th rib, right is a little more inferior
kidney’s are encapsulated by
perirenal fat and renal fascia
kidneys __ from pelvis during development
ascend
if kidneys do not develop correctly and remain in pelvic
ectopic pelvic
when the two kidney’s look like they are connected and get caught below __
horseshoe, IMA
transplanted kidneys are placed where
in lower abdomen
another name of adrenal glands
suprarenal glands because sit right on top of kidneys
enter and exit point of organs
hylum
fat of kidney that is outside renal fascia
paranephric fat
fat of the kidney that is inside the renal fascia
perinephric fat
function of kidneys
filtration of blood plasma
outer most layer of kidney
fibrous capsule
outer 1/3 of kidney
renal cortex
inner 2/3 of kidney
renal medulla
renal medulla contains
renal pyramids and columns
at the base of the renal pyramid we have __, for collecting and excreting filtrate
renal papillae
after renal papillae, minor calyces join to form ___,
major calyces
a couple major calyces of liver join together to form
renal pelvis which then goes to ureter
anterior to posterior we have an organization leave the kidney
vein, artery, ureter
between right and left kidneys we have
IVC and aorta
which is shorter, right or left renal vein?
right is shorter
which is shorter right or left renal artery
left is shorter
drainage of kidney: __receive urine at tips of pyramids then what
Renal papillae = receive (urine) at tips/apex of pyramids to Minor Calyces to Major Calyces to Renal pelvis to Ureter to Urinary bladder to Urethra
ureters are what kind of peritoneal
retro
ureter arteries arise from 3-4 sources
renal a
testicular or ovarian a.
abdominal aorta or common iliac a.
internal iliac a.
allows visualization of the ureters and bladder (clinical note)
Intravenous urogram
- patient is injected with iodinated medium
pain area of cutaneous innervation from Calculi (kidney stones)
rhythmic pain occurs as the kidney stone moves along, most pain is at T11-12
why is the right kidney a little lower than left
because of liver
roughly triangular, lies superior to right kidney and posterior to IVC
right adrenal or right suprarenal gland
semilunar shape, lies supermedial to left kidney near hilum
left adrenal or left suprarenal gland
gross features of adrenal (suprarenal) glands
fibrous capsule
adrenal cortex
adrenal medulla
outer layer of adrenal gland that produces adrenal steroids
adrenal cortex
has 3 zones
inner portion of adrenal glands that acts as sympathetic ganglion (modified neuronal cells)
adrenal medulla
modified neuronal cells of the adrenal medulla
chromaffin cells
adrenal gland is richly vascularized due to
endocrine function
suprarenal or adrenal gland blood supply - 3 sources
superior suprarenal aa (6-8) off inferior phrenic aa
middle suprarenal a (1) off the abdominal aa
inferior suprarenal aa(1) of the renal artery
the deepest muscle of the anterior abdominal wall
transversus abdominis m.
transversus abdominus m. , quadratus lumborum m., Psoas major m, iliacus m , psoas minor m, diaphragm
these muscles are located where
posterior abdominal wall
arterial supply of posterior wall
lumbar aa ( 4 pairs) branch of abdomen aorta
aorta bifurcation happens at what vertebral level
L4
usually the level of the umbilicus
L4
nerves of the posterior wall
ventral rami T12-L4
and lumbar plexus
subcostal nerve level
T12
iliohypogastric nerve level
L1
Supplies sensory to ant./lat. abd. wall
Supplies motor to abdominal mm.: EO, IO, TA, pyramidalis, RA, QL
subcostal nerve
ilioinguinal nerve level
L1
Can arise from common trunk
descend ant. to QL:
_1_supplies skin of suprapubic region
2 runs thru inguinal call to supply it
Both also supply abd. mm.
1 Iliohypogastric n.
2 Ilioinguinal n.
genitofemoral n level
L1-L2
Pierces psoas major m.
descends along ant. surface
Splits to femoral br. & genital br.
Supplies skin inf. & med. to inguinal ligament
Supplies cremaster m. (of spermatic cord)
genitofemoral n
lateral femoral cutaneous n level
L2-L3
Descends ant. to iliacus m.
Passes deep to inguinal ring
Inferior to ASIS
Supplies ant./lat. skin of thigh
lateral femoral cutaneous
femoral n level
L2-L4
Runs between iliacus & psoas major mm.
Passes deep to inguinal ligament
Inferior to ASIS
Supplies sensory & motor to anterior thigh
femoral n
obturator n level
L2-L4
Runs medial to psoas major mm.
Passes thru obturator foramen
Supplies sensory & motor to medial thigh
obturator n.
lumboscaral trunk n level
L4-L5
Large n. trunk crosses over ala of sacrum
Descends into pelvis to help form sacral plexus and sciatic nerve
Provides general contributions to both plexuses
lumbosacral trunk n
