Post Abd/Kidney/Diaphragm Flashcards
INSPIRATION:
what happens to lung size? diaphragm size? is muscle contracting or relaxing?
INSPIRATION
lungs increasing
diaphragm decreasing
because diaphragm contracting
EXPIRATION:
what happens to lung size? diaphragm size? is muscle contracting or relaxing?
EXPIRATION:
lungs decrease
diaphragm increases
muscle relaxing
What 3 nerves innervate the diaphragm?
Right phrenic nerve
Left phrenic nerve
Intercostal nerve
What do each of the 3 nerves that innervate the diaphragm innervate specifically?
Right phrenic = right hemidiaphragm
Left phrenic = left hemidiaphragm
Intercostal n = lateral borders of diaphragm
Where does phrenic nerve original (which vertebral level)
C3/4/5 KEEP ME BREATHING AND ALIVE
ventral rami of cervical plexus of nerves
How does the phrenic nerve run relative to the scalene muscle?
Phrenic nerve runs right over anterior surface of scalene muscle
How does the phrenic nerve run relative to the subclavian artery/vein?
Phrenic nerve runs BETWEEN subclavian artery and vein while moving towards thorax
What will detect irritation to superior/inferior surfaces of central diaphragm?
sensory fibers from phrenic nerve
*eventually anastomose with intercostal n
What will detect irritation to the superior/inferior surfaces of lateral diaphragm?
sensory fibers of intercostal n
*eventually anastomose with phrenic n
Paralysis of the cervical region results in paralysis of ______
diaphragmatic respiration
T/F Paralyzed hemidiaphragm remains low in thorax on an x-ray
FALSE
Paralyzed hemidiaphragm remains high in thorax because cannot contract (=descend)
What 3 structures pierce through the diaphragm?
IVC, Esophagus, Aorta
What are the 3 diaphragm aperatures? What are their vertebral levels? What pierces through them?
- Vena Cava Foramen
- T8, IVC - Esophageal hiatus
- T10, esophagus - Aortic Hiatus
- T12, aorta
What is the location of all diaphragm aperatures relative to vertebral column?
All aperatures are adjacent to the bodies of the vertebral column meaning they are close to the midline
What does arcuate mean?
Arch
Arcuate ligaments aka ______
lumbocostal arches
What are the 3 arcuate ligaments of the diaphragm?
aka lumbocostal arches
- median arcuate ligament
- medial arcuate ligaments
- lateral arcuate ligaments
What is the location of the 3 arcuate ligaments relative to the abdominal wall and diaphragm?
all on inferior edge of diaphragm
all against posterior abdominal wall
What does the median arcuate ligament arch over?
the aorta
it is the superior opening of the aortic hiatus
What do the medial arcuate ligaments arch over?
psoas major (the first muscle lateral to the vertebral column)
What do the lateral arcuate ligaments arch over?
arch over quadratus loborum m
What are the 4 vessels of the diaphragm?
- Pericardiophrenic
- Superior phrenic
- Inferior phrenic
- Musculophrenic
Pericardiophrenic and superior phrenic:
- what are they branches of? what do they supply?
Branches of internal thoracic and thoracic aorta
supply superior surface
Inferior phrenic
- what is it a branch of? what does it supply?
branch of abdominal aorta
supplies inferior surface
Musculophrenic aa
- what is it a branch of? what does it supply?
branch of internal thoracic
supplies periphery of diaphragm
Where is the kidney located relative to the vertebral column?
Lateral to column at levels T12-L3
Where are the superior poles of the right and left kidney?
right kidney = 12th rib
left kidney = 11th rib
Where do kidneys develop? How do they get to their permanent position?
develop in pelvic region and ascend to abdominal cavity
What is an ectopic pelvic?
kidney remains anterior to sacrum
What is a horseshoe kidney?
two kidneys appear fused at midline and cannot ascend because they are caught on the IMA
Where are transplanted kidneys placed?
In lower abdomen because it’s easier to vascularize there
Suprarenal gland aka ____
adrenal gland
Where are the suprarenal glands located?
superior pole of kidney
Is the hilum of the kidney concave or convex? how does vasculature get in?
hilum is concave and is split open so it is open for vessels to penetrate
Kidney is covered with ___ fascia on which surfaces? why?
renal fascia
covered anterior and posterior because kidney is retroperitoneal
What is the difference between paranephric fat and perinephric fat?
paranephric fat = outside renal fascia
perinephric fat = inside of renal fascia and extends into hilum to fill the hilum space
Layers of inner kidney from superficial to deep?
Dense, fibrous capsule = outer layer
Renal cortex = outer 1/3
Renal medulla = inner 1/3
What is within the renal medulla?
Renal pyramids and renal columns
What are renal papillae?
receive apex of pyramids and serves as collecting tip where excretory fluids begin to collect
What is the relationship between minor and major calyces?
Minor calyces come together to form a major calyce
From renal pyramids to ureter, trace the pathway of excretory fluid
renal pyramid -> renal papillae -> minor calyce -> major calyce -> renal pelvic -> ureter
Veins are ____(anterior/posterior)____ to arteries in kidney vasculature?
VEINS ARE ANTERIOR TP ARTERIES IN KIDNEY VASCULATURE
Between two kidneys is IVC and abdominal aorta. Which sits closer to which kidney?
IVC is near right kidney
Abdominal aorta is near left kidney
Which is longer: right or left renal artery?
right renal artery is longer than left renal artery
Which is longer: right or left renal vein?
left renal vein is longer than right renal vein
What is the path of the right renal artery?
passes posteriorly to IVC to reach right kidney
What is the path of the left renal vein?
passes anteriorly to abdominal aorta
What are the 3-4 vascular sources for the ureter?
- renal artery
- testicular/ovarian artery
- abdominal aorta/common iliac a
- internal iliac a (pelvic cavity)
Where does the ureter exit the kidney?
at the ureteropelvic junction of the hilum
Is the ureter retroperitoneal or intraperitoneal?
retroperitoneal
think: kidney is retroperitoneal too
What is the ureter’s pathway relative to the common iliac vein?
ureter crosses over the common iliac vein close to the pelvic brim
What is an intravenous urogram?
patient injected with iodonated contrast medium
media is excreted by glomerular filtration by renal tubules and allows visualization of the ureters and bladder
Why are kidney stones called calculi?
they are a buildup of calcium
What size kidney stone needs surgical removal?
ones larger than 1cm
What is lithotripsy?
ultrasonic crushing of a kidney stone to break it up
What is the shape of the right and left adrenal glands?
right adrenal gland = triangular shape
left adrenal gland = semilunar in shape
What is the position of right/left adrenal gland relative to the kidneys?
right adrenal gland: posterior to IVC and superior to right kidney
left adrenal gland: superomedial to left kidney near hilum
Three portions of the adrenal gland from superficial to deep?
Dense fibrous capsule = outermost
Adrenal cortex = outer layer
Adrenal medulla = inner layer
What does the adrenal cortex produce?
adrenal steroids
What is significant about the adrenal medulla?
acts as sympathetic ganglion
has chromaffin (modified medullary neuronal cells)
What are chromaffin?
Modified medullary neuronal cells found in the adrenal medulla
Why are the adrenal glands so vascularized?
because they’re part of the endocrine system which relies on vascular supply for their product distribution
3 main vessels that supply the adrenal glands? how many per each?
- superior suprarenal arteries 6-8
- middle suprarenal arteries 1+
- inferior suprarenal arteries 1+
Where do the 3 main adrenal gland vessels branch from?
- superior suprarenal arteries branch from inferior phrenic artery
- middle suprarenal arteries branch from abdominal aorta
- inferior suprarenal arteries branch from renal artery
What are the 6 musculs of the posterior abdominal wall?
- Transversus abdominus
- Quadratus Lumborum
- Psaos Major
- Iliacus m
- Psaos minor
- Diaphragm
What is the arterial supply for the posterior abdominal wall musculature?
lumbar arteries (4 pairs) - branches of abdominal aorta superior to bifurcation
What innervates the posterior abdominal wall musculature?
ventral rami T12-L4
LUMBAR plexus = somatic = sensory and motor
Are lumbar plexus sensory or motor?
lumbar plexus is somatic therefore sensory AND motor
What nerve originates at the following locations: T12: \_\_\_\_\_ L1: \_\_\_\_\_ L1-L2: \_\_\_\_\_ L2-L3: \_\_\_\_\_ L2-L4: \_\_\_\_\_ L2-L4: \_\_\_\_\_ L4-L5: \_\_\_\_\_
T12: subcostal nerve L1: iliohypogastric and ilioinguinal n L1-L2: genitofemoral nerve L2-L3: Lateral femoral cutaneous n L2-L4: femoral n L2-L4: obturator n L4-L5: lumbosacral trunk
Subcostal nerve location? What vertebral level?
~1cm inferior to 12th rib
@T12
What does the subcostal nerve supply for sensory? what about motor?
sensory: anterior and lateral abdominal wall
motor: EO, IO, TA, pyramidalis, RA, QL
What vertebral level do ilioinguinal and iliohypogastric n come from?
L1
can arise from common trunk - often do
Ilioinguinal and hypogastric n physical relationship with QL?
the nerves descend anterior to QL
What does the iliohypogastric nerve supply?
the suprarubic region
What does the ilioinguinal nerve supply?
runs through the inguinal canal to supply it
runs along roof of canal and exits superficial ring
What vertebral level does the genitofemoral nerve come from?
L1-L2
What does the genitofemoral nerve split into?
femoral branch (lateral) genital branch (mesial)
What muscle is the genitofemoral nerve associated with?
Psoas major
it pierces this muscle and runs along anterior surface of psaos major
What does the genitofemoral nerve supply?
supplies skin inferior and medial to inguinal ligament
also supplies cremaster muscle of spermatic cord
What vertebral level does the lateral femoral cutaneous nerve come from?
L2-L3
What muscle/structures are associated with the lateral femoral cutaneous nerve?
nerve descends anterior to iliacus m., passes deep to inguinal ring and exits inferior to ASIS
What does the lateral femoral cutaneous nerve supply?
supplies anterior/lateral skin of thigh
What vertebral level does the femoral nerve come from?
L2-L4
What two muscles does the femoral nerve run between?
iliacus and spoas major mm
What is the path femoral nerve takes to get to the thigh?
passes deep to inguinal ligament and inferior to ASIS
What does the femoral nerve supply?
supplies sensory and motor to anterior thigh
What vertebral level does the obturator nerve come from?
L2-L4
What course does the obturator nerve take to get to the thigh?
runs medial to psoas major mm
passes through obturator foramen
What does the obturator nerve supply?
supplies sensory and motor medial thigh
What is the difference between femoral n and obturator n? What are similarities?
both supply sensory and motor to thigh
femoral supplies anterior thigh
obturator supplies medial thigh
What vertebral level does the lumbosacral trunk come from?
L4-L5
What is the course of the lumbosacral trunk?
crosses over sacrum and descends into pelvis to help form sacral plexus
What does the lumbosacral trunk do?
provides general contributions to both plexus
joins with sacral trunk to form psiatic nerve
