Post. Abdominal Viscera And Wall Flashcards
Kidneys location
. T12 to L3 w/ right one lower than the left
. Inf. Pole may be palpable (esp. right one)
. Sup. Pole under cover of ribs
. W/in retroperitoneal fat
. Renal fascia encloses kidney and some fat
. Has fibrous capsule
Perirenal fat
. Btw kidney and renal fascia
. Surrounds and helps protect kidney
Pararenal fat
. Outside renal fascia
Hilus of kidney
. Where vessels enter/leave
. Has sinus that is space surrounding these vessels
Kidney parenchyma
. Cortex
. Medulla w/ renal pyramids (14 each, base towards cortex, apex/papilla into minor calyx) and renal column (cortical tissue extending into medulla)
Kidney duct system
. Dozen large collecting ducts of each pyramid empty at papilla into minor calyx
. 1+ papilla share minor calyx
. 2+ minor calyces unite to form major calyx
. 2-3 major calyces unit to form renal pelvis that drains to ureter
Kidney blood supply
. From renal a. That divides at hilus into 5 segmental branches
. Each is end artery
. Accessory renal aa. Also end arteries
. Venous drainage to IVC via renal vein
Kidney innervation
. Renal (aorticorenal) plexus
. Parasympathetic from vagus nerve
. Postganglionic sympathetic fibers from aorticorenal ganglion
. Visceral sensory fibers for pain travel along-side sympathetic motor
Ureter
. Muscular drainage tube from renal pelvis to post. Side of urinary bladder
. Bloackage causes severe pain when ureter contracts
. Descends vertically on psoas muscle then crosses at beginning of external iliac a. To enter pelvis
Ureter blood supply
. Renal a.
. Gonadal a.
. Abdominal aorta
Renal and ureteric calculi
. Calculi (pebbles) in calices of kidney, ureters, or urinary bladder
. Renal calculus pass from kidney into penal pelvis and ureter causing tube distension
. Severe rhythmic pain as it is gradually forced down ureter by waves on contractions
. Visceral afferents conveying pain to T11-L2 innervation areas (lumbar, hypogastric region, external genitalia, and testis)
Suprarenal (adrenal) glands structure and innervation
. Flat endocrine gland against diaphragm on sup. Pole of each kidney
. Cortex: outer part secreting steroids (essential for life)
. Medulla: inner that secretes catecholamines (not essential for life), secretory cells are modified sympathetic postganglionic neurons synapse gets w/ preganglionic fibers from T10-L2
. Blood supply: several suprarenal aa. To reach periphery of gland, venous from single suprarenal vein
Adrenal gland blood supply
. L suprarenal v. Drains into R suprarenal vein that goes to IVC
Thoraco-abdominal diaphragm
. Thin, voluntary muscle partition btw thoracic and abdominal cavities
. Dome-like, R side higher then L from liver
. Central tendon: C-shaped w/ convexity ant., aponeurosis for muscle fiber insertion
Diaphragm Origins
. Sternal from xiphoid process
. Costal from lower 6 costal cartilages and lower 2 bony ribs
. Vertebral: right crus (1st 3 lumbar bodies and discs, larger than L, surrounds esophageal hiatus) and left crus (1st 2 lumbar bodies/discs), arcuate ligaments
Diaphragm innervation
. Phrenic n. (All motor and sensory except to periphery)
. T6-11 intercostal/subcostal nn. (Periphery, mostly sensory but some motor)
Diaphragm superior surface blood supply
. Sup. Phrenic aa. Branches from aorta to post. Position
. Pericardiacophrenic and musculophrenic aa. From internal thoracic aa. To ant. And central position
. Lower 6 post. Intercostal and subcostal aa. From thoracic aorta to lat. positions
Inf. Surface diaphragm blood supply
. Inf. Phrenic aa.
Structures piercing diaphragm
. IVC via vena canal foramen in central tendon at T8
. Esophagus via esophageal hiatus at T10 w/ ant. And post. Vagal trunks
. Aorta via aortic hiatus under median arcuate ligament at T12
. Thoracic splanchnic nn. (Greater, lesser, least) pierce crura
Lower esophageal sphincter
. Prevents regurgitation by constricting when diaphragm contracts
. Physiological, not anatomical, sphincter
Psoas major OIA
. O: transverse processes of L1-5, sides of bodies T12-L5 and discs
. I: lesser trochanter via iliopsoas tendon
. A: bi/unilaterally flexes thigh, bilaterally flexes trunk if thigh stabilized, unilaterally lat. flexes vertebral column toward same side
Psoas major N
N: vertebral rami of L2-4 (post. Divisions)
Iliacus OIAN
. O: iliac crest and sup. 2/3 of iliac fossa, ala of sacrum, ant. Sacroiliac ligaments
. I: lesser trochanter of femur via iliopsoas tendon
. A: flexes thigh and stabilizes hip joint
. N: ventral rami of L2-4 nerves (post. Divisions)
Iliopsoas muscle
. Iliacus w/ psoas major
Psoas minor OIAN
O: T12-L1 bodies and disc I: iliopubic eminence A: weak trunk flexor N: ventral ramus of L1 . Absent in 40% people, when present it lies ant. To psoas major
Quadratus lumborum OIAN
O: iliolumbar ligament, internal lip of iliac crest
I: inf. Border 12th rib, transverse processes L1-4
A: one side contracted lat. flexes vertebral column to same side, fixes 12th rib during inspiration
N: subcostal n. And L1-4 (ant. Division)
Thoracolumbar fascia
. Thick, covers origin of erector spinae muscle in lumbar region
. Ant. Layer: ant. Surface of quadratus lumborum
. Middle layer: attached to transverse processes of lumbar vertebrae
. Post layer: attached to spinous processes
. Middle and post. Layers join lat. at aponeurosis of transversus abdominis muscle
Transversalis fascia
. Deep surface of transversus abdominis and quadratus lumborum muscles
. Part of larger fascial layer that lines deep surface of entire abdominal cavity (endoabdominal fascia)
Abdominal aorta course
. Enters through aortic hiatus
. Terminates at L4 by splitting into R/L common iliac aa.
. Common iliac aa. Split into external and internal iliac aa.
Abdominal aorta visceral branches
. Paired: suprarenal, renal, testicular/ovarian
. Unpaired: celiac a., sup. And inf. Mesenteric aa.
Abdominal aorta parietal branches
Paired: inf. Phrenic aa (to inf. Diaphragm)., lumbar aa
Unpaired: median sacral aa.
Lumbar arteries
. Post. Abdominal wall
. 4 arteries paired in segmental fashion
. Arise from post. Side of aorta
. Run post. To quadratus lumborum muscle
Median sacral artery
. Arises from inf. Surface of aorta as it bifurcated
. Runs along ant. Surface of sacrum
. Final pair of lumba aa. May arise from it
T/F IVC receives blood from GI tract
F, that is drained by portal v.
IVC tributaries
. Paired visceral vv. (Renal vv both drain to IVC., R testicular goes to IVC, L testicular goes to L renal v., R suprarenal v. To IVC, L suprarenal v. Goes to L renal v.)
. Paired parietal vv.: inf. Phrenic vv. To IVC, lumbar vv., hepatic vv. (3 branches drain liver)
Ascending lumbar vv.
. Connects lumbar, IVC, and lumbar vv. On each side
. Joins azygos system of veins sup.
Iliac lymph trunks
. Drain into lumbar lymph trunks alongside aorta
lumbar lymph nodes
Lay alongside aorta
Intestinal lymph trunk
. Drains most of abdominal digestive tract
Cisterna chyli
. Dilated inf. End of thoracic duct
. Gets lumbar lymph trunks and intestinal trunk
Lumbar plexus
. Ventral rami L1-4
. Roots of plexus
Branches of lumbar plexus
. Muscular branches to quadratus lumborum and psoas major muscles
. Iliohypogastric and ilioinguinal nn
. Genitofemoral n.
. Lat. femoral cutaneous n. (Lat. cutaneous n. Of thigh)
. Femoral n.
. Obturator n.
Iliohypogastric and ilioinguinal n.
. L1
. To muscles of lower abdominal wall, skin of upper high, and ant. Side of scrotum/labium majus
Genitofemoral n.
. L1-2
. Runs down ant. Surface of psoas muscle to reach cremaster, skin of upper thigh, and ant. Side of scrotum
. Involved in cremaster reflex
Lat. femoral cutaneous n.
. Post. Divisions of L2-3
. Sensory skin to thigh and buttock
Femoral nerve
. Post. Divisions of L2-4 . In groove btw iliacus and psoas major . Enters thigh lat. to femoral a. . Supplies skin of ant. And med. thigh . Motor to muscles in ant. Compartment of thigh and iliacus
Obturator n.
. Ant. Division L2-4
. Emerges med. to psoas major muscle and crosses pelvic brim
. Exits via obturator foramen
. Motor to muscles of med. compartment of the thigh
. Sensory to skin of med. thigh
Lumbosacral trunk
. part of L4 and all of L5
. Descends into pelvis where it contributes to sacral plexus
