Posterior Abdominal Organs, Posterior Abdominal Wall and Diaphragm Flashcards
1
Q
The posterior abdominal viscera are located in the (1) between the (2) and the (3) and (4) of the posterior abdominal wall
A
- retroperitoneal space
- posterior parietal peritoneum
- muscles
- bones
2
Q
The retroperitoneal space contains what?
A
- kidneys
- ureters
- suprarenal glands
- aorta
- IVC
- abdominal portions of sympathetic trunks
3
Q
What lies retroperitoneally on the posterior abdominal wall, one on each side of the vertebral column?
A
kidneys
4
Q
What is the function of the kidneys?
A
remove excess water, salts, and wastes of protein metabolism from blood white returning nutrients and chemicals to the blood
5
Q
What conveys the waste products from the blood into the urine, which drains through the ureters to the urinary bladder?
A
kidneys
6
Q
What run inferiorly from the kidneys, passing over the pelvic brim at the bifurcation of the common iliac arteries?
A
ureters
7
Q
What runs along the lateral wall of the pelvis and enter the urinary bladder?
A
ureters
8
Q
What type of epithelium are the ureters and bladder made of and what does it allow for?
A
- transitional epithelium
- allows for stretching
9
Q
The superomedial aspect of each kidney normally contacts a (1), which is separated from the kidney by a weak fascial septum
A
suprarenal gland
10
Q
The suprarenal glands function as part of the (1)
A
endocrine system
11
Q
What are the kidneys well protected by?
A
- their position within the abdomen
- cushioning layers of fat
** an outer pararenal layer
** inner perirenal layer
12
Q
What are the outer pararenal layer and inner perirenal layer of fat surrounding the kidneys separated by?
A
renal fascia
13
Q
What are the kidney coverings from superficial to deep?
A
- paranephric fat
- renal fascia
- perinephric fat
14
Q
What is the fat external to the renal fascia, is the most obvious on the posterior surface of kidneys, and surrounds the entire area?
A
paranephric fat
15
Q
What encloses the kidneys, suprarenal glands, and perinephric fat EXCEPT inferiorly?
A
renal fascia
16
Q
What is the renal fascia continuous with?
A
the diaphragmatic fascia
17
Q
What is found within renal fascia, extends into the renal sinus, is a fibrous capsule, and surrounds the kidney?
A
perinephric fat
18
Q
Inferior to the kidney, there is no (1)
A
- renal fascia
19
Q
The posterior surface of the kidney is related to the (1) muscle
A
quadratus lumborum
20
Q
What structures are located anterior to the right kidney?
A
- liver
- duodenum
- ascending colon
21
Q
What is the left kidney related to?
A
- stomach
- spleen
- pancreas
- jejunum
- descending colon
22
Q
What descends diagonally across the posterior surfaces of the kidneys?
A
- subcostal nerve and vessels
- iliohypogastric nerves
- ilioinguinal nerves
23
Q
Where is the diaphragm found in relation to the kidneys?
A
superiorly
24
Q
What is found on the anterior surface of the right kidney?
A
- liver
- duodenum
- ascending colon
- hepatorenal recess
25
What is found on the anterior surface of the left kidney?
- stomach
- spleen
- pancreas
- jejunum
- descending colon
26
At the concave medial margin of each kidney is a vertical cleft, the (1)
1. renal hilum
27
The renal hilum is the entrance to the space within the kidney, the (1), which is occupied by fat in which the renal pelvis, calices, vessels, and nerves are embedded
1. renal sinus
28
What is found in the renal hilum, anterior to posterior?
- renal vein
- renal artery
- renal pelvis
29
What provides some, but not much protection to the kidneys (less protection on the right side since the liver pushes the right liver down)?
ribs 11 and 12 (floating ribs)
30
What are the different parts of the kidneys?
- renal cortex
- renal medulla
** renal column
** renal pyramid
- papilla
- minor calyx
- major calyx
- renal pelvis
31
What does the renal pelvis drain into?
ureters
32
What parts of the kidney are important in the adrenal gland?
renal cortex and medulla
33
What contains lots of nephrons and glomeruli?
renal column
34
What is a major reason for anemia?
chronic kidney disease
35
The renal arteries arise at the level of the IV disc between which vertebrae?
L1 and L2
36
What does the right renal artery pass posterior to?
the IVC
37
Which renal artery is longer?
the right
38
Typically, each renal artery divides close to the hilum into (1) that are end arteries that do not anastomose?
1. 5 segmental arteries
39
What do the renal veins lie anterior to?
renal arteries
40
What does the left renal vein pass anterior to?
aorta
41
Which renal vein is longer?
left renal vein
42
Each renal vein drains into what?
the IVC
43
What are the names of the 5 segmental aa branching off the renal arteries?
- superior
- anterosuperior
- anteroinferior
- inferior
- posterior
44
25% of the population have what?
accessory (extrahilar) aa
45
What is the left renal vein found between?
SMA and aorta
46
What are tributaries of the left renal vein?
- inferior phrenic v
- suprarenal v
- gonadal v
47
What does the left gonadal v drain into?
left renal vein
48
What does the right gonadal v drain into?
the IVC
49
What are muscular ducts with narrow lumina that carry urine from the kidneys to the urinary bladder?
ureters
50
What is the superior end of the ureter, or renal pelvic, formed through?
merging of two or three major calices (each of which was formed by the merging of 2 or 3 minor calices)
51
Each minor calyx is indented by the apex of the (1) - the (2)
1. renal pyramid
2. renal papilla
52
The ureters run inferomedially anterior to the psoas major and tips of the transverse processes of the lumbar vertebrae and cross the (1) just beyond the bifurcation of the (2)
1. external iliac artery
2. common iliac artery
53
The ureters are normally constricted to a variable degree in what three places?
1. the junction of ureters and renal pelvis (renal uteropelvic junction)
2. where ureters cross the brim of the pelvic inlet ("pelvic inlet" brim)
3. during their passage through the wall of the urinary bladder
54
What are the constricted areas of the ureters potential sites of?
obstruction by ureteric (kidney) stones
55
Parts of the ureter that are more narrow, what will be more likely?
more constriction
56
What is the arterial supply of the ureters?
- renal artery
- gonadal arteries
- abdominal aorta (common iliac a)
57
What is the venous drainage of the ureters?
- renal veins
- gonadal vv
58
What are located between the superomedial aspects of the kidneys and diaphragmatic crura?
adrenal glands
59
What separates the adrenal glands from the kidneys?
fibrous tissue
60
What attaches the adrenal glands to the crura of the diaphragm?
renal fascia
61
What is the shape of the right adrenal gland?
pyramid-shaped
62
What is the shape of the left adrenal gland?
crescent-shaped
63
What does the right adrenal gland lie anterior to?
the diaphragm
64
What does the right adrenal gland make contact with?
- IVC (anteromedially)
- liver (anterolaterally)
65
What is the left adrenal gland related to?
- spleen
- stomach
- pancreas
- left crus of the diaphragm
66
What are the two parts of each adrenal gland?
- suprarenal cortex
- suprarenal medulla
67
What part of the adrenal gland secretes corticosteroids and androgens?
suprarenal cortex
68
What part of the adrenal gland secretes epinephrine and norepinephrine?
suprarenal medulla
69
What is the sympathetic response mediated by?
adrenal medulla
70
What are the arteries that supply the adrenal gland?
- superior suprarenal a (inferior phrenic a ~ 6-8)
- middle suprarenal a (abdominal aorta 1≥ SMA)
- inferior suprarenal a (renal a 1≥)
71
What is the venous drainage of the right adrenal gland?
IVC
72
What is the venous drainage of the left adrenal gland?
left renal vein (joined by inferior phrenic v)
73
What type of fibers synapse directly in the suprarenal gland?
pre-synaptic sympathetic fibers
74
What is the sympathetic innervation of the kidneys?
**aorticorenal ganglion**
- lesser splanchnic (T10-T11)
- least splanchnic (T12)
75
What is the innervation of the ureters?
**plexuses**
- renal
- abdominal aorta
- superior hypogastric
76
What supplies pain to the ureters?
GVA fibers (T11-L2)
77
What is the parasympathetic innervation of the kidneys and ureters?
vagus nerve
ureters also receive parasympathetic innervation from the pelvic splanchnics
78
What is the innervation of the adrenal glands?
**abdominopelvic splanchnic**
- lesser (T10-T11): aorticorenal
- least (T12): renal plexus
79
Are there parasympathetic fibers running to the adrenal medulla?
No, only sympathetic
80
What is the abdominal wall composed of from deep/posterior to superficial/anterior?
1. 5 lumbar vertebrae associated with IV discs
2. posterior abdominal wall muscles
3. lumbar plexus, composed of the anterior rami of lumbar spinal nerves
4. fascia (including thoracolumbar fascia)
5. diaphragm (contributing to superior part of the posterior wall)
6. fat, nerves, vessels, and lymph nodes
81
What are the posterior abdominal wall muscles?
- psoas
- quadratus lumborum
- iliacus
82
The posterior abdominal wall is covered with a (1) layer of endo-abdominal fascia, which lies between the parietal peritoneum and the muscles
continuous
83
What is the fascia lining the posterior abdominal wall continuous with?
the transversalis fascia that lines the transversus abdominis muscle
84
What is thickened superiorly to form the medial arcuate ligament and fuses laterally with the quadratus lumborum and thoracolumbar fascia?
the psoas fascia
85
Inferior to the iliac crest, the (1) is continuous with the part of the iliac fascia covering the iliacus muscle
1. psoas fascia
86
What is the anterior layer of the thoracolumbar fascia?
quadratus lumborum fascia
87
What covers the quadratus lumborum muscle?
quadratus lumborum fascia (anterior layer of thoracolumbar fascia)
88
What does the anterior layer of the thoracolumbar fascia attach to?
- anterior surface of transverse processes of lumbar vertebrae
- iliac crest
- the 12th rib
89
What is the anterior layer of the thoracolumbar fascia continuous laterally with?
the aponeurotic origin of the transversus abdominis muscle
90
What is thickened superiorly to form the lateral arcuate ligaments and is adherent inferiorly to the iliolumbar ligaments?
the anterior layer of the thoracolumbar fascia
91
What are the main pared muscles in the posterior abdominal wall?
- psoas major
- iliacus
- quadratus lumborum
92
What lies along the lateral sides of the inferior part of the psoas major?
iliacus
93
What lies adjacent to the transverse processes of the lumbar vertebrae and lateral to the superior parts of the psoas major?
quadratus lumborum
94
What do the iliacus and psoas form?
iliopsoas
95
What has a long flat tendon passing down the anterior surface of the psoas major muscle?
psoas minor muscle
96
What is absent entirely in some individuals and may be present on only one side of the body in others?
psoas minor muscle
97
What originates on the lateral surface of T12 and L1?
psoas minor muscle
98
What inserts onto the iliopubic eminence and arcuate line of the ilium?
psaos minor
99
What is the action of the psoas minor muscle?
tilts pelvis posteriorly
100
What innervates the psoas minor?
L1-L2
101
What originates on transverse processes of L1-L5, bodies of T12-L5 and IV discs below bodies of T12-L4
psoas major
102
What inserts on the lesser trochanter of the femur
psoas major
103
What innervates the psoas major?
L2-L4
104
What are the actions of the psoas major?
**flexion**
- thigh with iliacus
- vertebral column and lateral bending
- trunk with iliacus sitting
105
What muscle in only present in about 60% of the population?
psoas minor
106
What originates on the iliac fossa within the abdomen?
iliacus
107
What inserts on the lowermost surface of the lesser trochanter of the femur?
iliacus
108
What is the action of the iliacus?
- flexes thigh at the hip
- helps maintain erect position
- hip joint stabilizer
109
What innervates the iliacus?
femoral nerve (L2-L4)
110
What muscles are the chief thigh flexors?
iliopsoas muscles (iliacus + psoas)
111
What originates on the 12th rib and tips of lumbar transverse processes?
quadratus lumborum
112
What inserts onto the lip of the iliac crest?
quadratus lumborum
113
What are the actions of the quadratus lumborum?
- extends and laterally flexes vertebral column
- fixes 12th rib during inspiration
114
What innervates the quadratus lumborum?
T12 and lumbar plexus (L1-L4)
115
What is a dome-shaped, musculotendinous partition separating the thoracic and abdominal cavities?
diaphragm
116
What is the chief muscle of inspiration?
the diaphragm
117
What forms the convex floor of the thoracic cavity and the concave roof of the abdominal cavity?
diaphragm
118
What part of the diaphragm is the only part that moves during inspiration?
only its central parts
119
What does the periphery of the diaphragm (fixed origin of the muscle) attach to?
the inferior margin of the thoracic cage and superior lumbar vertebrae
120
Which dome of the diaphragm is higher due to the liver?
right
121
What is the muscular part of the diaphragm that is situated with fibers that converse radially on the trifoliate central aponeurotic part?
central tendon
122
What has no bony attachments and is incompletely divided into 3 leaves?
central tendon of the diaphragm
123
What is the superior aspect of the central tendon fused with?
the inferior surface of the fibrous pericardium
124
The central tendon of the diaphragm is closer to what?
anterior part of the thorax
125
What are the domes of the diaphragm formed by?
- the liver (right) with some contribution from the right kidney and adrenal gland
- fundus of the stomach and spleen (left) with some contribution from the left kidney and adrenal gland
126
What is the aponeurotic portion of the diaphragm?
where central tendon fuses with fibrous pericardium
127
What are the three parts of the diaphragm?
- sternal part
- costal part
- lumbar part
128
What does the sternal part of the diaphragm attach to?
posterior aspect of xiphoid process
129
What do the costal parts of the diaphragm attach to?
internal surfaces of the inferior six costal cartilages and adjoining ribs
130
What does the lumbar part of the diaphragm arise from?
- medial and lateral arcuate ligaments (aponeurotic arches)
- three superior lumbar vertebrae (L1-L3)
131
What part of the diaphragm forms the domes?
costal part
132
What part of the diaphragm forms the right and left muscular crura that ascend to the central tendon?
lumbar part
133
What are musculotendinous bundles that arise from the anterior surfaces of the bodies of the superior three lumbar vertebrae, anterior longitudinal ligament, and IV discs?
crura of the diaphragm
134
What crura is the larger and longer crus that arises from the first 3 or 4 lumbar vertebrae?
right crus
135
What crura arises from the first 2 or 3 lumbar vertebrae?
left crus
136
What are the right and left crura united by?
the median arcuate ligament
137
What crura passes over the anterior surface of the aorta?
median arcuate ligament
138
What attaches on each side of the diaphragm; they are thickenings of the fascia covering the psoas and quadratus lumborum muscles?
medial and lateral arcuate ligaments
139
What permits structures to pass between the thorax and the abdomen?
diaphragmatic apertures
140
What are the names for the 3 large apertures going into the diaphragm for the IVC, esophagus, and aorta?
- caval opening
- esophageal hiatus
- aortic hiatus
141
What level is the caval opening?
T8-T9
142
What level is the esophageal hiatus?
T10
143
What level is the aortic hiatus?
T12
144
What passes through the caval opening?
- IVC
- terminal branches of right phrenic n and lymph
145
What diaphragmatic aperture widens at inspiration?
caval opening
146
What passes through the esophageal hiatus?
- esophagus
- vagal trunks
- left gastric vessels and lymphatics
147
What passes through the aortic hiatus?
- aorta
- thoracic duct
- azygos vein
148
What nerve could be injured at T10?
vagus nerve
149
What innervates the diaphram, what fibers does it provide, and what do those fibers do?
- phrenic nerve
** GSE: motor innervation
** GSA: pain and proprioception
150
What blood vessels supply the superior surface of the diaphragm?
**internal thoracic a**
- pericardicophrenic vessels
- musculophrenic vessels
**thoracic aorta**
- superior phrenic artery
151
What blood vessels supply the inferior surface of the diaphragm?
**right inferior phrenic vessels**
- aorta (celiac a) and IVC
**left inferior phrenic vessels**
- IVC and L adrenal v
152
What are the unpaired abdominal arteries and their associated levels?
- celiac a (T12)
- SMA (L1)
- IMA (L3)
153
What are the paired visceral abdominal arteries and their associated levels?
- suprarenal (L1)
- renal a (L1)
- gonadal a (L2)
154
What are the paired parietal abdominal arteries and their associated levels?
- subcostal (L2)
- inferior phrenic (T12)
- lumbar (L1-L4)
- median sacral
155
What is the main vein of the posterior abdominal wall?
IVC (L3-L5)-T8
156
What collects poorly oxygenated blood from the lower limbs (non-portal blood)?
IVC
157
All tributaries of the IVC drain directly into it except what?
- left gonadal vein
- left suprarenal vein
158
What do the left gonadal and left suprarenal vein drain into?
left renal vein and then into the IVC
