Posterior Abdominal Region

Question 1

Kidney functions

Answer 1

Filters blood, rebasorbs water, creates urine

Question 2

Vessels associated with kidney (just see pic)

Answer 2

Question 3

Blood supply of kidney

Answer 3

Renal arteries

Question 4

Venous drainage of kidney

Answer 4

Renal veins drain into vena cava.

Question 5

Relationship of kidneys to diaphragm, psoas major, quadratus lumborum, transversus abdominis aponeurosis, surrounding organs, and ribs 11&12

Answer 5

Question 6

Kidneys in relation to the renal fascia, perirenal, and pararenal fat

Answer 6

Question 7

Ureters - course and relationships

Question 8

Blood supply to ureters

Answer 8

• Abdominal
  
  • Upper: Renal, gonadal, aorta
  • Middle: Gonadal & iliac
  • Lower/distal: Internal iliac leading to vesical arteries
• Pelvic: superior & inferior vesical arteries.

Question 9

Lymphatic drainage of ureters

Answer 9

Upper: joins renal lymphatics to lumbar nodes

Middle: to iliac nodes

Pelvic/distal: internal iliac and vesical nodes.

Question 10

Autnomic Innervation of ureters

Answer 10

The ureter is a smooth muscle for peristalsis –> autonomic

Sympathetic - lumbar splanchnic

Parasympathetic - pelvic splanchnic

Question 11

Sites of constriction of ureters

Answer 11

• Ureteropelvic junction: where ureter joins the renal pelvis
• Where it crosses the pelvic brim
• Ureterovesicular junction: Where it enters the wall of the urinary bladder

Question 12

Renal entrapment syndrome (Nutcracker)

Answer 12

Left renal vein is obstructed between the SMA and the aorta. –> L renal vein & left gonadal vein blockage

–> swelling of the teste or ovary on the left + backup of flow in the left suprarenal vein.

Question 13

Origin of the lumbar plexus

Answer 13

L1-L5

L1: Ilioinguinal/Iliohypogastric- dermatome runs along inguinal ligament and pubis

L1/L2: GFN

L2/L3: Lateral femoral cutaneous

L2-L4: Femoral/Obturator

L4/L5: Lumbosacral Trunk

Question 14

Innervation of diaphragm

Answer 14

Phrenic nerve

Question 15

Blood supply of diaphragm

Answer 15

Inferior phrenic artery

Pericardiacophrenic artery

Musculophrenic artery

Question 16

Openings in diaphragm and approximate vertebral level

Answer 16

IVC: T8

Esophageal hiatus: T10

Aortic Hiatus: T12

Question 17

Sympathetic trunks & Splanchnic nerves

Question 18

Abdominal prevertebral plexus & ganglia

Answer 18

Foregut (greater splanchnic T5-T9)

Midgut (lesser T10-T11)

Kidneys and ureters (least T12)

Hindgut (lumbar L1-L2)

Question 19

Pain from kidney stones- what innervates the ureters? where do the sensory fibers enter the spinal cord?

Answer 19

Pain comes from distention

• Innervation is from the renal, gonadal, and hypogastric plexus.
• Sensory fibers from ureters enter the spinal cord at T11-12.

Question 20

In appendicitis or peritonitis, what causes the pain?

Answer 20

Parietal peritoneum

Question 21

The purple space is

Answer 21

Retroperitoneal space.

Question 22

Retroperitoneal structures

Answer 22

• Pancreas
• Ascending (Right) and Descending (Left) Colon
• Duodenum (2nd and 3rd part )
• Rectum
• Kidneys
• Ureters
• Bladder
• Uterus
• Great vessels

Question 23

Branches off the aorta

Answer 23

1. Celiac immediately branches
2. SMA takes off at an angle -> often a site of emboli
3. Renals branches to left and right
   
   1. Right below it is the infra-aortic frequent site of aneurysm (AAA).
4. Minor:
   
   1. Diaphragmatic, Adrenal, Gonalda, Lumbar, Ureteral

Question 24

Birfucation of the aorta occurs around where?

Answer 24

The bellybutton

Question 25

The iliac vein is a little to the right/left of the spine?

Answer 25

right. This is why we often do central line placement ont he right side.

Question 26

Veins draining into the vena cava

Answer 26

* Iliacs * Renal * Hepatic veins * Gonadal on the right * Adrenal on the right

Question 27

**Left gonadal & adrenal veins** drain into the ___ to get to the vena cava; whereas, the **right gonadal & adrenal veins ....**

Answer 27

Left gonadal vein & left adrenal vein \> left renal vein \> vena cava Right gonadal & right adrenal vein directly drains into vena cava.

Question 28

Landmark for the left renal vein

Answer 28

The take off of the SMA

Question 29

A woman want sto donate her kidney. The left kidney has 2 renal arteries; whereas, the right has one. Why did the surgeons decide to remove the left kidney?

Answer 29

The left renal vein is longer.

Question 30

A woman wants to donate her kidney. Her left kidney has 3 renal arteries, 1 small superior pole, 1 large main pole, and 1 moderate inferior pole. Can we use this kidney? What considerations need to be made for a successful transplant? * Decline the donor * Implant all 3 arteries * Sacrifice the superior pole and implant the main & inferior * Sacrifice the inferior pole & hope for the best for the ureter

Answer 30

The superior pole (if small) doesn't supply much to the kidney; whereas, the inferior pole is largely responsible for the pelvis and ureter.

Question 31

A woman donates her kidney. A week later she feels full (early satiety) and bloated. On exam, she is distended with a fluid wave. What's going on? * Her cut ureter leak and she is full of urine * She took too many pain pills and is constipated * She has a pancreatic injury and leak * None of the above We then took a fluid sample and it's cloudy and high in triglycerides. What is the fluid?

Answer 31

None of the above. The ureter is unlikely to leak where it enters the kidney because there is a valve that prevents urine from coming out. A pancreatic injruy and leak would cause pain and sickness. It's lymph.

Question 32

Lymphatic drainage of the kidney

Answer 32

**Hilar nodes**

Question 33

Arterial dissection around the kidneys/ ureters will probably also dirsupt

Answer 33

lymphatic channels, because they run closely along the arterial vasculature.

Question 34

The lymphatic channels of the kidney and ureters all coalesce where?

Answer 34

**Cysterna chyli** near the starting point of the thoracic duct in front of L1 and L2.

Question 35

When you have a lymph leak, why do you put the patient on a lowfat diet?

Answer 35

To limit the in-flow into the lymphatics --\> it will heal itself.

Question 36

A woman has burning urination, some hematuria, and now-persistent backpain. She has costovertebral angle tenderness and is febrile. What is the pain from?

Answer 36

Costovertebral angle is on the back. It's inflammation of the peritoneum. Kidneys have got so inflamed that it's touched the peritoneum.

Question 37

What fibers are responsible for the referred pain felt by inflammation of the kidney?

Answer 37

Least splanchnics (T12, T12-L2 in lecture) are responsible for innervating the kidneys --\> can refer to their dermatome in the back

Question 38

An obese woman has excruciating back pain and urinates blood. 3 days later, the pain comes on worse and is more in her lower back. What's going on?

Answer 38

Kidney stone

Question 40

Kidney comes from __ derm

Answer 40

Mesoderm

Question 41

The primitive kidney is \_\_\_. It depends on the ingrowth of the \_\_\_(from the cloacae).

Answer 41

Metanephros. Depends on the growth of the ureteric bud from below; this bud eventually bifurcates.

Question 42

What disease is caused by the ureteric bud not forming? If it's incomplete?

Answer 42

No bud - Renal agenesis Incomplete bud - dysplastic kidneys

Question 43

A man with a history of diveritculitis of the left colon presented for interval left colectomy. There's a lot of inflammation, and after some time dissecting, teh oeprative field begins to continuously fill with clear fluid. What happened?

Answer 43

His ureter got cut - he is full of urine.

Question 44

Renal collecting system 1. Filtration 2. Reabsorption 3. Descending: 4. Ascending: 5. Reabsorption/Secretion 6. Reabsorption OR secretion, depending on physiological need

Answer 44

1. Filtration via **afferent arteriole** 2. Rebasorb **water, ions, organic nutrients** 3. Descending: reabsorb **water** 4. Ascending: reabsorb **Na & Cl** 5. Some reabsorption of **water** (ADH/Aldosterone), but mostly secretion of **acids, drugs, toxins** 6. Variable reabsorption of **water**; reabsorption OR secretion of **ions**