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Block II > Posterior Abdominal Region > Flashcards

Posterior Abdominal Region Flashcards

1
Q

Kidney functions

A

Filters blood, rebasorbs water, creates urine

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2
Q

Vessels associated with kidney (just see pic)

A
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3
Q

Blood supply of kidney

A

Renal arteries

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4
Q

Venous drainage of kidney

A

Renal veins drain into vena cava.

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5
Q

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

A
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6
Q

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

A
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7
Q

Ureters - course and relationships

A
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8
Q

Blood supply to ureters

A
  • Abdominal
    • Upper: Renal, gonadal, aorta
    • Middle: Gonadal & iliac
    • Lower/distal: Internal iliac leading to vesical arteries
  • Pelvic: superior & inferior vesical arteries.
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9
Q

Lymphatic drainage of ureters

A

Upper: joins renal lymphatics to lumbar nodes

Middle: to iliac nodes

Pelvic/distal: internal iliac and vesical nodes.

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10
Q

Autnomic Innervation of ureters

A

The ureter is a smooth muscle for peristalsis –> autonomic

Sympathetic - lumbar splanchnic

Parasympathetic - pelvic splanchnic

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11
Q

Sites of constriction of ureters

A
  • 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
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12
Q

Renal entrapment syndrome (Nutcracker)

A

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.

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13
Q

Origin of the lumbar plexus

A

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

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14
Q

Innervation of diaphragm

A

Phrenic nerve

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15
Q

Blood supply of diaphragm

A

Inferior phrenic artery

Pericardiacophrenic artery

Musculophrenic artery

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16
Q

Openings in diaphragm and approximate vertebral level

A

IVC: T8

Esophageal hiatus: T10

Aortic Hiatus: T12

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17
Q

Sympathetic trunks & Splanchnic nerves

A
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18
Q

Abdominal prevertebral plexus & ganglia

A

Foregut (greater splanchnic T5-T9)

Midgut (lesser T10-T11)

Kidneys and ureters (least T12)

Hindgut (lumbar L1-L2)

19
Q

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

A

Pain comes from distention

  • Innervation is from the renal, gonadal, and hypogastric plexus.
  • Sensory fibers from ureters enter the spinal cord at T11-12.
20
Q

In appendicitis or peritonitis, what causes the pain?

A

Parietal peritoneum

21
Q

The purple space is

A

Retroperitoneal space.

22
Q

Retroperitoneal structures

A
  • Pancreas
  • Ascending (Right) and Descending (Left) Colon
  • Duodenum (2nd and 3rd part )
  • Rectum
  • Kidneys
  • Ureters
  • Bladder
  • Uterus
  • Great vessels
23
Q

Branches off the aorta

A
  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
24
Q

Birfucation of the aorta occurs around where?

A

The bellybutton

25
Q

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

A

right.

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

26
Q

Veins draining into the vena cava

A
  • Iliacs
  • Renal
  • Hepatic veins
  • Gonadal on the right
  • Adrenal on the right
27
Q

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

A

Left gonadal vein & left adrenal vein > left renal vein > vena cava

Right gonadal & right adrenal vein directly drains into vena cava.

28
Q

Landmark for the left renal vein

A

The take off of the SMA

29
Q

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?

A

The left renal vein is longer.

30
Q

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
A

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

31
Q

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?

A

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.

32
Q

Lymphatic drainage of the kidney

A

Hilar nodes

33
Q

Arterial dissection around the kidneys/ ureters will probably also dirsupt

A

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

34
Q

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

A

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

35
Q

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

A

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

36
Q

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

A

Costovertebral angle is on the back.

It’s inflammation of the peritoneum. Kidneys have got so inflamed that it’s touched the peritoneum.

37
Q

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

A

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

38
Q

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?

A

Kidney stone

39
Q
A
40
Q

Kidney comes from __ derm

A

Mesoderm

41
Q

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

A

Metanephros.

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

42
Q

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

A

No bud - Renal agenesis

Incomplete bud - dysplastic kidneys

43
Q

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?

A

His ureter got cut - he is full of urine.

44
Q

Renal collecting system

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

Block II (17 decks)

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