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Block 3; Week 2 > Posterior Abdominal Wall > Flashcards

Posterior Abdominal Wall Flashcards

1
Q

Give a list of retroperitoneal structures that are primarily retroperitoneal. What does it mean to be primarily retroperitoneal?

A 
Primarily Retroperitoneal means that developmentally they started outside of the peritoneum and they finished that way.
Urinary System
Adrenal Glands
Sympathetic Trunk + Branches to Ganglia
Thoracic Duct + Cisterna Chyli
Posterior Abdominal Wall
Aorta & IVC
Rectum
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2
Q

What is the relationship b/w the rectum & the peritoneum?

A

The rectum is both retroperitoneal & subperitoneal.
The superior portion is retro & has peritoneum on its anterior surface. The middle & inferior portions are below the floor of the peritoneum & are not covered at all in it.

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3
Q

Double folds of peritoneum = ?

What runs thru this structure?

A

Ligament!!

blood vessels/vasculature stuff runs thru it

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4
Q

What 2 ligaments make up the lesser omentum?

A

hepatogastric ligament

hepatoduodenal ligament

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5
Q

What is the relationship b/w the lesser omentum & the lesser sac?

A

The lesser omentum is on the anterior surface of the lesser sac.

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6
Q

With the gastrosplenic ligament…the peritoneum comes from ___ & reflects ____.

A

Comes from the stomach & reflects onto the spleen.

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7
Q

Which kidney is typically lower? Why?

A

The right kidney b/c the liver is pushing down on it.

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8
Q

Which ribs typically cover the right & left kidney?

A

Right Kidney: typically covered by only 12th rib

Left Kidney: typically covered by 11th & 12th rib

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9
Q

What is the renal fascia?

A

It surrounds the kidneys…it is essentially a continuation of the kidney’s vasculature or adventitia…

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10
Q

What is the order of protective layers starting from the peritoneum & ending up in the kidney?

A 
Peritoneum
Pararenal fat
Renal Fascia
Perirenal fat
Kidney Capsule!
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11
Q

Describe the blood supply to the kidneys.

A

Renal arteries come off of the aorta near the SMA & divide into anterior & posterior segmental branches (to go to the 2 lobes of the kidney)…
There will also be polar branches from the kidney’s development & ascent.

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12
Q

What are 3 sources of blood supply for the ureter?

A

renal
gonadal
vesicular

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13
Q

Describe the functional sphincter of the ureter.

A

It enters the bladder at a diagonal so that when the bladder fills it pushes up against it & doesn’t back flow.

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14
Q

What are 3 sites of potential narrowing of the ureter where kidney stones can get stuck?

A

transition from pelvis to ureter
pelvic brim
entry into bladder

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15
Q

How many layers of muscle does the ureter have?

A

3–very muscular, can propel urine!!

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16
Q

Describing in terms of vertebrae–>what are 2 locations where kidney stones might get stuck?

A

T11-T12

L1-L2

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17
Q

the ureter enters the bladder @ the point where…

A

at the point where the common iliac divides into the internal & external iliacs.

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18
Q

Where do the sympathetics to the kidney come from?

A 
thoracic splanchnic nerves (lesser & least)
lumbar splanchnics (usu L1)
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19
Q

Where is the aorticorenal ganglion?

A

a small ganglia on the renal artery

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20
Q

Where do the sympathetics to the kidneys synapse?

A

aorticorenal ganglion

probably the SMA

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21
Q

Where do the parasympathetics to the kidneys come from?

A

pelvic splanchnics

vagus

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22
Q

Where do the parasympathetic to the kidneys synapse?

A

in the renal sinus

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23
Q

What bus do the sensory fibers hop on to on their return?

A

They return via the vagus & the sympathetics

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24
Q

What bus do the sensory fibers from the ureter hop on to?

A

Vagus
Sympathetics
dorsal root ganglions via T12-L2 spinal nerves

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25
Q

Describe the blood supply to the suprarenal glands.

A

Superior Suprarenal: from the inferior phrenic artery
Middle Suprarenal: from the aorta directly
Inferior Suprarenal: from the renal artery

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26
Q

Describe the venous drainage of the suprarenal glands.

A

The right kidney drains directly into the IVC.

The left kidney can either drain directly into the IVC or into a renal vein.

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27
Q

What is the only autonomic pathway with just one neuron?

A

The preganglionic sympathetic fibers that innervate the secretory cells of the adrenal medulla. These cells sorta act like postganglionic neurons by secreting “NT” of Epi or NE into the bloodstream. This produces slow acting but longer lasting affects in various parts of the body.

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28
Q

T/F The sympathetic innervation to the adrenal cortex is only preganglionic.

A

FALSE. To the adrenal medulla…to the adrenal cortex it is normal.

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29
Q

So…describe the innervation of the adrenal cortex & adrenal medulla with respect to the celiac ganglion.

A

Okay…so a bunch of fibers go to the celiac ganglion & synapse & then go to the adrenal cortex.
But a bunch of fibers peel away from the celiac ganglion & go to the adrenal medulla as preganglionics.

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30
Q

Stuff coming off of the sympathetic chain posterolaterally is considered…

A

communicating rami

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31
Q

If you see a communicating ramus (only 1) where are you in the body?

A

You are below the L2 region…b/c the 2 communicating rami only come off of the T1-L2 region. After that, it is just one.

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32
Q 
If you see stuff coming off the sympathetic chain in the anteriomedial direction...what does that mean?
What if it is in the:
thorax
lumbar
pelvis
A

Splanchnics!!
Thorax: thoracic splanchnics
Lumbar: lumbar splanchnics
Pelvis: sacral splanchnics

33
Q

90% of the innervation of the pelvic viscera comes from what?

A

Hypogastric nerves

34
Q

10% of the innervation of the pelvic viscera comes from what?

A

Sacral Splanchnics

35
Q

Where do the hypogastric nerves come from? Where do they go?

A

Come from: Superior Hypogastric Plexus

Go to: Inferior Hyopgastric Plexus

36
Q

Where does the vagus stop in the GI tract?

A

the splenic flexure

then pelvic splanchnics take over…

37
Q

What happens to the R & L Vagus nerves? Tell the full story.

A

R & L Vagus nerves
Go to the Esophageal Plexus
2 trunk: anterior (mainly L vagus) & posterior (mainly R vagus) on the distal end of the esophagus

38
Q

Where does the posterior trunk go?

A

to the greater curvature & to the jejunum & ileum & descending colon

39
Q

Where does the anterior trunk go?

A

to the lesser curvature & to the liver & celiac trunk etc.

40
Q

How far do the vagal trunks extend?

A

only to the splenic flexure…

After that: pelvic splanchnics

41
Q

What forms the thoracic duct?

A

one intestinal trunk & 2 lumbar trunks

42
Q

Where do they all join together?

A

@ cisterna chyli, a dilation just inferior to the diaphragm

43
Q

How can you access the cisterna chyli in lab?

A

by cutting thru the right crus of the diaphragm

44
Q

Do all of the intestinal loops drain into the intestinal trunk?

A

No. Some of them (esp the sigmoid colon & rectum) drain into the lumbar trunks.

45
Q

What are the quadratus lumborum & psoas major muscle mainly involved in?

A

MOVEMENT! How fun!

46
Q

What does the quadrates lumborum arise from & attach to? What is its main function?

A

Arises from: transverse processes from the vertebrae & ribs
Attaches to: superior border of the iliac crest
**keeps the pelvis from sagging

47
Q

Which 2 ligaments arch over the psoas major & quadratus lumborum muscles?

A

the medial & lateral arcuate ligaments

48
Q

What’s something identifying about the ilioinguinal nerve?

A

It enters the inguinal canal.

49
Q

T/F Both the ilioinguinal & iliohypogastric nerves enter the inguinal canal. This makes it hard to distinguish b/w them.

A

False.

Only the ilioinguinal nerve passes thru the inguinal canal.

50
Q

Where does the lateral femoral cutaneous nerve come off? Where does it go to?

A

It comes off the anterior superior iliac spine.

It goes to the anterior thigh.

51
Q

Where is the genitofemoral nerve found?

A

on top of the psoas major muscle…

52
Q

Where is the subcostal nerve found?

A

@ T12, just below the ribs!

53
Q

Where can the obturator nerve be found?

A

medial & inside the pelvic cavity…it enters the obturator foramen & pierces the obturator muscle…

54
Q

What vertebrae levels does the femoral nerve correspond to?

A

L2-L4

55
Q

What vertebrae levels does the obturator nerve correspond to?

A

L2-L4

56
Q

What 2 main things does the inferior phrenic artery supply?

A

the undersurface of the diaphragm & the superior suprarenal artery to the adrenal gland

57
Q

What is the tiny branch off of the aorta that goes straight down the middle by L5 b/w the iliacs?

A

median sacral artery

58
Q

What are the branches off of the abdominal aorta…in order from top to bottom?

A 
Inferior Phrenics
Celiac Artery
Middle Suprarenal
SMA
Renal
Gonadal
IMA
Lumbar arteries
Common iliacs
median sacral artery
59
Q

What is different about the gonadal vein on the left side?

A

On the right side…empties into the IVC

On the left side…empties into the renal vein & then into the IVC

60
Q

What are the posterior wall veins that drain into the IVC?

A 
Inferior Phrenic
Hepatic
Renal
Right Suprarenal
Right Gonadal
Common iliacs
Lumbar veins (somehow connected w/ the azygos)
61
Q

The medial arcuate ligament is found crossing what muscle?

A

the psoas major muscle

62
Q

The lateral arcuate ligament is found crossing which muscle?

A

the quadratus lumborum

63
Q

Where do the right & left crura extend? Which is longer?

A

They extend inferiorly to attach to vertebral bodies.

the right one is longer.

64
Q

Which hiatus do the crura extend into? One of them also creates the fascial lining for what?

A

Esophageal Hiatus

Ligament of Trietz

65
Q

What are the 3 important structures that create holes in the diaphragm? Where do they do this?

A

IVC @ T8
Esophagus @ T10
Aorta @ T12

66
Q

What little thing pierces thru the diaphragm?

A

thoracic splanchnic nerves

67
Q

How does the sympathetic trunk get thru the diaphragm?

A

It passes behind it.

68
Q

How does the vagal trunk get thru the diaphragm?

A

It passes thru the esophageal hiatus.

69
Q

What is the lumbocostal trigone? What can it cause?

A

It is a congenital defect formed by an area where 2 things fused…
It can cause a herniation of abdominal contents into the thorax…w/ a hypo plastic lung
**most common diaphragmatic hernia
**occurs on the left side more often than the right b/c of the presence of the liver

70
Q

The esophagus opening is usu formed almost entirely by fibers from______.

A

the right crus!!

71
Q

Which 4 embryonic structures form the diaphragm?

A

septum transversum
pleuroperitoneal membranes
dorsal mesentery of the esophagus
cervical somites

72
Q

What does the dorsal mesentery of the esophagus form?

A

crura

73
Q

What do the cervical somites form?

A

body wall

74
Q

What is the hernia from the lumbocostal trigone equivalent to?

A

Bochdalek hernia b/c of the failure to fuse 2 peritoneal folds…

75
Q

What does the septum transversum form?

A

the central tendinous region & a little bit of musculature

76
Q

What do the pleuroperitoneal membranes form?

A

musculature & posterior body wall

**doesn’t close off completely @ the area of the trigone

77
Q

T/F Anterior thoracic wall is another potential space for a diaphragmatic hernia.

A

True. B/c of the different embryological structures that fuse to form the membrane…a bunch of different hernias are possible.

78
Q

Postsynaptic sympathetic fibers off of the celiac ganglion travel on what?

A

mainly on blood vessels

Block 3; Week 2 (9 decks)

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