posterior abdominal wall

Question 1

lumbar triangle (of Petit)

Answer 1

-one of the relatively weaker areas of the back (hernias occur here)

Borders:

• lateral: external oblique
• medial: latissimus dorsi
• inferior: iliac crest

*however primary lumbar hernias are rare. They usually only occur secondary to trauma or surgery

Question 2

psoas abscess

Answer 2

-usually from TB

• TB abscess in the lumbar spine spreads to the psoas sheath.
• pus can collect at the inferior end of the psoas sheath deep to the inguinal ligament

Question 3

psoas sign

Answer 3

-pain on passive extension of right thigh

• can indicate psoas abscess
• can indicate appendicitis

Question 4

diaphragmatic hernia

Answer 4

• failure of diaphragm to develop correctly
• idiopathic
• happens more often to the left side than the right

-abdominal contents herniate and compress the developing lung.

Question 5

Eventration of Diaphragm

• what
• cause

Answer 5

• an elevation of the diaphragm

- due to congenital malformation or phrenic nerve interruption (from birth or operative trauma)

Question 6

abdominal aortic aneurysm

-Definition

Answer 6

-normal diameter = 3 cm

Question 7

What can happen if the left renal vein is blocked?

Answer 7

• edema of the left testicle and ovary
• remember that the left gonadal vein drains into the left renal vein, not directly into the IVC like the right gonadal vein does.

Question 8

perirenal space

Answer 8

-inside the renal fascia

Question 9

pararenal space

Answer 9

-around renal fascia

Question 10

cullen’s sign

Answer 10

• looks like weird bruising around the umbilicus
• caused by tracking of liberated pancreatic enzymes to the anterior abdominal wall from gastrohepatic ligament and across the falciform ligament
• indicative of acute pancreatitis

Question 11

grey-turner’s sign

Answer 11

• weird bruising around the flanks
• due to tracking of blood-stained pancreatic exudate from the anterior pararenal space through tissue planes, including the posterior renal fascia, to the abdominal wall

Question 12

nutcracker syndrome

Answer 12

-compression of the left renal vein

• can cause pain in the left flank, left gonad, and hematuria
• also left gonad edema

Question 13

pheochromocytoma

Answer 13

• tumor of the adrenal medulla chromaffin cells
• make way to much E and NE
• tachycardia
• nervousness

Question 14

the ureter is constricted in three places:

Answer 14

1. Where the renal pelvis narrows to become the ureter
2. Where the ureter crosses the pelvic brim (roughly where the common iliac artery divides)
3. Where the ureter enters the bladder

Question 15

polycystic kidney disease

Answer 15

• autosomal dominant
• tons of cysts
• can cause death in 4th decade (silent until then too)

Question 16

accessory renal arteries

Answer 16

• kidneys begin to develop in pelvis and have arteries there
• they are usually lost when they “ascend” to adult position and develop renal arteries
• but sometimes they can persist as an accessory renal artery

Question 17

kidney stones

-what?

Answer 17

small, hard deposits of mineral and acid salts on the inner surface of the kidneys

Question 18

kidney stones

-causes

Answer 18

• highly concentrated urine
• urine stasis
• imbalance of pH in urine

Question 19

Uric and Crystine kidney stones are caused by what type of a pH imbalance?

Answer 19

Acidic

Question 20

Calcium kidney stones are caused by what type of a pH imbalance?

Answer 20

Alkaline

Question 21

Hydronephrosis

Answer 21

urine extravasates into the perirenal space due to an obstructive kidney stone