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Anatomy Exam 2 > Posterior abdominal wall > Flashcards

Posterior abdominal wall Flashcards

1
Q

Describe the Kidneys and the layers of facia covering it, from superficial to deep

A

-Primarily retroperitoneal

1) Paranephric (pararenal) fat
2) Renal fascia
- Prolonged inferiorly along ureters
- Helps prevent the spread of infection/blood locally, but acts as a conduit for the spread of these fluids into the pelvis
3) Perinephric (perirenal) fat

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2
Q

Describe kidney location

A
  • At T12-L3 vertebral levels
  • Right kidney typically lies slightly more inferior than left kidney
  • Lie in the right or left upper quadrant
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3
Q

What are the outer borders of the kidney?

A
  • Superior pole: adjacent to adrenal gland
  • Inferior pole
  • Lateral border is convex
  • Medial border is concave and contains the renal hilum
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4
Q

Describe the Renal hilum

A
  • Vertical cleft on medial border
  • Arteries enter, veins and renal pelvis exit (VAP)
  • Anterior: renal vein
  • Middle: renal artery
  • Posterior: renal pelvis
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5
Q

What are the layers surrounding the Kidneys?

A
  • Renal capsule: is the very thin outer layer
  • Renal cortex: is deep to the capsule
  • Renal medulla: includes the renal pyramids and renal columns
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6
Q

Describe the pathway of the urine towards the ureter

A

Renal papillae –> 2-3 minor calyx –> 2-3 major calyx –> renal pelvis –> ureter

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7
Q

Describe the two cases of Anomalous kidneys

A

1) Pelvic kidney:
- Failure of kidney to ascend during development
2) Horseshoe kidney
- Right and left kidneys united at inferior poles
- Ascent stopped by IMA

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8
Q

Describe the Ureters

A
  • Primarily retroperitoneal
  • Fibromuscular tubes extending from renal pelvis to bladder
  • Transport urine via peristaltic contractions
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9
Q

Describe the Adrenal (suprarenal) glands

A
  • Primarily retroperitoneal
  • Located on superomedial aspect of kidneys
  • Enclosed by renal fascia
  • Located in the right or left upper quadrant
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10
Q

Describe the Lymphatics of the Kidneys/Adrenal Glands

A

-Lymph drains to lumbar lymph nodes (along aorta) –> drains into chyle cistern thoracic duct

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11
Q

Describe Parasympathetic Innervation of the Kidneys

A
  • Preganglionic cell bodies: brain
  • Preganglionic fibers: vagus nn. (CN X)
  • Postganglionic cell bodies and fibers: wall of kidney
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12
Q

Describe Sympathetic Innervation of the Kidneys

A
  • Preganglionic cell bodies: lateral horn of the thoracolumbar spinal cord
  • Preganglionic fibers travel from ventral root –> spinal nerve –> ventral ramus –> white ramus communicans –> sympathetic trunk –> thoracic splanchnic nn. (especially the least splanchnic n.)
  • Postganglionic cell bodies: renal (aorticorenal) ganglion
  • Postganglionic fibers: follow arterial branches to target organ
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13
Q

Describe Visceral pain from kidneys and ureters

A
  • Follow the sympathetic pathway back to the spinal cord

- Refer to back, flank, groin, and genitals

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14
Q

Describe Sympathetic Innervation of the Adrenal Glands

A
  • Preganglionic cell bodies: lateral horn of the thoracolumbar spinal cord
  • Preganglionic fibers travel from ventral root –> spinal nerve –> ventral ramus –> white ramus communicans –> sympathetic trunk –> thoracic splanchnic nn. (greater, lesser, and least splanchnic nn.)
  • Postganglionic cell bodies: secretory cells of adrenal medulla
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15
Q

What are the Vessels of the Posterior Abdominal Wall?

A
  • Abdominal aorta

- Inferior Vena Cava (IVC)

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16
Q

Where does the Abdominal aorta start, run, and bifurcate?

A
  • Begins at aortic hiatus of diaphragm (T12)
  • Located to left of midline
  • Bifurcates into common iliac arteries (L4)
17
Q

What are the Unpaired branches of the abdominal aorta?

What do they supply blood to?

A
  • Celiac trunk
  • Superior mesenteric artery (SMA)
  • Inferior mesenteric artery (IMA)

-Abdominal organs

18
Q

What are the Paired branches of the abdominal aorta?

What do they supply blood to?

A

-Primarily retroperitoneal organs, gonads, and body wall

1) Inferior phrenic arteries:
- Supply inferior surface of diaphragm, adrenal glands (via superior suprarenal arteries)
2) Middle suprarenal arteries
3) Renal arteries:
- Right renal artery is longer than left and courses posterior to IVC
- Can have accessory renal arteries (failure of embryonic arteries to degenerate)
- Inferior suprarenal arteries
4) Gonadal (testicular or ovarian) arteries
5) Subcostal arteries
6) Lumbar arteries

19
Q

What happens if an Abdominal aortic aneurysms ruptures?

A

-High mortality rates (~90%) if not diagnosed

20
Q

Describe the Inferior Vena Cava (IVC)

A

-Formed by union of common iliac veins at L5 vertebral level
-Located to right of midline
-Exits abdomen through the caval opening (T8) of the diaphragm
-Tributaries of the IVC parallel the paired branches of the aorta
-Notable exceptions:
• Left gonadal vein drains to left renal vein
• Hepatic veins have no arterial complement

21
Q

What are the Posterior Abdominal Wall Muscles?

A

1) Iliopsoas
a) Psoas major –> Origin: lumbar vertebrae
b) Iliacus –> Origin: iliac fossa
c) Psoas major fuses with iliacus to form iliopsoas, which inserts on the lesser trochanter of the femur

2) Quadratus lumborum –> Origin: 12th rib and lumbar vertebrae
- Insertion: iliac crest

22
Q

What are the Nerves of the Posterior Abdominal Wall?

A

1) Subcostal nerves (ventral rami, T12)
2) Lumbar spinal nerves (ventral rami L1-L5) form the lumbar plexus
• Iliohypogastric & ilioinguinal nerves (L1)
• Genitofemoral nerve (L1, L2)
• Lateral cutaneous nerve of the thigh (L2-L3)
• Femoral nerve (L2-L4)
• Obturator nerve (L2-L4)
*Remember that ventral rami carry somatic motor, somatic sensory, and sympathetic fibers
3) Greater, lesser, least splanchnic nerves pass through diaphragm
4) Sympathetic trunks

23
Q

Describe the Subcostal nerves (ventral rami*, T12)… where it passes, what it innervates, and what type of sensory it has.

A
  • Travel laterally across quadratus lumborum
  • Pierce transversus abdominis to enter abdominal wall
  • Sensory innervation and sympathetic innervation to the T12 dermatome
  • Motor innervation to external & internal obliques, transversus abdominis
24
Q

Describe the Sympathetic trunks

A
  • Continue from thorax

- Located just lateral to the lumbar vertebral bodies and along the anterior surface of the sacrum

Anatomy Exam 2 (10 decks)

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