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Emma IV > Posterior abdominal wall > Flashcards

Posterior abdominal wall Flashcards

1
Q

structures of post. abd wall

A

5 lumbar vertebra and their intervertebral discs
12th pair of ribs
upper part of bony pelvis

psoas major/minor
iliacus
quadratus lumborum
transversus abdominis

diaphragm

lumbar plexus

vessels (aorta, IVC)

lymph nodes

FAT

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2
Q

lumbar plexus

A

ventral primary rami of lumbar spinal nerves

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3
Q

lumbar triangle (of Petit)

A

floor - internal oblique

margins - latissimus dorsi, external oblique, iliac crest

lumbar hernia can occur here, loop of SI can protrude

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4
Q

psoas abscess

A

results from TB (usually) in lumbar spine that spreads from vertebrae into psoas sheath

pus from abscess –> passes inferiorly along psoas m. over pelvic brim and deep to inguinal ligament

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5
Q

+ psoas sign can indicate

A

possible appendicitis if appendix was pushed posteriorly in a retroperitoneal location

or inflamed sigmoid colon

(+ sign = pain on passive extension or flexion) or R thigh, extends pt’s right thigh while applying counter resistance to R hip)

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6
Q

What embryological structure forms the central diaphragm?

A

septum transversum

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7
Q

vertebral level of caval opening

A

T8

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8
Q

vertebral level of esophageal hiatus

A

T10

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9
Q

vertebral level where aorta comes out from behind diaphragm

A

T 12

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10
Q

phrenic n.

A

motor innervation to diaphragm and sensation to parietal peritoneum

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11
Q

paired branches of abd aorta

A

inferior phrenic a.
renal a.
middle suprarenal a.
gonadal a.

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12
Q

median sacral a.

A

last terminal branch of abd aorta

goes into pelvis, anastomoses w/ other vessels like internal iliac

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13
Q

unpaired branches of abd aorta

A

celiac trunk
superior mesenteric a.
inferior mesenteric a.
median sacral a.

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14
Q

abdominal aortic aneurysm

A

normal diameter <2.5 cm
aneurysm >3cm

dx w/ ultrasound, CT

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15
Q

if SMA constricts L renal vein, what other vessels might be blocked?

A

gonadal and L suprarenal v.

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16
Q

IVC begins at which vertebral level

A

L5 (just below abd aorta bifurcation)

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17
Q

L gonadal v. and L suprarenal v. drain first drain into _____, then drain into ______.

A

L gonadal v. and L suprarenal v. drain first drain into L RENAL V., then drain into IVC.

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18
Q

edema of L testicle and ovary can occur if _______ vein. is blocked

A

edema of L testicle and ovary can occur if L. RENAL VEIN is blocked

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19
Q

which two nerves cross over the quadratus lumborum and pierce through transverse abdominus?

A

iliohypogastric n. and ilioinguinal n.

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20
Q

subcostal n.

A

ventral primary ramus of T12 spinal n.

motor innervation to abd wall m. and sensation to T12 dermatome

runs right below 12th rib

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21
Q

lateral cutaneous n. of thigh

A

L2,3

runs along iliacus, goes underneath inguinal ligament

provides sensation to upper lateral thigh

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22
Q

which n. goes right thru psoas major?

A

genitofemoral n. (L1,L2)

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23
Q

2 branches of genitofemoral n.

A

genital branch (goes into spermatic cord, supplies motor innervation to cremaster m.)

femoral branch

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24
Q

which nerves supply motor innervation to abd muscles?

A

subcostal
iliohypogastric
ilioinguinal

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25
ilioinguinal n. (ant. scrotal branch)
L1 | supplies sensation to lateral scrotum
26
Lumbar plexus
``` subcostal n. (T12) iliohypogastric n. (L1) ilioinguinal n. (L1) genitofemoral n. (L1, L2) lateral cutaneous n. of thigh (L2, L3) femoral n. (L2,3,4) ```
27
which levels of the lumbar plexus have white and grey communicating rami?
L1,L2
28
preaortic ganglia
celiac ganglia superior mesenteric ganglion R/L aortic-renal ganglion inferior mesenteric ganglion
29
preaortic ganglia contain which cell bodies?
postganglionic sympathetic fibers visceral afferent fibers
30
Greater splanchnic n. (T5-T9) ganglion synapsed? arteries carrying post-gang fibers? area of referred pain?
celiac ganglion celiac trunk (foregut) epigastric pain
31
lesser splanchnic n. (T10-T11) ganglion synapsed? arteries carrying post-gang fibers? area of referred pain?
superior mesenteric ganglion superior mesenteric a. (midgut) periumbilical pain
32
least splanchnic n. (T12) ganglion synapsed? arteries carrying post-gang fibers? area of referred pain?
aorticorenal ganglion renal a. hypogastric pain
33
lumbar splanchnic n. (L1-L2) ganglion synapsed? arteries carrying post-gang fibers? area of referred pain?
inferior mesenteric ganglion inferior mesenteric a. (hindgut) hypogastric/inguinal pain
34
where is referred pain from testes or ovaries referred to?
lower abd (T11-T12)
35
somatic pain from skin of scrotum is felt in which area?
pudendal area - from pudendal n. (S2-S4)
36
parasympathetic innervation of large intestine
vagus n. (to proximal 2/3 of transverse colon) pelvic splanchnic n. (to distal colon)
37
pelvic splanchnic n.
(S2-S4) run along mesentery of sigmoid colon and reach up to splenic flexure supply distal colon
38
superior/inferior hypogastric plexus
preganglionic sympathetics from lumbar region preganglionic parasympathetics from sacral region
39
lateral aortic nodes (lumbar)
lie along aorta, IVC drain structures in posterior abd wall (kidneys, adrenal glands, ureters), pelvis, lower limbs
40
preaortic nodes
celiac superior mesenteric inferior mesenteric drain GI system
41
lumbar and intestinal lymph trunks converge on ________ at the lower end of _______
lumbar and intestinal lymph trunks converge on CISTERNA CHYLI at the lower end of THORACIC DUCT
42
dilatation of what could compress the cisterna chyli?
dilatation of the aorta
43
pt dx'd w/ cancer of sigmoid colon. metastasis of tumor would be expected to involve which group of lymph nodes first?
inferior mesenteric nodes (supply hindgut)
44
kidney major functions
``` removal of waste/xs H2o from blood excretion of metabolic waste in urine regulation of [ion] regulation of acid-base balane regulation of bp (renin) regulation of rbc production (erythropoietin) vitamin D metabolism ```
45
kidneys and adrenal glands are _______ ________ structures
primarily retroperitoneal
46
L kidney is related to which structures?
tail of pancreas | spleen
47
R kidney is related to which structures?
duodenum | liver
48
kidneys have no ______, so fat keeps them in place
mesentery
49
preirenal space vs. pararenal space locations in respect to renal fascia?
peririnal space --> inside fascia pararenal space --> around fascia
50
renal sinus contents
renal a. renal v. renal pelvis
51
Pouch of Morison
hepatorenal recess (between R kidney and liver) fluid that travelled thru foramen of Winslow can pass thru here then go further down to R paracolic gut
52
R and L paracholic gutters
peritoneal recesses on posterior abd wall lying alongside ascending and descending colon
53
where can fluid from a ruptured spleen get to?
can travel through L paracolic gutter and get to pelvis
54
main paracolic gutter
lies lateral to colon on each side
55
blood supply of adrenal glands
superior suprarenal a.s middle suprarenal a. inferior suprarenal a.s
56
superior mesenteric a. syndrome
3rd part of duodenum is being compressed by superior mesenteric a. can result in bilious vomiting
57
accessory renal arteries
result from a failure of the | transient arteries to degenerate during ascension
58
pelvic kidney
can result if a kidney fails to ascend
59
horseshoe kidney
can result if the inferior poles of the metanephroi fuse during ascension over the ventral side of the aorta, causing it to catch on the inferior mesenteric artery 1:500 births more common in males
60
kidney stones
small, hard deposits of mineral and acid salts on inner surfaces of kidneys aka renal lithiasis renal calculi nephrolithiasis (kidney stone disease) causes: highly concentrated urine, urine stasis, imbalance of pH in urine tx: extracorporal shock wave lithotripsy, retrograde ureteroscopy
61
acidic kidney stones
uric and cystine stones
62
alkaline kidney stones
calcium stones (more common) stones are radio-opaque
63
nephrolithiasis clinical presentation
(kidney stones) pain - paroxysms of severe pain, 20-60 min - originates in flank, radiates to groin (varies) - HEMATURIA (gross or microscopic) - nausea/vomiting - dysuria and urgency (less common)
64
hydronephrosis
distention/dilation of renal pelvis and calyces cause: usually obstruction of free urine glow if untreated --> progressive atrophy of kidney
65
hydroureteronephrosis
distension of both ureter and the renal pelvis and calices
66
perirenal peril
R kidney is swollen w/ stranding in perinephric fat and a dilated collecting system (hydronephrosis) stone in mid R ureter obstructs collecting system
67
L renal v. passes anterior to ______ and posterior to ______
L renal v. passes anterior to aorta and posterior to superior mesenteric a.
68
nutcracker syndrome
L. renal vein compression - edema - L flank, L gonad pain - hematuria (inc L renal venous pressure --> small venous ruptures into collecting system or between dilated venous sinuses and adjacent renal calyces)
69
angle between aorta and superior mesenteric artery is maintained by
retroperitoneal fat and 3rd part of duodenum
70
suprarenal (adrenal) medulla innervation
preganglonic sympathetic fibers --> cause a systemic sympathetic response
71
suprarenal (adrenal) medulla is modified _____ tissue
modified NERVE tissue activation of it --> release of NE and/or EPI --> enter blood stream and causes systemic response
72
innervation of suprarenal blood vessels
postganglionic neurons from the celiac ganglion that reach CORTICAL tissue of suprarenal glands
73
Derivation of chromaffin cells (within adrenal medulla)
neural crest cells
74
pheochromocytoma
tumor of chromatin cells of adrenal medulla MRI can show large suprarenal mass
75
Renal arteries branch into ________ to supply ________
Renal arteries branch into segmental arteries to supply each segment of kidney
76
at apex of each renal pyramid is a _______, which collects urine then joins a ________, then the _________.
at apex of each renal pyramid is a minor calyx, which collects urine then joins a major calyx, then the renal pelvis.
77
likely locations of kidney stone entrapment
1. where renal pelvis narrows to become ureter 2. where ureter crosses pelvic brim 3. where ureter enters bladder
78
parasympathetic innervation of upper pr. of ureter
vagus n. supplies parasympathetic innervation to upper part of ureter
79
parasympathetic innervation of lower pr. of ureter
pelvic splanchnic n. (S2-S4) supplies parasympathetic innervation to lower part of ureter
80
path of ureter along posterior abd wall
ureter passes posterior to gonadal vessels and runs along posas major
81
cells that secrete EPI/NE are innervated by preganglionic fibers from the
greater and lesser splanchnic n.

Emma IV (22 decks)

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