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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
Q

ilioinguinal n. (ant. scrotal branch)

A

L1

supplies sensation to lateral scrotum

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26
Q

Lumbar plexus

A 
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)
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27
Q

which levels of the lumbar plexus have white and grey communicating rami?

A

L1,L2

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28
Q

preaortic ganglia

A

celiac ganglia
superior mesenteric ganglion
R/L aortic-renal ganglion
inferior mesenteric ganglion

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29
Q

preaortic ganglia contain which cell bodies?

A

postganglionic sympathetic fibers

visceral afferent fibers

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30
Q

Greater splanchnic n. (T5-T9)

ganglion synapsed?
arteries carrying post-gang fibers?
area of referred pain?

A

celiac ganglion

celiac trunk (foregut)

epigastric pain

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31
Q

lesser splanchnic n. (T10-T11)

ganglion synapsed?
arteries carrying post-gang fibers?
area of referred pain?

A

superior mesenteric ganglion

superior mesenteric a. (midgut)

periumbilical pain

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32
Q

least splanchnic n. (T12)

ganglion synapsed?
arteries carrying post-gang fibers?
area of referred pain?

A

aorticorenal ganglion

renal a.

hypogastric pain

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33
Q

lumbar splanchnic n. (L1-L2)

ganglion synapsed?
arteries carrying post-gang fibers?
area of referred pain?

A

inferior mesenteric ganglion

inferior mesenteric a. (hindgut)

hypogastric/inguinal pain

34
Q

where is referred pain from testes or ovaries referred to?

A

lower abd (T11-T12)

35
Q

somatic pain from skin of scrotum is felt in which area?

A

pudendal area - from pudendal n. (S2-S4)

36
Q

parasympathetic innervation of large intestine

A

vagus n. (to proximal 2/3 of transverse colon)

pelvic splanchnic n. (to distal colon)

37
Q

pelvic splanchnic n.

A

(S2-S4)

run along mesentery of sigmoid colon and reach up to splenic flexure

supply distal colon

38
Q

superior/inferior hypogastric plexus

A

preganglionic sympathetics from lumbar region

preganglionic parasympathetics from sacral region

39
Q

lateral aortic nodes (lumbar)

A

lie along aorta, IVC

drain structures in posterior abd wall (kidneys, adrenal glands, ureters), pelvis, lower limbs

40
Q

preaortic nodes

A

celiac
superior mesenteric
inferior mesenteric

drain GI system

41
Q

lumbar and intestinal lymph trunks converge on ________ at the lower end of _______

A

lumbar and intestinal lymph trunks converge on CISTERNA CHYLI at the lower end of THORACIC DUCT

42
Q

dilatation of what could compress the cisterna chyli?

A

dilatation of the aorta

43
Q

pt dx’d w/ cancer of sigmoid colon. metastasis of tumor would be expected to involve which group of lymph nodes first?

A

inferior mesenteric nodes (supply hindgut)

44
Q

kidney major functions

A 
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
Q

kidneys and adrenal glands are _______ ________ structures

A

primarily retroperitoneal

46
Q

L kidney is related to which structures?

A

tail of pancreas

spleen

47
Q

R kidney is related to which structures?

A

duodenum

liver

48
Q

kidneys have no ______, so fat keeps them in place

A

mesentery

49
Q

preirenal space vs. pararenal space

locations in respect to renal fascia?

A

peririnal space –> inside fascia

pararenal space –> around fascia

50
Q

renal sinus contents

A

renal a.
renal v.
renal pelvis

51
Q

Pouch of Morison

A

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
Q

R and L paracholic gutters

A

peritoneal recesses on posterior abd wall lying alongside ascending and descending colon

53
Q

where can fluid from a ruptured spleen get to?

A

can travel through L paracolic gutter and get to pelvis

54
Q

main paracolic gutter

A

lies lateral to colon on each side

55
Q

blood supply of adrenal glands

A

superior suprarenal a.s
middle suprarenal a.
inferior suprarenal a.s

56
Q

superior mesenteric a. syndrome

A

3rd part of duodenum is being compressed by superior mesenteric a.

can result in bilious vomiting

57
Q

accessory renal arteries

A

result from a failure of the

transient arteries to degenerate during ascension

58
Q

pelvic kidney

A

can result if a kidney fails to ascend

59
Q

horseshoe kidney

A

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
Q

kidney stones

A

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
Q

acidic kidney stones

A

uric and cystine stones

62
Q

alkaline kidney stones

A

calcium stones
(more common)

stones are radio-opaque

63
Q

nephrolithiasis clinical presentation

A

(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
Q

hydronephrosis

A

distention/dilation of renal pelvis and calyces

cause: usually obstruction of free urine glow

if untreated –> progressive atrophy of kidney

65
Q

hydroureteronephrosis

A

distension of both ureter and the renal pelvis and calices

66
Q

perirenal peril

A

R kidney is swollen w/ stranding in perinephric fat and a dilated collecting system (hydronephrosis)

stone in mid R ureter obstructs collecting system

67
Q

L renal v. passes anterior to ______ and posterior to ______

A

L renal v. passes anterior to aorta and posterior to superior mesenteric a.

68
Q

nutcracker syndrome

A

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
Q

angle between aorta and superior mesenteric artery is maintained by

A

retroperitoneal fat and 3rd part of duodenum

70
Q

suprarenal (adrenal) medulla innervation

A

preganglonic sympathetic fibers –> cause a systemic sympathetic response

71
Q

suprarenal (adrenal) medulla is modified _____ tissue

A

modified NERVE tissue

activation of it –> release of NE and/or EPI –> enter blood stream and causes systemic response

72
Q

innervation of suprarenal blood vessels

A

postganglionic neurons from the celiac ganglion that reach CORTICAL tissue of suprarenal glands

73
Q

Derivation of chromaffin cells (within adrenal medulla)

A

neural crest cells

74
Q

pheochromocytoma

A

tumor of chromatin cells of adrenal medulla

MRI can show large suprarenal mass

75
Q

Renal arteries branch into ________ to supply ________

A

Renal arteries branch into segmental arteries to supply each segment of kidney

76
Q

at apex of each renal pyramid is a _______, which collects urine then joins a ________, then the _________.

A

at apex of each renal pyramid is a minor calyx, which collects urine then joins a major calyx, then the renal pelvis.

77
Q

likely locations of kidney stone entrapment

A
  1. where renal pelvis narrows to become ureter
  2. where ureter crosses pelvic brim
  3. where ureter enters bladder
78
Q

parasympathetic innervation of upper pr. of ureter

A

vagus n. supplies parasympathetic innervation to upper part of ureter

79
Q

parasympathetic innervation of lower pr. of ureter

A

pelvic splanchnic n. (S2-S4) supplies parasympathetic innervation to lower part of ureter

80
Q

path of ureter along posterior abd wall

A

ureter passes posterior to gonadal vessels and runs along posas major

81
Q

cells that secrete EPI/NE are innervated by preganglionic fibers from the

A

greater and lesser splanchnic n.

Emma IV (22 decks)

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