Posterior Abdominal Wall and Kidneys Flashcards
The diaphragm has 3 openings or hiatus’s, what are they?
Inferior vena cava, esophageal and vagal trunks, aortic, azygos and thoracic ducts.
At what vertebral level does the inferior vena cava opening come in to the diaphragm?
Esophageal and vagal trunks?
Aortic, azygos and thoracic duct?
T8, T10, T12
What is the treatment for chronic hiccups?
crush the phrenic nerve
Bochdalek’s hernia is … and …
back and left
Morgagni hernia is a ….
hole in the front of the diaphragm
2 fascias of the abdominal wall
psoas fascia and renal or Gerota’s fascia.
Psoas fascia forms the…
medial arcuate ligament
Posterior abdominal wall muscles
QL, psoas, iliacus
Psoas abscess
collection of pus in the iliopsoas muscle
Primary psoas abscess risk factors..from distant site.
diabetes, intravenous drug use, HIV, renal failure, other forms of immunosuppression
Secondary psoas abscess occurs as a result of direct spread of infection to psoas from adjacent structures such as..
vertebrae, hip arthroplasty, GI, aorta, genitourinary tract
Psoas abscesses are more common in
males
Posterior abdominal wall nerves (8)
subcostal, iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral, obturator, lumbosacral trunk
subcostal nerve vertebral column
T12
iliohypogastric nerve vertebral column
L1
ilioinguinal nerve vertebral column
L1
genitofemoral nerve vertebral columns
L1, L2
Lateral femoral cutaneous nerve vertebral columns
L2, L3
Femoral nerve vertebral columns
L2-L4
Obturator nerve vertebral columns
L2-L4
Lumbosacral trunk nerves vertebral columns
L4, L5
Subcostal nerve runs… to 12th rib.
inferior
Subcostal nerve is … to QL
anterior
Subcostal nerve acts as a … nerve to hypogastrium and lateral cutaneous.
sensory
Subcostal nerve serves as a…nerve to anterior wall/diaphragm.
motor
Iliohypogastric nerve is … to QL. Serves as a ….nerve to hip. It might be joined with.
anterior, sensory, ilioinguinal nerve
Ilioinguinal nerve is on the ….of QL. It comes out of the ….
anterior surface, superficial inguinal ring
Lateral femoral cutaneous nerve of the thigh runs …to iliacus muscle. When compressed it causes?
anterior
meralgia paresthetica or lateral femoral cutaneous nerve syndrome
Femoral nerve runs … to psoas.
lateral
Femoral nerve serves as a ….nerve to psoas, iliacus, anterior thigh muscles and … to thigh and leg.
motor, sensory
Genitofemoral nerve runs ….of psoas muscle. The genital branch serves as a … nerve to cremasteric muscle and ….to scrotal/labial skin.
Femoral branch is sensory to skin over…
anterior
motor
sensory
femoral triangle and medial thigh
Cremastic reflex tests the…
genitofemoral nerve and L1/L2
Obturator nerve runs …. psoas. It serves as a … nerve to the adductor muscles of the thigh and … to medial thigh above the knee.
deep on, medial border; motor, sensory
Lumbosacral trunk runs … and …. to psoas and obturator nerve. It joins S1 at …. It is … and …. to glute, thigh and leg.
deep and medial.
sacral plexus
motor and sensory
Adrenal gland is on the posterior wall at which vertebral column?
T12-L1
Adrenal glands are …
retroperitoneal
Adrenal glands are enclosed in
renal fascia (Gerotas)
Adrenal glands are composed of 2 parts:
cortex endocrine, medulla sympathetic ganglion
There is no….innervation of adrenal glands.
parasympathetic
Adrenal glands only have … fibers and release …% norepinephrine and …% epinephrine.
pre-ganglionic
20
80
The renal pelvis is also called..
infudibulum
Renal arteries arise from ….intervertebral discs.
L1/L2
Right renal artery passes …to IVC.
posterior
Left renal artery passes… to left renal vein.
posterior
Left renal vein receives …. and passes anterior to aorta.
left testicular/ovarian vein (gonadal veins)
Nerve innervation to the kidneys
lesser splanchnic and least splanchnic (T10-L1)
Most common type of kidney stone? What causes them?
calcium oxalate; inadequate calcium and fluid intake
Another reason for a kidney stone?
uric acid
The horse-shoe kidney is formed because it is prevented from raising up by the …
root of the inferior mesenteric artery
Horse-shoe kidney is found people with what syndrome?
Turners
People with Horse-shoe kidneys have ….at a greater frequency.
UTIs
3 non-paired vessels of the abdmen
celiac trunk
superior mesenteric artery
inferior mesenteric artery
The two vessels we need to know that are paired in the abdomen?
renal, gonadal
Celiac trunk supplies blood to …
foregut organs
Superior mesenteric artery supplies blood to the …
midgut organs
Inferior mesenteric artery supplies blood to the …
hindgut organs
Abdominal aorta enters the abdomen through the diaphragm at …., branches off the …artery at …., SMA at inferior edge of …., renal artery and vein at …., IMA at …. and bifurcates into common iliac arteries at inferior edge of ….
T12 Celiac, T12/L1 L1 L1-L2 L3 L4
Abdominal Aortic Aneurysm is defined as having an aorta that is larger than…cm and if it becomes …cm it will need to be repaired.
3
over 5
Most common site of AAA is
below the renal arteries
AAA presents as….
painless pulsatile abdominal mass
AAA is common in
adults over 60 and males more than females
AAA is associated with
atherosclerosis
AAA is the …. leading cause of death.
13th
At T12/L1, short anterior branch of celiac artery gives off…
left gastric
splenic
common hepatic
Celiac trunk and branches provide
blood to foregut organs
Left gastric artery has an …branch. It is located on the … side of the lesser curvature of the stomach. It …with the right gastric artery.
esophageal
left
anastomosis
The splenic artery is …and …along the superior border of the pancreas.
retroperitoneal
coiling
The splenic artery branches off to ….
pancreatic branch
short gastric arteries to the fundus of the stomach
left gastro omental
Common hepatic artery bifurcates at the pylorus into…
hepatic proper and gastroduodenal artery
Hepatic proper artery is ….while gastroduodenal is …
ascending
descending
Hepatic proper artery branches off into
right gastric artery
left and right hepatic artery
Superior mesenteric artery descends anterior to…
left renal vein, 3rd part of duodenum an uncinate process of pancreas.
The superior mesenteric artery has … branches.
intestinal
The superior mesenteric artery (descending toward the right) into 3 branches:
middle colic, right colic, and ileocolic
Superior mesenteric artery supplies blood to …organs
midgut
Inferior mesenteric artery originates @ …level.
L3
The inferior mesenteric artery descends toward rectum with 3 branches:
left colic, sigmoid, superior rectal
Inferior mesenteric artery supplies blood to …organs
hindgut
Variation of SMA and IMA is … which shortcuts SMA and IMA
Arc of Riolan
The hepatic portal vein has ….valves
no
The hepatic portal vein collects …blood from GI organs and sends to the …
high nutrient blood
liver
After the hepatic portal vein sends blood to liver, it returns it to … via hepatic veins.
IVC
Portal vein is formed by…
splenic vein and SMV
The portal vein is ..pancreas neck at the …plane.
behind
transpyloric
The portal vein is …. to IVC.
Anterior
The portal vein is ..portal triad.
within
Portal vein is on the … wall of the omentum foramen.
anterior
The portal vein enters …
porta hepatis
What venous plexuses allow portal vein to anastomose with systemic veins?
esophageal plexus
paraumbilical plexus
rectal plexuses
Paraumbilical plexus clinical manefistation?
caput Madusae
Rectal plexuses clinical manesfistation?
hemorrhoids
Portal hypertension
increased pressure of hepatic portal vein due to scarring or fibrosis of the liver or obstruction of the blood flow
Portal hypertension causes lower esophageal …. which are abnormally dilated veins.
venous varices
In general, most sensory information is carried through the … portion of ANS. Exception to this rule?
sympathetic
some sensory from pelvic
Visceral innervation is mostly..
sympathetic T1-L2
Greater splanchnic nerves vertebral associations? Which organs do they innervate?
T5-T9
celiac ganglion and foregut organs
Lesser splanchnic nerves vertebral associations? Which organs do they innervate?
T10-11
superior mesenteric ganglion and midgut organs
Least splanchnic nerves vertebral associations? Which organs do they innervate?
T12
inferior mesenteric ganglion and hindgut organs
Lumbar and sacral nerves, what do they innervate?
superior and inferior hypogastric plexus and pelvic organs
Sympathetic nerve fibers route starting from the spinal cord: preganglionic fibers leave spinal nerve via … and … in paravertebral ganglion.
Preganglionic fibers … or ….
Preganglionic fibers that descended within sympathetic trunk to …or … vertebral level then synapse. Post ganglionic fibers go back into spinal nerve via …
Preganglionic fibers pass through ….and become …, travel … and synapse.
white rami communicantes synapse ascend or descend higher or lower gray rami communicantes para-vertebral ganglion splanchnic nerves pre aortic/prevertebral gang
All primary rami of spinal nerves carry ….fibers.
postganglionic sympathetic efferent
Visceral innervation-parasympathetic has two centers: …via…to all abdominal organs and … via ….to hindgut organs.
brainstem via vagus nerve
S2-4 via pelvic splanchnic nerve
