Posterior Abdominal Wall and Kidneys Flashcards
Where is the posterior abd wall
Posterior to gastrointestinal tract, spleen and pancreas
Extension of posterior mediastinum
What is in the retroperitoneal space
Posterior abd wall
What is retroperitoneal space bounded by
Posterior =Bones, muscles
Anterior = peritoneum
What passes through retroperitoneal space
Structures between thorax to pelvis, head to abd region, transit region, big vessels
Aorta, nerve plexuses, ivc , sympathetic trunk, lymphatic, lumbar plexus, kidney and suprarenal glands (urinary system)
WHAT ARE BONY BOUNDARIES OF POST ABD WALL
Lumbar vertebrae
Pelvis
Thorax
Describe lumbar vertebrae - bones post abd wall
5
Lordosis
Inward curvature
Describe pelvis - Gen - bones post abd wall
Superior aspect of pelvic bone, crest, ilia, pubic symphysis, psis, asis
Describe ilia - pelvis - bones post abd wall
Attached laterally to sacrum (sacroiliac joint)
Upper part of each ilium expand outward wing like area = iliac fossa- forms bone
Describe important landmark of pelvis - bones post abd wall
Anterior superior iliac spine = anterior extremity of iliac bone
Describe pubic symphysis - pelvis- bones post abd wall
Between the 2 pubic tubercles
Describe thorax - bones post abd wall
Costal margin, ribs 11-12, xiphoid process
Describe relationship of ribs of thorax that bound post abd wall and kidneys
Rib 11 is posterior to superior part of left kidney
Rib 12 is posterior to superior part of BOTH kidneys
Describe muscles of post abd wall - medially
Psoas major and minor
Fills space between vertebral bodies and transverse processes of t12 to L5
For hip flexion + iliacus muscle, proximal insertion on femur
What muscle passes under MEDIAL accurate ligament of diaphragm
Psoas
Describe bursa pain
Psoas major, going out = bursa, can be inflamed = pain when work out a lot
Describe muscles of post abd wall - laterally
Quadratus lumborum
Square muscle, lumbar, seals back, laterally. = abd muscle, but at back = open so filled with this muscle
Fills space between rib 12 and iliac crest
Overlapped by Psoas medially
What passes under lateral accurate ligament of diaphragm
Quadratus lumborum
Describe muscles of post abd wall - inferiorly
Iliacus
Fills iliac fossa on each side - anterior aspects
Joins Psoas before insertion on proximal femur
More support for Psoas, and stronger powerful hip flexion, also for caecum and sigmoid = cushions gut
Describe muscles of post abd wall - superiorly
Diaphragm - must jump over the muscles to properly seal abd region
Anchored to lumbar vertebrae by musculotendinous crura =
Right crus = l1-l3 - lower due to liver
Left crus = l1-l2
Describe Crura of post and wall generally
From tending us arch to allow passage between cavities
Describe median arcuate ligament
Under = Aorta - t12 (passes between the 2 crura, needs to be protected, follows spine closely), thoracic duct (drains Lower ribs and abd), lymphatic confluent (drains all uppe body)
MIDLINE - between 2 crura
Describe medial arcuate ligament
L for more lateral than median
Psos under, sympathetic trunk - continues down and follows spine
From transverse process l1 to crus
Describe lateral arcuate ligament
From transverse process l1 to rib 12 laterally
Quadratics lumborum under
What passes trough crura
Greater, lesser and least splanchnic nerves= though muscle fibre, presyn symp to gut, can be impinged - sciatic, through priformis muscle
Azygous/hemiazygous = azygous - muscles, help go up against gravity, hemi - ascending lumbar, passes through diaphragm
Name 3 principe hiatuses in diaphragm
T8 = caval aperture, IVC
T10 = esophageal aperture, eso, vagal trunk
T12= aortic aperture, aorta, thoracic duct
What is the superior lumbar triangle
Region of weakness
What are borders of superior lumbar triangle
Medially = quadratus lumborum muscle
Laterally = internal oblique abd muscle
Superiorly = rib 12
Floor of triangle = transversalis fascia
NO STRONG MUSCLES
Describe superior lumbar triangle clinical correlate
In regard to inf pole of kidneys - location for lumbar hernia
Protrusion of abd content bc wall cannot resist increased abd pressure
Just fascia - only thing between quadrants and transverus abdominus is transversalis fascia
Describe post abd wall - costovertebral angle
Vulnerable
Zone of superior lumbar triangle overlying the kidney
Describe kidney punch test
Costovertebral angle tenderness - cvat, Murphys punch signs = medical test
If percussion of the area elicits pain,test is positive and would suggest infection around kidney = if triggers pain
Mechanically induce stimulation
Wresting - done sometimes
What conditions can be found by kidney punch
Perinephric Abscess
Pyelonephritis
Renal stone
Describe importance of abdominal muscle tone
Contraction of abd wall muscles - especially trans versus abdominus = important to maintain core, popcan core
If push on it = expands, do not want diaphragm to be tense but TIGHT - if too tense = will increase pressure in muscle layer on compartments
Also pelvic floor muscles need to be tonic to resist pressure - icreases when breathes and with organ functions - like peristalsis
Name all intraperitoneal organs
Stomach,
* Duodenum (1st part)
Liver,
* Spleen,
* Pancreas (only tail)
* Jejunum
* Ileum,
* Cecum,
* Appendix,
* Transverse colon,
* Sigmoid colon,
Name all retroperitoneal organs
S = suprarenal glands
* A = Aorta and IVC
* D = Duodenum (all but the 1st part)
* P = Pancreas (all but the tail)
* U = Ureter and bladder
* C = Colon (ascending and descending)
* K = Kidneys
* E = Esophagus
* R = Rectum (Lower 2/3)
= attached to, but not in It
Describe spaces of peritoneal cavity
Folding of parietal to visceral peritoneum creates recesses/spaces
Serous fluid -lube, everything slides
Name spaces of peritoneal cavity
Paracolic gutter
Hepatorenal recess
Subphrenic recess
Lesser sac
Describe paracolic gutter
Space between colon and abd wall - connect inf portion abd region to upper portion
Describe hepatorenal recess
Morrisons pouch
Between posterior aspect of liver and anterior aspect kidneys
DESCRIBE subphrenic recess
Between diaphragm and liver
Describe lesser sac - spaces of peritoneal cavity
Behind lesser omentum, opening behind hepatoduodenal ligament
Bad since celiac trunk, and, plexuses, pancreas
Describe clinical relevance of spaces of peritoneal cavity
Bile pus or blood from abd vsicera can collect in sites remote from organ of origin
Ex = spine position, infected fluid from right iliac fossa (appendicitis), can enter hepatorenal/subphrenic recesses
= ex = fluid moves to paracolic (behind liver), gutter can reach liver region and get to hepatorenal recess and then subphrenic recess = infect kidneys liver…
Peritonitis
DYNAMIC, moves
Describe kidney
Bean shaped organ - 11 cm length
What is function of kidney
Filter blood
Regulate blood pressure, ionic and hydric balance
Eliminate metabolic waste —> produce urine
About 1.2litres/min in adult
Where is general location of kidney
Retroperitoneal
Anterior to quadratus lumborum
Anterior to psoas
Under diaphragm
Describe left kidney
Anterior to rib 11 and 12
Vertebral level of t12 to l2 - slightly higher
Posterior to spleen, tail of pancreas and left colic Flexure
More protected by ribs
Describe right kidney
Anterior to rib 12
Vertebral level of l1-l3 - lower since liver takes up space
Posterior to liver descending portion of duodenum, right colic Flexure
Nam renal fascia arrangement from superficial to deep
Cushions, more padding, layers of abd wall
Posterior abdominal wall muscles
Transversalis fascia
Pararenal fat
Renal fascia
Perirenal fat
Fibrous renal capsule
Describe pararenal (paranephric) fat
Accumulation of fat posterior and lateral to kidney
extra layer fat, only on posterior side
Describe renal fascia
Gerota’s
Like sock for kdiney - pouch
Membranous fat condensation, surrounds each kdiney and suprarenal gland
Enclosing perirenal fat
Describe perirenal (perinephric) fat
Contained in renal fascia
Extraperitoneal fat
Outside renal capsule, surrounding kidneys
Describe fibrous renal capsule
Completely invest kidneys
Describe kidneys external structure
10-15 cm long
Lateral edge =smooth and convex
Medial border = hilum pierced by renal vein, artery and renal pelvis/ureter
Renal sinus = expansion of hilum within kidney, filled of perirenal fat
Describe internal structure kidneys
Cortex and medulla
Contains 2 mil nephrons, renal functional units
Describe renal cortex
Outer region
Deep to fibrous capsule
Extend into medullary region as renal Columns
Describe renal medulla
Inner region
Arranged into renal pyramids, base face outwards
Apex fitting in miso calyx - renal papilla
Describe blood filtration pathway
Blood filtered through pyramids (nephrons) —> urine secreted at papilla —> into 11 minor calyx —> 3 major calyx —> eventually into renal pelvis and to ureter
Describe hillum of kidney
Vessels enter organ - midline medial
Front = vein, mid = artery, behind = ureter
Describe renal sinus
Open space where urinary system and vessels enter kdiney, not sealed
Describe renal pyramids
Where urine produced and converge to papilla
Describe arterial supply kidneys
Renal arteries from abd aorta - paired visceral
Right renal = longer, since passes under ivc (left renal artery shorter)
Describe venous drainage kidneys
Renal veins from ivc, anterior to arteries
Left renal vein is longer, passes under SMA
(Right renal vein shorter)
* left gonadal vein, left adrenal vein drain into left renal vein
Describe innervation of kidneys - gen
Renal plexus from celiac Plexus
Found along renal ateries
Desire in certain of kidneys - specific psns and sns
Sns = triggers vasoconstriction, reducing renal blood flow
Psns = not well understood
Describe clinical relevance - nutcracker syndrome
Left renal vein entrapment Sydney me - due to dilation of sma
If collapse or high pressure sma = can block left renal vein
In Amab = cause varicoceles, = enlargement of testicular veins in scrotum - varices,
What is female Equivalent of nutcracker syndrome
Conjecture pelvic syndrome
During messes = pain, tenderness and discomfort due to lack of Venous drainage
Describe ureter
Muscular tube transport urine from kdiney to bladder
Delicate, carries urine
Where is general location of ureter
Retroperitoneal
Oriented vertically, anterior to psoas muscle
Enters pelvis by crossing common iliac artery
Water under the bridge - under organs
Describe the 3 points of constriction of ureter
Where stones can get lodged- when try to get out
- ureteropelvic junction - junction renal pelvis/ureter
Crosses iliac vessels - strong arteries, where most get lodged
Entry to bladder
What is urine pathway
Renal papilla —> minor calyx —> Major calyx —> Renal pelvis —> Ureter —> Bladder
Where is general location of suprarenal glands
Retroperitoneal
Associated with superior pole of each kidney - top of kdiney
Contained in renal fascia and perirenal fat
Describe anatomy of suprarenal Glands generally
Outer cortex and inner medulla
Describe suprarenal gland cortex
Influence blood pressure and volume
Controlling sodium and water retention by kidneys
Describe suprarenal gland medulla
Primarily composed of nervous tissues =
Stimulated by preganglionic symapthetic fibres from celiac plexus
Functions like sympathetic ganglia - secrete catecholamines (epinephrine, norepinephrine)
Describe suprarenal glands arterial supply
Vital gland so 3 regions give it blood
Suprarenal arteries
Superior = from inferior phrenic from abd aorta
Middle = directly from abd aorta
Inferior = from renal artery
Describe suprarenal glands venous drainage
Usually 1 suprarenal vein
Right = ivc
Left = drains into renal vein first
