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ANAT 214 > Posterior Abdominal Wall and Kidneys > Flashcards

Posterior Abdominal Wall and Kidneys Flashcards

1
Q

Where is the posterior abd wall

A

Posterior to gastrointestinal tract, spleen and pancreas
Extension of posterior mediastinum

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2
Q

What is in the retroperitoneal space

A

Posterior abd wall

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3
Q

What is retroperitoneal space bounded by

A

Posterior =Bones, muscles
Anterior = peritoneum

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4
Q

What passes through retroperitoneal space

A

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)

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5
Q

WHAT ARE BONY BOUNDARIES OF POST ABD WALL

A

Lumbar vertebrae
Pelvis
Thorax

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6
Q

Describe lumbar vertebrae - bones post abd wall

A

5
Lordosis
Inward curvature

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7
Q

Describe pelvis - Gen - bones post abd wall

A

Superior aspect of pelvic bone, crest, ilia, pubic symphysis, psis, asis

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8
Q

Describe ilia - pelvis - bones post abd wall

A

Attached laterally to sacrum (sacroiliac joint)
Upper part of each ilium expand outward wing like area = iliac fossa- forms bone

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9
Q

Describe important landmark of pelvis - bones post abd wall

A

Anterior superior iliac spine = anterior extremity of iliac bone

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10
Q

Describe pubic symphysis - pelvis- bones post abd wall

A

Between the 2 pubic tubercles

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11
Q

Describe thorax - bones post abd wall

A

Costal margin, ribs 11-12, xiphoid process

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12
Q

Describe relationship of ribs of thorax that bound post abd wall and kidneys

A

Rib 11 is posterior to superior part of left kidney
Rib 12 is posterior to superior part of BOTH kidneys

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13
Q

Describe muscles of post abd wall - medially

A

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

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14
Q

What muscle passes under MEDIAL accurate ligament of diaphragm

A

Psoas

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15
Q

Describe bursa pain

A

Psoas major, going out = bursa, can be inflamed = pain when work out a lot

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16
Q

Describe muscles of post abd wall - laterally

A

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

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16
Q

What passes under lateral accurate ligament of diaphragm

A

Quadratus lumborum

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17
Q

Describe muscles of post abd wall - inferiorly

A

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

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17
Q

Describe muscles of post abd wall - superiorly

A

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

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18
Q

Describe Crura of post and wall generally

A

From tending us arch to allow passage between cavities

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19
Q

Describe median arcuate ligament

A

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

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20
Q

Describe medial arcuate ligament

A

L for more lateral than median
Psos under, sympathetic trunk - continues down and follows spine
From transverse process l1 to crus

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21
Q

Describe lateral arcuate ligament

A

From transverse process l1 to rib 12 laterally
Quadratics lumborum under

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22
Q

What passes trough crura

A

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

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23
Q

Name 3 principe hiatuses in diaphragm

A

T8 = caval aperture, IVC
T10 = esophageal aperture, eso, vagal trunk
T12= aortic aperture, aorta, thoracic duct

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24
Q

What is the superior lumbar triangle

A

Region of weakness

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25
Q

What are borders of superior lumbar triangle

A

Medially = quadratus lumborum muscle
Laterally = internal oblique abd muscle
Superiorly = rib 12
Floor of triangle = transversalis fascia
NO STRONG MUSCLES

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26
Q

Describe superior lumbar triangle clinical correlate

A

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

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27
Q

Describe post abd wall - costovertebral angle

A

Vulnerable
Zone of superior lumbar triangle overlying the kidney

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28
Q

Describe kidney punch test

A

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

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29
Q

What conditions can be found by kidney punch

A

Perinephric Abscess
Pyelonephritis
Renal stone

30
Q

Describe importance of abdominal muscle tone

A

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

31
Q

Name all intraperitoneal organs

A

Stomach,
* Duodenum (1st part)
Liver,
* Spleen,
* Pancreas (only tail)
* Jejunum
* Ileum,
* Cecum,
* Appendix,
* Transverse colon,
* Sigmoid colon,

32
Q

Name all retroperitoneal organs

A

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

33
Q

Describe spaces of peritoneal cavity

A

Folding of parietal to visceral peritoneum creates recesses/spaces
Serous fluid -lube, everything slides

34
Q

Name spaces of peritoneal cavity

A

Paracolic gutter
Hepatorenal recess
Subphrenic recess
Lesser sac

35
Q

Describe paracolic gutter

A

Space between colon and abd wall - connect inf portion abd region to upper portion

36
Q

Describe hepatorenal recess

A

Morrisons pouch
Between posterior aspect of liver and anterior aspect kidneys

37
Q

DESCRIBE subphrenic recess

A

Between diaphragm and liver

38
Q

Describe lesser sac - spaces of peritoneal cavity

A

Behind lesser omentum, opening behind hepatoduodenal ligament
Bad since celiac trunk, and, plexuses, pancreas

39
Q

Describe clinical relevance of spaces of peritoneal cavity

A

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

40
Q

Describe kidney

A

Bean shaped organ - 11 cm length

41
Q

What is function of kidney

A

Filter blood
Regulate blood pressure, ionic and hydric balance
Eliminate metabolic waste —> produce urine
About 1.2litres/min in adult

42
Q

Where is general location of kidney

A

Retroperitoneal
Anterior to quadratus lumborum
Anterior to psoas
Under diaphragm

43
Q

Describe left kidney

A

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

44
Q

Describe right kidney

A

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

45
Q

Nam renal fascia arrangement from superficial to deep

A

Cushions, more padding, layers of abd wall
Posterior abdominal wall muscles
Transversalis fascia
Pararenal fat
Renal fascia
Perirenal fat
Fibrous renal capsule

46
Q

Describe pararenal (paranephric) fat

A

Accumulation of fat posterior and lateral to kidney
extra layer fat, only on posterior side

47
Q

Describe renal fascia

A

Gerota’s
Like sock for kdiney - pouch
Membranous fat condensation, surrounds each kdiney and suprarenal gland
Enclosing perirenal fat

48
Q

Describe perirenal (perinephric) fat

A

Contained in renal fascia
Extraperitoneal fat
Outside renal capsule, surrounding kidneys

49
Q

Describe fibrous renal capsule

A

Completely invest kidneys

50
Q

Describe kidneys external structure

A

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

51
Q

Describe internal structure kidneys

A

Cortex and medulla
Contains 2 mil nephrons, renal functional units

52
Q

Describe renal cortex

A

Outer region
Deep to fibrous capsule
Extend into medullary region as renal Columns

53
Q

Describe renal medulla

A

Inner region
Arranged into renal pyramids, base face outwards
Apex fitting in miso calyx - renal papilla

54
Q

Describe blood filtration pathway

A

Blood filtered through pyramids (nephrons) —> urine secreted at papilla —> into 11 minor calyx —> 3 major calyx —> eventually into renal pelvis and to ureter

55
Q

Describe hillum of kidney

A

Vessels enter organ - midline medial
Front = vein, mid = artery, behind = ureter

56
Q

Describe renal sinus

A

Open space where urinary system and vessels enter kdiney, not sealed

57
Q

Describe renal pyramids

A

Where urine produced and converge to papilla

58
Q

Describe arterial supply kidneys

A

Renal arteries from abd aorta - paired visceral
Right renal = longer, since passes under ivc (left renal artery shorter)

59
Q

Describe venous drainage kidneys

A

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

60
Q

Describe innervation of kidneys - gen

A

Renal plexus from celiac Plexus
Found along renal ateries

61
Q

Desire in certain of kidneys - specific psns and sns

A

Sns = triggers vasoconstriction, reducing renal blood flow
Psns = not well understood

62
Q

Describe clinical relevance - nutcracker syndrome

A

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,

63
Q

What is female Equivalent of nutcracker syndrome

A

Conjecture pelvic syndrome
During messes = pain, tenderness and discomfort due to lack of Venous drainage

64
Q

Describe ureter

A

Muscular tube transport urine from kdiney to bladder
Delicate, carries urine

65
Q

Where is general location of ureter

A

Retroperitoneal
Oriented vertically, anterior to psoas muscle
Enters pelvis by crossing common iliac artery
Water under the bridge - under organs

66
Q

Describe the 3 points of constriction of ureter

A

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

67
Q

What is urine pathway

A

Renal papilla —> minor calyx —> Major calyx —> Renal pelvis —> Ureter —> Bladder

68
Q

Where is general location of suprarenal glands

A

Retroperitoneal
Associated with superior pole of each kidney - top of kdiney
Contained in renal fascia and perirenal fat

69
Q

Describe anatomy of suprarenal Glands generally

A

Outer cortex and inner medulla

70
Q

Describe suprarenal gland cortex

A

Influence blood pressure and volume
Controlling sodium and water retention by kidneys

71
Q

Describe suprarenal gland medulla

A

Primarily composed of nervous tissues =
Stimulated by preganglionic symapthetic fibres from celiac plexus
Functions like sympathetic ganglia - secrete catecholamines (epinephrine, norepinephrine)

72
Q

Describe suprarenal glands arterial supply

A

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

73
Q

Describe suprarenal glands venous drainage

A

Usually 1 suprarenal vein
Right = ivc
Left = drains into renal vein first

ANAT 214 (34 decks)

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