Posterior Abdominal Wall and Renal System

Question 1

Explain the three layers of the thoracolumbar fascia including what attaches to each

Answer 1

Anterior Layer
*Quadratus Lumborum
Middle Layer
*Erector Spinae
Posterior Layer

Question 2

Psoas major attachment sites

Answer 2

*Originates from the transverse processes and vertebral bodies of T12 – L5.
*Moves inferiorly and laterally, running deep to the inguinal ligament
*Attaching to the lesser trochanter of the femur.

Question 3

Psoas minor attachment sites

Answer 3

*Originates from the vertebral bodies of T12 and L1
*Attaches to a ridge on the superior ramus of the pubic bone, known as the pectineal line

Question 4

Iliacus attachment sites

Answer 4

*Originates from the surface of the iliac fossa and anterior inferior iliac spine (AIIS).
*Its fibres combine with the tendon of the psoas major
*Inserting into the lesser trochanter of the femur.

Question 5

Quadratus Lumborum Attachment sites

Answer 5

*From 12th rib & transverse processes of L1-4
*To iliolumbar ligament & iliac crest

Question 6

Name the openings in the diaphragm and the structures that pass through them

Answer 6

*Median arcuate lig. - Aortic hiatus
*Medial arcuate lig. - Psoas
*Lateral arcuate lig. - Quadratus lumborum
*Caval opening (T8) - Inferior vena cava
*Esophageal hiatus (T10) - Esophagus, Parasymp (vagal trunks)
*Aortic hiatus (T12) - Descending aorta, Thoracic duct

Question 7

Summarize the lumbar plexus using a drawing

Answer 7

Question 8

Describe the arterial supply of the posterior abdominal
wall

Answer 8

Question 9

Describe the venous drainage of the posterior abdominal
wall

Answer 9

Question 10

Review the retroperitoneal structures and their relation to the posterior abdominal wall

Answer 10

Kidneys
Adrenal Glands
Pancreas
Duodenum
Ascending and Descending Colon

Question 11

Describe the external and internal features of the kidneys

Answer 11

1. Surface features
   a. Suprarenal gland
   b. Upper pole
   c. Inferior pole
   d. Hilum [L. a small bit or trifle]
   e. Capsule
   f. Sinus
2. Internal features
   a. Renal cortex [L. bark]
   i. Renal columns
   b. Renal medulla [L. marrow, middle]
   i. Pyramid of medulla - Papillae
   c. Pelvis
   i. Major & minor calyces [L. cup of a flower]
3. Retroperitoneal features
   a. Pararenal fat
   b. Perirenal fat
   c. Renal fascia

Question 12

Identify A

Answer 12

Suprarenal gland

Question 13

Identify B

Answer 13

Superior/upper pole

Question 14

Identify C

Answer 14

Inferior pole

Question 15

Identify D

Answer 15

Hilum

Question 16

Identify A

Answer 16

Renal Cortex

Question 17

Identify B

Answer 17

Renal column

Question 18

Identify C

Answer 18

Renal pyramid

Question 19

Identify D

Answer 19

Papilla

Question 20

Identify E

Answer 20

Renal pelvis

Question 21

Identify F

Answer 21

Minor calyx

Question 22

Identify G

Answer 22

Major calyx

Question 23

Explain the autonomic innervation of the kidneys

Answer 23

Parasympathetic
*Vagus (CN X) > esophageal plexus > post vagal trunk > celiac ganglion & plexus > renal nerve plexus > kidney (synapse)

Sympathetic
*Lesser splanchnic (T10-11) or least splanchnic (T12) > aorticorenal ganglion (synapse) > renal nerve plexus > kidney

Question 24

Explain the autonomic innervation of the urinary bladder

Answer 24

Sympathetic
*T10-12, L1-2 > lumbar splanchnic > superior/inferior hypogastric plexus > inferior hypogastric plexus (synapse) > wall relaxation

Parasympathetic
*S2-4 > pelvic splanchnic > inferior hypogastric plexus > wall (synapse; contraction)

Question 25

Explain the relation between the ureter and the testicular artery

Answer 25

Ureter passes posterior to the testicular artery

Question 26

Define the trigone of the urinary bladder

Answer 26

Postero-inferior surface of the inside of the bladder.
Triangular surface between ureteric orifices and urethral orifice

Question 27

Contrast the anatomy of the male and female urethra

Answer 27

Male = 20cm on average
Female = 4cm