posterior abdominal walls and kidneys

Question 1

anterior to the 12th ribs with one higher than the other

Answer 1

retroperitoneal, anterior to the 12th ribs with the left kidney slightly higher than the right

1. renal arteries and veins

Question 2

describe general surface anatomy of the kidneys

Answer 2

1. 2 surfaces
   
   1. anterior and posterior
2. 2 poles
   
   1. superior and inferior
3. 2 borders
   
   1. medial
      
      1. has HILIUM- continuous with the renal sinus
         
         1. ​ VAU + lymphatics and
   2. lateral

Question 3

differentiate the Left and Right kidney relationships

Answer 3

left

1. anterior
   
   1. stomach
   2. spleen
   3. pancreas
   4. left colic flexurwe
   5. descending colon
   6. jejunum
2. posterior
   
   1. anterior to 11-12 ribs

right

1. anterior surface
   
   1. liver
   2. descending duodenum
   3. right colic flexure
   4. small interstine
2. anterior to the 12th ribs

both

1. nerves
   
   1. iliohypogastric
   2. iliolingual
2. muscles
   
   1. diaphragm
   2. psoas major
   3. quadratus lumborum
   4. transversus abdominis

Question 4

detail the construct of a kidney

Answer 4

1. cortex
   
   1. pyramids
      
      1. renal papilla- apical projecrions feeding in to the minor calyx
2. medulla
   
   1. minor calyx
   2. major calyx- 2-3
3. hilum
   
   1. renal pelvus
   2. ureter

Question 5

describe the arterial flow to the kidneys

Answer 5

1. renal arteries
   
   1. feed into 5 segments, each recieving its own segmental artery
      
      1. NO ANASTOMOSES=no collateral circulation
         
         1. impeding blood flow to an area leads to necrosis, can also be used when surgically removing a segment of the kidney
   2. acessory renal arteries
      
      1. extra hilar
2. venous flow
   
   1. right
      
      1. straight to the inferior vena cava, no tributaries
   2. left
      
      1. tributaries with left gonadal and left suprarenal gland
      2. renal vein passes deep to the mesenteric artery, where it can be compressed
         
         1. renal vein entrapment syndrome
            3.

Question 6

kidney translplant is placed where? describe

Answer 6

donor kidney may be transplanted to replace nonfunctional kidney

1. placed within iliac fossa
   
   1. blood vessels
      
      1. external iliac artery/vein
   2. ureter directly into the bladder

Question 7

loin to groin pain is felt by Jerry, describe the nerves involved with the referred pain

Answer 7

1. cutaneous areas
   
   1. T11-L2
2. kidney stones may obstruct and cause loin to groin pain
   
   1. may lead to hydronephrosis-distension of the kidney and eventually kidney failure

Question 8

describe the vascular supply to the ureters

Answer 8

1. arteries
   
   1. longitudinal anastamoses
      
      1. upper- renal artery
      2. middle -gonadal, abdominal aorta, common ilian
      3. pelvic-internal iliac
2. veins
   
   1. upper-renal v
   2. middle -gonadal
   3. pelvic cavity-internal iliac

Question 9

what is the lymph drainage destination for the kidneys and ureters?

Answer 9

1. kidneys
   
   1. paraaortic- nodes around the renal artery
2. ureters
   
   1. upper- paraaortic
   2. middle-common iliac
   3. inferior-external/internal iliac nodes

Question 10

describe the nerve supply of the kidneys and ureters

1. kidney-symp/parasym
2. ureters-symp/parasym

Answer 10

1. kidney
   
   1. T10-T12
   2. vagus
2. ureters
   
   1. T11-L2
   2. vagus + S2-S4

Question 11

differentiate the two parts of the suprarenal gland and general secretion

Answer 11

1. cortex
   
   1. secretes corticosteroir hormones important for carbohydrate and protein metabolism
2. medulla
   
   1. collection of postganglionic sympathetic neuron cell bodies-
      
      1. catecholamines
3. medulla

Question 12

describe the vascularture of the suprarenal glands

Answer 12

1. arteries- three segments, from three different locations
   
   1. both are the same
   2. inferior phrenic
      
      1. superior suprarenal artery
   3. abdominal aorta
      
      1. middle suprarenal artery
   4. renal artery
      
      1. inferior suprarenal artery
2. veins
   
   1. right
      
      1. to the inferior vena cave
   2. left
      
      1. left suprarenal vein(deep to the mesenteric artery)
      2. inferior vena cava

Question 13

describe the nerves supply to the suprarenal gland

Answer 13

1. presymp fibers: greater, lesser and least splanchnic nerves
   
   1. preganglionic nerve fibers with in the adrenal medulla
      
      1. postganglionic fibers - to blood vessels

Question 14

important vasculature that lies at T12

Answer 14

aortic hiatus of the diaphragm

Question 15

where is the aortic haitus and the bifurcation into the common iliac

Answer 15

T12

L4

Question 16

list the posterior, terminal, paired and unpaired visceral arteries from the abdominal aorta

Answer 16

1. posterior
   
   1. inferior phrenic
      
      1. diaphragm
   2. lumbar arteries
      
      1. 4 pairs
      2. posterior wall of abdominal muscles
   3. median sacral artery
2. terminal
   
   1. common iliac arteris
3. paired
   
   1. middle suprarenal artteries
   2. renal arteries
      
      1. kidneys and inferior portion of the suprarenal gland
   3. testicular or ovarian artery
      
      1. testes/ ovaries
4. unpaired
   
   1. celiac artery L1
      
      1. forgut
   2. mesenteric
      
      1. L2
   3. inferior mesenteric
      
      1. L3

Question 17

describe the formation of the inferior vena cava- 11 tributaries

Answer 17

1. formed by union of common iliac - L5
2. tributaries
   
   1. common iliacs
   2. 5 lumbar veins
      
      1. 1&2 drain in azygos and hemiazygos via lumbar vein
      2. 3&4 drain directly into the IVC
      3. 5 drains in IVC via iliolumbar vein
   3. righ gonadal vein
   4. renal veins
      
      1. left drain left gonadal and suprarenal
   5. right suprarenal
   6. inferior phrenic
   7. hepatic veins

Question 18

what acts as a collateral channel between upper and lower parts of the body in the IVC is blocked

Answer 18

azygos and hemiazygos

Question 19

largest lymphatic vessel

Answer 19

thoracic duct- drains all of the body below the diaphragm and the left half of the body avove the diaphragm

Question 20

chief muscle of inspiration

consists of.

attachements

Answer 20

diaphragm

1. central tendon
2. peripheral muscle fibers convergin to insert into the central tendon
3. domes
   
   1. right
      
      1. arches as high as 5th rib
   2. left
      
      1. arches to 5th intercostal space

attachments

1. xiphoid process (sternal part)
2. lower 6 costal cartilages and ribs
3. lumbar vetwebrae and associated aponeurtotic arches (lumbar portion)

Question 21

draw/describe the lumbar attachments of the diaphragm

Answer 21

1. right crus
   
   1. L1-3
2. left crus
   
   1. L1-2
3. median arcuate ligament
   
   1. arching over the aorta
4. medial arcuate ligmanet
   
   1. arching over the psoas major
5. lateral arcuate ligament
   
   1. arching over the quadratus lumborum

Question 22

apertures in diaphragm

1. border and name for aperture that allows the IVC and right phrenic nerve. what level of the spine?
2. border and name for aperture that allows the esphagul and anterior/posterior vagal nerve to pass. what level of the spine?

Answer 22

1. caval opening
   
   1. central tendon
   2. T8
2. esophageal hiatus
   
   1. muscle of the right crus for the esphagus
   2. level T10

Question 23

describe the aortic hiatus, nerves and vessels involved with the daphragm

Answer 23

1. passagways
   
   1. aortic haitus-anterior to T1/posterior to arcuate median ligament
      
      1. aorta
      2. thoracic duct
      3. sympathetic trunk
2. nerves
   
   1. left phrenic nerve- pierces the diaphragm muscle
   2. right phrenic nerve- passes with IVC in the Caval Opening
   3. splanchnic nerves
      
      1. greater and lesser pass throug hthe crura on either side.
3. arteries
   
   1. hemiazygos vein passes throug hthe left crus
      2.

Question 24

descreibe the innervation of the diaphragm: motor vs sensory.

Answer 24

1. motor
   
   1. phrenic nerves
      
      1. anterior rami C3-C5​
2. sensory
   
   1. phrenic nerves
      
      1. orgin to septum transversum
   2. lower 6 intercostal and subcostal nerves (T5-T12)
      
      1. Orgin to mesoderm from body wall
3. referred pain from diaphragm
   
   1. 2 different areas based on sensory innervation
      
      1. phrenic nerves- C3-C5
      2. T5-T12, costal margin of anteriolateral abdominal wall from peripheral regions of diaphragm

Question 25

what could lead to paradoxical movement of the diaphragm?

Answer 25

one phrenic nerve is injured -> hemidiaphragm, ipsilateral paralysis.

leads to a paradoxical movement.

Question 26

describe/draw the blood supply of the diaphragm

Answer 26

1. arteries
   
   1. superior surface
      
      1. pericardiacophrenic
      2. musculophrenic
      3. superior phrenic
   2. inferior surface
      
      1. inferior phrenic
2. veins
   
   1. superior surface
      
      1. pericardiacophrenic
      2. musculophrenic- tributaries to internal thoracic veins
   2. inferior surface
      
      1. right inferior phrenic->IVC
      2. left inferior phrenic ->supra renal vein

Question 27

what are the muscles in contact and their involvment with the abdominal wall?

Answer 27

1. iliopsoas
   
   1. two muslces
      
      1. psoas major
         
         1. spinal nerves-nerve-L1-L3
      2. illiacus
         
         1. femoral nerve-L2-L4
   2. origin- T12-L5 inserts= lesser tronchanter
   3. funciton
      
      1. flexes the thigh(from below) and the trunk(from above)
2. psoas minor
   
   1. present in 60% of people
   2. T12-L1
   3. innervated- L1
   4. function
      
      1. weak flexion of the trunk
3. quadratus lumborum
   
   1. origin= iliac crest, insert= 12th rib and lumbar transverse processes
   2. innervated by T12-L4
   3. funciton
      
      1. bilateral flexion
         
         1. stabalize 12th rib
      2. unilateral flexion
         
         1. lateral flexion

Question 28

lumbar plexus

1. contributions
2. location
3. branches- anterior/posterior and lumbar involved

Answer 28

1. contirbutions
   
   1. anterior rami
      
      1. spinal nerves L1- L4
   2. subcostal
      
      1. T12
2. origin
   
   1. anterior to the transverse processes of lumbar vertebrae, embedded with in the psoas major muscle
3. branches
   
   1. anterior
      
      1. genitofemoral nerve-L1-2
   2. medial
      
      1. obtorator-L2-4
   3. lateral
      
      1. iliohypogastric-L1
      2. ilioinguinal-L1
      3. femoral-L2-4
      4. lateral cutaneous nerve of the thigh

Question 29

describe/draw lumbar plexus

1. origin(5)- destination(9)
2. cutaneous involvment

Answer 29