Recap lecture 10 abdomen Flashcards
What are the 4 main parts of the abdomen?
1) Abdominal wall
2) Abdominal cavity
3) Peritoneal cavity
4) Viscera
What innervates the viscera pre-splenic flexure?
Vagus nerve
What does the pelvic brim separate?
Greater pelvis of abdominal cavity and lesser pelvis of pelvic cavity
What is the superior part of the ilium bones called?
Iliac crest
1) What is the most medial anterior part of the pelvis called?
2) What is superior and slightly lateral to this?
1) Symphysis
2) Pubic tubercle
What is the importance of the linea alba?
If you cut vertically down it you won’t cut through muscle.
(goes from xyphoid process, through umbilicus, to pubic symphysis)
What are the layers of the anterolateral abdominal wall? (from superficial to deep)
1) Skin
2) Superficial fascia (SQ)
3) Investing (deep) fascia
4) Endo-abdominal fascia
5) Extraperitoneal fat
6) Parietal peritoneum
What covers external aspects of 3 muscle layers of abdominal wall and their aponeurosis?
Investing (deep) fascia
What are the two layers of the superficial fascia of the anterolateral abdominal wall? Describe each
1) Camper fascia: fatty layer
2) Scarpa fascia: deep membranous layer
Where is the superficial fascia of the abdomen found? How many layers does it have?
Inferior to umbilicus; 2 layers
What does the parietal peritoneum line?
Abdominal cavity
Where in the abdomen is there a potential space for fluid/infection to spread?
Between scarpa fascia and deep fascia covering abdominal muscles
What does the Scarpa fascia attach and fuse to?
Attaches to pubic bone and fuses with deep fascia of thigh
List the 5 paired muscles of the abdominal wall
-3 flat muscles: External oblique, internal oblique, transversus abdominis mm.
-2 vertical muscles: Rectus abdominis, pyramidalis mm.
What forms the aponeurosis anterior?
Flat muscle
1) What encloses the rectus abdominis?
2) What does enclosing structure then form at the midline?
1) Rectus sheath
2) Linea alba
Where does the linea alba run from and to?
Xyphoid to pubic symphysis
What are the anterolateral abdominal muscles? (6)
1) Obliques: EO, IO, TA
2) Rectus: rectus sheath, linea alba
3) Pyramidalis
1) What encloses the pyramidalis muscle? Where is it?
2) What does it arise from and insert into?
3) When does it tense?
1) Rectus sheath; pyramidalis is anterior to inferior part of rectus m.
2) Arises from pubic crest, inserts into linea alba
3) During Valsalva maneuver
What is the aponeurosis of flat abdominal muscles?
Rectus sheath
What are the 3 sections of the rectus sheath?
1) Superior to arcuate line
2) Arcuate line
3) Inferior to arcuate line
Superior to the arcuate line:
1) What makes up the anterior rectus?
2) What makes up the posterior rectus?
1) Anterior: EO fascia + anterior lamina of IO
2) Posterior: Posterior lamina of IO + TA fascia
(eo is external oblique, io is internal oblique, TA is transversus abdominis
1) Where is the arcuate line?
2) What does it demarcate?
1) 1/3 distance from umbilicus to pubic symphysis
2) The transition between the posterior rectus sheath covering the superior ¾ of the rectus abdominis proximally, and the transversalis fascia covering the inferior ¼
At the arcuate line, what pierce the posterior rectus sheath to provide blood to rectus muscle?
Inferior epigastric arteries and veins
1) What 2 muscles are contained within the rectus sheath?
2) What vessels are enclosed within it?
3) What nerves are enclosed within it?
1) Rectus abdominis m. and pyramidalis m.
2) Anastomosing inferior and superior epigastric vessels, lymphatics
3) Thoraco-abdominal and subcostal nerves (anterior rami of distal T7-12 spinal nerves)
What are the 5 peritoneal folds that pass toward the umbilicus?
1) Median umbilical fold (ligament) (remnant of urachus, which is the apex of fetal bladder to umbilicus)
2&3) R & L medial umbilical fold (ligament) (umbilical arteries remnant)
4&5) R & L lateral umbilical fold over Inferior Epigastric a
What is the urachus? What is a remnant of it?
The apex of fetal bladder to umbilicus; median umbilical fold (ligament)
What is the remnant of the umbilical arteries?
Right and left medial umbilical folds (ligaments)
The right and left lateral umbilical folds are over what?
Inferior epigastric arteries
1) Where are indirect inguinal hernias found?
2) Where are direct inguinal hernias (straight through inguinal triangle) found?
1) Lateral inguinal fossa
2) Medial inguinal fossa
There’s a small amt of peritoneal fluid in abdominal cavity; abnormal accumulation is called what?
Ascites
Visceral pain tends to be with _____________ of GI tract
distention
Describe the associated organs of the abdominal cavity
1) Liver: produces bile which helps digest fats
2) Pancreas: secretes pancreatic enzymes to help with digestion via exocrine process
3) Spleen: immune and hematological functions, can add RBCs
Superficial to the pelvic diaphragm and deep to the skin is the ________________.
perineum
List the 4 dermatomes of the abdomen. Where are they, and what does each innervate?
1) Thoracoabdominal: T7-11
-Lateral and anterior branches (of intercostal segmental nerves)
2) Subcostal: T12
-Lateral and anterior branches
3) Iliohypogastric: L1
-Skin over iliac crest, upper inguinal and hypogastric region
4) Ilioinguinal: L1
-Skin of scrotum or labia majorus, mons, adjacent medial aspect of thigh (afferent for cremaster reflex)
Infection below umbilicus will infect ___________ nodes first, chest infection will affect the ______________ lymph nodes
inguinal; axillary
What vein runs up the lateral side of the abdomen? What does it come from and turn into?
Thoraco-epigastric vein from superficial epigastric (from femoral) turns into lateral thoracic vein
1) Where does the inguinal ligament run from?
2) What forms the inguinal ligament?
1) ASIS to PUBIC tubercle
2) Inferior margin of EO
1) What does the inguinal canal do?
2) What is responsible for much of the structural features of the inguinal canal/ region
1) Allows structures to travel between abdominal cavity and scrotum
2) Descent of testis from abdomen into perineum during development; “vascular and nerve follow the bouncing ball”
What structures are inferior (not to be confused w deep) to the inguinal ligament? What can one of them cause?
1) Lateral cutaneous nerve of the thigh (compression can cause meralgia parasthetica)
2) Femoral canal with: femoral n., fem art, fem vein (VAN)
1) The internal surgical landmark corresponding to the inguinal ligament is the ____________________
2) What does the EO form?
3) Which is important to surface anatomy, inguinal ligament and iliopubic tract?
1) Iliopubic tract
2) Inguinal ligament
3) Inguinal ligament
VANs are __________to inguinal ligament, and inferior epigastric nerves are _____________ to deep ring
inferior; lateral
1) What makes up the inguinal triangle? (3 things)
2) A direct hernia pushed through triangle medially to what?
1) Rectus, inguinal ligament, inferior epigastric vessels
2) Inferior epigastric vessels
What is the clinical application of the fact that the ligament follows spermatic cord from internal ring?
Direct hernias don’t go all the way into scrotum usually, but indirect hernias that follow the spermatic cord can go into the testicles
What’s the difference between a direct and indirect hernia?
1) Direct hernia: hernia sac pushes MEDIAL to inferior epigastrics thru peritoneum, transversalis fascia and inguinal triangle, parallels spermatic cord, weakness in anterior abd wall, usually > 40 y/o
2) Indirect hernia: hernia sac inside spermatic cord, younger men, patency of processus vaginalis
Inferior epigastric vessels follow what?
Arcuate line
1) What is a hydrocele? What side is it more common on?
2) What is a varicocele? What side is a pampiniform plexus varicocele usually on?
1) Buildup of fluid in scrotum; equally common bilaterally
2) Varicose vein in scrotum; benign usually on left side because the right comes out of IVC at a different angle.
1) What is the cremaster muscle a continuation of?
2) What does its contraction do?
3) What innervates it?
4) What reflex is it involved in? Explain this reflex.
1) IO muscle
2) Raises the testicle
3) Genital branch of the genitofemoral nerve
4) Cremaster reflex: reflex is elicited (very active in kids) by stroking the inner thigh, afferent via ilio-inguinal n., efferent genitofemoral n.
What is the Dartos muscle and what does it do?
1) Smooth muscle in the wall of the scrotum (gentofemoral nerve innervates?)
2) Contraction of skin of scrotum; wrinkles
What muscles (2) and veins (1) help keep the testicle close to body in cold temps?
1) Cremaster muscle and dartos muscle
2) Pampiniform venous plexus
What do the parietal and visceral layers of the tunica vaginalis make up?
1) Parietal: Cavity of the tunica vaginalis
2) Visceral: Testis
What do the testicular arteries arise from?
Abdominal aorta (L2)
-What do the left and right testicular veins empty into?
-In which testicular vein are varicoceles more common? Where are they concerning?
1) Left testicular vein empties into left renal vein
-Varicocele more common
2) Right testicular vein empties into IVC
-Varicocele concerning for IVC mass; renal cell carcinoma
What are the endocrine and exocrine functions of the testes?
1) Endocrine function: Testosterone
2) Exocrine function: Sperm
Where is fluid located in the scrotum?
Tunica vaginalis
List the nerves of the scrotum and what each innervates
1) Genital br. of the genitofemoral n: to anterolateral surface
2) Ilioinguinal n: to anterior surface
3) Perineal br of Pudendal nerve: to posterior surface
4) Perineal br of posterior cutaneous nerve: of the thigh
1) Where does vascular supply and drainage of the scrotum come from?
2) Where do the scrotal lymphatics drain? How is this different from testicular lymphatics?
1) Pudendal vessels
2) To superficial inguinal nodes
-Testicular lymphatic drainage: goes to midline (pre-aortic) nodes
What provide the afferent and efferent parts of the Cremaster reflex?
1) Afferent: ilio-inguinal nerve
2) Efferent: genital br. of the genitofemoral nerve
1) Where does lymph from the scrotum drain?
2) Where does lymph from the testes drain?
3) What does this explain?
1) To the inguinal lymph nodes and veins
2) To the pre-aortic lymph nodes
3) Difference in area at risk from cancer and infection of testes vs. scrotum
1) What makes up the abdominopelvic cavity?
2) What makes up the thoracic cavity?
1) Peritoneum and viscera
2) Pleura, mediastinum, viscera
What are the two layers of the peritoneum? What does each line?
1) Parietal peritoneum: lines internal surface of the abdominopelvic wall
2) Visceral peritoneum: covers viscera; retro peritoneal and intraperitoneal visceral
1) What is the peritoneal cavity (space)?
2) What does it contain?
3) Is it closed or open in men and women?
1) Potential space between the parietal and visceral peritoneum
2) Thin fluid; peritoneal fluid, but NO ORGANS in this cavity (except ovaries in females)
3) Closed in males; open in females (fallopian tubes into uterus, cervix and vagina to exterior)
1) What is the mesentery? Describe it.
2) What type of communication does it provide the means for?
3) What property does it provide?
1) Double layer of peritoneum, occurs from invagination of peritoneum by organ, continuity of parietal and visceral peritoneum
2) Means for neurovascular communication between organ and body wall
3) Mobility (also allows torsion)
1) What is the peritoneal ligament?
2) What is the omentum? Where does it go from and to?
1) Double layer of peritoneum that connects organs or organ to body wall (falciform ligament connecting liver to anterior abdominal wall)
2) Double layered extension of peritoneum from STOMACH or proximal DUODENUM to adjacent organs
1) What organs are retroperitoneal?
2) What organs are intraperitoneal?
1) Retroperitoneal: kidneys, aorta, IVC, pancreas (except tail), ascending and descending colon, duodenum (except ampulla)
2) Intraperitoneal: stomach, spleen, transverse colon, jejunum and ilium
Where is the lesser omentum? What is deep to it?
Lateral to the curve of the stomach, continues behind greater omentum to portal triad; lesser sac
What 3 ligaments make up the greater omentum?
Gastrophrenic ligament
Gastrosplenic ligament
Gastrocolic ligament
What are the two ligaments that form the lesser omentum? What does one contain?
1) Gastrohepatic ligament
2) Hepatoduodenal ligament: contains portal triad: Portal vein, hepatic artery,& bile duct
1) What is the portal triad?
2) What does the lesser omentum’s omental foramen open into?
1) Portal vein, hepatic artery, & bile duct
2) Into omental bursa (lesser sac of peritoneal cavity)
1) What divide the greater sac?
2) What two compartments does this form?
1) Greater omentum (gastrocolic ligament) and transverse mesocolon (mesentery of transverse colon)
2) Supracolic and infracolic compartments
What do the supracolic and infracolic compartments contain?
1) Supracolic compartment – stomach, liver, spleen
2) Infracolic compartment – small intestines, colon
1) Where is the infracolic compartment?
2) What spaces are in this compartment?
3) What allows for free communication between the infracolic and supracolic compartments?
1) Lies posterior to Gr Omentum
2) Right and left infracolic spaces
3) Right and left Paracolic gutters
1) What is an omental bursa hernia (internal hernia) of the peritoneal cavity?
2) What can it cause?
1) Abdominal contents from infracolic region cause internal herniation; where a piece of omentum or small intestine goes through the bursa to the lesser sac
2) Can cause strangulation of herniated tissue.
Fluid from a ruptured appendix can do what?
Go up right paracolic gutter up into hepatorenal recess, subphrenic recess, or subhepatic space
1) What supplies the midgut? Be specific about the boundaries of this area
2) What supplies the hindgut? Be specific
1) SMA
-second part of duodenum to splenic flexure of colon (transition point)
2) IMA
-splenic flexure of colon to the sigmoid colon & superior rectal aa
1) What supplies the thoracic esophagus with blood?
2) What supplies the foregut? Be specific about the boundaries of this area
1) Esophageal arteries
2) Celiac trunk
-Abdominal esophagus to the descending (2nd part) of duodenum where bile duct enters (transition point)
Where does the aorta bifurcate?
About L4-5; sacral plane (iliac crests); 2-3 cm inferior and to the left of the umbilicus
Is McBurney’s point somatic or visceral pain?
Somatic
Initial pain around T10 dermatome (periumbilical) that transitions to RLQ pain is likely what?
Appendicitis
What is the esophageal hiatus also called?
(Distal) esophageal sphincter
1) What is the esophagogastric junction/ where is it?
2) Is the esophagus retroperitoneal or intraperitoneal in the abdomen?
3) What is the difference between the gastric mucosa and esophageal mucosa?
1) It’s the “Z” line; abrupt transition in mucosa; left of the midline, 7th costal cartilage/T11
2) Retroperitoneal in abdomen
3) Esophageal mucosa is not well-suited to high-acidity like gastric juices, gastric mucosa is because it has tight junctions and lots of mucous cells.
1) What makes up the esophageal muscle layers?
2) What are the 3 esophageal muscle layers?
-Somatic blended into visceral muscle
1) Superior 1/3: voluntary m.
2) Middle 1/3: transition
3) Inferior 1/3: smooth m.
What part of the stomach does the esophagus enter? What is right next to that area?
Cardia; cardial notch
The bile and main pancreatic duct enter the posteromedial wall via hepatopancreatic ampulla at what part of the small intestine?
Descending (2nd) part of the duodenum
What part of the small intestine is between aorta and SMA?
Inferior (horizontal/ third) part of the duodenum
What are the first 2cm of the duodenum called? What is unique about it?
Ampulla or duodenal cap; it’s “free” suspended by mesentery
What does the hepatoduodenal ligament containing the portal triad demarcate?
The end of the ampulla or duodenal cap (first 2cm of duodenum) being suspended freely be mesentery; it’s intraperitoneal after this point
1) Suspensory ligament of duodenum (ligament of Treitz aka suspensory muscle of the duodenum) is located where?
2) What is its significance?
1) Duodenojejunal flexure
2) Clinically divides “upper GI” from “lower GI” tract
1) What artery has branches that runs between layers of mesentery in the jejunum and iliac regions?
2) Where does it go?
1) Superior mesenteric artery (SMA)
2) Sends many branch arteries to jejunum & ilium, unite to form loops or arches called arterial arcades which gives rise to vasa recta
Semilunar folds and haustra are characteristics of what part of the intestine?
Cecum
1) Is the ascending colon retroperitoneal or intraperitoneal?
2) What is its feature? What artery supplies this pt of the colon?
3) What flexure is here?
1) Retroperitoneal
2) Right paracolic gutter; SMA
3) Right colic or hepatic flexure
1) Describe the mobility of the transverse colon. Why is it this way?
2) What supplies this part of the colon?
3) What flexure is here?
1) Mobile due to transverse mesocolon, often swings inferior to umbilicus or below
2) Mostly SMA
3) Left colic or splenic flexure
1) Is the descending colon retroperitoneal or intraperitoneal?
2) What is its feature?
3) What supplies this part of the colon with blood?
1) Retroperitoneal
2) Left paracolic gutter
3) IMA
All lymph drainage of the abdomen ultimately goes where?
To thoracic duct
True or false: the abdomen has a rich supply of lymph nodes and spread of infection and or metastatic spread of cancer can be vast
True
All the lymph vessels, arteries, and nerves that supply the large intestine are where?
Within the mesentery/ retroperitoneal
1) What is ischemic colitis?
2) What is the area most affected by this called?
1) Reduced blood flow
2) “Water shed” area.
What are the two anatomical arterial transitions in the gut
1) Duodenum has artery supply from 2 different vessels
-1st and 2nd part via celiac trunk via supraduodenal and gastroduodenal aa.
-3rd and 4th part of the duodenum to splenic flexure of colon via SMA via pancreaticoduodenal a.
2) Splenic or left flexure of the colon
-SMA and IMA
Duodenum has artery supply from 2 different vessels; what are they?
1) 1st and 2nd part via celiac trunk via supraduodenal and gastroduodenal aa.
2) 3rd and 4th part of the duodenum to splenic flexure of colon via SMA via pancreaticoduodenal a.
What two things supply the splenic or left flexure of the colon?
SMA and IMA
1) What type of gland is the pancreas?
2) Where is it? Is it retroperitoneal or intraperitoneal?
3) What are its three parts?
1) Accessory digestive gland
2) Retroperitoneal (almost all) against posterior wall
3) Head, body, tail
1) Describe the mobility of the spleen
2) What type of organ is it?
3) Is it intraperitoneal or retroperitoneal?
4) Where is it normally located? Where does it not descend below?
5) What vein drains it?
1) Mobile
2) Lymphoid organ
3) Intraperitoneal; suspended via mesentery
4) Normally rests on the left colic flexure and does not descend below costal arch
5) Drains via portal vein
1) Where is the tail of the pancreas and what’s unique about it?
2) Where does the pancreas drain lymph?
1) Adjacent to splenic hilum; only part of pancreas that’s intraperitoneal
2) Towards the midline
1) What forms the posterior wall of the omental bursa?
2) What about the anterior wall?
1) Pancreas
2) Lesser omentum and the stomach.
1) What does the sphincter of the bile duct do?
2) What does the sphincter of the pancreatic duct do?
3) What is the hepatopancreatic sphincter also called?
1) Controls flow of bile
2) Prevents reflux of bile into pancreatic duct
3) “Sphincter of Oddi”
Name two organs that are mobile because they have mesentery.
Spleen and stomach
1) What two things form the left sagittal fissure?
2) What does this fissure do?
1) Round ligament (umbilical vein) & ligamentum venosum (ductus venosus)
2) Separates the right and left livers (portal lobes)
1) What uses ductus venous to bypass the fetal liver?
2) What does this turn into after birth?
1) Umbilical vein
2) Round ligament & ligamentum venous
1) What bypasses the fetal lungs?
2) What does it turn into after birth?
1) Ductus arteriosus
2) Ligamentum arteriosus
-What two main things supply the liver with blood
Describe the oxygenation and origin of the blood in each, and how much of the liver each supplies.
-What do these two things divide into?
1) Hepatic Portal Vein (HPV) -75%
-Poorly oxygenated, nutrient dense blood from GI track
2) Hepatic Artery (HA) – 25%
-Oxygen rick blood from systemic circulation
-Both divide into right and left branches at or near portal hepatis then form Segmental branches
Describe the “in” and “out” of the liver
1) IN: Hepatic portal veins and hepatic artery
2) OUT: Hepatic veins + bile collecting system
1) What skips the liver?
2) What drains the liver of blood?
1) Systemic IVC
2) Hepatic vein (NOT the hepatic portal vein)
What make up the interlobular portal triads between liver lobules?
Hep artery, portal vein, bile duct
Portosystemic anastomosis:
1) What anastomose with the left gastric vein (portal)?
2) What is it called when this anastomosing area is dilated?
1) Esophageal veins via azygos v. (systemic)
2) Esophageal varices
Portosystemic anastomosis:
1) What anastomose with superior rectal veins continuing as the IMV (portal)?
2) What is it called when this anastomosing area is dilated?
1) Inferior and middle rectal veins via IVC (systemic)
2) Hemorrhoids
1) What is the hepatic nerve plexus derived from?
2) What do the hepatic nerve plexus nerves accompany?
3) Where do the sympathetic fibers here come from?
4) What about the parasympathetic fibers?
1) Celiac plexus
2) Branches of vessels
3) Celiac plexus
4) Parasympathetic fibers from CN X, Vagus n. via anterior and posterior Vagal trunks (from esophageal plexus)
1) What is cholelithiasis?
2) What is cholecystitis?
1) Stones in gall bladder
2) Inflammation/ infection of gall bladder often due to blockage of cystic duct
1) What is cholangitis?
2) What is pancreatitis?
1) A redness and swelling (inflammation) of the bile duct system that results from bacterial infection.
2) Inflammation of pancreas, often related to blocked duct by stone or alcohol use
1) Gallstones can occur in biliary passages; what is the most common location for impaction?
2) What is a cholecystectomy?
1) The narrowest site, the ampulla sphincter.
2) Removal of the gall bladder due to biliary colic
1) What artery should you keep in mind during a cholecystectomy?
2) What anatomically define the cystohepatic triangle?
1) Cystic a. most commonly arises off the right hepatic a. in the cystohepatic triangle (Calot triangle)
2) Cystic duct, common hepatic duct, and inferior surface of the liver
-Must be ID’d early in procedure to safeguards these structures, especially with anatomic variations
1) Where are the kidneys?
2) Where is the inferior pole of the kidneys? What varies between the two kidneys?
1) Lie posterior abdominal wall T-12 to L3 (umbilicus ~L3)
2) About level of umbilicus; right kidney a bit lower
Portosystemic anastomosis:
1) What anastomose with the superficial epigastric veins (systemic)?
2) What is it called when this anastomosing area is dilated?
1) Para umbilical veins of anterior abdominal wall (portal)
2) Caput medusa
1) Are the kidneys intraperitoneal or retroperitoneal?
2) What is the renal hilum (vertical cleft)?
3) What does the renal sinus contain?
1) Retroperitoneal
2) Entrance to the renal sinus
3) Mostly fatty tissue embedding renal pelvis, calices, vessels and nerves
1) What two things traverse the renal columns?
2) What is the apex of the renal pyramid (loops of Henle) called?
1) Renal artery and veins
2) Renal papilla
1) Are the ureters intraperitoneal or retroperitoneal?
2) What do they cross? Where?
3) What are its 3 important areas?
1) Retroperitoneal
2) Inferiorly cross external iliac just after bifurcation of common iliac and lateral wall of pelvis to bladder
3) The 3 areas of “constriction”
List the 3 areas of “constriction”/ potential sites of obstruction of the ureters.
What is the significance of these?
1) Ureteropelvic junction
2) Crossing external iliac vessels at sacrum
3) Ureter traverses bladder wall
-Most likely places to find a kidney stone stuck
1) What protects the adrenal/ supra renal glands?
2) What is the second layer of the adrenal glands? What two things does this structure secrete?
3) What is the thick inner layer of the adrenal glands called? What does this structure secrete?
1) Fibrous capsule
2) Cortex: secrets corticosteroids and androgens
3) Medulla: secrets catecholamines (epinephrine and norepinephrine)
What two things are different about the right renal artery when compared to the left one?
1) Longer
2) Passes posterior to IVC
1) Superior suprarenal arteries come from where?
2) Middle suprarenal arteries come from where?
3) Inferior suprarenal arteries come from where?
1) Inferior phrenic artery
2) Abdominal aorta near origin of SMA
3) Renal artery
1) Where does the renal artery divide? Into how many things?
2) Then what do those turn into?
1) Close to Hilum divides into 5 segmental a.
2) End arteries
What are the 3 ureter vascular supply sources?
1) Renal artery
2) Testicular or ovarian artery
3) Abdominal aorta
What are the 3 blood supply sources for the suprarenal glands? Were does each come from?
1) Superior suprarenal (6-8): from inferior phrenic a.
2) Middle (1+): from aorta near origin of SMA
3) Inferior (1+): from the renal artery
What does each renal vein of the kidneys drain into?
The IVC (NOT the hepatic portal)
Describe the route of the left renal vein. Is it longer or shorter than the right?
Left renal vein longer, passes anterior to aorta but under the SMA
What is the vein of suprarenal glands?
State whether the left or right one is shorter and which drains directly into the IVC
Large suprarenal vein;
1) Shorter right into IVC
2) Longer left into the left renal vein, then into IVC
1) Define cisterna chyli
2) What flows into here?
1) A dilated sac at the lower end of the thoracic duct (in most mammals)
2) Lymph from the intestinal trunk and two lumbar lymphatic trunks flow.
1) What vertebral level are the kidneys at?
2) What about the renal arteries?
3) What about the infra renal aorta?
1) T12-L3 (umbilicus ~ L3)
2) ~L1/2 (RAS)
3) ~L2/3 (AAA)
1) Generally, kidneys not palpable; why?
2) Where are the ureters? What is the significance of this?
1) Retroperitoneal and under ribs except for inferior poles
2) Occupy sagittal plane that intersects tips of transverse processes of lumbar vertebrae
-important radiographic landmark
1) Where is CVA tenderness?
2) Where is the transpyloric plane?
3) What is the scapular line?
1) Just below last rib
2) ~T-12: hilum of left kidney, superior pole right kidney
3) The sagittal line passing thru inferior angle of scapula
What are the veins of the posterior abdominal wall?
1) IVC (from two common iliac veins)
2) Portal venous system
What does the IVC drain blood from? (4 places)
LE, most of the back, the abdominal walls, pelvic viscera
What are the 8 tributaries of the IVC?
1) Common iliac veins
2) 3rd and 4th lumbar veins
3) Right testicular or ovarian veins (left via the left renal vein)
4) Right and left renal veins
5) Ascending lumbar veins + azygos/hemi-azygos veins – connect the IVC with SVC
6) Right suprarenal vein (left via the left renal vein)
7) Inferior phrenic veins
8) Hepatic veins
Which testicular/ ovarian veins are direct tributaries of the IVC, left or right? Where does the other one come from?
Right testicular or ovarian veins; left via left renal vein
What connect the IVC with SVC?
Ascending lumbar veins + azygos/hemi-azygos veins
1) Which suprarenal vein are direct tributaries of the IVC, left or right?
2) Which lumbar veins are tributaries of the IVC?
1) Right suprarenal vein (left via the left renal vein
2) 3rd and 4th
1) What part of what muscle is the lumbar plexus on?
2) What nerves does it come from?
3) Where does it supply motor innervation to?
1) Posterior part of psoas m.
2) L1-4 spinal nerves
3) Iliopsoas
