Retroperitoneal Organs

Question 1

Retroperitoneal organs and structures

Answer 1

Primary: develop retroperitoneally
Secondary: develop intraperitoneally and then become retroperitoneal
PEAR DUCKS
Pancreas, esophagus, aorta & IVC, rectum, duodenum, ureter, colon, kidneys, suprarenal glands
(ascending and descending portions of colon are retroperitoneal)

Question 2

Urinary System

Answer 2

Produces and excretes urine
Spans the kidneys to the urethra
Kidneys – ureter – bladder – urethra
Kidneys and ureter are retroperitoneal
Bladder and urethra are extraperitoneal

Question 3

Kidneys

Answer 3

Located on posterior abdominal wall
Span from T12-L3
Responsible for regulating blood (ionic composition, pH, volume and pressure), hormone production, and excretion of waste
Receive 20% of cardiac output
Cortex - glomerulus (blood filtering)
Medulla - collecting ducts
Selective absorption of ions and water occurs, and urine is passed into ureters

Question 4

Renal Pain

Answer 4

Renal pain is generally caused by: Stretching capsule due to increased internal pressure; or spasm of smooth muscle of the renal pelvis
Renal pain is generally referred to cutaneous area of T12 - Territory of the subcostal nerve

Question 5

Renal Transplant

Answer 5

Fairly common surgical procedure
The implanted kidney is inserted into iliac fossa - Accessed via an incision over and parallel to the inguinal ligament
The vessels are then anastomosed - Renal artery to external iliac artery & Renal vein to external iliac vein
It is vital to tag which vessel is which
A ureterocystostomy is then done straight into bladder

Question 6

Kidney Malformations

Answer 6

Bilateral/unilateral renal agenesis
Supernumerary kidneys
Renal fusion
Ectopic kidney
Simple/polycystic kidney

Question 7

Suprarenal/Adrenal Glands

Answer 7

Separate from kidneys in own fascial compartment
Shape: right is pyramidal, left is semilunar
Internal anatomy: cortex - corticosteroids, sex hormones; medulla - adrenaline
Neurovascular supply: sup, mid and inferior suprarenal arteries, suprarenal veins, abdominopelvic nerves (greater, lesser and least splanchnic)

Question 8

Ureters

Answer 8

Muscular tubes to convey urine to the bladder
Clinical relevance: kidney stones
Calculi can become lodged in the ureter preventing urine flow
The three narrowest points are:
o Pelviureteric junction
o Crossing iliac vessels/pelvic brin
o Entering bladder

Question 9

Kidney Stones

Answer 9

Can be seen on plain film radiographs - Highlights the kidney stones as the soft tissue of the ureter is not generally visible on x rays
CT urography is also a useful method
CT utilising contrast medium to highlight the urine production and excretion
Cause of renal colic: pain caused by peristaltic movement of ureters trying to move the stone; generally felt in waves, but can also be felt on the skin
Shock wave lithotripsy is the standard treatment for kidney stones – less invasive than laparoscopic surgery

Question 10

Bladder and Urethra

Answer 10

The bladder is the distensible muscular sac which acts as a reservoir for urine
The urethra is the muscular duct which conveys urine form the bladder to the external environment; longer in males and serves reproductive purpose in males

Question 11

Renal Imaging

Answer 11

Contrast radiology, CT or MRI needed - soft tissues