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Retroperitoneal Organs of PAW Flashcards

1
Q

The retroperitoneum

A
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2
Q

Contents of the Retroperitoneum abbreviation

A

PEAR DUCKS

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3
Q

Contents of the Retroperitoneum: PEAR DUCKS:

A
  • Pancreas
  • Oesophagus
  • Aorta & IVC
  • Rectum
  • Duodenum
  • Ureter
  • Colon
  • Kidneys
  • Suprarenal glands
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4
Q

Contents of the Retroperitoneum

A
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5
Q

The kidneys lie in the

A

Paravertebral gutter formed by the angle (renal angle) between erector spinal and the quadratic lumborum muscles (psoasmuscles too)

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6
Q

Which parts of the large intestine are NOT retroperitoneal?

A
  • transverse colon is intraperitoneal
  • sigmoid colon is intraperitoneal
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7
Q

Kidney basics structure

A
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8
Q

Order of structures at the Hilum of kidney anterior to posterior

A

Renal vein, renal artery, ureter

VAU

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9
Q

Kidney function abbreviation

A

A WET BED

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10
Q

Kidney function: A WET BED:

A

I

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11
Q

Kidney structure

A

Renal pyramids ending in papilla, where collecting ducts of nephrons emerge
Minor Calyces (8-10) joint to form major calyces (4-6)
Renal sinus contains fat

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12
Q

Transpyloric plane

A

Through the lower order of L1 vertebra Posteriorly and across 9th CC anteriorly

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13
Q

Calyx is

A

Collecting duct

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14
Q

A kidney will typically have how many major calyces?

A

4-6

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15
Q

Renal columns are

A

Extensions of cortex between medulla

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16
Q

Which kidneys lies lower and why?

A

Right lies lower than left due to the presence of the liver

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17
Q

Anterior Relationships of the Right Kidney:
Anterior:
Medial:
Superior:
Posterior:

A
  • anterior: hepatic flexure of colon, liver
  • medial aspect of kidney: 2nd duodenum
  • superior: adrenal gland
  • posterior: diaphragm, adrenal gland???
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18
Q

What is the problem with using the umbilicus as a surface marking?

A

Not in a fixed position
Variable

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19
Q

Anterior Relationships of Left Kidney:

A

Anterior: splenic flexure of Large bowel
Pancreas tail over upper pole and Hilum
Left suprarenal gland lies on top
Spleen is anterior and superior

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20
Q

Kidneys posterior relationships

A
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21
Q

Posterior Relationships of the Left Kidney:

A

Left kidney sits on top of iliohypogastric nerve and ilioinguinal nerve
Psoas muscle lies on top of left kidney
Quadratus Lumborum lies on top of Psoas

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22
Q

Kidneys anterior relationships

A
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23
Q

Kidneys posterior relationships

A

Insert diagram

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24
Q

Upper pole and lower pole of kidney to midline distance

A

Upper Pole: 5cm
Lower Pole: 15cm

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25
Q

Kidney: Fascia and Coverings:

A
  • renal fascia envelops kidney and adrenal gland
  • perinephric fat is loose fatty i tissue inside renal fascia
  • paranephric fat is OUTSIDE gerotas fascia
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26
Q

If a surgeon approaches a kidney Posteriorly, what must be cut through T to reach blood vessels?

A

Renal fascia (Gerota’s fascia) and perinephric fat

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27
Q

The left renal vein is located under which artery?

A

The superior mesenteric artery

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28
Q

Aorta anteriorly 3 branches are

A

Coeliac trunk
Superior mesenteric artery
Inferior mesenteric artery

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29
Q

Renal arteries arise from

A

The lateral border of the aorta

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30
Q

In 70% of people there are three or more renal arteries.

True or False?

32
Q

Kidney blood supply

33
Q

Segmental arteries

A

Open down brodel line to avoid damage to major arteries

34
Q

Segmental arteries anastomose.

True or False?

A

False
Segmental arteries are end arteries
Run risk of scarring of tissue supplied by a blocked segmental artery

35
Q

Which renal vein is shorter?

A

IVC more to the right of midline
Right renal vein is shorter

36
Q

gonadal veins on the right side drain directly into IVC and left side drain into renal vein.

True or False?

37
Q

Adrenal vein on right drains directly into the IVC and on the left drains into the left renal vein.

True or False?

38
Q

Why is it easier to transplant a left kidney than a right?

A

Renal vein on left is longer and easier to anastomose

39
Q

Lumbar veins on the left may drain into the renal vein. Implication on surgery?

A

On both sides if cutting renal vein may cut into a lumbar vein which drains directly into IVC.

40
Q

Venous drainage of the bowels is

A

Into separate Azygous system of veins

41
Q

Kidney venous drainage

42
Q

Retroperitoneal nerve supply: ——— plexus (4):

A

Preverterbral plexus:
- coeliac plexus
- aortic plexus
- superior hypogastric plexus
- inferior hypogastric plexus

43
Q

Prevertebral plxus provide preganglionic and visceral afferents:

  • sympathetic:
  • parasympathetic:
  • preganglionic parasympathetic fibres
A
  • sympathetic: thoracic and lumbar splanchnic nerves
  • parasympathetic: Vagus CNX
  • parasympathetic: pelvic splanchnic nerves
44
Q

Retroperitoneal nerve supply

45
Q

Nerve supply retroperiotneal

46
Q

Renal and ureteric pain

A

Insert slide

47
Q

Pain afferents from all abdominal viscera pass

A

Retrogradely back to the spinal cord through thoracic and lumbar splanchnic nerves T5-L2

48
Q

Pain afferents from pelvic viscera follow

A

Pelvic splanchnic parasympathetic nerves S2-4 into the cord and largely confined to the pelvic regions

49
Q

Lymphatics of kidneys

50
Q

Lymphatics of Retroperitoneum:

A

Internal iliac nodes drain pelvis. External iliac nodes drain legs. Pre-aortic chain formed on top of aorta, para-aortic nodes on the side, all join to form cisterna chyli which drain into the thoracic duct

51
Q

Applied anatomy of kidneys

52
Q

Difference in shape between right and left adrenal glands?

A
  • right is pyramidal
  • left is semi-lunar
53
Q

Right renal grand location

A

On top of upper pole of right kidney tucked away behind IVC

54
Q

Left renal gland location

A
  • larger, crescent shaped, sits medial to the upper pole
55
Q

Blood supply to renal glands

A
  • superior branch of suprarenal arteries (branch of infraphrenic)
  • middle suprarenal artery (branch of aorta or renal artery)
  • inferior suprarenal artery is a branch of renal artery
56
Q

Veins of renal glands

A
  • one vein per each
  • right directly to IVC, left into left renal vein
57
Q

Adrenal glands: Position and blood supply:

58
Q

Suprarenal Gland internal structure and function:

A
  • Cortex:
    • corticosteroids (cortisol, aldosterone)
      - adrenal androgens (sex hormones)
  • Medulla:
    - adrenaline
59
Q

Nerve supply of suprarenal glands

A

Sympathetic Innervation: T8-L1
(Greater, lesser,least splanchnic)

60
Q

Nephron structure

61
Q

Renal cortex and Medulla

62
Q

Ureteric anatomy

63
Q

Ureteric blood supply

A

Proximal ureter = renal artery
Bottom part of ureter: internal iliac branches

64
Q

Which parts of ureter have good blood supply?

A

Pelvic ureter has good blood supply, as has proximal ureter but mid ureter blood supply is relatively poor

65
Q

Bladder anatomy

66
Q

Key features of bladder anatomy:

A
  • urinary bladder is highly distensible
  • deter us or muscle forms the bulk of bladder wall
  • body base apex neck trigone
  • lining transition cell epithelium
67
Q

Urethra

68
Q

Innervation of lower urinary tract

69
Q

Innervation of lower urinary tract

70
Q

Innervation of lower urinary tract

A

Insert table

71
Q

Sites of ureteric obstruction

72
Q

Narrow points of ureter (3):

A
  • exit out of kidney at PUJ
  • crossing sacral iliac joints
  • enters muscle wall of bladder
73
Q

Exctraperitoneal bladder injuries are not as severe as intraperitoneal because

A

Intraperitoneal urine will fill pelvic cavity
Extraperitoneal fat

74
Q

Trigone of bladder

A

Ureter orifices where ureters pass into the bladder Posteriorly

Smoother area behind orifices because comes from mesenteric duct embyologically

Activation of nerve endings in trigone results in need to urinate

NME (52 decks)

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