Retroperitoneal organs of the posterior abdominal wall

Question 1

What is the retroperitoneal space?

Answer 1

A space within the abdominopelvic cavity

“Retro” refers to “behind”

-Whereas “intra” means “within”

Question 2

Where is the retroperitoneal space?

Answer 2

The space is posterior to the parietal peritoneum

Question 3

What are primary and secondary retroperitoneal structures?

Answer 3

• Primary develop in the retroperitoneally
• Secondary develop intraperitoneally and then become retroperitoneal

Question 4

What are the retroperitoneal structures?

Answer 4

Question 5

Which portions of the colon are retroperitoneal?

A.Ascending

B.Descending

C.Ileum

D.Jejunum

E.Transverse

Answer 5

A.Ascending

B.Descending

Secondary retroperitoneal

Question 6

What is the urinary system?

Answer 6

Question 7

Where are the kidneys?

Answer 7

Located on the posterior abdominal wall

Span from T12 - L3

Question 8

What are the kidneys responsible for?

Answer 8

• Regulating blood:
• ionic composition & pH
• volume & pressure
• Hormone production (e.g. calcitriol)
• Excretion of waste

Question 9

Kidneys recieve ~___% of cardiac output

Answer 9

20

Question 10

What are the 2 regions of the kidney?

Answer 10

• Cortex - Glomerulus
• Medulla - Collecting ducts

Question 11

Answer 11

Question 12

What happens in the kidney?

Answer 12

Blood is filtered at the glomerulus

Selective absorption of ions and water occurs

Urine is then passed into the ureters

Question 13

Lable the internal anatomy of the kidney

Answer 13

Question 14

Answer 14

Question 15

How are kidneys imaged?

Answer 15

Contrast radiography, CT or MRI needed

-Due to soft tissues

Question 16

What muscles are labelled?

Answer 16

Question 17

What is renal pain caused by?

Answer 17

• Stretching capsule, due to increased internal pressure
• Spasm of smooth muscle of the renal pelvis

Question 18

Where is renal pain felt?

Answer 18

Renal pain is generally referred to the cutaneous area of T12

-Territory of the subcostal nerve

Question 19

Where is renal pain felt?

Answer 19

Question 20

How is a renal transplant performed?

Answer 20

Fairly common surgical procedure - Video

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 21

Kidneys are the most prevalent organ to suffer _________

Answer 21

Kidneys are the most prevalent organ to suffer malformations

Question 22

What malformations can kidneys cause?

Answer 22

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

Question 23

Label the kidney malformation and the types shown

Answer 23

Question 24

Label the types of kidney malformation

Answer 24

Question 25

What blood vessel will prevent a horseshoe kidney from ascending to its anatomical position in the upper abdomen? A.Coeliac trunk B.Gonadal vein C.Inferior mesenteric artery D.Superior mesenteric artery E.Umbilical vein

Answer 25

C.Inferior mesenteric artery

Question 26

What are the suprarenal/adrenal glands?

Answer 26

Supra = above Separate from kidneys in own fascial compartment Shape: Right - pyramidal Left - semilunar

Question 27

What is the internal anatomy of the adrenal glands?

Answer 27

- Cortex: - Corticosteroids (e.g. cortisol) - Sex hormones (e.g. progesterone) - Medulla: - Adrenaline (epinephrine)

Question 28

Label the diagram

Answer 28

Question 29

What is the neurovascular supply to the adrenal glands?

Answer 29

- Sup., Mid. & Inf. suprarenal arteries - Suprarenal veins - Abdominopelvic n. (greater, less and least splanchnic)

Question 30

Why is the extensive blood supply to the adrenal gland functionally significant? A.Close relation to the abdominal aorta B.Close relation to the kidneys C.High metabolic rate D.It is an endocrine gland Removal of damaged red blood cells

Answer 30

D.It is an endocrine gland

Question 31

What are the ureters?

Answer 31

Muscular tubes to convey urine to the bladder

Question 32

How do kidney stones form?

Answer 32

Calculi can become lodged in the ureter preventing urine flow. The three narrowest points are: - Pelviureteric junction - Crossing iliac vessels/pelvic brim - entering bladder

Question 33

What is circled in red?

Answer 33

Calculi can become lodged in the ureter preventing urine flow. The three narrowest points are: - Pelviureteric junction - Crossing iliac vessels/pelvic brim - entering bladder (circled in red)

Question 34

Can kidney stones be seen on imaging?

Answer 34

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.

Question 35

Whats the diagnosis?

Answer 35

Question 36

How can CT urography be used?

Answer 36

-CT utilising contrast medium to highlight the urine production and excretion

Question 37

What are the causes of renal colic?

Answer 37

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

Question 38

What is the standard treatment for kidney stones? A.Diuretics B.IV fluids C.Laparoscopic surgery D.Pain management E.Shock wave lithotripsy

Answer 38

E.Shock wave lithotripsy

Question 39

What is the bladder?

Answer 39

The bladder is the distensible muscular sac which acts as a reservoir for urine

Question 40

What is the urethra?

Answer 40

The urethra is the muscular duct which conveys urine from the bladder to the external environment

Question 41

What are the 2 differences between male and female urethras?

Answer 41

- Length differs greatly between males and females - It also serves a reproductive purpose in males

Question 42

Which group is more likely to contract a urinary tract infection (UTI)? A.Children B.Females C.Males D.Smokers Under 30s

Answer 42

B.Females

Question 43

Which structures pass through the hilum of the kidney?

Answer 43

the renal vein and artery accompanying autonomic nerves and lymphatics pelvis of the ureter