Retroperitoneal Structures

Question 1

Retroperitoneal

• What does it mean?
• Primary structures
• Secondary structures

Answer 1

• A structure that lies posterior to the parietal peritoneum
• Develop posterior to the peritoneum and stay that way. Kidneys, suprarenal glands, vessels and nerves.
• Covered by peritoneum during development and remains that way in adults. Most of duodenum, pancreas, ascending colon, descending colon and the upper 2/3 of the rectum.

Question 2

Kidneys

• Hilum
• Urinary tract

Answer 2

• @ approx L1. Renal vein and branches of the renal artery. Ureter is most posterior structure.
• Kidneys, ureters, bladder and urethra

Question 3

Relations of Right Kidney

• Anterior
• Posterior

Answer 3

• Suprarenal gland, liver (pushes it down a lot compared to left), 2nd part of duodenum and right colic flexture.
• Diaphragm, rib 12, psoas, quadratus lumborum, transversus abdominis and subcostal nerve (T12)

Question 4

Relations of the Left Kidney

• Anterior
• Posterior

Answer 4

• Suprarenal gland, spleen, stomach, pancreas, left colic flexture, jejunum.
• Diaphragm, ribs 11+12, psoas, quadratus lumborum, transversus abdominis, subcostal nerve.
• Better protected than right kidney by ribs 11 and 12. Sits behind the splenic flexure, stomach and spleen.

Question 5

Kidney Blood Supply and Lymph

• Renal arteries
• Renal veins
• Lymphatics
• Nerves

Answer 5

• Branches off aorta at L1, then into anterior and posterior branches, then into segmental arteries which enter the hilum. Right is longer and moves behind IVC.
• Veins go into IVC. Left is 3x longer than right and passes behind splenic vein and pancreas. Joined by gonadal vein and suprarenal vein.
• To lateral aortic nodes in the region of renal artery origin.
• From renal sympathetic pexuses. Afferent fibres enter the spinal cord at T10-12.

Question 6

Ureters

• Travels via
• Enters bladder at
• Urine propelled by

Answer 6

• From hilus over surface of psoas, across bifurcation of common iliac artery, lateral wall of pelvis towards ischial spine. Normally related to tips of lumbar transverse processes.
• Inferior surface through trigone
• Muscular contractions in the ureter wall.

Question 7

Ureter Constrictions

• First
• Second
• Third

Answer 7

• Junction of ureters and renal pelvis
• Where ureters cross pelvic brim
• As they enter the wall of the bladder

Question 8

Blood, Lymph and Nerve Supply to Ureters

• Arterial supply
• Venous supply
• Lymphatics
• Nerves

Answer 8

• Changes depending on location. Renal artery, testicular/ovarian artery, and superior vesical artery.
• Veins correspond to arteries
• Drains to lateral aortic nodes at level of L1, and iliac nodes
• From renal, testicular/ovarian and hypogastric plexuses. Afferent fibres to L1/L2

Question 9

Suprarenal Glands

• Right
• Left
• Arteries
• Veins
• Lymph
• Nerves

Answer 9

• Pyramidal. Behind right lobe of liver
• Cresenteric. Behind stomach, pancreas and lesser sac
• Suprarenal branches of inferior phrenic, aorta and renal arteries
• Single vein on either side. Right goes to IVC and left goes to left renal vein.
• Lateral aortic nodes
• Pre-ganglionic sympathetic from splanchnic nerves