Retroperitoneal Structures and Posterior Abdominal Wall Flashcards
Contents of Retroperitoneal Space
Part of the duodenum, most of the pancreas, ascending and descending colon, kidneys, suprarenal glands, major vessels, some muscles
Secondarily retroperitoneal organs
duodenum, pancreas, portions of colon
Layers of retroperitoneal Fascia
parietal peritoneum (anteriorly), transversalis fascia (laterally), thoracolumbar fascia (posteirorly), renal fascia to surround suprarenal glands, kidneys, ureters, major vessels, and fat.
Perinephric fat
Bury the suprarenal/adrenal glands
Relationship of kidneys to ribs
Left kidney–> 11th and 12th ribs
Right kidney–> 12th rib only, more inferior
function of renal medulla
Concentration of urine
Flow from renal papilla to ureter
renal papilla–> minor calyces–> major calyces–> renal pelvis–> ureter
Course of ureters
Course along transverse processes of lumbar vertebrae, cross the external iliac arteries, enter the posterolateral wall of the bladder
Blood supply of suprarenal glands
Superior suprarenal artery from inferior phrenic artery, middle suprarenal artery from aorta, and inferior suprarenal artery from renal artery
Branches of renal artery
inferior suprarenal artery, gonadal artery, arteries to ureter
Nutcracker syndrome
Congenital compression of left renal vein between the SMA and aorta. Can cause renal hypertension, swelling/pain in gonads,
Posterior abdominal wall muscles
Quadratus lumborum, psoas major, iliac, psoas minor
Innervation of quadratus lumborum
Ventral rami of T12, L1-L4
Innervation of psoas major
Lumbar plexus branches L2-L4
Positive psoas sign
Pain on contraction of psoas major can support diagnosis of inflamed appendix
Innervation of iliacus muscle
Femoral nerve L2-L4
Innervation of psoas minor muscle
lumbar peux branches L2-L4
Action of psoas minor
Weak flexor of trunk
Action of iliacus muscle
flexion, lateral rotation of the hip
Action of psoas major muscle
flexion, lateral rotation at the hip, lateral bending, flexion of trunk
Action of quadratus lumborum
Lateral bending of trunk
Origin of quadratus lumborum
Iliac crest
Origin of iliacus muscle
iliac fossa
Insertion of iliacus
lesser trochanter of femur
Insertion of psoas major
lesser trochanter of femur
Insertion of diaphragm
Central tendon
Lateral arcuate ligament
Passage of quadratus lumborum, subcostal neurovascular bundle
Medial arcuate ligament
Passage of psoas major, sympathetic trunk
Median arcuate ligament
forms aortic hiatus
Caval foramen
passageway for IVC at T8
Esophageal hiatus
esophagus, vagal trunks at T10
Aortic hiatus
aorta, thoracic duct at level of T12
Venous drainage of left gonadal vein
goes to left renal vein then to IVC
Venous drainage of ascending lumbar vein
goes to azygos/hemiazygos vein
Renal Fascia
surrounds kidney, suprarenal glands, ureters, major vessels, and fat
Medulla of adrenal glands
Target for preganglionic sympathetic fibers. It’s like a ganglion that secretes hormones.
Right adrenal gland
pyramid shaped, positioned between kidney and IVC, also in contact with bare area of liver.
Left adrenal gland
crescent shaped, sits right behind the body of the stomach, tucked behind the spleen, splenic artery, pancreas and stomach.
Venous drainage of kidney
Not a digestive organ so it does NOT go to the liver. It goes to IVC.
Function of kidney
excretion of waste, excess solutes, resorption of nutrients, critical role in maintaining blood volume and pressure.
What passes through the hilum of the kidney
renal artery, renal vein, ureter, nerves, and lymphatics
Blood supply to kidneys
Renal artery from aorta branches to segmental arteries (usually 5), then further subdivided into interlobar arteries.
Right renal artery relationship to IVC
Passes posterior to IVC
Inferior phrenic arteries
Branch off of abdominal aorta and supply diaphragm from inferior surface as well as adrenal glands
Middle suprarenal arteries
come right off of aorta?
Inferior suprarenal arteries
come off of renal artery
Location of the left renal vein
crosses over aorta, beneath superior mesenteric artery
right suprarenal veins
drain directly to IVC
left suprarenal veins
drain to renal vein then to IVC
