Retroperitoneum Flashcards
1
Q
What are the 5 muscles of the posterior abdominal wall?
A
Diaphragm Psoas major Psoas minor Quadratus lumborum Iliacus
2
Q
What muscle forms the superior most region of the posterior abdominal wall?
A
Diaphragm
3
Q
Where does the psoas major originate?
A
Lumbar vertebrae
4
Q
What muscles form the ilipsoas muscle?
A
Psoas major
Iliacus
5
Q
Where does the iliopsoas muscle insert?
A
Lesser trochanter of the femur
6
Q
Which muscle is a powerful flexor of the thigh?
A
Iliopsoas
7
Q
Where does the quadratus lumborum lie?
A
Lateral to psoas major
8
Q
Where does the quadratus lumborum originate?
A
12th rib
9
Q
Where does the quadratus lumborum insert?
A
Iliac crest
10
Q
The quadratus lumborum has an extra site of attachments before insertion. Where are they?
A
Transverse processes of lumbar vertebrae
11
Q
What are the 2 functions of the quadratus lumborum?
A
Flex spine laterally
Stabilize 12th rib during valsalva
12
Q
What nerves innervate the quadratus lumborum?
A
Branches of lumbar plexus
13
Q
What nerves innervate the psoas major?
A
Branch of the lumbar plexus
14
Q
Upon inspiration, the diaphragm flattens and squishes which 3 organs?
A
Liver
Spleen
Kidneys
15
Q
What 3 structures are where the diaphragm originates?
A
Xyphoid process
Ribs
Lumbar vertebrae
16
Q
What is a crura?
A
Part of the diaphragm that originates at the vertebrae
17
Q
Which side of the diaphragm is higher?
A
Right- liver pushes it up
18
Q
Where does the IVC pass through the diaphragm?
A
T8
19
Q
Where does the esophagus pass through the diaphragm?
A
T10
20
Q
Where does the aorta pass through the diaphragm?
A
T12
21
Q
2 structures pass through the crura. They are?
A
Thoracic splanchnic nerves (all 3)
Azygos vein
22
Q
Where does the sympathetic trunk lie in relation to the diaphragm?
A
Posterior
23
Q
There are 3 arteries that supply the diaphragm. What are they and their origins?
A
Pericardiophrenic - internal thoracic artery
Musculophrenic - internal thoracic artery
Inferior phrenic - abdominal aorta
24
Q
Which nerve(s) supply the motor innervation to the diaphragm?
A
Phrenic
25
Which nerve(s) supply the sensory information from the diaphragm?
Phrenic (central diaphragm)
| T6-T12 intercostals (periphery)
26
True or False. The entire diaphragm is covered in a serosa.
False. Most of it is covered by a sensitive serosa of peritoneum except where bare area of liver joins
27
Below the abdominal musculature but above the peritoneum lies which layer?
Transversalis fascia
28
Between which 2 layers lies the extraperitoneal space?
Peritoneum and transversalis fascia
29
The anterior extraperitoneal space is referred to as?
Properitoneal space
30
The posterior extraperitoneal space is referred to as?
Retroperitoneal space
31
Name the layers of the posterior abdominal wall inward from the muscles.
Posterior abdominal wall muscles --> transversalis fascia --> retroperitoneal space --> peritoneum --> posterior body organs
32
Where do the vessels and nerves enter the kidney?
Renal hilum
33
What is the renal sinus and where is it located?
Fatty concavity of the medial hilum
34
The outer 1/3 of the kidney is?
Cortex
35
The renal medulla contains?
Renal pyramids
36
Cortical tissue between the renal pyramids is called?
Renal columns
37
The pointed ends of the renal pyramids are?
Renal papillae
38
Renal papillae empty urine into?
Minor calices
39
Merging of minor calices forms what?
Major calices
40
Where does the urine collect in the kidney before leaving into the ureters?
Renal pelvis
41
The kidneys receive blood from?
Renal arteries
42
Trace the path of the right and left renal arteries.
Right- passes posterior to IVC and connects to aorta (left of vertebrae)
Left- direct path to aorta (left of vertebrae)
43
Trace the path of the left and right renal veins.
Right- posterior to descending duodenum to IVC (right side of vertebrae)
Left- anterior to aorta and posterior to SMA (in angle) to IVC (right side of vertebrae)
44
Where do the renal arteries branch from?
Abdominal aorta at L1 below the SMA
45
What structure enters the hilum most anterior? Most posterior?
Anterior- Renal vein
Middle- Renal artery
Posterior- Renal pelvis
46
Where do the kidneys lie in relation to the vertebral column?
T12 to L3
47
What do the kidneys rest against superiorly? Inferiorly?
Superiorly- diaphragm
| Inferiorly- quadratus lumborum
48
Where does one percuss for kidney tenderness?
CVA- between 12th rib and vertebral column
49
Which kidney is higher than the other?
Left kidney higher
| Right is pushed down by liver
50
Where do the adrenal glands lie on the kidneys?
Superior and medial
51
Do the adrenal glands directly contact the kidney?
No, there's a fibrous capsule between them
52
What are the layers of fat and fascia surrounding the kidney from the outside inward?
Outside --> pararenal fat --> renal fascia --> perirenal fat --> renal capsule
53
Where do the renal arteries branch?
Close to the hilum
54
What do the renal arteries branch into?
4 anterior and 1 posterior branch
55
If blockage of a renal artery occurs, how else does the kidney receive blood?
It doesn't! Renal arteries are end arteries and don't have any anastomosis
56
The adrenal glands lie within which layer surrounding the kidneys?
Renal fascia
57
The adrenal gland has two divisions. They are?
Cortex
| Medulla
58
The outermost layer of the adrenal gland is what? What does it secrete?
Cortex
| Corticosteroids
59
The innermost layer of the adrenal gland is? What does it secrete?
Medulla
| Epinephrine and norepinephrine
60
What three arteries supply the adrenal gland?
Superior suprarenal arteries
Middle suprarenal arteries
Inferior suprarenal arteries
61
The superior suprarenal artery is a branch of what?
Inferior phrenic artery
62
The middle suprarenal artery is a branch of?
Aorta
63
The inferior suprarenal artery is a branch of what?
Renal arteries
64
Where does the right adrenal gland blood drain?
Right suprarenal vein --> IVC
65
Where does the left adrenal gland blood drain?
Left suprarenal vein --> Left renal vein
66
As the ureter descends from kidneys to bladder, it passes:
Posterior to gonadal vessels
| Anterior to bifurcation of common iliacs
67
What 3 locations are where the ureters can become constricted?
1. Ureteropelvic junction
2. Pelvic brim (crossing common iliac vessels)
3. Ureterovesical junction
68
Where does the abdominal aorta enter the abdominal cavity?
T12
69
At what level does the abdominal aorta bifurcate?
Umbilicus!
L4
T10 dermatome
70
What does the abdominal aorta branch into?
2 common iliac arteries
71
Where does the abdominal aorta run in relation to vertebrae and IVC?
Anterior to vertebrae
| Left of IVC
72
How many visceral and parietal branches come from the aorta?
6 visceral
| 3 parietal
73
The branches of the aorta can be subdivided into 4 regions:
Ventral
Lateral
Dorsal
Terminal
74
See the sheet for abdominal aorta branches
Memorize this!!
75
IVC splits into common iliac veins where?
L5
76
Trace the collateral venous circulation starting with the segmental lumbar veins. What does this bypass?
Segmental lumbar veins --> ascending lumbar veins --> azygos/hemiazygos --> SVC
This bypasses the IVC!
77
Intraperitoneal viscera of the foregut lymph drains where?
Celiac nodes
78
Intraperitoneal viscera from the midgut lymph drains where?
Superior mesenteric nodes
79
Intraperitoneal viscera from hindgut lymph drains where?
Inferior mesenteric nodes
80
Where do primarily retroperitoneal organs lymph drain?
Right and left lumbar nodes (along aorta and IVC)
81
What are the three lymphatic trunks located in the abdominal cavity?
Right lumbar trunk
Left lumbar trunk
Intestinal trunk
82
Where do the right, left and intestinal trunks drain?
Cisterna chyli
83
What do the right and left lumbar trunks drain?
Legs, pelvis, urogenital system, abdominal wall, abdominal viscera
84
What do the intestinal lymph trunks drain?
Celiac, superior and inferior nodes
85
Primarily retroperitoneal organs are innervated by which sympathetic nerves?
Thoracic splanchnics
86
Where do the thoracic splanchnics synapse?
Paravertebral/Pre-aortic ganglia
87
What parasympathetics innervate the retroperitoneal organs?
Vagus nerve
88
Somatic structures like the posterior muscles are innervated by what?
Branches of the lumbar plexus
89
What three things make up the posterior abdominal wall?
Lumbar vertebrae
Skeletal muscles
Transversalis fascia
90
What are the 3 types of visceral nerves that form plexuses in the abdomen?
Sympathetic visceral efferent
Parasympathetic visceral efferent
Visceral afferent
91
What plexus do the visceral nerves form in the abdomen?
Aortic plexus
92
Where do the sympathetic efferent nerves synapse?
Prevertebral ganglia
93
What are the 2 types of sympathetic nerves that enter the aortic plexus?
Thoracic splanchnics
| Lumbar splanchnics
94
Where do the prevertebral ganglia for sympathetic synapse reside?
Within the aortic plexus
95
Generally, thoracic splanchnics provide innervation to what regions of the abdomen?
Foregut
| Midgut
96
Generally, lumbar splanchnics provide sympathetic innervation to which abdominal region?
Hindgut
| Pelvis
97
What is the primary role of sympathetic efferents in the abdomen?
Constrict abdominal blood vessels to divert to structures that need it (during flight or fight)
98
What are the 2 types of parasympathetic nerves that enter the aortic plexus?
Vagal trunks
| Pelvic splanchnics
99
Where do vagus nerves enter the abdomen?
With the esophagus at T10
100
Where do the parasympathetics synapse in the abdomen?
Enteric ganglia in target organ
101
True or False. The pelvic splanchnics synpase in the aortic plexus.
False. They synapse in the pelvic plexus, though it IS continuous with the aortic plexus.
102
What is the main function of parasympathetics in the abdomen?
Promote digestion
103
Visceral afferents carrying pain, nausea, cramps, etc. travel how?
Along with sympathetic AND parasympathetic fibers
104
Visceral pain afferents travel how?
With sympathetic nerves
105
Which afferent fibers travel with parasympathetic neurons?
Visceral reflex afferents
