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HAE - Quiz 5 > Retroperitoneum > Flashcards

Retroperitoneum Flashcards

1
Q

Posterior Abdominal Wall

(contents)

A
  1. Lumbar Vertebral Column
  2. Skeletal Muscle (Psoas Major and Psoas Minor, Iliacus, Quadratus Lumborum, Diaphragm)
  3. Overlying Transversalis Fascia
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2
Q

Psoas Major

A

Origin: Lumbar Vertebrae

Combines with: Iliacus Muscle (Iliopsoas)

Insertion: Lesser trochanter of the femur

Action: most powerful flexor of the thigh at the hip joint

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3
Q

Quadratus Lumborum

A
  • lateral to the psoas major

Origin: 12th Rib

Insertion: Iliac Crest

Attachments: Lumbar Vertebrae

Action: Flexes spine laterally

**stabalized 12th rib and therefore diaphragm during respiratory exersion (i.e. valsalva maneuver)

Nerve Supply: Lumbar Plexus

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4
Q

Iliacus

A

Origin: Ilium

Insertion: Lesser trochanter of the femur

**combines with psoas major to form iliopsoas

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5
Q

Diaphragm

A
  • thin dome-shaped musculo-tendinous partition separating the thoracic and abdominal contents

Action: flattens during inspiration pushing down abdominal contents

Origins: Xiphoid process, ribs, and lumbar vertebrae

** higher on right side because of the liver

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6
Q

Crura

A
  • parts of the diaphragm that arise from the vertebrae
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7
Q

Major Openings of the Diaphragm

A

T8 - IVC (Foramen of the Vena Cava)

T10 - Esophagus (Esophageal Hiatus)

T12 - Aorta (Aortic Hiatus)

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8
Q

Structures that pass through Diaphragm

(Other)

A

Pass through Crura:

  • Greater, Lesser, and Least Splanchnic Nerves
  • Azygous veins

Pass posterior to diaphragm:

  • Sympathetic trunks

Pass through the diaphragm:

  • Phrenic Nerves
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9
Q

Blood Supply to the Diaphragm

A

Two branches of the internal thoracic artery:

  1. Percardiophrenic Artery
  2. Musculophrenic Artery

Directly from the aorta:

  1. Inferior Phrenic Arteries
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10
Q

Abdominal Surface of the Diaphragm

A
  • except for bare area covered by highly sensitive serosal layer of the peritoneum
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11
Q

Diaphragm Innervation

A

Phrenic Nerve - motor (efferent) and sensory (afferent) innervation (C3, C4, C5)

Intercostal Nerves - sensory (afferent) innervation to the periphery of the diaphragm (T6-T12)

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12
Q

Properitoneal Space

A
  • ANTERIOR extraperitoneal space between the transversalis fascia and the peritoneum
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13
Q

Retroperitoneal Space

A
  • POSTERIOR extraperitoneal space between the transversalis fascia and the peritoneum
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14
Q

Viscera of the Retroperitoneal Space

A

Kidneys (primary)

Adrenal Glands (primary)

Ureters (primary)

Duodenum (Distal) (secondary)

Pancreas (secondary)

Ascending/Descending Colons (secondary)

(arteries, veins, nerves, and lymphatics)

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15
Q

Kidneys (Function)

A
  • filter 200 liters fluid/day
  • urinary output 600-1500 cc/day
  • regulate total water volume of body and osmolality
  • regulate concentration of extracellular ions
  • help regulat longer term acid-base balance
  • help eliminate drugs/toxins

**therefore complex anatomy

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16
Q

Renal Hilum

A
  • vertical cleft on the medial margin of the kidney where vessels, nerves, and lympatics enter/leave
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17
Q

Renal Sinus

A
  • fat-filled cavity at the medial border of the renal hilum
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18
Q

Renal Cortex

A
  • forms out 1/3 of renal substance
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19
Q

Renal Medulla

A
  • composed of renal pyramids
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20
Q

Renal Columns

A
  • cortical substance that extends between the renal pyramids into the medulla
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21
Q

Renal Pyramids

A
  • project from the renal sinuses towards the surface of the kidneys
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22
Q

Renal Papillae

A
  • blunted, perforated apices (area cribosa( of the pyramids projecting into the minor calyces of the renal pelvis where they discharge urine
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23
Q

Minor calyces

A
  • each receives a renal papillae
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24
Q

Major Calyces

A
  • 2 or 3 minor calyces coalesce to form the major calyx
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25
**Renal Pelvis**
- major calyces come together to form this funnel-shaped area located at the hilum of the kidney which tapers to form the ureter
26
**Kidney Blood Supply**
- **Renal Arteries** - arise just caudal to the SMA at L1 **Right Renal Artery** - runs posterior to the IVC
27
**Renal Veins**
- drain blood from the kidneys - *anterior* to the renal arteries and renal pelvis **Left Renal Vein** - empties directly into IVC after crossing *anterior* to the aorta between the aorta and the SMA (superior to the duodenum) **Right Renal Vein** - runs *posterior* to the descending duodenum and empties in the IVC
28
**Location of Kidneys**
Between T12-L3 Renal Arteries - arise at L1 Superiorly - separated from costodiaphragmatic recess and 12th rib by the diaphragm Caudally - lie against the quadratum lumborum muscles Right Kidney - slightly more caudal because of liver - both kidneys cushioned by retroperitoneal fat
29
**Costovertebral Angle**
CVA - lies on either side of the spine - where you percuss to identify tenderness in the kidneys
30
**Morison's Pouch**
- hepatorenal fossa
31
**Suprarenal Gland Location**
- sit on top of the kidney on the superomedial aspect - separated from the kidney by a thin fibrous renal capsule
32
**Renal Fascia**
aka **Gerota's Fascia** - located within retroperitoneal fat **Perirenal Fat** - deep to renal fascia **Pararenal Fat** - superficial to renal fascia
33
**Layers Surrounding Kidney**
Renal Capsule Perirenal Fat Renal Fascia (Gerota's Fascia) Pararenal Fat
34
**Renal Arteries**
- END ARTERIES (no anatomosies) - occlusion can lead to renal infarction 4 anterior segmental renal artery branches 1 posterior segmental renal artery branch
35
**Adrenal Glands**
- paired, flattened, endocrine glands that sit loosely on the superomedial aspect of the kidneys and lie within the renal fascia
36
**Adrenal Gland Cortex**
- derived from mesoderm - secretes corticosteroids - surrounds the medulla
37
**Adrenal Gland Medulla**
- derived from neural crest cells - secretes catecholamines (norepinephrine and epinephrine)
38
**Blood Supply to Adrenal Glands**
Three Different Arteries: Superior Suprarenal Arteries - _Inferior Phrenic Artery_ Middle Suprerenal Arteries - _Aorta_ Inferior Suprarenal Arteries - _Renal Artery_
39
**Veinous Drainage of the Adrenal Glands**
Right Adrenal Gland - IVC Left Adrenal Gland - Left Renal Vein
40
41
**Ureter**
- hollow tube that conveys urine from the kidney to the bladder - descends into the pelvis and travels * Anterior -* to the bifurcation of the _common iliac vessels_ * Posterior* - to the _gonadal vessels_
42
**Ureter Constriction Sites**
1. Uteropelvic Junction (UP) - between the renal pelvis and the ureter 2. Pelvic Brim - where cross the common iliac vessels 3. Ureterovesical Junction (UV) - between the ureter and the bladder entry
43
**Abdominal Aorta**
- Passes through diaphragm at T12 - anterior to vertebral bodies and left of the IVC - shorter in length and smaller (2cm) than the IVC
44
**Aorta Bifurcation**
- at L4 into the Common Iliac Arteries | (level of umbilicus and T10 dermatome)
45
**Aortic Branches**
6 Visceral, 3 Parietal Ventral, Lateral, Dorsal, Terminal Branches
46
**Ventral Aortic Branches**
Three _Visceral_ Branches 1. Celiac (supplies foregut) - T12 2. Superior Mesenteric Artery (supplies midgut) - L1 3. Inferior Mesenteric Artery (supplies hindgut) - L3
47
**Lateral Aortic Branches**
_3 Visceral Branches_: 1. **Middle Suprarenal Artery** - supplies adrenal gland (L1) 2. **Renal Artery** - supplies kidney (L1) 3. **Ovarian/Testicular Artery** - supplies gonads _1 Parietal Branch:_ 1. **Inferior Phrenic Artery** (T12)- supplies abdominal aspect of diaphragm and gives rise to **Superior Renal Artery**
48
**Dorsal Aortic Branches**
_2 Visceral Branches:_ 1. **Lumbar Arteries** (4) - supply musculature of the posterior abdominal wall, vetebrae, and spinal cord (important source of collateral circulation) (L1-L4) 2. **Medial Sacral Artery** - vestigial vessel (supplies tail of animals) (L4)
49
**Terminal Aortic Branches**
Aorta Bifurcates into the Common Iliac Arteries at _L4_ **Common Iliac Arteries** bifurcate into: - R/L **Internal Iliac Arteries** - descend into the pelvis - R/L **External Iliac Arteries** - enter the thigh deep to the inguinal ligament (halfway between the ASIS and the pubic tubercle) - gives rise to arteries that supply abdominal muscles: 1. **Inferior Epigastric Artery** 2. **Circumflex Iliac Arteries**
50
**Inferior Vena Cava**
- forms at the junction of the common iliac veins at L5 (just caudal to the aorta) Receives: - lumbar veins - R gonadal vein - renal veins - R suprarenal vein - hepatic veins - inferior phrenic veins
51
**Deep Collateral Venous Drainage**
Segmental lumbar veins → ascending lumbar veins → azygous and hemiazygous → SVC
52
**Three Lymphatic Trunks of the Abdomen**
Right Lumbar Trunk Left Lumbar Trunk (legs, pelvic viscera, urogenital system, abdominal wall and abdominal viscera) Intestinal Trunk (celiac, superior and inferior mesenteric lymph nodes) → all drain into the cisterna chyli
53
**Major Lymph Nodes of the Abdomen**
_Celiac Nodes_ - abdominal foregut _Superior Mesenteric Nodes_ - abdominal midgut _Inferior Mesenteric Nodes_ - abdominal hindgut _Right and Left Lumbar Nodes_ - primary retroperitoneal organs and genitourinary tract
54
**Thoracic Splanchnic Nerves**
- Sympathetic nerves that supply the primarily retroperitoneal organs \*\*Pass through the sympathetic chaing but DO NOT synapse there _Synapse_ - prevertebral ganglia in the abdominal plexuses
55
**Parasympathetic Nerves of the Abdomen**
_Vagus Nerve_ - innervate kidneys and ureters
56
**Lumbar Plexus**
- formed by the ventral rami of L1-L4 _Iliohypogastric_ _Ilioinguinal_ _Genitofemoral_ _Muscular Branches_ - of posterior abdominal wall
57
**Iliohypogastric**
Supplies: - layered muscles of the abdominal wall - skin of the lower abdomen
58
**Ilioinguinal**
Supplies: - layered muscles of the abdominal wall - skin of the medial thigh and superior portion of the scrotum/labia
59
**Genitofemoral**
Supplies: - cremaster muscles - skin of the anterior scrotum/labia
60

HAE - Quiz 5 (3 decks)

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