Retroperitoneum Flashcards
describe the posterior of the abdominal wall
made up of vertebral column, psoas major and minor, iliacus, and quadratus lumborum. the diaphragm contributes superiorly and the transversalis fascia is also present
what is the origin and insertion of the psoas major? what does it do?
lumbar vertebrae to greater trochanter of the femur. hip flexor
what is the origin and insertion of the quadratus lumborum. what does it do?
12th rib to iliac crest and to the transverse lumbar vertebrae. it flexes the spin laterally and stabilizes the diaphragm
what are the parts of the diaphragm that originate from vertebrae?
crura
what are the main to branches off the internal thoracic arteries that supply the diaphragm?
pericardiophrenic and muscophrenic
describe the innervation of the diaphragm
central diaphragm is innervated by the phrenic nerve. peripheral diaphragm is innervated by intercostal nerves.
where is transversalis fascia found?
between the parietal peritoneum and the musculature surrounding the entire abdominal cavity
what is the space that exists between the transversalis fascia and the musculature
anteriorly- properitoneal space. posteriorly- retroperitoneal
what are the viscera found in the retroperitoneal space?
kidneys, adrenal glands, duodenum, pancreas, ascending and descending colon, ureters
how many liters per day do the kidneys filter? what is normal urine output?
200 L total filtration. 600-1500 cc/day urine
what are the following kidney parts?: renal hilum, sinus, cortex, medulla, columns, pyramids, papillae, minor calyces, major calyces, pelvis
hilum- where all the vessels nerves and lymphatics enter on the medial border
sinus- fat filled concavity at medial border
cortex- outer 1/3 of renal substance
medulla- composed of renal pyramids
columns- cortical substance that extends between pyramids into the medulla
pyramids- project from the renal sinuses toward the kidney surface
papillae- apices of the pyramids projecting into the minor calyces of the renal pelvis
minor calyces- each receives a papillae
major- combination of multiple minor
pelvis- major calyces come together to form this funnel shaped area located in the hilum
where do the renal arteries branch off the aorta?
at L1, just caudal to the SMA.
does the right renal artery travel anteriorly or posteriorly to the IVC?
posteriorly
describe the organization of the renal vein, artery, and sinus at the hilum
vein is anterior to artery which is anterior to hilum
describe the course of the renal veins back to the IVC
left- crosses the aorta anteriorly just under the SMA to join the IVC. right- runs posterior to the duodenum and enters IVC
what is the CVA and why is it important?
costalvertertebral angle. this is where you percuss to assess kidney tenderness on exam
what vertebrae describe the range of the kidneys?
t12-L3
which kidney is more caudal? why?
right- liver
describe the 4 layers of fat and fascia encompassing the kidneys
- renal capsule- the outside layer of the kidney
- perirenal fat- fat between the capsule and the renal fascia
- renal fascia (gerotas fascia)- layer between peri and para renal fat
- pararenal fat
what does it mean that renal arteries are endpoint arteries
they have no anastomes and an occlusion will lead to infarction
where does the aorta split into the common iliacs?
L4 (umbilicus)
describe the 3 ventral aortic branches
supply to viscera. celiac trunk t12 (foregut), SMA l1 (midgut), and IMA l3 (hindgut)
describe the 4 lateral aortic branches
inferior phrenic t12 (parietal)- abdominal side of diaphragm. middle suprarenal L1 - adrenal gland, renal artery L1, ovarian/testicular
where does the superior suprarenal artery start
branches off inferior phrenic artery
describe the dorsal aortic branches
lumbar arteries L1-4- supply the musculature of the abdominal wall. sacral - L4 vestigal vessel that would supply tail
describe the bifurcation of the common iliac arteries
into internal and external iliacs. external will eventually supply inferior epigastric and deep circumflex arteries
where does the IVC bifurcate?
L5- one level lower than aorta
what veins drain the abdominal diaphragm?
inferior phrenic veins
what veins drain the adrenal gland?
suprarenal veins (via the renal vein in the left side)
name two superficial veins that drain the abdomen
thoracoepigastric and superficial epigastric
describe lymph drainage from the foregut, midgut and hindgut
celiac, superior mesenteric, and inferior mesenteric nodes found on the aorta
where do retroperitoneal structures drain their lymph?
left and right lumbar nodes on the aorta and IVC respectively
describe the sympathetic innervation of the abdominal organs
thoracic splanchnic (greater, lesser, least)- celiac plexus- stomach, liver, kidneys, spleen, pancreas.
thoracic splanchnics- SMA plexus- small bowel, ascending colon
lumbar splanchnic- IMA plexus- descending bowel
describe the parasympathetic innervation of the abdomen
vagus- stomach liver, pancreas, kidney, small bowel, ascending colon
pelvic splanchnic- descending colon
where do the pelvic splanchnics originate?
s2-4
describe the lumbar plexus
t12- subcostal
L1- iliohypogastric and ilioinguinal, genitofemoral
L2- lateral femoral cutaneous nerve and obturator
L3- obturator and femoral
l4/5- lumbosacral trunk
what do the unnamed lumbar branches supply?
quadratus lumborum, psoas major, psoas minor, iliacus
what does the iliohypogastric innervate?
layered muscles of ab wall and lower ab skin
what does the ilioinguinal innervate?
muscles of the ab wall, skin of the medial thigh, superior scrotum/labia
what does the genitofemoral innervate?
creamaster muscle and skin of anterior scrotum
