Retroperitoneum Flashcards
Which abdominal muscles attach to the thoracolumbar fascia?
Internal oblique
Transverse Abdominus
If you see muscle fibers in the posterior back during kidney surgery, is it the internal oblique or transverse abdominal?
Internal oblique
Which nerves are between the internal oblique and transverse abdominal muscle?
Subcostal
Iliohypogastric
Ilioinguinal nerves
What does the transversalis fascia turn into posteriorly?
Endoabdominal fascia
Describe the thoracolumbar fascia
The anterior portion is continuous with the endoabdominal fascia
The middle layer is between the QL and Erector Spinae/Lats
The posterior layer is most posterior
It’s like the rectus sheath, but it hooks onto the spine and is more strong
-The rectus sheath hooks onto the Linea alba and is more weak’
What is the origin of the Psoas Major?
What is its innervation?
T12-L5
Anterior Rami of lumbar nerves (L1, L2) L3
Parenthesis mean more
Quadratus lumborum
Origin
Insertion
Innervation
Inferior medical half of 12th rib and lumbar transverse processes
Iliolumbar ligament and iliac crest
Anterior branches of T12-L4
What nerves are protruding poseriorerly to QL? (Superior to inferior)
Subcostal nerve
Iliohypogastric
Ilioinguinal
Iliacus
Origin
Innervation
Iliac fossa, sacrum, anterior sacroiliac ligaments
To lesser trochanter or femur (only muscle attaches there)
Femoral Nerve L2-4
(Joins psoas)
Structures of retroperitoneum
Kidney, ureter, abdominal aorta, inferior vena cava, lumbar plexus, abdominal sympathetic chain and ganglia, lymph channels and nodes
Where does the aorta descend into their retroperiteneum?
Aortic hiatus
T12
Which side of the vertebrae does the aorta run?
Left
Where does the abdominal aorta bifurcate?
L4
Between the transpyloric plane and L4 plane above the ilicus, what is the parietal branches of the aorta and what are they?
Parietal branches supply the abdominal wall and associated muscles
Paired: Inferior phrenic, subcostal, lumbar
Unpaired: Medial sacral (between bifurcation)
What are the visceral paired?
Paired:
Suprarenal (L1)
Renal L1
Gonadal (L2)
Common iliac (L4) (considered paired visceral arteries of abdomen)
Unpaired: Celiac Trunk T12, Superior mesenteric (L1) Inferior Mesenteric (L3)
Where do the left/right common iliac veins come together?
L5, (Inferior vena cava)
Does blood drain from abdominopelvic viscera? How?
Yes, via hepatic veins
If the abdominal aorta is blocked, how does blood make it to the heart?
Ascending lumbar vein joins with subcostal veins on either side to the azygos system
Where would blood drain from the superficial epigastric if the great saphenous was blocked?
Lateral thoracic - axillary- SVC
Where does blood from epidural venous plexus drain if vertebral colum to IVC is blocked?
Ascending lumbar v (Azygos to SVC) Look these up in an atlas, THERE WILL BE A QUESTION
What contributions make the lumbar plexus and is it somatic or visceral?
T12-L4, somatic
Although it is connected to sympathetic trunk by rami communicantes
What are the contributions of the Lumbar Plexus?
T12 Subcostal
L1 Iliohypogastric
L1 Ilioinguinal
L2-L3 Lateral femoral cutaneous (anteriolateral cuteanous innervation of thigh)
L2-L4 Femoral nerve (flexors of the thigh and extensor of the knee)
L1-L2 Genitofemoral (pierces through psoas major to innervate cremaster muscle) It breaks into a genital branch and femoral branch
L2-L4 Obturator- Medial to psoas, through obturator foramen to supply ADDuctors of the thigh, sometimes has accessory obturator (L3-L4)
The ventral Ramis of L4-L5 join together to form?
Lumbrosacral trunk, which joins together with S1 to make the sacral plexus
Abdominal splanchnic nerves are the source?
Sympathetic innervation is mostly vaso ________
Sympathetic innervation
Constriction (in the GI tract acts to slow/stop peristalsis)
Where do presynaptic splanchnic nerves come from?
Latera horn of gray matter segments T5-L2
Fibers pass to white rami communicans
What is the route of a presynaptic splanchnic nerve?
Lateral horn of gray matter segments T5-L2
Ventral rootlet
Ventral Ramos of spinal nerve
White Ramos communicans
Paraverterbral ganglion and trunk
Turns into Abdominalpelvic splanchnic nerve
What do abdominopelvic splanchnic nerves do?
Provide sympathetic innervation to abdominal viserca
Where do presympathetic nerves synapse? Then what?
Prevertebral ganglion, they then to into a plexus and then go to the organs
They are all over the aorta
What is the greater splanchnic contributions?
Where do they go?
T5-9 or T6-10
Celiac prevertebral ganglia
Lesser Splanchnic contributions?
To where?
T10-T1
Superior mesenteric prevertebral ganglia
Least splanchnic?
Where
T11 and or T12
To aorticorenal prevertebral ganglia
Lumbar splanchnics?
Where?
L1-L2
They convey presynaptic fibers to ganglia of: Inferior mesenteric, intermesenteric and superior hypogastric plexuses
The superior hypogastric plexus is right at the bifurcation of the aorta
What about GVA?
They are taking the same route back as the GVE, but are one nueron systems
Left vagus nerve forms?
Anterior Vargas trunk.
It runs in front of the esphagus and splits after the esphageal hiatus
The right vagus nerve courses on the ____ side of the aorta?
Posterior side, to for the posterior fatal trunk inferior to the esophageal hiatus
Do the trunks get fibers from both vagus nerves?
Yup
How many motor nueron system is the parasympathetic from the vagus?
Where do they synapse?
One
Within the visceral walls
What are the abdominal autonomic nerve plexuses and periarterial nerve plexuses?
22:26
Where does the vagus parasympathetic innervation end?
Left colic flexure
What gives parasympathetic innervation after the left colic flexure?
Pelvic splanchnic nerves (S2-S4) Directly from ventral rami. They are 2 neuron system with a little neuron in the organ to synapse on
The superior hypogastric plexus condenses to form?
Hypogastric nerve, not a real nerve, but bundles
What do the hypogastic nerves fan out into?
Inferior hypogastric plexus
Pelvic splanchnic nerves will meet the inferior hypogastric plexus?
Para or sympathetic?
Yes
Para
Sacral splanchnic sympathetic or para?
Sympathetic
Where does lymph join into the thoracic duct?
L1/2
25% of the population have a dilated sac called?
Cisterns Chyli
Kidney levels?
T12-L3
What do kidneys do?
Look it up
Which kidney is higher?
The left, the right is blocked by the liver
What are the poles of the kidney
Superior, inferior
And it has a hilum
How far is the kidney above the iliac crest?
One finger
Superior poles of left kidney location?
Inferior pole of right?
T12
L3
What is the structure inside the kidney that has fat, metabolic waste, callesis, and renal pelvis
Renal sinus
What is the renal pelvis?
The beginning of the ureter
What is the outter cortex called between the medulla?
Renal columns
What are the medullary shapes called?
Renal pyramids*
What do medulla have striations for?
Collecting tubules
What do the apex of the medullary pyramids drain into?
Minor calyx*
What do the minor calyces join to form?
Major calyx*
What do the major calyces join to form?
Renal pelvis
Which nerves are poking out behind the kidneys?
Subcostal T12
Iliohypogastric L1
Ilioinguinal L1
What are the segmental arteries of the kidney?
Anterior Superior/ Inferior
Posterior (takes up the same amount as the anterior two arteries)
Apical (superior)
Inferior
What is the path of blood starting at the renal artery?
Renal Artery
(Anterior Superior) Segmental Artery
Interlobar artery
ARCuate arteries (over the arc)
Interlobular arteries pass into the cortex
(Lobular is smaller than a lobe)
Afferent Arterioles
Glomerulus (where filtration and removal of waste occurs)
Efferent arterioles
Vasa Rectae/Venule Rectae Capillary Bed
Interlobular v
Arcuate v
Interlobar
Just and anterior and posterior vein
Renal vein
IVC
Aberrant
Departing from accepted standard
What happens if there are aberrant renal arteries?
The inferior segmental artery off of the abdominal aorta may push against the ureter, which can stop them from draining metabolic waste, which can lead to Hydonephrosis, water on the kidney
Untreated, can lead to kidney atrophy and eventual failure
What are common kidney variation? Give a brief summary
Retrocaval ureter (ureter post. To IVC)
Horseshoe kidney (inf. Poles fuse, IMA prevents ascension)
Ectopic pelvic kidney (kidney fails to ascend)(Shorter ureter)
Nephroptosis (kidney drops and you can tell by length of ureter)
Small Renal cysts? How
Happens with age
Large renal cysts?
PKD
Autosomal Dom w/100% penetrance
Renal Vein Entrapment Syndrome
Left renal vein is caught under SMA limiting flow back to IVC
Causes blood in urine
Also limits left gonadal vein (swelling in testies)
How are the kidneys innervated?
From the renal nerve plexus.
Supplied largely by lesser and least splanchnic nerves
(Vasoconstriction/reduces blood flow)
&
Posterior vagal trunk
(The sympathetic goes through aorticorenal ganglion then to renal plexus with para)
Referred pain from T10-11 dermatone region
Describe fluid to ureter from Collecting tubules
Collecting Tublules
Renal Papilla (Apex of medullary pyramid)
Minor Calyx
Major Calyx
Renal Pelvis
Ureter
Describe ureter path to pelvis
Relationships
Anterior surface of psoas major
Anterior to genitofemoral nerve
Posterior to gonadal vessels
Important for lighting gonadal vessels, don’t wanna legate the ureter
What is the ureter blood supply?
Ureteric branch of renal artery*
Aortic branch
Iliac Branch
Superior vesicular artery branch
What is the innervation of the ureter?
In the abdomen, Renal and gonadal plexuses
In the pelvis, inferior hypogastric plexus
This causes Loin to Groin referred pain
(for Renal calculi (kidney stones)
What are the two parts of the suprarenal gland and what are their functions?
Cortex- influences kidneys to retain water and sodium
Medulla- releases hormones directly into blood stream (fight or flight)
What arteries supply the SUPRARENAL GLANDS* (ADRENAL*)?
INFERIOR PHRENIC ARTERIES* gives rise to 6-8 SUPERIOR SUPRARENAL A*
The abdominal aorta gives rise to at least 1 MIDDLE SUPRARENAL A*
The RENAL ARTERY* gives rise to at least 1 INFERIOR SUPRARENAL A*
Where do the LEFT and RIGHT SUPRARENAL VEINS go to?
RIGHT SUPRARENAL VEIN* goes directly to IVC
LEFT SUPRARENAL V* goes to LEFT RENAL V*
Because of difference, be specific in lab
Suprarenal Gland innervation?
Sympathetic- from greater splanchnic nerve, goes through CELIAC GANGLION without synapsing, through the suprarenal plexus and go directly to gland. This allows the fast fight or flight
Para- Anterior and posterior vagal trunk
Which hiatus does the vagus nerve go through in the diaphragm?
Esophageal hiatus
