Sievert- Posterior Abdominal Wall Flashcards by Danielle Hayes

What are all the primary retroperitoneal structures?

Urinary system
Adrenal glands
Sympathetic trunk and its branches to ganglia
Thoracic duct/cisterna chyli
Posterior abdominal wall
Aorta and IVC
Rectum

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All the lymphatics from the gut drain ultimately to the (blank).

thoracic duct

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The (blank) is where the thoracic duct has a dilation where all the lymphatics form the gut join together.

cisternae chyli

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The rectum is both (blank) and (blank)

retroperitoneal

subperitoneal (distal 2/3rds)

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2 layers of peritoneum with nerve fibers and blood vessels constitute a (Blank)

ligament

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The (blank) makes up the anterior surface of the lesser sac

lesser omentum

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Which kidney is lower?

right

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The (blank) come off the aorta near the SMA and divide into anterior and posterior segmental branches as they reach the hilum.

renal arteries

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These may have polar arteries on either pole due to developmental differences?

renal arteries

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what does the blood supply to the ureter?

the renal, gonadal and vesicular arteries, illiac

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What are the three sites of potential narrowing of the ureter?

transit from pelvis to ureter
pelvic brim
enrtance to the bladder

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The ureter enters the bladder (blank

diagonlly

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What is the innervation to the ureter?

T11-L2

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What is the innervation to the kidney?

Parasympathetics S2-4 (pelvic) and Vagus

Sympathetics- thoracic splachnic nerves (lesser and least) and lumbar splachnics

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Where do the sympathetics to the ureter synapse?

ganglia (aorticorenal,small ganglia on the renal artery and SMA)

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Where do the parasympathetics synapse?

in renal sinu

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The sensory fibers from the kidney return via the (blank) and (blank)

vagus and sympathetics

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Sensory fibers from the ureters can travel similiar to he kidneys, but also return to DRGs; via (blank) spinal nerves, hence the changes that occur in pain as a (blank) moves along the ureter

T12-L2

renal calculus

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(blank) Are only anatomically, not developmentally related to the kidney

suprarenal glands

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(blank) is an endocrine gland

suprarenal glands

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What is the blood supply to the adrenal gland?

Superior suprarenal off inferior phrenic
Middle suprarenal directly off the aorta
Inferior suprarenal off the renal

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What is the venous drainage of the adrenal glands?

Venous drainage comes from signal vein. On the left you might have a branch that goes into renal vein. But both eventually go to IVC. Right typically just goes straight into IVC

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What is the innervation to the adrenal glands?

Sympathetic fiber that enters adrenal medulla, enter as a preganglionic fiber 
Adrenal cortex has postganglionic fibers

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(blank) fibers innervate secretory cells of the adrenal medulla

preganglionic sympathetic

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The cells of the adrenal medulla will respond to stimulation of preganglionic by .......

secreting secreting epinephrine and norepinephrine for a systemic sympathetic response

What thoracic splachnic enters the adrenal medulla?

greater thoracic through celiac ganglion

(blank) arise from the superior hypogastric plexus and supply the inferior plexus with 90% of the sympathetics to the pelvis. The remaining 10% come from sacral splanchnics.

hypogastric nerves

hypogastric nerves arise from the (Blank) and supply the inferiorplexus with 90% of the sympathetics to the pelvis. THe remaining 10% comes from (blank)

hypogastric plexus | sacral splachnics

What innervates the infeiror plexus?

90% hypogastric nerves from superior hypogastic plexus | 10% sacral splachnics

How can you differentiate between parasympathetics and sympathetics?

Sympathetics have to come from sympathetic chain | Parasympathetics come off the spinal cord (S2-4) and innervate the GI structures in the abdominal cavity.

The anterior and posterior vagal | Trunks course onto the anterior and posterior surfaces of the (blank) at its junction to the cardiac stomach.

esophagus

The anterior and posterior vagal Trunks course onto the anterior and posterior surfaces of the esophagus at its junction to the cardiac stomach. From here they send fibers to the digestive organs as far as the (blank)

left colic flexure

pelvic splachnics S2-4

(blank) takes care of lesser curvature of stomach, some liver

Anterior vagal trunk

(blank) takes care of greater curvature and intestinal track DJI and part of colon.

posterior vagal trunk

The (blank) is formed by the combination of two lumbar trunks and one intestinal trunk at a small dilatation just inferior to the diaphragm known as the cisterna chyli

thoracic duct

The left and right lumbar trunk meets up at the (blank)

cisterna chyli

The cisterna chyli is the start of the (blank)

thoracic duct

The thoracic duct is formed by the combination of (blank)

2 lumbar trunks and one intestinal trunk

HOw do you get to the cistern chyli?

slit the right crus of the diaphragm

What are the posterior wall muscles?

quadratus lumborum and psoas major

Contraction of this can cause irritation of an inflamed appendix

psoas muscle

What function in movement, not protection

posterior wall muscles

(blank) attaches to illiac crest and stabilizes pelvis

quadratus lumborum

What go over the quadratus lumborum and psoas muscle?

medial and lateral arcuate ligaments

What are the nerves of the posterior wall?

``` subcostal illiohypogastric illioinguinal lateral femoral cutaneous genitofemoral femoral obturator ```

What level is the subcostal nerve at?

T12

What level is the femoral nerve at?

L2-4

What level is the obturator at?

L2-4

What is on top of the psoas muscle>

genitofemoral nerve

What nerve is the highest up right below diaphragm

subcostal nerve

What nerve enters inguinal canal

illioinguinal nerve

What nerve comes out right below illiac spine and into thigh?

lateral femoral

What nerve is lateral to the psoas muscle?

the femoral

What nerve is medial to the psoas muscle

the obturator

What do the inferior phrenics supply?

adrenal gland and diaphragm

What are the posterior wall veins to the IVC?

``` inferior phrenic hepatic renal right suprarenal gonadal common illiacs lumbar veins-> ascending lumbar-> azygos system ```

What are the abdominal aortic branches?

``` inferior phrenics celiac artery middle suprarenal renal gonadel IMA lumbar arteries common iliacs median sacral artery ```

What artery supplies the foregut?

celiac

What artery supplies the midgut?

SMA

What artery supplies the hindgut?

IMA

What are all the parts of the diaphragm?

``` central tendinous part (white inner) peripheral muscular area medial arcuate ligament lateral arcuate ligament crura ```

(blank) is where the diaphragm abuts the psoas major muscle

medial arcuate ligament

(blank) is where the diaphragm abuts the quadratus lumborum m.

lateral arcuate ligament

(blank) extend inferiorly to attach to the vertebral bodies

crura

HOw many cruras are there?

What extend down onto lumbar vertebra?

crura

Which is longer and wide, the left or right crua?

right crur

What makes up the esophageal hiatus and sends its fascial lining down to the ligament of trites?

the right crura

What structures penetrate the diaphragm?

``` Inferior vena cava T8 Esophagus T10 Aorta T12 Thoracic splanchnic nerves Sympathetic trunk Vagal trunks ```

What level does the IVC penetrate the diaphragm?

What level does the esophagus penetrate the diaphragm?

T10

What level does the aorta penetrate the diaphragm?

T12

Note that the esophagus opening is usually formed entirely by fibers from the (blank)

right crura

(blank) is an area developmentally where 2 things are closing off. Potential spot for weak area as a congential defect and can cause herniation; and result in hypoplastic lung. MOST common diaphragmatic hernia and results in poor lung development

lumbocostal trigone

Why can hernias arise on the left(at lumbocostal trigone) much more often than the right side?

liver protects the right side

What are the four embryonic structures the diaphragm comes from?

1. Septum transversum 2. Pleuroperitoneal membranes 3. Dorsal mesentery of esophagus forms the crura 4. Body wall from cervical somites

A site of congenital diaphragmatic hernia is the left side in the area of the lumbocostal trigone. This is equivalent to a (blank) from failure to fuse of the pleuroperitoneal folds

Bochdalek hernia

A site of congenital diaphragmatic hernia is the left side in the area of the lumbocostal trigone. This is equivalent to a Bochdalek hernia from failure to fuse of the (blank)

pleuroperitoneal folds