Surgical anatomy of the retroperitoneum, adrenal, kidney and ureters

Question 1

The dorsal lumbotomy incision to expose the kidney

Answer 1

Splits the lumbodorsal fascia without incising muscle,. This approach allows entrance to the retroperitoneum without violation of musculature

Question 2

The lumbodorsal fascia originates from the

Answer 2

Lumbar vertebrae

Question 3

The lumbodorsal fascia consists of how many layers

Answer 3

3- Posterior, middle and anterior

Posterior: covering for the sacrospinalis, latissimus dorsi origin

Middle: separates the anterior of of sacrospinalis from the posteror aspect of the quadratus lumborum,

Anterior: lumodorsal fascia probides the anterior covering to the quadratus lumborum muscle and forms the posterior margin of the retroperitoneum

Question 4

All three layers of the lumbodorsal fascia join to form the a single thick aponeurosis lateral to the quadratus lumborum muscle before extending further anterolaterally, where they are contiguous with the aponeurosis of the ____________.

Answer 4

Transversus abdominis muscle

Question 5

The psoas major joins the iliacus muscle, which originates ____, to become the _____ and insert on the _____ and _____ the thigh at the hip

Answer 5

1. Inner aspect of the iliac wing of the pelvis
2. iliopsoas
3. lesser trochanter
4. flex

Question 6

What is the boundary of the retroperitoneum?

Answer 6

Posterior surface: lumbar vertebral bodies covered by shiny, longitudinal fibers of the anterior spinous ligament, these are flanked bilaterally by the psoas. Psoas is covered by the psoas sheath which are contiguous with the transversus abdominis muscle

LAterally: transversus abdominis

Superior: posterior insertion of the diaphragm along the lower ribs

Inferior: below the level of the iliac crest, iliopsoas forms the posterior confine

Question 7

in a subcostal flank approach to the kidney, which of the ff may be incised to increase upward mobility of the 12th rib

Answer 7

the costovertebral ligament

Question 8

What are the first abdominal branches of the aorta

Answer 8

the paired inferior phrenic arteries

Question 9

which of the following arteries branches from the celiac trunk?

a. the left gastric
b. the right gastric
c. the pancreaticoduodenal
d. SMA

E. IMA

Answer 9

A. left gastric

The short celiac arterial trunk trifurcates into common hepatic, left gastric, and splenic branches

Question 10

The renal arteries typically branch from the abdominal aorta at the level of the ____

Answer 10

2nd lumbar

Question 11

the testicular arteries commonly originate from the

Answer 11

Abdominal aorta below the renal arteries

Question 12

The inferior mesenteric artery can be sacrificed without complication

Answer 12

True, especially in individuals without atherosclerotic occlusive arterial disease

Question 13

Which of the following drains directly to the IVC?

REnal veins, IMV,SMV,splenic veins

Answer 13

only renal vein, the rest drains into to the portal vein

Question 14

the left gonadal vein usually enters the ____

Answer 14

inferior aspect of the left gonadal vein

Question 15

left renal vein receives the ff

Answer 15

left adrenal, left lumbar, left gonadal

Question 16

cysternal chyli is located

Answer 16

located at the 1st lumbar vertebra posterior to aorta

Question 17

the right testis lymphatics drains into

Answer 17

interaortocaval region

Question 18

the lumbar sympathetic chains

Answer 18

1. Run vertically in the retroperitoneum, ,medial to the psoas muscles
2. contain numerous sympathetic ganglia
3. Closely associated with the lumbar blood vessels

contain postganglionic sympathetic neurons supplying the lower ex

Question 19

Disruption of which sympathetic nervous plexus on this anterior abdominal aorta during retrpoperioneal dissection will likely cause loss of seminal emission?

A. Celiac plexus

B. Renal plexus

C. Superior mesenteric plexus

D. Superior hypogastric plexus

E AOTA

Answer 19

D. superior hypogastric plexus
From book: At the lower extent of the abdominal aorta, much of the autonomic input to the pelvic urinary organs and genital tract travels through the superior hypogastric plexus. This plexus lies on the aorta anterior to its bifurcation and extends inferiorly on the anterior surface of the fifth lumbar vertebra. This plexus is contiguous bilaterally with inferior hypogastric plexuses, which extend into the pelvis. Disruption of the sympathetic nerve fibers that travel through these plexuses during retroperitoneal dissection can cause loss of seminal vesicle emission and/ or failure of bladder neck closure, resulting in retrograde ejaculation.

Question 20

23
In the lateral abdominal wall, the iliohypogastric nerve will be found coursing in the plane:

a
deep to the transversalis fascia.

b
between the transversalis fascia and the transversus abdominis muscle.

c
between the transversus abdominis and internal oblique muscles.

d
between the internal oblique and external oblique muscles.

e
superficial to the external oblique muscle.

Answer 20

c. In between the transversus abdominis and internal oblique muscles.

Question 21

The cremaster muscle is innervated by the:

a
ilioinguinal nerve.

b
iliohypogastric nerve.

c
obturator nerve.

d
genital branch of the genitofemoral nerve.

Answer 21

D. genital branch

Question 22

In the retroperitoneum, where can the genitofemoral nerve be found?

a
Posterior to the psoas muscle

b
On the anterior surface of the psoas muscle

c
Lateral to the psoas muscle

d
Medial to the psoas muscle

Answer 22

B. the genitofemoral branch lies directly atop and parallels the psoas on most of its retroperitoneal course

Question 23

Autonomic system divided into sympathetic and parasympathetic fibers. The sympathetitic ganglion originates from ___ while the parasymphatetic originates from ____. The major autonomic plexuses are associated with the primary branches of the aorta namely: ___, ___, ___

Answer 23

sympathetic: thoracic and lumbar portions

PArasymphathetic: Cranial and sacral collumns

Major autonomic branches: Celiac, superior hypogastric, inferior hypogastric plexus

Question 24

26
The descending duodenum:

a
lies within the retroperitoneum.

b
receives the common bile duct.

c
lies lateral to the head of the pancreas.

d
lies anterior to the right renal hilum.

e
does all of the above.

Answer 24

e. The second part of the duodenum descends vertically, directly anterior to the right renal hilum, and this is intimately related on its posterior aspect to the medial margin of the right kidney, right renal vessels, renal pelvis, UPJ, upper right ureter, the CBD also lies posterior and drains into this part

Question 25

The posterior surface of the tail of the pancreas is closely associated with:

a
the splenic artery.

b
the splenic vein.

c
the upper pole of the left kidney.

d
the left adrenal gland.

e
all of the above.

Answer 25

e all of the above

Question 26

In cases of renal ectopia, the ipsilateral adrenal gland is typically:

a
absent.

b
found in its normal anatomic position in the upper retroperitoneum.

c
found in association with the contralateral adrenal gland.

d
found closely applied to the superior pole of the ectopic kidney.

e
found closely associated with the ipsilateral renal artery.

Answer 26

B. found in its normal position in the upper retroperitoneum

Question 27

30
Which of the following statements is NOT true?

a
The right renal vein is much shorter than the left renal vein.

b
The right adrenal vein is much shorter than the left adrenal vein.

c
The right kidney is typically located lower in the retroperitoneum than the left kidney.

d
The right adrenal gland is typically located lower in the retroperitoneum than the left adrenal gland.

e
Both c and d

Answer 27

d

Question 28

s one proceeds outward from the adrenal medulla, the three separate functional layers of the adrenal cortex are, in correct order:

a
zona reticularis, zona fasciculata, and zona glomerulosa.

b
zona fasciculata, zona reticularis, and zona glomerulosa.

c
zona glomerulosa, zona fasciculata, and zona reticularis.

d
zona glomerulosa, zona reticularis, and zona fasciculata.

e
zona reticularis, zona glomerulosa, and zona fasciculata.

Answer 28

a

Question 29

Which of the following statements is (are) NOT true?

a
The adrenal medulla produces catecholamines in response to stimulation from the sympathetic nervous system.

b
The zona glomerulosa produces aldosterone in response to angiotensin II.

c
The zona reticularis of the adrenal cortex produces androgens in response to luteinizing hormone (LH).

d
The zona fasciculate of the adrenal cortex produces glucocorticoids in response to adrenocorticotropic hormone (ACTH).

e
Both b and c

Answer 29

C. it is regulated by ACTH not LH

Question 30

The adrenal arteries are branches from:

a
the aorta.

b
the inferior phrenic arteries.

c
the renal arteries.

d
the celiac arterial trunk.

e
a, b, and c.

Answer 30

e

Question 31

The kidney produces:

a
renin.

b
angiotensin.

c
erythropoietin.

d
both a and c.

e
a, b, and c.

Answer 31

D. Kidneys play a central role in the fluid electrolyte, and acid base balance in humans, but they have important endocrine functions known to include vit D met and the production of both renin and erythropoietin

Question 32

The normal kidney in an avg sized adult man weighs

Answer 32

150 grams

Question 33

Persistent fetal lobation identified in the kidney of an adult patient:

a
indicates the presence of a congenital renal disorder.

b
indicates childhood renal injury due to infection.

c
is observed only with long-standing obstructive uropathy.

d
is normal.

e
is never seen.

Answer 33

d

Question 34

The upper pole of the kidney lies anterior to:

a
the 12th rib.

b
the diaphragm.

c
the pleura.

d
all of the above.

e
none of the above.

Answer 34

D

Question 35

Which of the following statements regarding the typical anatomic positioning of the kidney is TRUE?

a
The lower pole of the kidney lies more anterior than the upper pole.

b
The lower pole of the kidney lies more lateral than the upper pole.

c
The medial aspect of the kidney lies more anterior than its lateral aspect.

d
The anterior renal calyces lie lateral to the posterior renal calyces.

e
All of the above.

Answer 35

e

Question 36

During left radical nephrectomy performed via a transabdominal approach, excessive traction on which of the following structures might be expected to produce a significant injury to the spleen?

a
Left adrenal gland

b
Splenorenal ligament

c
Splenocolic ligament

d
Both b and c

e
a, b, and c

Answer 36

D

Question 37

Gerota fascia envelops and contains:

a
the adrenal gland.

b
the kidney.

c
the ureter.

d
the gonadal vessels.

e
all of the above.

Answer 37

E

Question 38

After blunt trauma to the right kidney, with a major laceration to the renal parenchyma and ongoing hemorrhage, the expanding hematoma contained within Gerota fascia will tend to extend:

a
across the midline into Gerota fascia surrounding the left (contralateral) kidney.

b
downward into the pelvis.

c
upward into the thorax.

d
anterolaterally, deep to the transversalis fascia.

e
anterolaterally, between the peritoneum and transversalis fascia.

Answer 38

b

Question 39

After blunt trauma to the right kidney, with a major laceration to the renal parenchyma and ongoing hemorrhage, the expanding hematoma contained within Gerota fascia will tend to extend:

a
across the midline into Gerota fascia surrounding the left (contralateral) kidney.

b
downward into the pelvis.

c
upward into the thorax.

d
anterolaterally, deep to the transversalis fascia.

e
anterolaterally, between the peritoneum and transversalis fascia.

Answer 39

B.

Question 40

The first branch segmental artery from the main renal artery is typically the:

a
apical anterior segmental artery.

b
lower anterior segmental artery.

c
posterior segmental artery.

d
upper anterior segmental artery.

e
middle anterior segmental artery.

Answer 40

C. posterior branch

Question 41

4
During pyeloplasty, the posterior segmental renal artery is inadvertently divided. This will produce:

a
no effect on the kidney.

b
ischemic loss of a large posterior segment of the renal parenchyma.

c
ischemic loss of a small posterior segment of the renal parenchyma.

d
ischemic loss of a segment of upper pole renal parenchyma.

e
ischemic loss of a segment of lower pole renal parenchyma.

Answer 41

b

Question 42

The sequential branches of the renal artery are, in order, the:

a
segmental, interlobar, arcuate, interlobular, and afferent arteriole.

b
segmental, interlobular, arcuate, interlobar, and afferent arteriole.

c
segmental, subsegmental, interlobar, interlobular, arcuate, and afferent arteriole.

d
segmental, arcuate, interlobar, interlobular, and afferent arteriole.

e
segmental, interlobar, interlobular, arcuate, and afferent arterio

Answer 42

a

Question 43

48
The most common renal vascular anomaly is a:

a
supernumerary left renal artery.

b
supernumerary right renal artery.

c
supernumerary left renal vein coursing anterior to the aorta.

d
supernumerary left renal vein coursing posterior to the aorta.

e
supernumerary right renal vein.

Answer 43

A

Question 44

After involvement of lymph nodes directly at the renal hilum, the primary lymph node drainage site for the left kidney is:

a
the left lateral para-aortic lymph nodes.

b
the interaortocaval lymph nodes.

c
the right paracaval lymph nodes.

d
the left retrocrural lymph nodes.

e
all of the above.

Answer 44

A-

Question 45

In a typical human kidney, there are approximately how many renal papillae and corresponding minor calyces?

a
3 to 5

b
7 to 9

c
11 to 12

d
14 to 15

e
17 to 18

Answer 45

B

Question 46

51
A compound renal papilla and calyx:

a
is protective against ascending infection.

b
is least common at the upper pole of the kidney.

c
is a rare finding.

d
is commonly associated with formation of kidney stones.

e
is none of the above.

Answer 46

E.

Question 47

The ureteral smooth muscle consists of:

a
a single layer of longitudinally oriented muscle bundles.

b
a single layer of circular and obliquely oriented muscle bundles.

c
a single layer of randomly oriented muscle bundles.

d
two layers—an inner layer of longitudinal muscle and an outer layer of circular and oblique muscle.

e
two layers—an inner layer of circular and oblique muscle and an outer layer of longitudinal muscle.

Answer 47

d

Question 48

The ureter receives its blood supply from the:

a
renal artery.

b
aorta.

c
common iliac artery.

d
gonadal artery.

e
all of the above.

Answer 48

e

Question 49

An invasive transitional cell carcinoma is diagnosed in the left proximal ureter, at the level of the third lumbar vertebral body. The primary site of potential nodal metastases from this lesion will be the:

a
left para-aortic lymph nodes.

b
interaortocaval lymph nodes.

c
left common iliac lymph nodes.

d
lymph nodes at the left renal hilum.

e
left external iliac lymph nodes.

Answer 49

a

Question 50

During surgical dissection, the ureter can be identified as it enters the pelvis:

a
at the aortic bifurcation.

b
crossing the superior border of the sacrum.

c
crossing the common iliac artery at the branching of the internal iliac artery.

d
crossing the uterine artery.

e
at the internal inguinal ring.

Answer 50

c

Question 51

A young man with right-sided abdominal pain is diagnosed with right hydroureteronephrosis by renal ultrasonography. Which of the following inflammatory processes might impinge on the right ureter and cause obstruction?

a
Acute appendicitis

b
Crohn ileitis

c
Perforated cecal carcinoma

d
All of the above

Answer 51

d

Question 52

Narrowing of the ureteral luminal caliber naturally occurs at:

a
the ureteropelvic junction.

b
the crossing of the iliac vessels.

c
the ureterovesical junction.

d
all of the above.

e
none of the above.

Answer 52

D

Question 53

Sympathetic nerve input to the kidney typically travels through:

a
the celiac plexus.

b
the superior mesenteric plexus.

c
the superior hypogastric plexus.

d
the inferior hypogastric plexus.

e
none of the above.

Answer 53

a- the kidneys receive preganglionic sympathetic input from the eight thoracic through the first lumbar segements. Postganglionic fibers arise from the celiac and aorticorenal ganglia

Question 54

Ureteral peristalsis requires:

a
intact sympathetic input.

b
intact parasympathetic input.

c
both sympathetic and parasympathetic input.

d
intact spinal cord.

e
intrinsic smooth muscle pacemakers in the renal collecting system.

Answer 54

e