TBL 28 Flashcards
Which abdominal organs when inflamed would elicit a positive psoas test and how is the test administered?
Kidneys, ureters, cecum, appendix,
sigmoid colon, pancreas.
Note: Also lumbar lymph nodes and nerves of the posterior abdominal wall.
Do the adrenal glands descend with the kidneys when the body is erect?
No, when kidneys descend, the suprarenal
glands remain in place because they lie in a separate
fascial compartment and are fi rmly attached to the diaphragm.
The layers of renal fascia do not fuse firmly
inferiorly to offer resistance, abnormally mobile
kidneys may descend more than the normal 3 cm
when the body is erect.
Why can hematuria and/or proteinuria with left testicular pain result from renal vein entrapment syndrome?
In crossing the midline to reach the IVC, the longer
left renal vein traverses an acute angle between the
SMA anteriorly and the abdominal aorta posteriorly. Downward traction on the SMA may compress
the left renal vein (and perhaps the third part of the duodenum) resulting in a renal vein entrapment syndrome (mesoaortic compression of the left renal vein), also known as “nutcracker syndrome” based on the appearance of the vein in the acute arterial angle in a sagittal view.
Note: Hematuria and/or proteinuria due to venous hypertension leading to rupture of thin walled vein and blood draining into the collecting system of renal tubules.
Left testicular pain in men (related to the left testicular vein draining into the left renal vein proximal to the compression.
Why do obstructive ureteric calculi cause severe, intermittent pain, rather than dull, diffuse pain?
COA-Pg 300
The distention of the ureter will contact the parietal peritoneum to cause the severe intermittent pain.
it causes excessive distension of this muscular tube, the ureteric calculus will cause severe intermittent pain (ureteric colic) as it is gradually forced down the ureter by waves of contraction.
The pain is referred to the cutaneous areas innervated by
spinal cord segments and sensory ganglia, which also receive visceral afferents from the ureter, mainly T12–L2. The pain passes inferoanteriorly “from the loin to the groin” as the stone progresses through the ureter. (The loin is the lumbar region, and the groin is the inguinal region.) The pain may extend into the proximal anterior aspect of the thigh by projection through the genitofemoral nerve (L1, L2), the scrotum in males and the labia majora in females.
Why is the donor kidney positioned in the iliac fossa?
This site supports the transplanted kidney, so that traction
is not placed on the surgically anastomosed vessels. The
renal artery and vein are joined to the external iliac artery and vein, respectively, and the ureter is sutured into the urinary bladder.
Why is the levator ani tonically contracted and when must it be relaxed?
The levator ani forms a dynamic fl oor for supporting the abdominopelvic viscera. It is tonically contracted most of the time to support the abdominopelvic viscera, and to assist in maintaining urinary and fecal continence.
The levator ani must relax to allow urination and defecation.
How is cystotomy performed to prevent peritonitis?
Approached surgically superior to the pubic symphysis for the introduction of indwelling catheters or instruments without traversing the peritoneum and entering the peritoneal cavity.
Cystotomy traversing the peritoneal cavity may increase the risk of introducing urinary contents (toxins) into the peritoneal cavity.
Why can rupture of the bladder cause urine extravasation either extraperitoneally or intraperitoneally?
Rupture superior to the pubic symphysis for the introduction of indwelling catheters
-or-
instruments without traversing the peritoneum and entering the peritoneal cavity.
In males, what is the only structure that passes between the parietal peritoneum and the ureters during their course from the retroperitoneal space of the abdomen into the pelvic cavity?
Ductus deferens.
It crosses the ureter within the ureteric fold of peritoneum. The ureter lies posterolateral to the ductus deferens and enters the posterosuperior angle of the bladder, just superior to the seminal gland.
How are contractions of the detrusor muscle and the internal urethral sphincter regulated during micturition in males?
The presynaptic parasympathetic fibers (S2-S4 via the anterior rami of spinal nerves S2-S4 via the inferior hypogastric and pelvic plexuses to the bladder) are motor to the detrusor muscle and inhibitory to the internal urethral sphincter of the male bladder. Hence, when visceral afferent fibers are stimulated by stretching, the bladder contracts reflexively, the internal urethral sphincter relaxes (in males), and urine flows into the urethra.
Note: Innervation of bladder- parasympathetic fibers from sacral spinal cord levels are conveyed by the pelvic splanchnic nerves and the inferior hypogastric plexus.
Presynaptic parasympathetic fibers to the bladder arise from neurons in the S2–S4 spinal cord segments and pass from the anterior rami of spinal nerves S2–S4 via the pelvic splanchnic nerves and inferior hypogastric and vesical (pelvic) plexuses to the bladder. They synapse with post synaptic neurons located on or near the bladder wall. Visceral afferent fi bers conveying refl ex information and pain sensation from subperitoneal viscera (inferior to
the pelvic pain line) follow parasympathetic fi bers retrogradely to the S2–S4 spinal ganglia
How can a sympathetic response hamper urination in males?
A sympathetic response at moments other than ejaculation (e.g., self- consciousness when standing at the urinal in front of a waiting line) can cause the internal sphincter to contract, hampering the ability to urinate until parasympathetic inhibition of the sphincter occurs.
Why are bladder infections more common in females?
Infections of the urethra, and especially the bladder,
are more common in women because the female urethra is short, more distensible, and is open to the exterior through the vestibule of the vagina
What occupies the central part of the posterior abdominal wall?
Five lumbar vertebrae and associated IV discs occupy the central part of the posterior abdominal wall.
What is the chief flexor of the thigh and discuss the components to making it and reference vertebral bodies.
Vertebral bodies are proximal attachments for the psoas major that with the iliacus forms the iliopsoas muscle, the chief flexor of the thigh.
Identify femoral and obturator nerves and recollect their respective distributions to the (2).
femoral and obturator nerves and recollect their distributions to the anterior and medial thigh, respectively.
diaphragm forms the _______ of the ________ abdominal wall.
diaphragm forms the superior part of the muscular posterior abdominal wall.
Identify quadratus lumborum and it joins (structure) to form the INFERIOR part of the (structure).
joins the transverse abdominis to form the inferior part of the abdominal muscular wall.
kidneys, ureters, and adrenal glands are retroperitoneal viscera.
Informational
EACH kidney is surrounded by _______ fat that extends into (structure and describe).
each kidney is surrounded by perinephric fat that extends into its hollow center, the renal sinus.
Discuss the fibrous renal fascia (surrounds and its continuation inferiorly).
the fibrous renal fascia encloses the kidney and perinephric fat, except inferiorly, and continues along the ureter as the periureteric fascia.
Discuss the renal fascia and reference adrenal glands and its continuation superiorly.
after enclosing the adrenal glands, the renal fascia is continuous superiorly with the diaphragmatic fascia.
(Structure) separates the adrenal glands from the kidneys.
What is the primary fascial attachment of the adrenal glands?
a fascial septum separates the adrenal glands from the kidneys
the primary fascial attachment of the adrenal glands is to the diaphragmatic fascia not the renal fascia.
Which kidney is depressed by the liver?
Discuss the position of superior portions of both kidneys relative to the ribs.
the right kidney is depressed by the liver
its superior portion is deep to the 12th rib and the superior portion of left kidney is deep to the 11th rib.
In which direction do kidneys move during respiration and change of supine to erect position.
the kidneys move vertically during respiration and when changing between supine and upright positions.
Discuss the relative position of renal pelvis.
the renal pelvis is posterior to the renal vessels at the hilum of the kidney.
Origin of renal arteries and blood supply to renal adrenal glands (2).
the renal arteries arise from the abdominal aorta in close proximity to the SMA
the adrenal glands are supplied by small branches arising from the renal arteries and the aorta.
Discuss the particularity of the left renal course and its drainage location, similar to the right renal vein.
the left renal vein traverses the acute angle between the aorta and SMA and like the right renal vein, terminates in the IVC.
Lymph from (3) drain into LUMBAR LYMPH NODES along the (structure).
lymph from the kidneys, ureters and adrenal glands drains into the bilateral LUMBAR LYMPH NODES along the abdominal aorta.
Discuss what forms plexus around renal arteries.
the lesser and least splanchnic nerves synapse in the aorticorenal ganglion and postsynaptic sympathetic fibers with visceral afferent fibers from the DRG at T12-L2 form plexuses around the renal arteries.
