The Abdomen (2) Flashcards
1
Q
State the boundaries of the abdomen.
A
Superior: 5th intercostal space, xiphoid process, diaphragm
Inferior: pubic bone, iliac crest at the level of L4
Anterior: umbilicus at the level of L3-4
Posterior: lumbar vertebrae, psoas, iliacus, quadratus lumborum
2
Q
The abdomen may be split into 4 quadrants, name them.
A
RUQ, LUF, RLQ, LLQ
3
Q
The abdomen may be split into 9 parts, name them, from left to right, and then from up to down.
A
Right hypochondrium, epigastric, left hypochondrium, right flank, umbilical, left flank, right inguinal, pubic, left inguinal
4
Q
State the layers of the abdominal wall from superficial to deep. (10)
A
Skin, Camper fascia (adipose), Scarpa fascia (membrane), rectus sheath (rectus abdominis), external oblique, internal oblique, transversus abdominis, transversalis fascia, extraperitoneal fat, parietal peritoneum
5
Q
What separates the right and left rectus abdominis?
A
Linea alba
6
Q
State some functions of the abdominal wall.
A
Protection of organs, movement of vertebrae, coughing, emesis, urination, childbirth
7
Q
Where do the rectal sheaths connect?
A
At the linea alba
8
Q
At what point do the aponeuroses stop having a posterior and anterior division around abdominal muscles and run solely anteriorly?
A
The arcuate line, about midway between the pubic symphysis and the umbilicus. Hence, the rectus abdominis is in direct association with transversalis fascia
9
Q
State the major fossae of the abdomen which are potential sites for herniation.
A
Medial inguinal fossa, lateral inguinal fossa
10
Q
What is a hernia?
A
A hernia is the protrusion of tissue through the wall of the cavity that contains it.
11
Q
What are the most common abdominal wall hernias?
A
Inguinal, femoral and incisional hernias
12
Q
State the nerve supply of the muscles of the abdominal wall.
A
T6-L1 spinal nerves
13
Q
Where do nerves pierce the abdomen?
A
They pierce the abdomen at the anterior ends of the intercostal spaces
14
Q
Between what layers do the nerves run?
A
Between the internal oblique and the transversus abdominis layers
15
Q
State the continuation of the ilioinguinal nerve.
A
The ilioinguinal nerve originates from ventral ramus of L1 spinal nerve and continues through the inguinal canal.
16
Q
What are the major sources of blood supply to the abdomen?
A
The superior and inferior epigastric arteries
17
Q
What is McBurney’s point?
A
McBurney’s point approximates the location of the appendix. It is located 1/3rd of the way along the imaginary line from the right ASIS of the pelvis to the umbilicus. A gridiron incision is made here. Tenderness at this spot is a sign of acute apendicitis.
18
Q
State the attachments of the inguinal ligament.
A
ASIS and pubic tubercle
19
Q
What is the neurovascular significance of the inguinal ligament?
A
The femoral nerve, artery and vein enter the thigh by passing deep to the inguinal ligament.
20
Q
State the biological sex differences of the inguinal canal.
A
The superficial inguinal ring is larger in males. Far more contents in males than in females.
21
Q
State the location of the openings of the inguinal canal.
A
The deep inguinal ring is the opening of the invagination of the transversalis fascia. It lies above the inguinal canal, midway between the ASIS and the pubic tubercle.
The superior inguinal ring is a triangular defect in the aponeurosis of the external oblique muscle layer. Lies superolateral to the pubic tubercle.
22
Q
State the contents of the inguinal canal that are common to both sexes.
A
Ilioinguinal nerve and lymph vessels
23
Q
State the contents of the inguinal canal in males (spermatic cord,10).
A
A. to vas deferens, vas deferens, genital branch of genitofemoral nerve, testicular arteries, pampiniform plexus of testicular veins, cremaster artery, vein and muscle, processus vaginalis, autonomic nerves.
24
Q
State the superior and inferior borders of the ilioinguinal canal.
A
Superior: arching fibers of the internal oblique and TA muscles
Inferior: superior surfaces of inguinal and lacunar ligaments
25
State the cause and location of a direct inguinal hernia.
Typically occurring in older men due to weakness in abdominal wall behind or lateral to superficial inguinal ring. It occurs medial to the epigastric vessels.
26
State the cause and location of an indirect inguinal hernia.
It traverses deep and superficial inguinal rings and inguinal canal. It lies within coverings of spermatic cord. It may descend into scrotum. More common in young males. It lies lateral to the epigastric vessels.
27
State the boundaries of Hesselbach's triangle.
Lateral: inferior epigastric vessel
Medial: lateral border of RA
Inferior: inguinal ligament
28
State the relation of (in)/direct hernias to Hesselbach's triangle.
Direct hernia's leave the abdomen through Hesselbach's triangle. Indirect hernias protrude lateral to Hesselbach's triangle
29
What ligament connects the stomach and the transverse colon?
The gastrocolic ligament
30
Where does the oesophagus meet the stomach?
The oesophago-gastric junction
31
Where does the stomach meet the duodenum?
The pylorus
32
State the 3 parts of the SI.
Duodenum, jejunum, ileum
33
What is the part of the stomach leading to the pylorus called?
The pyloric antrum
34
What direction do the curves of the stomach face?
The greater curve faces left, the lesser curve faces right
35
What is the fundus?
The fundus is the upward and backward bulge of the stomach. It digests proteins and mixes the contents of the stomach.
36
What are the walls of the stomach made of?
Smooth muscle and mucosa
37
State the difference between the mucosa in the fundus and pyloric antrum of the stomach.
Mucosa is smooth in the fundus, but exists in longitudinal folds in the antrum.
38
What is the difference between the sphincter at the oesphago-gastric junction and the pylorus?
The sphincter is partially effective at the OG junction, preventing contents from passing upward. However, it is highly effective at the pylorus and releases contents intermittently into the SI.
39
Where do the omenta originate?
The greater omentum originates from the greater curve of the stomach, while the lesser omentum originates from the lesser curve.
40
What foramen leads into the lesser sac?
The epiploic foramen
41
State the organs of the foregut. (9)
Pharynx, lower respiratory system, oesophagus, stomach, duodenum, liver, pancreas, gallbladder, spleen
42
State the organs of the midgut.
Duodenum, SI, caecum, appendix, ascending colon, right 2/3rds of transverse colon
43
State the organs of the hindgut.
Left 1/3 of transverse colon, descending colon, sigmoid colon, rectum, anal canal
44
State the position and branches of the abdominal aorta.
The abdominal aorta is the final part of the descending aorta. Begins at diaphragm, from T12-L4. Its branches are labelled anterior, posterior and lateral.
45
What is the arterial supply of the gastrointestinal tract?
The 3 anterior branches supply the GI tract. Coeliac trunk (T12) supplies the foregut. Superior mesenteric artery (L1) supplies the midgut. Inferior mesenteric artery (L3) supplies the hindgut.
46
State the major veins of the gastrointestinal tract.
Splenic vein - foregut
Superior mesenteric vein - midgut
Inferior mesenteric vein - hindgut
All the above veins then drain into the hepatic portal vein.
47
What happens to the arterial supply in the GI tract before reaching the hepatic portal vein?
It divides into a capillary network within the GI tract and organs, then drains into the hepatic portal vein.
48
Where does the hepatic portal vein transport blood?
It transports blood to the liver.
49
What happens to blood in the liver before returning to the heart?
It flows through the liver sinusoids before merging into the IVC.
50
What percentage of the liver’s blood supply comes from the hepatic branch of the coeliac artery?
20-25%
51
State the attachments and functions of the phrenico-oesophageal ligament.
The phrenico-oesophageal ligament connects the oesophagus to the diaphragm. It restricts upwards movement while permitting some movement for swallowing and external respiration.
52
How many litres of food/liquid can the stomach hold?
1-2L, 4L at a stretch
53
State the function of HCl in the stomach.
HCl inhibits bacterial growth and activates pepsinogen (a precursor to pepsin) and helps release B12.
54
What is the relationship between the stomach and vitamin B12?
Parietal cells in the stomach secrete intrinsic factor, a glycoprotein essential for B12 absorption.
55
What is the cardia? At what level is it located?
The cardia is the 1st region of the internal stomach. It contains mucous-secreting glands but lacks acid-secreting parietal cells. T10
56
At what level is the pylorus located?
L1
57
What is the cardiac sphincter?
The cardiac sphincter is a valve at the oesophago-gastric junction that prevents backflow of food and digestive enzymes.
58
What is the function of the pylorus?
To contract to empty materials from the stomach to the SI.
59
State the attachments and functions of the hepatoduodenal ligament.
Attachments: liver, duodenum
Function: contains portal triad; bile duct, hepatic portal vein and hepatic portal artery
60
State the attachments and functions of the hepatogastric ligament.
Attachments: liver, lesser curve of stomach
Function: anchors liver to stomach
61
Label the diagram.
1=lesser omentum
2=portal triad
3,4,5=hepatic artery, bile duct, hepatic portal vein
6=hepatogastric ligament
7=stomach
8=visceral peritoneum
9=gastrosplenic ligament
10=visceral peritoneum
11=parietal peritoneum
12=spleen
13=splenorenal ligament
14=left kidney
15=abdominal aorta
16=IVC
17=right kidney
18=parietal peritoneum
19=omental foramen
20=greater sac
21=lesser sac
62
State the volume of peritoneal fluid in the peritoneal cavity.
50mL
63
State the attachments and functions of the gastrosplenic ligament.
Attachments: greater curve, hilum of spleen
Function: contains short gastric arteries and support
64
State the attachments and functions of the splenorenal ligament.
Attachments: hilum of spleen, posterior left kidney
Function: contains splenic artery and vein, support
65
State the attachments and functions of the falciform ligament.
Attachments: anterior left lobe of liver
Function: contains round ligament of liver (ligamentum teres) which is a remnant of the umbilical vein
66
State the 3 ligaments of the greater omentum.
Gastrophrenic, gastrocolic, gastrosplenic
67
State the 2 ligaments of the lesser omentum.
Hepatogastric, hepatoduodenal
68
State the attachments of the gastrophrenic ligament.
Left greater curve and diaphragm
69
Compare the infant and adult omental bursa.
In infants, the omental bursa is an isolated portion of the peritoneal cavity. It is dorsal to the stomach. Its 2 recesses are superior (toward liver and diaphragm) and inferior (between layers of the greater omentum).
In adults, the layers of the greater omentum fuse. Inferior recess is only as far as the transverse colon. The omental bursa communicates with the greater sac through the omental foramen.
70
State the muscular layers of the stomach wall.
Outer longitudinal, middle circular, inner oblique (improper)
71
What is the myenteric plexus (Auerbachs plexus)?
The myenteric plexus lies in the connective tissue lamina between circular and longitudinal fibers. It provides motor innervation to outer longitudinal and middle circular fibers, both sympathetic and parasympathetic input.
72
From what muscular layer are the sphincters formed?
The lower oesophageal and pyloric sphincters are formed from the inner (middle) circular muscle layer.
73
What are the 4 layers of the gut wall?
Outer visceral peritoneum, smooth muscle, submucosal layer, inner lining of mucous membrane
74
State the position of the duodenum relative to the peritoneum.
The duodenum is retroperitoneal.
75
How does the duodenum receive bile and enzymes?
Bile from the gallbladder and liver via the bile duct. Enzymes from the pancreas via main pancreatic duct.
76
What are the 3 branches of the coeliac trunk?
The left gastric, splenic and common hepatic arteries
77
What does the left gastric artery supply?
Oesophagus and stomach (piercing at lesser curve)
78
What does the splenic artery supply?
Spleen, gives rise to gastric branches, supplying stomach
79
What does the common hepatic artery supply?
Gives rise to the right gastric artery, supplying the lesser curve
80
How is the lesser curve of the stomach supplied blood?
Left and right gastric artery
81
How is the greater curve of the stomach supplied blood?
The right and left gastroepiploic (gastro-omental) artery (from common hepatic artery)
82
How is the fundus of the stomach supplied blood?
Vasa brevia (short gastric arteries) from splenic artery
83
State the arterial supply of the proximal duodenum.
Superior pancreaticoduodenal artery, arising from the gastroduodenal artery
84
State the arterial supply of the distal duodenum.
Inferior pancreaticoduodenal artery, arising from the superior mesenteric artery
85
State the venous drainage of the stomach and duodenum.
splenic, right and left gastric, superior mesenteric (pancreaticoduodenal and gastroepiploic) veins
86
State the sympathetic innervation of the stomach muscle.
Solar plexus, conducting the splanchnic nerves
87
State the parasympathetic innervation of the stomach muscle.
Right vagus innervates the posterior stomach and the left vagus innervates the anterior stomach. It is responsible for gastric secretions.
88
How is the duodenum innervated?
The vagus and abdominopelvic splanchnic nerves
89
State the sympathetic innervation of the SI.
T9/10 via celiac and superior mesenteric plexuses
90
State the parasympathetic innervation of the SI.
Vagus nerve (CN X)
91
State the sympathetic/parasympathetic innervation of the LI.
Aortic/intermesenteric, celiac, superior mesenteric, inferior mesenteric, hypogastric nervous plexuses. T10-L3/S2-4, CN X
92
State the components of the enteric nervous system. Where is it?
Submucosal (Meissner) and myenteric (Auerbach) plexuses, in the colon
93
State the medical term for swallowing.
Deglutition
94
What % of nutritional absorption takes place in the SI?
95%
95
State the arterial supply of the SI.
Superior mesenteric artery
96
State the venous drainage of the SI.
Superior mesenteric vein, to hepatic portal vein
97
What are the layers of the gut wall, from superficial to deep?
Outer visceral peritoneum, smooth muscle (muscularis externa), submucosal layer, inner lining of mucous membrane
98
Distinguish between the jejunum and the ileum in the living body?
The jejunum's wall is thick and heavy, while the ileum's wall is thin and light. The jejunum is a deeper red, the ileum is a paler pink. There is more mesenteric fat in the jejunum.
99
What are some modifications of the intestine to increase surface area apart from (micro)villi?
Plicae circulares (Valves of Kerckring) (circular folds)
100
Where are the plicae circulares most well developed?
Jejunum
101
What are the distinctive features of the LI?
The absence of villi, presence of goblet cells and deep intestinal glands.
102
What vitamins does the microbiome of the LI produce?
Vitamins B and K
103
State the components of the LI.
Cecum, colon, rectum, anal canal
104
What happens when cecal distention occurs?
Cecal distention causes a local reflex, and the ileocecal valve constricts.
105
What is the purpose of the ileocecal valve constricting during cecal distention?
It prevents more chyme from entering the cecum.
106
How does ileocecal valve constriction affect digestion and absorption?
It increases digestion and absorption in the small intestine by slowing the progress of chyme.
107
What does the constriction of the ileocecal valve prevent?
It prevents backflow of chyme into the small intestine.
108
At what point does the ileum join the LI?
Ileocaecal fold, closed by the sphincter of the ileocaecal valve
109
State the position of the caecum, relevant to the ileocaecal fold.
Inferior
110
What is the arterial supply of the caecum and appendix?
Superior mesenteric artery
111
What are the 4 parts of the colon?
The ascending, transverse, descending and sigmoid colon
112
What are omental appendices, where are they found?
They are short peritoneal folds filled with fat. They are found all of the LI except the rectum and anal canal.
113
What are the paracolic gutters?
They are the 2 spaces between the ascending and descending colons and the posterolateral abdominal wall.
114
How is the colon supplied blood?
The ascending and proximal 2/3rds are supplied by the superior mesenteric artery, by the branches: ileocolic, middle colic and right colic arteries.
The distal 1/3rd and descending colon are supplied by the inferior mesenteric artery, by the branches: left colic, superior sigmoid and sigmoid arteries.
The lymph channels follow the arteries.
115
What is the venous drainage of the colon?
The tributaries of the superior and inferior mesenteric veins
116
What is the anorectal angle?
80 degrees
117
What muscle holds the rectum in place?
Puborectalis, forming the puborectal sling
118
At what level is the rectum?
S3
119
What are the transverse folds of the rectum otherwise known as?
Houston's valves
120
What is the arterial supply of the rectum?
The superior, middle and inferior rectal arteries
121
What is the fibromuscular ring formed at the rectum where it is connected to the puborectalis?
Anorectal ring
122
Differentiate the cell types of the superior and inferior anal canal.
The superior epithelium is simple columnar, while the inferior epithelium is stratified squamous.
123
What symptoms are observed in hemorrhoids of the rectum?
Localised vein enlargement or inflammation is seen
124
How is serosa distributed in the LI?
Serosa lines every part of the LI, except for the following areas: posterior ascending colon, posterior descending colon, lower 1/3rd of rectum (ampulla).
125
What are the teniae coli?
The teniae coli are 3 longitudinal muscular bands. They cause peristalsis and form sacs called haustra in the process.
126
How is a single contrast study carried out?
A cleansing enema is administered. Then a Ba enema is administered. A fluoroscope is then used to analyse the intestines.
127
How is a double contrast study carried out?
Following the single contrast study, the Ba is evacuated and the colon is distended with air. There remains a layer of Ba on the luminal surface.
128
What is the frenulum?
The frenulum is a transverse fold that runs just superior to the ileocecal valve.
129
What is the uncinate process of the pancreas?
It is a prolongation of the head.
130
What is the arterial blood supply of the pancreas?
Body and tail: splenic artery from celiac trunk
Head: superior pancreatico-duodenal artery, from common hepatic artery and inferior pancreatico-duodenal artery, from superior mesenteric artery
131
What is the venous drainage of the pancreas?
Pancreatico-duodenal veins to SMV and splenic vein to portal vein
132
State the parasympathetic innervation of the pancreas.
Vagus nerve
133
State the sympathetic innervation of the pancreas.
T5-10 of celiac plexus
134
What are the sympathetic and parasympathetic functions of the pancreas?
Endocrinally speaking, the pancreas stimulates insulin production for insulin uptake and storage. It also inhibits insulin production and boosts glucagon output.
135
State the course of the pancreatic duct.
The pancreatic duct begins at the tail and gets larger, it drains the tail and the body. It is joined by the bile duct in the head at the hepatopancreatic ampulla. It then opens into the wall of the descending duodenum at the major duodenal papilla. The inlet is controlled by the hepatopancreatic sphincter.
136
State the course of the accessory pancreatic duct.
The accessory pancreatic duct drains the head and uncinate process. It empties into the minor duodenal papilla. It is just superior to the major.
137
What are the different endocrine cells of the islets of Langerhan?
Alpha, beta, delta (D), gamma (G), B and PP cells
138
State the function of alpha cells.
Secrete glucagon
139
State the function of beta cells.
Secrete insulin
140
State the function of delta cells.
Secrete somastatin
141
State the function of F/gamma/PP cells.
Secrete pancreatic polypeptides
142
How is the pancreas implicated in type 1 and 2 DM?
1: beta cell insufficiency, too little insulin produced
2: glucose insensitivity
143
In what areas is the liver NOT covered by visceral peritoneum.
The posterior bare area, fossa of the gall bladder, porta hepatis
144
State the attachments of the ligamentum venosum.
The portal vein at porta hepatis and the IVC. It has its own fissure which divides the caudate and left lobes of the liver. It is a remnant of the ductus venosus which connected the left umbilical vein to the IVC in intra-uterine life.
145
State the 2 coronary ligaments of the liver.
Right and left triangular ligaments
146
State the attachments of the coronary ligaments of the liver.
The right triangular ligament connects the right lobe to the diaphragm.
The left triangular ligament connects the left lobe to the diaphragm.
147
Which of the liver's lobes is the largest?
Right
148
To which lobe of the liver is the quadrate and caudate considered to be a part of?
Right
149
Label this diagram of the posteroinferior liver.
1=caudate lobe
2=left lobe
3=umbilical fissure (left sagittal)
4=porta hepatis
5=quadrate lobe
6=course of middle hepatic vein (through main portal fissure)
7=right lobe
8=right sagittal fissure
150
What does the common hepatic artery divide into?
Proper hepatic artery and gastroduodenal artery
151
How is the proper hepatic artery different to the hepatic artery proper?
They are very closely related in both definition and geography. While the common hepatic artery divides into 2 branches, one of them being the proper hepatic artery, the common hepatic artery may then continue as the hepatic artery proper. Thus, the hepatic artery proper is the continuation of the common hepatic artery. There is only one hepatic artery proper, whereas there are 2 proper hepatic arteries.
152
State the arterial supply of the liver.
Right and left proper hepatic arteries for the right and left lobes
153
State the venous drainage (supply) of the liver.
The right, middle and left hepatic veins. Blood is also received from the portal vein, this blood is low in O2 but rich in nutrients as it is from the GI tract.
154
What veins unite to form the portal vein?
The superior mesenteric vein and the splenic vein
155
What is the fibrous layer that covers the liver?
Glisson's capsule
156
How many surgically resectable sections of the liver are there?
8
157
How are the surgically resectable segments of the liver determined?
Segments are based on the primary division of the portal triad.
158
What is the portal triad?
The portal triad consists of the portal vein, hepatic artery and bile passages.
159
What are the 8 subdivisions of the liver, where are they?
The caudate lobe (I)
Left lobe: lateral segment (II), left lateral anterior segment (III)
Right lobe: left medial segment (IV) (quadrate lobe), anterior medial segment (V), right anterior lateral segment (VI), posterior lateral segment (VII), posterior lateral segment (VIII)
160
Where is the hepatorenal recess? What is its clinical significance?
It is in the posterosuperior right subhepatic space, between the visceral liver and kidney. Fluid from the omental bursa may drain here when supine. It may form an abscess.
161
What is ascites?
Fluid build-up in the abdomen
162
What is hemoperitoneum?
Blood build-up in the abdomen
163
What is parenchyma?
The functional tissue of an organ (not connective tissue)
164
How are individual hepatocyte supplied with blood?
Through the surrounding network of sinusoids
165
How does blood flow from the portal vein to the IVC?
Portal vein, central vein, interlobular vein, hepatic vein, IVC
166
What is the innervation of the liver's parenchyma?
The hepatic plexus (T5-9 and CN X). It is derived from the coeliac plexus
167
How do nerves course through the liver?
They pierce the liver at the porta hepatis and they follow the hepatic artery and portal vein branches.
168
How is Glisson's capsule innervated?
Branches of the lower intercostal nerves
169
What are the 3 types of hepatic lymphatic vessels?
Portal lymphatic vessels (80%), sublobular lymphatic vessels, superficial lymphatic vessels
170
Where does hepatic lymph drain to?
They drain to hilar lymph nodes/nodes in lesser omentum, then to coeliac node, ultimately draining into the thoracic duct.
171
What are the components of the biliary tree?
Intrahepatic ducts, extrahepatic ducts, gallbladder, common bile duct
172
What does the biliary tree secrete?
Bile - to reduce stomach activity and emulsify fats
Enzymes - trypsin, amylase and lipase, to breakdown proteins, carbs and fats
173
State the function of the gallbladder.
To store and concentrate bile
174
State the position of the gallbladder relevant to the liver.
Right of the caudate lobe
175
State the parts of the gallbladder.
Fundus, body, neck, infundibulum
176
What is cholecystitis?
Cholecystitis is inflammation of the gallbladder.
177
What is Murphy's sign?
The RUQ is palpated while the patient is breathing deeply, a positive sign is sudden pain and a halt in inspiration. Symptomatic of cholcystitis
178
Describe the passage of bile.
Bile flows from the liver through the hepatic ducts into the gallbladder via the spiral sphincter valve (of Heister) when the bile duct sphincter is closed (no digestion), causing bile to back up through the cystic duct for storage and concentration. When needed, bile exits the gallbladder via the cystic duct, flows into the common bile duct, merges with the pancreatic duct at the ampulla of Vater, and enters the small intestine at the major duodenal papilla.
179
State the arterial supply of the gallbladder.
Cystic artery, arising from the right hepatic artery
180
State the venous drainage of the gallbladder.
Cystic vein, draining to the portal vein
181
State the innervation of the gallbladder.
Coeliac plexus (T5-9)
182
What hormones are released by the kidneys?
Erythropoietin (in response to hypoxia to produce RBCs), renin (regulates aldosterone), calcitriol (promotes Ca absorption in intestines and phosphate absorption in kidneys)
183
Label the diagram of the right kidney.
1=superior pole
2=medial margin
3=renal hilum
4=renal artery
5=renal vein
6=renal pelvis
7=ureter
8=inferior pole
9=fibrous capsule
10=cortex
10.1=minor calyx
10.2=major calyx
10.3=calices
11=pyramid (medulla)
12=renal pelvis
13=renal sinus
14=papilla
15=medullary ray
16=ureter
184
How many renal pyramids are there in each medulla?
Up to 12
185
What are the layers of fasciae surrounding the kidney?
Fibrous renal capsule, perirenal adipose tissue, renal fascia of Gerota, pararenal fat
186
Which layer of fascia surrounding the kidney is continuous with the outer layer of ureter and contains nociceptors?
Fibrous renal capsule
187
What is the renal fascia of Gerota continuous with?
Fascia of transversalis, diaphragm above suprarenal gland, IVC, psoas and aorta
188
How does the renal artery branch throughout the kidney?
The renal artery gives off the inferior suprarenal, posterior, superior, anterior superior, anterior inferior, inferior and ureteric branch of renal arteries. These are segmental arteries. Each segmental artery gives off 2 or 3 interlobar arteries. These give rise to the arcuate arteries at the cortex-medulla junction.
189
Which renal vein is longer?
Left
190
Which is more anterior at the hilum, renal artery or vein?
Renal vein
191
State the venous drainage of the kidneys.
Peritubular venules, interlobar veins, renal vein
192
What is the sympathetic nerve supply of the kidneys?
Renal sympathetic plexus, entering the spinal cord at T10-12 spinal nerves.
193
Localise the lateral aortic lymph nodes.
Origin of the renal artery
194
How do the ureters enter the pelvis?
By crossing the bifurcation of the common iliac artery, in front of the SI joint. They are retroperitoneal.
195
How may the kidneys be imaged?
Radiograph - intravenous urogram (pyelogram)
196
What are the uretic constriction sites? Why are they significant?
Ureteropelvic junction where the renal pelvis joins the ureter at psoas major. As it crosses the pelvic brim, crossing over internal/common iliac artery. As it pierces the bladder wall (intra-mural).
197
How are the various parts of the ureter supplied by blood?
Superior: renal artery
Middle: testicular/ovarian artery from aorta
Pelvis: superior vesical artery from internal iliac artery
198
What is the nerve supply of the ureter?
Sympathetic renal nerves arising from superior mesenteric ganglion (T10,11), arising from splanchnic nerve. Afferent fibers enter the spinal cord at T10-L2.
199
What hormones does the cortex secrete?
Corticoids - controls fluid and electrolyte balance
Glucocorticoids - regulates metabolism of food
Gonadocorticoids - responsible for prepubertal development of the sex organs
200
What hormones do the suprarenal glands secrete?
Catecholamine, epinephrine, norepinephrine
201
Of the suprarenal glands, which is crescent-shaped and which is pyramidal?
Left is crescent
Right is pyramidal
202
What is the arterial supply of the suprarenal glands?
Superior suprarenal (from inferior phrenic artery), middle suprarenal (from aorta) and inferior suprarenal arteries (from renal artery)
203
What is the venous drainage of the suprarenal glands?
Right suprarenal vein to IVC
Left suprarenal vein to left renal vein
204
What is the nervous supply of the suprarenal glands? What is unique about it?
Greater splanchnic nerve (T5-9)
No synapses at the ganglia
Lesser and least splanchnic nerves are also involves (T10-12)
205
State an alternative name for the suprarenal gland.
Adrenal gland
206
What are the parenchyma of the suprarenal gland?
Chromaffin cells
207
Explain hiccups.
Hiccups involve the involuntary spasmodic contraction of the diaphragm and closure of the glottis of the larynx.
