The Kidney and Posterior Abdominal Wall Flashcards
What can be found against the posterior abdominal wall
Retroperitoneal organs (kidneys, asc, desc colon, recon, duodenum, pancreas), aorta, IVS Parietal peritoneum against posterior wall, has retroperitoneal fat
Muscles of the posterior abdominal wall
Diaphragm
Quadratus lumborum
Psoas
Illiacus
Where does the diaphragm attach to
Back of 12th rib, lumbar vertebrae and arcuate ligament
Location of the arcuate ligament
Comes over quadrates lumborum (lateral arcuate ligament) and psoas major (medial arcuate ligament)
Where does the quadratus lumborum attach to
Posterior iliac crest and 12th rib
Balances the pull of the diaphragm when breathing
Where does the psoas major attach to
L1-5 and femur lesser trochanter
Receives innervation from lumbar plexus L1-3
Where does the illiacus attach to
How does the illiacus relate to the psoas major
Iliac fossa
Tendons on illiacus + tendons of psoas major = illiopsoas tendon
Receives innervation from the femoral nerves L2-3
Importance of the psoas major
Covered by psoas sheath
Bacteria (TB) can enter, fill it up with pus, irritate muscle
Cause swelling of sheath at inguinal ligament, looks like hernia
Muscle spasms here cause flexion at hip
Haematomas can form here (v vascular)
Nerves of lumbar plexus and where do they originate?
Iliohypogastric L1 Illioinguinal L1 (branch of illiohypogastric) Genitofemoral L1-2 (L1-femoral branch, L2-genital branch) Lateral femoral L2-3 Femoral L2-4 Accessory obturator L3-4 Obturator L2-4 Lumbosacral L4-5
What does the iliohypogastric innervate
Cutaneous for lower anterior abdominal wall and superopubic region
What does the ilioinguinal innervate
Internal oblique, transversus abdominus
Cutaneous anterior innervation of scrotum/labia majora
What does the genitofemoral innervate
L1, cutaneous to the top of the thigh
L2, supplies cremaster muscle
What does the obturator innervate
Medial thigh compartment
What does the femoral innervate
Anterior thigh
What does the lateral femoral innervate
Lateral thigh
What does the lumbosacral innervate
Posterior thigh and lower limbs
Major abdominal arteries and their origin
Abdominal aorta continued on form descending thoracic artery emerged from behind diaphragm at rib 12
Coeliac trunk T12
Superior mesenteric L1
Inferior mesenteric L3
Bifurcation => common iliac L4
Major abdominal veins and their origins
Common iliac => IVC L5
IVC passes up to top of diaphragm T8
Structure of the abdominal aorta
T12, coeliac trunk, inferior phrenic L1, middle adrenal, superior mesenteric L1-4 4 pairs of lumbar arteries L1-2 renal L2 gonadal L3 inferior mesenteric L4 common iliac Median sacral comes off bottom of bifurcation Internal iliac bifurcates off external iliac
What does the phrenic artery supply
Supply abdominal wall
What does the median sacral artery supply
Sacrum
What does the internal iliac artery supply
Pelvis, perineum
What does the external iliac artery supply
Lower limbs
What arteries are found in pairs
Adrenal, kidney, gonadal
Structure of the inferior vena cava
T8, hepatic R, M, L, inferior phrenic L1-4 lumbar L1-2 R renal L2 R gonadal L5 bifurcation of common iliac vein
L1-2 L renal, adrenal, gonadal
Median sacral vein comes off bottom of bifurcation
Internal iliac bifurcates off external iliac
Why do the L adrenal, gonadal veins join to to L renal before joining the IVC at L1-2
Easier for organs on R to access IVC
Function of each part of the urinary system
Kidneys, purifies blood
Ureters, drain urine from kidney to bladder via peristalsis and gravity
Bladder, stores urine, bag of smooth muscle
Urethra, drains urine from bladder => outisde
Position of kidneys and ureters
Hilium, more medial and anterior than back of kidney
R lower than L due to liver
Center of R helium below transpyloric plane
L kidney top touches R11, bottom is 2/3 between L2-3
R kidney top in 11th intercostal space, bottom is at level of L3
Ureters cross tips of lumbar vertebra
Relations of the kidney, anterior
Retroperitoneal, posterior to parietal peritoneum
Cut edges of peritoneal reflection form mesenteries/ligaments
R triangular, L semilunar adrenal glands on kidneys
Duodenum in front of R
Transverse mesocolon, hepatic flexure (R), splenic flexure, pancreatic tail (L) in front
Relations of the kidney, posterior
L kidney from top to bottom
Rib 11
Rib 12
Diaphragm covers ribs
From L to R
Transversus abdominis
Quadrates lumborum
Psoas
R kidney from top to bottom
Rib 12
Diaphragm covers ribs
From L to R
Psoas
Quadratus lumborum
Transversus abdominis
Important of the psoas major next to the kidneys
Infection from the psoas can spread around the body and the kidneys
Structures around the kidneys
Kidney and adrenal gland within kidney capsule
Capusules, aorta and VC surrounded by perirenal fat
Perirenal fat surrounded by renal fascia
Renal fascia surrounded by pararenal fat
Separated from retroperitoneal fat
Internal structure of the kidney
Cortex
Renal columns between pyramids in medulla
Apex of pyramids = papilla (location of CD)
Bottom of renal columns = sinus
Ducts open up into minor calyces
Many minor calyces => major calyx => renal pelvis => ureter
Helium (whether vessels enter an organ)
Renal and adrenal arteries
Superior suprarenal branches from inferior phrenic
Middle suprarenal branches from abdominal aorta
Inferior suprarenal branches from renal arteries
Renal and adrenal veins
Veins infant of arteries and pelvis
R suprarenal vein drains => IVC
L suprarenal vein drains => L renal vein
Renal and suprarenal vasculature (arteries)
Each kidney has several lobes during development, each lobe has its own arterial supply
Lobes disappear but arteries don’t
Arcuate arteries don’t anastomose, form end arteries
Veins freely anastomose
Arteries are polar have superior and inferior entering hilium
Arterial supply of the ureters
Freely anastomotic connections around ureter
Aberrant arteries normally disappear as the arteries rise up the pelvis into the abdomen
If they remain, can press on ureters, cause problems
Structure and relations of the ureters
Ureters leave the hilium at pelvicuretic junction (narrowest)
Crosses over external iliac and psoas major
Enters bladder from the back
Renal stones and colic
Referred pain
Renal stones can form in the ureter
Ureter smooth muscle tries to move stones by peristalsis
Ureter spasms cause pain
Referred pain in kidneys, anterior and posterior
Around the bottom of the ribcage
Referred pain in ureters, anterior
From the top of the pelvis to the pubis on the side affected
Referred pain in ureters, posterior
Around the top of pelvis on affected side
Structure of the suprarenal glands and functions
Cortex
Zona glomerulosa, controls salt and water balance
Zona fasciculata, regulates body carbohydrates
Zona reticularis, secretes precursor steroid sex hormones
Medulla
Chromaffin cells
Auguments SNS, adrenaline, noradrenaline secretion
What is the most posterior structure at the hilum
Ureter
