The Kidney and the Posterior Abdominal Wall

Question 1

Name the retroperitoneal structures.

Answer 1

• duodenum
• pancreas
• kidneys
• ascending and descending colon
• rectum

Question 2

What is the name of the triangle of connective tissue found at the base of the back?

Answer 2

The thoracolumbar fascia

Question 3

What are the names of the connective tissues where the diaphragm arches over the posterior abdominal wall muscles and vessels?

Answer 3

The median, medial and lateral arcuate ligaments

Question 4

What is the most lateral posterior abdominal wall muscle?

What are it’s origins and attachments?

Answer 4

Quadratics lumborum

It attaches to the:

• The lumbar vertebra transverse processes medially
• 12th rib
• posterior iliac crest

Question 5

What is the more medial posterior abdominal wall muscle?

What are it’s origins and attachments?

Answer 5

Psoas major

It is attached to:

• Iliacus muscle on the iliac fossa to form iliopsoas which attaches to the lesser trochanter of the femur
• Transverse processes of the lumbar vertebrae

Question 6

What is the nerve supply to both psoas major and quadratics lumborum?

Answer 6

From the lumbar plexus (L1, 2 and 3)

Question 7

Where is the lumbar plexus found?

Answer 7

Inside psoas major

Question 8

Which level spinal nerves form the lumbar plexus?

Answer 8

T12 - L5

Question 9

At what level does the thoracic aorta enter the abdominal cavity and through which structure?

Answer 9

It travels under the median arcuate ligament created by the diaphragm at the level of T12

Question 10

At what level does the vena cava enter the abdominal cavity?

Answer 10

T8

Question 11

At what level does the oesophagus enter the abdominal cavity?

Answer 11

T10

Question 12

At what level does the abdominal aorta bifurcate?

What does it bifurcate into?

Answer 12

L4

Right and left common iliac arteries

Question 13

What are the X3 lateral branches of the abdominal aorta, what level does each arise and what does each supply?

Answer 13

1) suprarenal = L1 = suprarenal gland
2) renal = L1/2 = kidneys
3) gonadal = L2 = gonads

Question 14

How many paired branches does the abdominal aorta give off to supply the body wall?

Answer 14

X4

Question 15

At what level do the right and left common iliac veins converge to for, the IVC?

Answer 15

L5

Question 16

What is the name for the opening in the diaphragm through which the vena cava enters the thoracic cavity?

At what level does this occur?

Answer 16

The caval opening

T8

Question 17

What are the tributaries of the IVC?

Answer 17

NOT the arterial supply of the GI tract, these are drained via the hepatic portal system.

The lumbar and renal veins are the same as the arteries.

The gonadal and suprarenal veins drain into the left renal vein, and therefore the IVC via this

Question 18

Between what X2 levels do the aorta and IVC move from anterior/posterior and vice verse?

Which is anterior higher up?

Answer 18

The IVC is more anterior around the level of the kidneys.

They swap before the level of bifurcation so that the aorta is more anterior.

Question 19

Is the renal vein or renal artery more anterior?

Answer 19

Renal vein

Question 20

Which aortic vessel travels over the top of the renal vein?

Answer 20

The superior mesenteric artery

Question 21

What level are the middle of the kidneys?

Answer 21

L1

Question 22

Which kidney is higher and which is lower?

Why is this?

Answer 22

Right = lower
Left = higher

Due to liver

Question 23

What ribs are at the level of each kidney?

Answer 23

Right = 12th

Left = 11th

Question 24

Which of the suprarenal glands is triangular in shape and which is crescent?

Answer 24

Right = triangular

Left = crescent

Question 25

What are layers surrounding the kidney?

Answer 25

Kidney 
Renal capsule
Perirenal fat
Renal fascia
Pararenal fat

Question 26

What is the name of the cortex of kidney that extends between the triangular sections of medulla?

Answer 26

Renal columns

Question 27

What are the triangular sections of kidney medulla called?

Answer 27

Renal pyramids

Question 28

What are the initial structures of drainage that extend off each renal pyramid?

Answer 28

Minor calcycles

Question 29

What is the main section of kidney that links the major calyces with the ureters?

Answer 29

The renal pelvis in the renal hilum

Question 30

What is the arterial supply to the suprarenal glands?

Where do each of these arteries arise from?

Answer 30

There is x3 arteries:

1) superior suprarenal
= from the inferior phrenic which comes off the aorta

2) middle suprarenal
= direct from the aorta

3) inferior suprarenal
= from the renal artery

Question 31

How many functional lobes does the kidney have?

Answer 31

X5

Question 32

Where does the suprarenal vein drain on the right hand side?

Answer 32

Direct to the IVC

Question 33

Where does the suprarenal vein drain on the left hand side?

Answer 33

Down to the left renal vein then to the IVC

Question 34

Which structure do the ureters cross over on the way to the bladder?

Answer 34

The external iliac arteries