The Retroperitoneum Flashcards
State the structures found on the posterior abdominal walls and how can this be divided?
SAD PUCKER
Primary: Kidneys and Ureters Suprarenal glands Aorta and IVC Oesophagus Rectum
Secondary:
Duodenum (2nd and 3rd)
Pancreas (not tail)
Colon (ascending and descending)
Which organs are in contact with the posterior abdominal wall?
Aorta (and IVC)*
Colon (ascending and descending)
Kidneys
Describe the way the duodenum is divided, and describe the vertebral levels with the length of each part?
First part - 1st 2 cm has a mesentery. Lies anterior to the bile duct, portal vein and gastroduodenal artery.
Second part - Bile duct and pancreatic ducts open into it. Root of the transverse mesocolon crosses it
Third part – Crossed anteriorly by the superior mesenteric artery & vein
Fourth part (5 cm)- leads into the jejunum
The first ‘superimposed structure 5 cm long, L1 level 7-10 cm, rt of L1-L3 6-8 cm, crosses L3 5 cm, to L2
Describe the arrangement of the kidneys in the body. What vertebral level are they at?
The kidneys are at vertebral level L1 - the left kidney is slightly higher than the right.
The superior poles of the kidneys are closer to the median plane than the inferior poles.
The 12th ribs run posteriorly across the back of the kidneys.
3-4 cm superior to the iliac crest
5 cm from the vertebral bodies
What are the primary retroperitoneal structures?
Abdominal aorta and its branches Inferior vena cava and its tributaries Kidneys & ureters Adrenal glands Nerves (lumbar plexus & sympathetic trunk)
These structures developed outside the parietal peritoneum. They never had a mesentery.
Describe the pancreas location?
Exocrine and endocrine gland
Derived from buds growing into dorsal and ventral foregut mesenteries
Head, neck, uncinate process - lie in “G” of duodenum anterior to IVC
Body - extends to the left side across the aorta to left kidney
Tail - kidney to spleen in dorsal foregut mesentery (lieno-renal or spleno-renal ligament)
Describe the arrangement of the renal veins.
The renal veins join the inferior vena cava. The left renal vein runs anterior to the aorta just under the superior mesenteric artery.
What are the four parts of the duodenum and how long are each of them?
Superior - 1.5 cm
Descending - 2.7 - 10 cm
Inferior - 3.6 - 8 cm
Ascending - 4.5 cm
What structures are near the first part of the duodenum?
The first part of the duodenum is anterior to the common bile duct, the hepatic portal vein and the gastroduodenal artery.
What structures open into the second part of the duodenum
The common bile duct and the pancreatic duct open into the duodenum through the ampulla of vater. There is a small lump in the duodenum at this point called the major duodenal papilla. The release of substances from the ampulla of vater is controlled by the sphincter of Oddi.
What structures are close to the third part of the duodenum?
Superior mesenteric artery and vein cross anteriorly.
What part of the pancreas is intraperitoneal?
Tail of the pancreas (it is encased by the splenorenal ligament)
What is the pancreas derived from?
The ventral pancreatic bud and the dorsal pancreatic bud
What is the name of the mesentery between the spleen and the left kidney?
Lieno-renal ligament or spleno-renal ligament
What is the space between the liver and the right kidney called?
Heptorenal recess (of Rutherford and Morris)
What are the three branches of the coeliac trunk?
Left Gastric Artery
Splenic Artery
Common Hepatic Artery
What are the three arteries that supply the adrenal gland?
Superior suprarenal arteries, middle suprarenal artery and inferior suprarenal artery
Describe the layers of fat and fascia around the kidneys.
The kidney is encased in renal fascia
There is perirenal fat within the fascia
There is pararenal fat between the renal fascia and the transversalis fascia.
Describe the visceral relations of the kidneys.
The RIGHT kidney is covered superiorly by the liver, inferiorly by the hepatic flexure
2nd part of duodenum on the right
Ascending colon on the right
The LEFT kidney is covered by the loops of small intestine
Descending colon and stomach
Left Colic Flexure
Descending colon and stomach on the left
Spleen on the left
Tail of pancreas on the left
Coils of small bowel especially on the left
Adrenal glands on both sides
Describe where the ureters lie.
The ureters lie anterior to the transverse processes of the lumbar vertebrae
Which rib runs posterior to the kidneys?
12th ribs run along the posterior surface of the kidneys
What are the posterior relations of the kidneys?
Lie on the diaphragm, psoas major, quadratus lumborum and transversus abdominis.
Between kidneys and muscles cross the T12 (subcostal) and L1 (ilio-hypogastric and ilio-inguinal) nerves
A posterior approach to the kidneys is used for open surgery and for renal biopsy
Which nerves lie between the kidneys and the muscle?
Subcostal Nerve (T12)
Ilio-inguinal nerve (L1)
Ilio-hypogastric nerve (L1)
What are the 3 constrictions of the ureter
Ureter narrows at 3 places: 1) ureteropelvic junction, 2) at pelvic brim (common iliac vessels cross) 3) Entrance of urinary bladder
- Junction of the ureter and the renal pelvis
- When the ureters cross the common iliac arteries at the pelvic brim
- During their entry through the wall of the urinary bladder: vesiureteric junction
