The Retroperitoneum

Question 1

State three primary retroperitoneal structures.

Answer 1

Kidneys and Ureters

Aorta and Inferior Vena Cava

Oeosphagus

Question 2

State three secondary retroperitoneal structures.

Answer 2

Duodenum

Ascending and Descending Colon

Pancreas

Question 3

Describe the arrangement of the kidneys in the body. What vertebral level are they at?

Answer 3

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.

Question 4

Describe the arrangement of the renal veins.

Answer 4

The renal veins join the inferior vena cava. The left renal vein runs anterior to the aorta just under the superior mesenteric artery.

Question 5

What are the four parts of the duodenum and how long are each of them?

Answer 5

Superior - 1.5 cm

Descending - 2.7 - 10 cm

Inferior - 3.6 - 8 cm

Ascending - 4.5 cm

Question 6

What structures are near the first part of the duodenum?

Answer 6

The first part of the duodenum is anterior to the common bile duct, the hepatic portal vein and the gastroduodenal artery.

Question 7

What structures open into the second part of the duodenum?

Answer 7

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.

Question 8

What structures are close to the third part of the duodenum?

Answer 8

Superior mesenteric artery and vein cross anteriorly.

Question 9

What part of the pancreas is intraperitoneal?

Answer 9

Tail of the pancreas (it is encased by the splenorenal ligament)

Question 10

What is the pancreas derived from?

Answer 10

The ventral pancreatic bud and the dorsal pancreatic bud

Question 11

What is the name of the mesentery between the spleen and the left kidney?

Answer 11

Lieno-renal ligament or spleno-renal ligament

Question 12

What is the space between the liver and the right kidney called?

Answer 12

Heptorenal recess (of Rutherford and Morris)

Question 13

What are the three branches of the coeliac trunk?

Answer 13

Left Gastric Artery

Splenic Artery

Common Hepatic Artery

Question 14

What are the three arteries that supply the adrenal gland?

Answer 14

Superior suprarenal arteries, middle suprarenal artery and inferior suprarenal artery

Question 15

Describe the layers of fat and fascia around the kidneys.

Answer 15

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.

Question 16

Describe the visceral relations of the kidneys.

Answer 16

The RIGHT kidney is covered superiorly by the liver, inferiorly by the hepatic flexure

Part of the duodenum

Small intestine

The LEFT kidney is covered by the loops of small intestine

Descending colon and stomach

Tail of the pancreas

Spleen

Left Colic Flexure

Adrenal glands on both sides

Question 17

Describe where the ureters lie.

Answer 17

The ureters lie anterior to the transverse processes of the lumbar vertebrae

Question 18

Which rib runs posterior to the kidneys?

Answer 18

12th ribs run along the posterior surface of the kidneys

Question 19

What are the posterior relations of the kidneys?

Answer 19

Lie on the diaphragm, psoas major, quadratus lumborum and transversus abdominis.

Question 20

Which nerves lie posteriorly between the kidneys and the muscle?

Answer 20

Subcostal Nerve (T12)

Ilio-inguinal nerve (L1)

Ilio-hypogastric nerve (L1)