Trans - Retroperitoneum, Posterior Abdominal Wall, Lumbar Plexus Flashcards
Contents of retroperitoneum
SADPUCKER
Suprarenal glands Aorta and IVC (great vessels) Duodenum (descending and transverse) Pancreas (except tail) Ureters Colon (ascending and descending) Kidneys Esophagus Rectum
Primarily retroperitoneal organs: definition and examples
Organs that are retroperitoneal since embryonic development
e.g. urinary organs, great vessels, thoracic esophagus, part of rectum
Secondarily retroperitoneal organs: definition and examples
Organs that become retroperitoneal due to post-embryonic rotation
e.g. pancreas (head, neck, body), duodenum (distal segments), colon (ascending and descending)
3 main compartments of retroperitoneum
- Anterior pararenal
- Perirenal
- Posterior pararenal
Perirenal space: contents
Kidney, adrenals, ureters, hilar vessels, lymph nodes, fat
Posterior pararenal space: contents
Fat
3 anatomic zones of retroperitoneum
- Centromedial
- Lateral
- Pelvic
Anatomic zone where hematoma needs immediate operation
Centromedial
Centromedial zone: contents
Great vessels - aorta and IVC
Lateral zone: contents
Suprarenal glands, kidneys, ureters, pancreas, colon (ascending and descending)
Pelvic zone: contents
Spermatic cord, ovarian vessels, bladder, distal ureters, branches of common iliac
Level of the caval hiatus
T8
Level of the esophageal hiatus
T10
Level of the aortic hiatus
T12
Psoas major: action
Pulls the leg and thigh towards the body
Psoas major: innervation
L2-L4
Psoas sign: definition
Sign indicating irritation of the iliopsoas group of hip flexors – manifests as pain in psoas region upon flexing hip
Iliacus: innervation
L2-L4
Iliacus: action
Thigh and trunk flexion
Quadratus lumborum: innervation
L1-L3
Location of bifurcation of abdominal aorta
L4 level
Left of the iliac crest, 2cm below the navel
Origin of median arcuate ligament
crura of diaphragm
Origin of medial arcuate ligament
psoas fascia
Origin of lateral arcuate ligament
quadratus lumborum fascia
What passes through the median arcuate ligament
aorta
What passes through the medial arcuate ligament
psoas major
What passes through the lateral arcuate ligament
quadratus lumborum
Level where the common iliac veins unite to form the IVC
L5
Path of blood from the abdominal viscera to the IVC
Viscera –> portal venous system (through liver) –> hepatic vein –> IVC
Veins of the posterior abdominal wall all drain into the IVC except for the (a)________ which drains into the (b)________
a. left gonadal vein
b. left renal vein
Lymph drainage of intraabdominal structures
Intestinal lymphatic trunk
Lymph drainage of retroperitoneal structures
Lumbar lymphatic trunk
Lymph drainage of foregut derivatives
Celiac nodes
Lymph drainage of midgut derivatives
Superior mesenteric nodes
Lymph drainage of hindgut derivatives
Inferior mesenteric nodes
Cisterna chyli: definition
Dilated sac at the lower end of the thoracic duct into which lymph from the intestinal trunk and lumbar lymphatic trunks flow
Difference in shape of suprarenal glands
Right – triangular/pyramidal
Left – semilunar
Suprarenal cortex: function
Produce corticosteroids (mineralocorticoids and glucocorticoids) and androgens
Suprarenal medulla: function
Produce catecholamines (fight or flight hormones during stress)
Contributing nerves to the lumbar plexus
Ventral primary divisions of L1-L3
Greater part of L4
Contributions from T12
Iliohypogastric nerve: divisions
- Lateral cutaneous branch
- Anterior cutaneous branch
- Muscular branches (to internal oblique, transversus abdominis)
Iliohypogastric nerve: innervations
Abdominal muscles and skin of the inguinal and pubic regions
Ilioinguinal nerve: divisions
- Cutaneous branch
2. Muscular branch
Genitofemoral nerve: innervations
Caudal part of the parieties of the abdominal wall
Genitofemoral nerve: divisions
- genital branch
2. femoral branch
Genital branch of genitofemoral nerve: innervations
cremaster muscle and skin of scrotum/adjacent thigh
Femoral branch of genitofemoral nerve: innervations
skin of proximal part of anterior surface of thigh
Lateral femoral cutaneous nerve: innervations
Skin of thigh until knee
Lateral femoral cutaneous nerve: divisions
- anterior branch
2. posterior branch
The lateral femoral cutaneous nerve forms part of the ________ along with the anterior cutaneous branch of the femoral nerve and the infrapatellar branch of the saphenous nerve
Patellar plexus
Calvin Klein syndrome is caused by _________
Compression of the lateral femoral cutaneous nerve, usually due to tight jeans
Obturator nerve: innervations
Skin and adductor muscles of medial thigh
Obturator nerve: divisions
- Anterior branch – to hip joint
2. Posterior branch – muscular branch to adductor muscles
Accessory obturator nerve: innervation
Pectineus
Largest branch of the lumbar plexus
Femoral nerve
Which colic flexure is more superiorly located?
Left colic flexure
Spinal nerve origin of iliohypogastric nerve
L1
Spinal nerve origin of ilioinguinal nerve
L1
Spinal nerve origin of genitofemoral nerve
L1, L2
Spinal nerve origin of lateral femoral cutaneous nerve
L2, L3
Spinal nerve origin of obturator nerve
L2, L3, L4
Spinal nerve origin of accessory obturator nerve
L3, L4
Spinal nerve origin of femoral nerve
L2, L3, L4
T/F: retroperitoneal tumors are usually malignant
T
Fascia anterior to the perirenal space
Fascia of Gerota (anterior renal fascia)
Fascia posterior to the perirenal space
Fascia of Zuckerkandl (posterior renal fascia)
Lateroconal fascia is a continuation of ________
Fascia of Zuckerkandl (posterior renal fascia)
T/F: there is usually a need for surgical intervention in hematomas of the lateral retroperitoneum (anatomic zone)
F
T/F: during surgery, both the internal iliac and external iliac arteries may be ligated
F, only the internal iliac may be ligated
The right phrenic nerve passes through which hiatus
Caval hiatus
The anterior and posterior vagal trunks pass through what hiatus
Esophageal hiatus
T/F: the aorta passing through the aortic hiatus pierces the diaphragm
F, it runs posterior to the diaphragm
Quadratus lumborm: action
Stabilizes the 12th rib during inspiration, lateral bending of the trunk
The right gonadal vein drains into:
IVC
What veins are part of the collateral circulation between the superior and inferior vena cavae
- inferior epigastric vein (IVC) and superior epigastric vein (SVC) anastomose at rectus sheath
- superficial epigastric vein (IVC) anastomoses with lateral thoracic vein (SVC)
- epidural venous plexus, lumbar veins (IVC), and azygos venous system (SVC) anastomose
T/F: the IVC can be ligated suprarenally
F, they may only be ligated infrarenally. Suprarenal ligations cause kidneys to lose venous drainage
Region where the IVC can be ligated
Infrarenally.
Location of the suprarenal glands
Between the superomedial aspect of the kidney, and the diaphragm
The suprarenal glands are enclosed by __________
Adipose capsule of the kidney
A pathology affecting this muscle will affect all nerves of the the lumbar plexus
Psoas major
Nerve that is involved in the cremasteric reflex
Genitofemoral nerve
The left suprarenal vein drains into the (a)__________, while the right suprarenal vein drains into the (b)___________
a. Left renal vein
b. IVC