Vascular Supply, Retroperitoneal Viscera and Posterior Abdominal Wall Flashcards

1
Q

Foregut: Artery, Parasympathetic innervation, Vertebral level, and Structures supplied

A

Celiac
Vagus
T12/L1
esophagus to upper duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hindgut: Artery, Parasympathetic innervation, Vertebral level, and Structures supplied

A

IMA
Pelvic splanchnic nerve
L3
Distal 1/3 of transverse colon to anal above pectinate line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Midgut: Artery, Parasympathetic innervation, Vertebral level, and Structures supplied

A

SMA
Vagus
L1
Lower duodenum to proximal 2/3 of transverse colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Arteries supplying GI structures are ____

A

single and branch anteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Compress transverse (third) portion of duodenum

A

Superior mesenteric artery syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Two areas of colon that have dual blood supply from distal arterial branches (watershed regions) - susceptible in colonic ischemia

A
  1. Splenic flexure - SMA and IMA

2. Rectosigmoid junction - last sigmoid arterial branch from the IMA and superior rectal artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Arises from the front of the abdominal aorta immediately below the aortic hiatus of the diaphragm, between the right and left crura.

A

Celiac Trunk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Branches of celiac trunk

A

left gastric artery,
splenic artery,
common hepatic arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Is the smallest branch of the celiac trunk
Runs upward and to the left toward the cardia, giving rise to __ and __ branches and then turns to the right and runs along the lesser curvature within the lesser omentum to anastomose with the right gastric artery

A

Left Gastric Artery

Esophageal and hepatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Is the largest branch of the celiac trunk and runs a highly tortuous course along the superior border of the pancreas and enters the lienorenal ligament.

A

Splenic Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Branches of splenic artery

A
dorsal pancreatic artery
short gastric arteries
 left gastroepiploic (gastro-omental) artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pass through the lienogastric ligament to reach the fundus of the stomach

A

short gastric arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Reaches the greater omentum through the lienogastric ligament and runs along the greater curvature of the stomach to distribute to the stomach and greater omentum

A

left gastroepiploic (gastro-omental) artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Runs to the right along the upper border of the pancreas and divides into the proper hepatic artery, the gastroduodenal artery, and possibly the right gastric artery.

A

Common Hepatic Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Branches of Common Hepatic Artery

A

proper hepatic artery,
gastroduodenal artery, and possibly
right gastric artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ascends in the free edge of the lesser omentum and divides, near the porta hepatis, into the left and right hepatic arteries

A

Proper Hepatic Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Ascends in the free edge of the lesser omentum and divides, near the porta hepatis, into the left and right hepatic arteries

A

Proper Hepatic Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Gives rise, near its beginning, to the right gastric artery

A

Proper Hepatic Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the origin branch of cystic artery in the cystohepatic triangle of Calot?

A

right hepatic artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Arises from the proper hepatic or common hepatic artery, runs to the pylorus and then along the lesser curvature of the stomach, and anastomoses with the left gastric artery.

A

Right Gastric Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Descends behind the first part of the duodenum, giving off the supraduodenal artery to its superior aspect and a few retroduodenal arteries to its inferior aspect.

A

Gastroduodenal Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Two major branches of Gastroduodenal Artery

A
right gastroepiploic (gastro-omental) artery
superior pancreaticoduodenal artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Runs to the left along the greater curvature of the stomach, supplying the stomach and the greater omentum.

A

right gastroepiploic (gastro-omental) artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Passes between the duodenum and the head of the pancreas and further divides into the anterior-superior pancreaticoduodenal artery and the posterior-superior pancreaticoduodenal artery.

A

superior pancreaticoduodenal artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

It is a temporary cross-clamping (intermittent soft vascular clamping) of the hepatoduodenal ligament containing portal triads at the foramen of Winslow for control of hepatic bleeding during liver surgery or donor hepatectomy for living donor liver transplantation.

A

Pringle maneuver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q
  • Arises from the aorta behind the neck of the pancreas.
    • Descends across the uncinate process of the pancreas and the third part of the duodenum and then enters the root of the mesentery behind the transverse colon to run to the right iliac fossa.
A

Superior Mesenteric Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Passes to the right and divides into the anterior-inferior pancreaticoduodenal artery and the posterior-inferior pancreaticoduodenal artery, which anastomose with the corresponding branches of the superior pancreaticoduodenal artery.

A

Inferior Pancreaticoduodenal Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Branches of SMA

A
Inferior Pancreaticoduodenal Artery
Middle Colic Artery
Right Colic Artery
Ileocolic Artery
 Intestinal Arteries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Enters the transverse mesocolon and divides into the right branch, which anastomoses with the right colic artery, and the left branch, which anastomoses with the ascending branch of the left colic artery. The branches of the mesenteric arteries form an anastomotic channel, the marginal artery, along the large intestine.

A

Middle Colic Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Arteries supplying non-GI structures are ______

A

paired and branch laterally and posteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q
  • Arises from the superior mesenteric artery or the ileocolic artery.
  • Runs to the right behind the peritoneum and divides into ascending and descending branches, distributing to the ascending colon
A

Right Colic Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

• Descends behind the peritoneum toward the right iliac fossa and ends by dividing into the ascending colic artery, which anastomoses with the right colic artery, anterior and posterior cecal arteries, the appendicular artery, and ileal branches.

A

Ileocolic Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q
  • Are 12 to 15 in number and supply the jejunum and ileum.

* Branch and anastomose to form a series of arcades in the mesentery.

A

Intestinal Arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

It is caused by a thrombus, an embolus, atherosclerosis, an aortic aneurysm, a tumor in the uncinate process of the pancreas, compression by the third part of the duodenum, or surgical scar tissue.

A

Superior mesenteric artery obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

• Passes to the left behind the peritoneum and distributes to the descending and sigmoid colons and the upper portion of the rectum.

A

Inferior Mesenteric Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Branches of Inferior Mesenteric Artery

A

Left Colic Artery
Sigmoid Arteries
Superior Rectal Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Runs to the left behind the peritoneum toward the descending colon and divides into ascending and descending branches.

A

Left Colic Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Are two to three in number, run toward the sigmoid colon in its mesentery, and divide into ascending and descending branches.

A

Sigmoid Arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Is the termination of the inferior mesenteric artery, descends into the pelvis, divides into two branches that follow the sides of the rectum, and anastomoses with the middle and inferior rectal arteries.

A

Superior Rectal Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Arterial supply of right 2/3 of transverse colon

A

right and middle colic arteries of SMA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Arterial supply of left 1/3 of transverse colon

A

left colic artery from IMA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Venous drainage of transverse colon

A

veins of corresponding arterial supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Arterial supply of rectum

A

Superior rectal artery - IMA
Middle rectal artery - internal iliac artery
Inferior rectal artery - internal pudendal artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

A system of vessels in which blood collected from one capillary bed (of intestine) passes through the portal vein and then through a second capillary network (liver sinusoids) before reaching the IVC (systemic circulation).

A

Hepatic Portal Venous System

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Formed by the union of the splenic vein and the superior mesenteric vein posterior to the neck of the pancreas.

A

Portal Vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Drains the abdominal part of the gut, spleen, pancreas, and gallbladder and is 8 cm (3.2 in.) long

A

Portal Vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Carries three times as much blood as the hepatic artery and maintains a higher blood pressure than in the IVC

A

Portal Vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

It results from liver cirrhosis or thrombosis in the portal vein, forming esophageal varices, caput medusae, and hemorrhoids.

A

Portal hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q
  • Accompanies the superior mesenteric artery on its right side in the root of the mesentery
    • Crosses the third part of the duodenum and the uncinate process of the pancreas and terminates posterior to the neck of the pancreas by joining the splenic vein, thereby forming the portal vein.
    • Has tributaries that are some of the veins that accompany the branches of the superior mesenteric artery
A

Superior Mesenteric Vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q
  • Is formed by the union of tributaries from the spleen.

* Receives the short gastric, left gastroepiploic, and pancreatic veins.

A

Splenic Vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Formed by the union of the superior rectal and sigmoid veins.

A

Inferior Mesenteric Vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What does the inferior mesenteric vein receive?

A

Left colic vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Where does inferior mesenteric vein drain?

A

Usually into the splenic vein
May drain into the superior mesenteric vein
Junction of superior mesenteric and splenic veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Has esophageal tributaries that anastomose with the esophageal veins of the azygos system at the lower part of the esophagus and thereby enter the systemic venous system.

A

Left Gastric (Coronary) Vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q
  • Are found in the falciform ligament and are virtually closed; however, they dilate in portal hypertension
    • Connect the left branch of the portal vein with the small subcutaneous veins in the region of the umbilicus, which are radicles of the superior epigastric, inferior epigastric, thoracoepigastric, and superficial epigastric veins.
A

Paraumbilical Veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Important Portal-Caval (Systemic Anastomoses)

A

LGV & EVAS 1. The left gastric vein and the esophageal vein of the azygos system.
SRV & MIRV 2. The superior rectal vein and the middle and inferior rectal veins.
PUV & REV 3. The paraumbilical veins and radicles of the epigastric (superficial and inferior) veins.
• Spider angiomata - patients with liver cirrhosis
RV - RSG Veins4. The retroperitoneal veins draining the colon and twigs of the renal, suprarenal, and gonadal veins.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q
  • Consist of the right, middle, and left hepatic veins that lie in the intersegmental planes and converge on the IVC.
  • Have no valves, and the middle and left veins frequently unite before entering the vena cava.
A

Hepatic Veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

It is an occlusion of the hepatic veins and results in high pressure in the veins, causing hepatomegaly, upper right abdominal pain, ascites, mild jaundice, and eventually portal hypertension and liver failure.

A

Budd-Chiari syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Retroperitoneal structures

A
SAD PUCKER
Suprarenal (adrenal) glands
Aorta and IVC
Duodenum (2nd through 4th part)
Pancreas (except tail)
Ureters
Colon (ascending and descending)
Kidneys
Esophagus (thoracic portion)
Rectum (partially)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Remnant urachus

A

Median Umbilical Fold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Remnant of umbilical arteries

A

Medial Umbilical Fold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Lodges inferior epigastric arteries

A

Lateral Umbilical Fold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Is retroperitoneal and extends from T12 to L3 vertebrae in the erect position.

A

Kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Where is the right and left kidney related to?

A

right kidney - rib 12 posteriorly

left kidney - ribs 11 and 12 posteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What invests and surrounds the kidney?

A

invested by a firm, fibrous renal capsule

surrounded by the renal fascia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Lies in the perinephric space between the renal capsule and renal fascia

A

perirenal (perinephric) fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Lies external to the renal fascia

A

pararenal (paranephric) fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Where does ureter, renal vessels, and nerves enter or leave the kidney?

A

hilus-on its medial border

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What are the functional units of kidney?

A

Nephrons (1 to 2 million in each kidney)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What consists the nephron?

A

renal corpuscle (found only in the cortex),
proximal convoluted tubule,
Henle loop,
distal convoluted tubule.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What are the arterial segments in kidney with surgical importance?

A

superior, anterosuperior, anteroinferior, inferior, and posterior segments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Functions of kidney

A
Produce urine
Excrete urine
Regulate salt, ion (electrolyte), and water balance
Produce erythropoietin 
Produces renin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What produces renin in the kidney?

A

juxtaglomerular cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

It increases blood pressure and volume and stimulates aldosterone production by the suprarenal cortex, thereby regulating the salt, ion, and water balance between the blood and urine.

A

angiotensin Il

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Physiologic process involved in renin of the kidney

A

RAAS - renin, angiotensin, aldosterone system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Forms the outer part of the kidney and also projects into the medullary region between the renal pyramids as renal columns.

A

Cortex

76
Q

Contains renal corpuscles and proximal and distal convoluted tubules.

A

Cortex

77
Q

Contains renal corpuscles and proximal and distal convoluted tubules.

A

Cortex

78
Q

What consists the renal corpuscle?

A

glomerulus (a tuft of capillaries) surrounded by a

glomerular (Bowman) capsule, which is the invaginated blind end of the nephron

79
Q

Forms the inner part of the kidney and consists of 8 to 12 renal pyramids (of Malpighi)

A

Medulla

80
Q

What contains the renal pyramids (of Malpighi)?

A
straight tubules (Henle loops)
collecting tubules
81
Q

An apex of the renal pyramid which fits into the cup-shaped minor calyx on which the collecting tubules open (10 to 25 openings).

A

renal papilla

82
Q

Receive urine from the collecting tubules and empty into two or three major calyces.

A

Minor Calyces

83
Q

Where do major calyces empty into?

A

renal pelvis - upper dilated portion of the ureter

84
Q

It is formed by combination of a high level of calcium with oxalate, phosphate, urea, uric acid, and cystine.

A

Kidney stone (renal calculus or nephrolith)

85
Q

Bilateral kidney stones

A

End stage kidney failure

86
Q

Nephrolithiasis if in ureter?

A

ureterolithiasis

87
Q

Smallest size of stone passing through ureter to bladder?

A

0.5 cm

88
Q

Is a retroperitoneal muscular tube that begins with the renal pelvis, extending from the kidney to the urinary bladder

A

Ureter

89
Q

What is the junction of ureter and renal pelvis?

A

ureteropelvic junction

90
Q

Where is the junction where ureter enters the wall of the urinary bladder?

A

ureterovesicular junction (least diameter for passage)

91
Q

Receives blood from the aorta and from the renal, gonadal, common, and internal iliac, umbilical, superior and inferior vesical, and middle rectal arteries.

A

Ureter

92
Q

Is innervated by the lumbar (sympathetic) and pelvic (parasympathetic) splanchnic nerves.

A

Ureter

93
Q

Where are the ureteric constrictions?

A
  1. Ureteropelvic junction
  2. Crossing of external/ common iliac artery
  3. Ureterovesicle junction
94
Q

It occurs by renal calculi or kidney stones where the ureter joins the renal pelvis, where it crosses the pelvic brim, or where it enters the wall of the urinary bladder.

A

Obstruction of the ureter

95
Q

It is a fluid-filled enlargement of the renal pelvis and calyces as a result of obstruction of the ureter.

A

Hydronephrosis

96
Q

Is a retroperitoneal organ lying on the superomedial aspect of the kidney. It is surrounded by a capsule and renal fascia.

A

Suprarenal (Adrenal) Gland

97
Q

Shape of Suprarenal (Adrenal) Gland on the right and left

A

pyramidal - right

semilunar - left

98
Q

Part of Suprarenal gland that produces three types of steroid hormones

A

cortex

99
Q

The outer zona glomerulosa produces?

A

mineralocorticoids: aldosterones (salt steroids)

100
Q

The middle zona fasciculata produces?

A

glucocorticoids: cortisol and corticosterone (‘energy’ steroids)

101
Q

The inner zona reticularis produces?

A

androgens: testosterone, DHEA, androstenedione (‘sex’ steroids)

102
Q

Part of suprarenal gland that is derived from embryonic neural crest cells, receives preganglionic sympathetic nerve fibers directly, and secretes epinephrine and norepinephrine

A

Medulla

103
Q

Where is medulla of suprarenal gland derived?

A

embryonic neural crest cells

104
Q

What are arterial supply of suprarenal gland?

A

superior suprarenal artery from the inferior phrenic artery,
middle suprarenal artery from the abdominal aorta,
inferior suprarenal artery from the renal artery

105
Q

What drains the suprarenal gland?

A

suprarenal vein, which empties into the IVC on the right and the renal vein on the left.

106
Q

Passes through the aortic hiatus in the diaphragm at the level of T12, descends anterior to the vertebral bodies

A

Aorta

107
Q

What are the bifurcations of aorta and at what level?

A

right and left common iliac arteries anterior to L4

108
Q

Arise from the aorta immediately below the aortic hiatus, supply the diaphragm, and give rise to the superior suprarenal arteries.

A

Inferior Phrenic Arteries

109
Q

Arise from the aorta and run laterally on the crura of the diaphragm just superior to the renal arteries

A

Middle Suprarenal Arteries

110
Q

Arise from the aorta inferior to the origin of the super mesenteric artery. The right artery is longer and a little lower than the left and passes posterior to the IVC; the left artery passes posterior to the left renal vein.

A

Renal Arteries

111
Q

What are branches of renal arteries?

A

inferior suprarenal artery

ureteric artery

112
Q

Descend retroperitoneally and run laterally on the psoas major muscle and across the ureter.

A

Testicular or Ovarian Arteries

113
Q

Accompanies the ductus deferens into the scrotum, where it supplies the spermatic cord, epididymis, and testis.

A

testicular artery

114
Q

It enters the suspensory ligament of the ovary, supplies the ovary, and anastomoses with the ovarian branch of the uterine artery.

A

ovarian artery

115
Q
  • Consist of four or five pairs that arise from the back of the aorta.
    * Run posterior to the sympathetic trunk, the IVC (on the right side), the psoas major muscle, the lumbar plexus, and the quadratus lumborum
    * Divide into smaller anterior branches (to supply adjacent muscles) and larger posterior branches, which accompany the dorsal primary rami of the corresponding spinal nerves and divide into spinal and muscular branches.
A

Lumbar arteries

116
Q
  • Arises from the back of the aorta, just above its bifurcations descends on the front of the sacrum, and ends in the coccygeal body
    * Supplies the rectum and anal cane, and anastomoses with the lateral sacral and superior and inferior rectal arteries,
A

Middle Sacral Artery

117
Q

Is formed on the right side of L5 by the union of the two common iliac veins, below the bifurcation of the aorta.

A

Inferior Vena Cava

118
Q

Is longer than the abdominal aorta and ascends along the right side of the aorta.

A

IVC

119
Q

Passes through the opening for the IVC in the central tendon of the diaphragm at the level of?

A

T8

120
Q

IVC receives the right gonadal, suprarenal, and inferior phrenic veins. Where do these veins drain in the left?

A

Left renal vein

121
Q

Also receives the three (left, middle, and right) hepatic veins and right and left renal veins.

A

IVC

122
Q

Is the lower dilated end of the thoracic duct and lies just to the right and posterior to the aorta. usually between two crura of the diaphragm.

A

Cisterna Chyli

123
Q

What forms Cisterna Chyli?

A

intestinal and lumbar lymph trunks

124
Q

Include the celiac, superior mesenteric, and inferior mesenteric nodes; drain the lymph from the GI tract, spleen, pancreas, gallbladder, and liver; and their efferent vessels form the intestinal trunk.

A

Preaortic Nodes

125
Q

• Drain lymph from the kidneys, suprarenal glands, testes or ovaries uterus, and uterine tubes; receive lymph from the common, internal, or external iliac; and their efferent vessels form the right and left lumbar trunks.

A

Para-aortic, Lumbar, or Lateral Aortic Lymph Nodes

126
Q
  • Is formed by the union of the ventral rami of the first three lumbar nerves and a part of the fourth lumbar nerve.
    • Lies anterior to the transverse processes of the lumbar vertebrae within the substance of the psoas muscle.
A

Lumbar Plexus

127
Q

Runs behind the lateral lumbocostal arch and in front of the quadratus lumborum. Penetrates the transverse abdominal muscle to run between it and the internal oblique muscle.

A

Subcostal Nerve (T12)

128
Q

What does the Subcostal Nerve (T12) innervate?

A

external oblique, internal oblique, transverse, rectus abdominis, and pyramidalis muscles

129
Q
  • Emerges from the lateral border of the psoas muscle and runs in front of the quadratus lumborum.
    * Pierces the transverse abdominal muscle near the iliac crest to run between this muscle and the internal oblique muscle.
    * Pierces the internal oblique muscle and then continues medially deep to the external oblique muscle.
A

Iliohypogastric Nerve (L1)

130
Q

What does Iliohypogastric Nerve (L1) innervate?

A

internal oblique and transverse muscles of the abdomen
skin above the pubis - anterior cutaneous branch
skin of gluteal region - lateral cutaneous branch

131
Q

Runs in front of the quadratus lumborum, piercing the transverse and then the internal oblique muscle to run between the internal and external oblique aponeuroses.

A

Ilioinguinal Nerve (L1)

132
Q

What does Ilioinguinal Nerve (L1) accompany?

A

spermatic cord (or the round ligament of the uterus)

133
Q

What does ilioinguinal nerve (L1) innervate?

A

internal oblique and transverse muscles

upper medial part of the thigh - femoral cutaneous branches + anterior scrotal or labial branches

134
Q

Emerges on the front of the psoas muscle and descends on its anterior surface.

A

Genitofemoral Nerve (L1-L2)

135
Q

Genitofemoral Nerve (L1-L2) divides into what branch which enters the inguinal canal through the deep inguinal ring to reach the spermatic cord and supply the cremaster muscle and the scrotum (or labium majus)?

A

genital branch

136
Q

Genitofemoral Nerve (L1-L2) divides into what branch which supplies the skin of the femoral triangle?

A

femoral branch

137
Q

Emerges from the lateral side of the psoas muscle and runs in front of the iliacus and behind the inguinal ligament.

A

Lateral Femoral Cutaneous Nerve (L2-L3)

138
Q

Innervates the skin of the anterior and lateral thigh.

A

Lateral Femoral Cutaneous Nerve (L2-L3)

139
Q
  • Emerges from the lateral border of the psoas major and descends in the psoas and iliacus. groove between
    * Enters the femoral triangle deep to the inguinal ligament and lateral to the femoral vessels, outside the femoral sheath, and divides into numerous branches.
A

Femoral Nerve (L2-L4)

140
Q

Innervates the skin of the thigh and leg, the muscles of the front of the thigh, and the hip and knee joints, quadriceps femoris, pectineus, and sartorius muscles

A

Femoral Nerve (L2-L4)

141
Q

What are the branches of Femoral Nerve (L2-L4)?

A

anterior femoral cutaneous nerve

saphenous nerve

142
Q

Arises from the second, third, and fourth lumbar nerves and descends along the medial border of the psoas muscle. It runs forward on the lateral wall of the pelvis and enters the thigh through the obturator foramen.

A

Obturator Nerve (L2-L4)

143
Q
  • Is present in approximately 9% of the population.
    • Descends medial to the psoas muscle, passes over the superior pubic ramus, and supplies the hip joint and the pectineus muscle.
A

Accessory Obturator Nerve (L3-L4)

143
Q
  • Is present in approximately 9% of the population.
    • Descends medial to the psoas muscle, passes over the superior pubic ramus, and supplies the hip joint and the pectineus muscle.
A

Accessory Obturator Nerve (L3-L4)

144
Q

• Is formed by the lower part of the fourth lumbar nerve and all of the fifth lumbar nerve, which enters into the formation of the sacral plexus.

A

Lumbosacral Trunk (L4-L5)

145
Q

What are the Autonomic Nerves in the Abdomen?

A

Autonomic Ganglia
Splanchnic Nerves
Autonomic Plexuses
Enteric Division

146
Q
  • Are composed primarily of ascending and descending preganglionic sympathetic general visceral efferent (GVE) fibers and general visceral afferent (GVA) fibers with cell bodies located in the dorsal root ganglia.
    • Also contain cell bodies of the postganglionic sympathetic fibers.
A

Sympathetic Chain (Paravertebral) Ganglia

147
Q
  • Include the celiac, superior mesenteric, aorticorenal, and inferior mesenteric ganglia, usually located near the origin of the respective arteries.
    • Are formed by cell bodies of the postganglionic sympathetic fibers.
A

Collateral (Prevertebral) Ganglia

148
Q

How do Collateral (Prevertebral) Ganglia receive preganglionic sympathetic fibers?

A

greater, lesser, and least splanchnic nerves

149
Q
  • Are also called aortic bodies, Zuckerkandl bodies, organs of Zuckerkandl, or aortic glomera.
    • Are small masses of chromaffin cells found near the sympathetic chain ganglia along the abdominal aorta and serve as chemoreceptors responsive to lack of oxygen, excess of carbon dioxide, and increased hydrogen ion concentration that help to control respiration.
A

Para-aortic Bodies

150
Q

What are the Autonomic Ganglia?

A

Sympathetic Chain (Paravertebral) Ganglia
Collateral (Prevertebral) Ganglia
Para-aortic Bodies

151
Q

Contain preganglionic sympathetic (GVE) fibers, with cell bodies located in the lateral horn (intermediolateral cell column) of the spinal cord, and GVA fibers, with cell bodies located in the dorsal root ganglia.

A

Thoracic Splanchnic Nerves

152
Q

Where do greater splanchnic nerve, lesser splanchnic nerve, least splanchnic nerve enter/join?

A

greater splanchnic nerve enters the celiac ganglion
lesser splanchnic nerve enters the aorticorenal ganglion
least splanchnic nerve joins the renal plexus

153
Q
  • Arise from the lumbar sympathetic trunks and join the celiac, mesenteric, aortic, and superior hypogastric plexuses.
    • Contain preganglionic sympathetic and GVA fibers.
A

Lumbar Splanchnic Nerves

154
Q

What are the splanchnic nerves?

A

Thoracic Splanchnic Nerves

Lumbar Splanchnic Nerves

155
Q

Is formed by splanchnic nerves and branches from the vagus nerves.

A

Celiac Plexus

156
Q

Is formed by splanchnic nerves and branches from the vagus nerves.

A

Celiac Plexus

157
Q

What does Celiac Plexus contain and form along the branches of the celiac trunk?

A

celiac ganglia

subsidiary plexuses

158
Q

Is also called the solar plexus.

A

Celiac Plexus

159
Q

The combined nerve plexus of the celiac and superior mesenteric plexuses.

A

Solar plexus

160
Q
  • Extends from the celiac plexus along the front of the aorta,
    • Extends its branches along the arteries and forms plexuses that are named accordingly superior mesenteric, testicular (or ovarian), and interior mesenteric.
A

Aortic Plexus

161
Q
  • Extends from the celiac plexus along the front of the aorta,
    • Extends its branches along the arteries and forms plexuses that are named accordingly superior mesenteric, testicular (or ovarian), and interior mesenteric.
A

Aortic Plexus

162
Q

What does Aortic Plexus form just below the bifurcation of the aorta?

A

superior hypogastric plexus

163
Q

What are autonomic plexuses?

A

Celiac Plexus
Aortic Plexus
Superior and Inferior Hypogastric Plexuses

164
Q

Have sympathetic nerves that inhibit GI motility and secretion and constrict GI sphincters; parasympathetic nerves stimulate GI motility and secretion and relax GI sphincters.

A

Enteric Division

165
Q

Located chiefly between the longitudinal and circular muscle layers of enteric division responsible for GI motility

A

myenteric (Auerbach) plexus

166
Q

Located in the submucosa of enteric division which has secretory function.

A

submucosal (Meissner) plexus

167
Q

Arises from the xiphoid process (sternal part), lower six costal cartilages (costal part), medial and lateral lumbocostal arches (lumbar part)

A

Diaphragm

168
Q

Diaphragm
Right crus:__
Left crus:__

A

Right crus: L1 - L3

Left crus: L1 - L2

169
Q

Diaphragm inserts into the ___ and is the principal muscle of inspiration.

A

central tendon

170
Q

Where does the central part and peripheral part of diaphragm receive sensory fibers?

A

central part: phrenic nerve

peripheral part: intercostal nerves

171
Q

Where does the central part and peripheral part of diaphragm receive sensory fibers?

A

central part: phrenic nerve

peripheral part: intercostal nerves

172
Q
  • Receives blood from the musculophrenic, pericardiophrenic, superior phrenic, and inferior phrenic arteries.
    • Descends when it contracts, causing an increase in thoracic volume by increasing the vertical diameter of the thoracic cavity and thus decreasing intrathoracic pressure
A

Diaphragm

173
Q
  • Receives blood from the musculophrenic, pericardiophrenic, superior phrenic, and inferior phrenic arteries.
    • Descends when it contracts, causing an increase in thoracic volume by increasing the vertical diameter of the thoracic cavity and thus decreasing intrathoracic pressure
    • Ascends when it relaxes, causing a decrease in thoracic volume with an increased thoracic pressure.
A

Diaphragm

174
Q

Extends from the body of L1 to the transverse process of L1 and passes over the psoas muscle and the sympathetic trunk.

A

Medial Arcuate Ligament (Medial Lumbocostal Arch)

175
Q

Extends from the transverse process of L1 to rib 12 and passes over the quadratus lumborum.

A

Lateral Arcuate Ligament (Lateral Lumbocostal Arch)

176
Q

Lies in the central tendon of the diaphragm at the level of T8 and transmits the IVC and occasionally the right phrenic nerve.

A

Vena Caval Hiatus (Vena Caval Foramen)

177
Q

Lies in the muscular part of the diaphragm (right crus) at the level of T10 and transmits the esophagus and anterior and posterior trunks of the vagus nerves.

A

Esophageal Hiatus

178
Q

Lies behind or between two crura at the level of T12 and transmits the aorta, thoracic duct, azygos vein, and occasionally greater splanchnic nerve.

A

Aortic Hiatus

179
Q

Action of iliacus and psoas muscles

A

Flexes thigh on trunk

180
Q

Origin of iliopsoas muscle

A

Iliacus: iliac fossa of hipbone
Psoas: Transverse processes, intervertebral disks T12-L5 & T12-L1

181
Q

Insertion of iliopsoas muscle

A

lesser trochanter of femur

182
Q

Nerve supply of iliopsoas muscle

A

Femoral nerve

Psoas: Lumbar plexus

183
Q

Origin of Quadratus Lumborum

A

Iliac crest, Transverse process L3-L5, iliolumbar ligament

184
Q

Insertion of Quadratus Lumborum

A

12th rib

185
Q

Nerve supply of Quadratus Lumborum

A

Lumbar plexus

186
Q

Action of Quadratus Lumborum

A

Depresses rib 12, flexes trunk laterally