Anatomy 2 Hm- Posterior Abdominal Wall 1 And 2

Front 1

what ribs are associated with the kidneys location?

Back 1

11 and 12

Front 2

describe the structures of the diaphragm

Back 2

-right crus- from L1-L3; left- from L1-L2
-2 crura join to form aortic hiatus
-arch connecting crura is reinforced by median arcuate ligament; medial arcuate ligament on each side over psoas from L1 and L2 vertebra to L1 transverse process
-lateral arcuate lig- thickenings of fascia on quadratus lumborum m from transverse process of L1 to tip of 12th rib

Front 3

describe psoas and iliacus muscles

Back 3

-psoas- from transverse processes and bodies of t12-l5; innervated by vpr of L1-3
-iliacus- iliac fossa; femoral n
-together flex thigh at hip or flex trunk when thigh is fixed and body is supine (sit ups)

Front 4

describe quadratus lumborum

Back 4

-from iliac crest and transverse processes of L5, inserts on transfer processes of L1-4 and 12th rib
-innervated by VPR of T12, L1-4
-assits in lateral bending of trunk

Front 5

describe abdominal aorta and its branches

Back 5

-begins at T12 in aortic hiatus to L4 where it bifurcates to 2 common iliac arteries
-paired branches- T12 inferior phrenic a; L1 middle suprarenal (adrenal) arteries; between L1 and L2 renal arteries; L2 gonadal a; L1-4 lumbar segmental a supply abdominal wall running between muscles of lateral and wall
-unpaired- T12 celiac- foregut and glands; L1 superior mesenteric- midgut; L3 inferior mesenteric- hindgut; L4- median sacral a branches just superior to bifurcation to descend in pelvis

Front 6

describe tributaries of IVC

Back 6

-from L5 where 2 common iliac veins are united, leaves abdomen at T8 through central tendon of diaphragm
-from inferior to superior
-right gonal vein- left into renal vein first
-renal veins- ant to renal arteries, left crosses ant aorta and passes under sup mesenteric artery to IVC
-right suprarenal vein- left into renal first
-3 hepatic veins
-2 inf phrenic veins
-IVC does not receive venous blood directly from GI tract as all goes through portal vein first
-5 segmental lumbar veins- 1 and 2 may drain into azygos and hemiazygos; 5 may drain to iliolumbar

Front 7

describe lumbar plexus

Back 7

-VPR of L1-L4; within psoas muscle
-subcostal nerve inf to 12th rib on post wall
-L1- iliohypogastric and ilioinguinal nerves
-L1, L2- genitofemoral, lateral femoral (runs lateral thigh under lateral end of inguinal ligament)
-L2,3,4- femoral (lateral to psoas) and obturator nerve (medial)
-L4 to lumbosacral trunk to form sciatic nerve

Front 8

describe sympathetic trunk

Back 8

-meet at ganglion impar
-cell bodies only in lateral horns of spinal cord between T1 and L2

Front 9

describe splanchnic nerves

Back 9

-preganglionic sympathetic nerves enter sympathetic trunk via white communicating rami but leave without synapsing
-synpase in prevertebral ganglia
-greater t5-9- synapse in celiac ganglion around celiac trunk
-lesser t10-11
-least t12
-lumbar splanchnics L1-2
-lesser, least, lumbar- synapse in superior mesenteric, aorticorenal, and inferior mesenteric ganglion

Front 10

describe parasympathetic innervation to abdominal viscera

Back 10

-anterior and posterior vagal trunks on abdominal esophagus
-join prevertebral plexuses to reach parasympathetic ganglia within or near walls of viscera
-vagal nerves CN X supply GI to level of hind gut
-S2-S4 preganglionic parasympathetics through hypogastric plexus to reach ganglia in or near hindgut and kidney

Front 11

describe relationship of renal art/vein
describe structures in renal sinus

Back 11

-renal artery runs anterior to renal vein
-expanded ureter is renal pelvis and in space called renal sinus
-renal vessels, branches, fat (perinephric fat), nerves and lymphatics also in renal sinus

Front 12

describe calyces

Back 12

-pelvis gives rise to 2-3 major calyces which give rise to 2-3 minor calyces
-each minor calyx receives a renal papilla (tip of pyramid)

Front 13

describe blood supply to kidneys; what is resultant consequence of structure of vasculature of kidney?

Back 13

-right renal artery is longer and passes posterior to IVC
-5 segmental arteries within renal sinus; 4 ant, 1 post to renal pelvis
-each segmental divides into lobar branches, interlobar to each side of pyramind, arcuate along base of papilla, interlobular, afferent arterioles, end in glomerular capillary tufts
-NO anastomose therefore more susceptible to hypoxic infarct to specific, well defined area

Front 14

describe ureters; what is blood supply

Back 14

-10 in long
-muscular tube from renal pelvis to bladder
-retroperitoneal, post wall of abdomen
-3 constrictions which can trap renal stones- as renal pelvis joins ureter, where ureter crosses pelvic brim, where ureter pierces wall of bladder
-blood supply- upper- branches of renal artery; middle- testicular/ovarian a; lower- multiple, aorta, common iliac, superior/inf vesicular a, uterine; good anastomses

Front 15

describe autonomic nerve supply of kidney

Back 15

-sympathetic from lease and lumbar splanchnics (T12-L2)
-preganglionic fibers synpase in aortico-renal ganglion
-parasympathetic from S2-S4, travel through hypogastric plexus to reach small ganglia in kidney
-visceral afferents travel up T-11-L2
-note because kidneys develop and ascend

Front 16

describe afferent fibers in kidney and ureter

Back 16

-visceral afferents return to same level of spinal cord that is origin of sympathetic nerves that serve teh organ
-afferents for kidney return T11-12, ureter L1-2
pain referred associated with dermatomes

Front 17

describe adrenal glands- shapes and intra or retroperitoneal

Back 17

-retroperitoneal; not attached to kidneys
-left- crescent shaped, lower, medial aspect of kidney
-right- pyramid shaped, posterior to IVC, superior

Front 18

describe adrenal blood supply

Back 18

-superior adrenal arteries from inferior phrenic artery
-middle adrenal from aorta
inferior adrenal art from renal art or segmental branch
-left adrenal vein drains to left renal vein
right adrenal vein drains into IVC

Front 19

describe the organ structure and what is produced in each section

Back 19

-cortex (derived from mesoderm)
Go Make- Glomerulosa, Mineralocorticoids
Find Good- Fasiculata, Glucocorticoids
Rex Sex- Reticularis, Androgens
-medulla (derived from neural crest)
secrete EPI and NE

Front 20

describe kidney and adrenal development in terms of its location

Back 20

-kidneys ascend during development to meet adrenal glands which never change position
-in adrenal gland is much larger relative to size of kidney in fetus; provisional fetal cortex loses 1/3 of its weight in first 2 weeks after birth and is replaced by permanent cortex within first year of life

Front 21

describe adrenal nerve supply

Back 21

-cortex- receives preganglionic sympathetic fibers from greater splanchic nerve, synapse in pre-aortic or aortico-renal ganglia
-medulla receives preganglionic sympathetic nerves that synapse with cells of adrenal medulla

Front 22

describe specific secretions of the cortex

Back 22

glomerulosa- balls, stimulated by angiotensin 2 to produce aldosterone
fasciculata- bundles of cords, stimulated by ACTH to produce cortisol
reticularis- net like, stimulated by ACTH

Front 23

describe cells of adrenal medulla and overall blood supply structures

Back 23

-relatively large venous sinuses in medulla
-cells of medulla called chromaffin cells and are arranged in capillaries
-chromaffin cells contain catecholamines; 80% produce EPI, 20 NE- innervated by sympathetic preganglionic fibers
-cortisol secreted through long straight fenestrated capillaries leaving subcapsular plexus and percolate through cortex ending in capillary plexus in reticular is before draining into medulary capillaries; other vessels extend long, straight medullary arterioles extend through cortex to medullary capilaries running with connective tissue trabeculae, do not branch

Front 24

describe the position of the organs of the posterior wall

Back 24

-right kidney t12-L1 and ant to 12th rib, psoas, quadrates lumborum and transverse abdominis muscles; subcostal (T12) and ioliohypogastric (L1) nerves run post
-left kidney is higher, 11 rib
-adrenal glands are ant to diaphragm
-ureters are medial to kidneys and ant to psoas muscle

Front 25

describe the renal fat and fascia

Back 25

-peri-renal fat surrounds the kidney and enters the pelvic sinus; separates kidney from adrenal gland
-pararenal fat is continuous with extraperitoneal fat of abdominal wall; most concentrated post to kidney
-renal fascia separates peri-renal from para-renal fat; tethers organs from diaphragm
-collagen fibers from teh renal fascial layer extend into both fat layers to stabilize the organs
-lack of inferior support
-renal vessels also attach to posterior body wall

Front 26

describe the ant relationships of the adrenal gland and ureter

Back 26

-right kidney- adrenal, 2nd part of duodenum; right adrenal- IVC
-left kidney- adrenal, stomach, pancreas, jejunum; left adrenal- pancreas, lesser sac, stomach
-left ureter descends lateral to inferior mesenteric vein
-both ureters cross bifurcation of common iliac artery
-gonadal vessels cross ureters

Front 27

describe lymphatic drainage

Back 27

-pre-aortic nodes- celiac, superior and inferior mesenteric; drain lymph from GI tract served by those arteries, connected and drained by intestinal trunk
-para-aortic or lumbar nodes- drains kidneys, adrenals, gonads, common iliac nodes, deep wall; connected and drained by right and left lumbar trunks
-cisterna chyli- receives lymph from 3 trunks and transmits it to thoracic duct