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80 Cards in this Set
- Front
- Back
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Where does the psoas major arise from?
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Transverse processes & intervertebral discs T12-L5
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What is the nerve supply to the psoas major ? |
Direct branches from lumbar plexus, L2-L3
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Where do the fibres of the quadratus lumborum arise from? |
From the lower aspect of 12th rib & the transverse processes of L1-L4
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Where does the psoas minor originate from? |
T12-L1. May be present on anterior surface of psoas major
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What is the iliopsoas muscle? |
Combination of psoas major & iliacus muscle both muscles fuse at their midpoint to form a common insertion at the lesser trochanter of the femur.
It passes under inguinal ligament together with the femoral nerve to enter the thigh. It is the strongest flexor of the hip joint |
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Where does the iliacus muscle arise from? |
Inner aspect of iliac fossa
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What is the nerve supply to the iliacus muscle? |
Direct branches from lumbar plexus L2 L3 and from the femoral nerve
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What does the posterior part of the diaphragm lie behind? |
Stomach, spleen, liver, upper half of kidneys & suprarenal glands.
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Where do gonadal and suprarenal veins on the left drain into? |
Left renal vein
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Where do hepatic veins drain into? |
IVC
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Where do the ascending lumbar veins join? |
Run upwards on the vertebrae to join the azygous and hemizygous veins
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What parts of the duodenal are retroperitoneal (and therefore immobile) ? |
Parts 2,3 & 4
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What organs/features are found on the transpyloric plane? |
Pancreas, beginning & end of duodenum, hilum of each kidney, fundus of gall bladder, splenic vein, beginning of SMA & the end of the spinal cord
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What are the relations of the first part of the duodenum? |
Gall bladder & quadrate lobe anteriorly
Bile duct, HPV, IVC, head of pancreas & gastroduodenal artery posteriorly |
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What are the features of the first part of the duodenum? |
Goes upwards and backwards
Continuous with pylorus of stomach Lies at L1 Greater omentum attached to it for ~2cm Lesser omentum has a free border than runs from 1st part of duodenum to liver |
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What are the features of the second part of the duodenum? |
Descends
At L2 level Descends & crosses over hilum of right kidney |
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What are the relations of the 2nd part of the duodenum? |
Common bile duct & pancreatic duct enter duodenum here at the duodenal papilla
Transverse mesocolon is in front of 2nd part of duodenum |
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What are the features of the 3rd part of the duodenum? |
Is level
Lies just above umbilicus at L3 |
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What are the relations of the 3rd part of the duodenum? |
IVC & aorta behind it, as well as right gonadal vein & artery
Superior mesenteric vessels pass in front of the 3rd part |
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What are the features of the 4th part of the duodenum? |
-Ascends
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What is the ligament of Treitz (suspensory ligament)? |
= suspensory ligament made of smooth muscle & elastic fibres that connects the superior part of the duodenum with the right crus of the diaphragm, inserting into the 4th part of the duodenum close to the duodenojejunal junction (as well as near right crus of diaphragm)
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What are the superior and inferior duodenal fossa? |
Folds of peritoneum that can be found around the 4th part of the duodenum. They form pouches as the duodenum re-enters the peritoneal cavity.
Small bowel may get trapped in one of these fossa = internal hernia |
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What lies underneath the free border of the lesser omentum that passes from the 1s part of duodenum to the underside of the liver? |
Epiploic foramen
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The pancreas is retroperitoneal apart from what part? |
The tail
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Relationship between pancreas and SMA? |
SMA squeezes out from behind the pancreas to run on the front of the 3rd part of the duodenum
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Where does the pancreatic duct join the common bile duct? |
Head of the pancreas
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Where can the sphincter of Oddi be found? |
At the greater duodenal papilla
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What pass through the head & neck of the pancreas |
Aorta, IVC, common bile duct & hepatic portal vein
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What is the uncinate process? |
Small part of the pancreas (that developed in the ventral mesentery) that hooks behind the SMA
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Where do the superior pancreaticoduodenal arteries arise from? |
Gastroduodenal artery
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Where do the superior pancreaticoduodenal arteries travel? |
Run around inner aspect of the curve of the duodenum and anastomose with the inferior pancreaticoduodenal arteries from the SMA
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What do the superior & inferior pancreaticoduodenal arteries supply? |
Head of the pancreas.
Inferior also supplies uncinate process of the pancreas, as well as the duodenum |
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Where does the inferior pancreaticoduodenal artery come from? |
Given off by SMA, as the superior mesenteric vessels pass in front of the 3rd part of the duodenum
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What is venous drainage of the pancreas? |
Much goes into the splenic vein, which runs behind the pancreas, but there are also pancreaticoduodenal veins.
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What makes up the hepatic portal vein? |
Superior mesenteric vein joins with splenic vein to form hepatic portal vein. This occurs behind the neck.
(IM vein joins the splenic vein behind the pancreas) |
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What is the relationship between the duodenum and kidney? |
2nd part of duodenum = in front of hilum of right kidney
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What is the relationship between the pancreas and the portal vein? |
Neck of pancreas is in front of portal vein
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Learn structure of kidney |
Now
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What is the renal capsule formed of? |
Thin layer of fibrous connective tissue that surrounds & adheres to each kidney
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What does the renal capsule do? |
Provides protection from trauma & infection
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Where is the perineal fat layer found? |
Between the renal fascia (outermost layer) and the renal capsule
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Where does the left renal vein cross in front of the aorta? |
Just below the origin of the SMA
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Which renal vein is shorter, right of left? |
Right.
It passes steeply backwards to reach the right kidney |
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Where does the renal pelvis emerge from? |
Emerges from the hilum behind the blood vessels. It narrows to become continuous with the ureter which takes urine to the bladder
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What does the ureter do? |
Crosses the bifurcation of the common iliac artery to get to pelvis & urinary bladder just as the common iliac artery becomes the internal & external iliac arteries.
It runs down on psoas major |
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What is the relation between the gonad vessels (testicular/ovarian) and the ureter? |
Gonad vessels pass in front of the ureter
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What is the sensory nerve supply to the ureter? |
T11-T12
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What arteries supply the ureter? |
Renal, gonadal & common iliac
Ureters supplied by different sources as they descend through the abdomen |
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What do we mean by “loin to groin” |
Referred pain from the ureter occurs, loin to groin
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Where is the ureter the most narrow? |
The origin
Where it crosses the pelvic brim Where is passes through the wall of the bladder Stones may get caught in these narrow areas |
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What ribs are the kidneys related to? |
Left kidney behind 11 and 12th
Right kidney is lower down than left so may not be high enough to reach 11th rib, but 12th rib is related to kidney |
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Identify structures of PAW from CT scan |
Do it
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What does the right crus of the diaphragm do? |
Prevents reflux from stomach into oesophagus
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What is the median arcuate ligament? |
= thickening of edges of aortic opening in diaphragm
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What is the medial arcuate ligament? |
= thickening of fascia covering psoas major
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What is the lateral arcuate ligament? |
= thickening of fascia covering quadratus lumborum
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What is the point of the medial and lateral arcuate ligaments? |
Allow the psoas & quadratus lumborum muscles to move independently from the diaphragm
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What is the suprarenal (adrenal) gland? |
Endocrine gland that produces a variety of hormones incl. adrenaline & steroids (aldosterone & cortisol).
The crura of the diaphragm lie behind these glands |
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What is the location of the right suprarenal gland? |
Part of it lies behind the bare area of the liver.
The gland is superior to the right kidney & posterior to the IVC (squeezes medially under the IVC) |
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What is the location of the left suprarenal gland? |
Extends down to hilum of kidney more than on right.
Lies in front of upper part of left kidney, close to left crus of the diaphragm |
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What does the medulla of the suprarenal gland do? |
Has preganglionic sympathetic nerve supply to control production of adrenaline
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What does the cortex of the suprarenal gland do? |
Produces steroid hormones (aldosterone & cortisol) under the control of the pituitary gland
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What is the blood supply TO the suprarenal glands? |
Inferior phrenic artery superior suprarenal artery
Aorta middle suprarenal artery Renal arteries inferior suprarenal artery |
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What is the blood supply AWAY from the suprarenal glands? |
Just 1 suprarenal vein drains into the IVC on the right
On the left, this drains into the renal vein which drains into the IVC |
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What is the lumbar plexus? |
= Ventral rami of L1-L4
Is a mixing of nerves Is found inside psoas major Its branches emerge onto PAW (be able to identify them) |
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What are the lymph nodes draining the colon? |
See diagram and learn goddamit
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Where does the subcostal nerve arise from? |
T12
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Where does the subcostal nerve travel? |
Passes beneath the lateral arcuate ligament & onto the surface of the quadratus lumborum. Now it can pierce the transversalis abdominis enter the neurovascular plane
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Where does the ilioinguinal nerve arise from? |
L1
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Where does the ilioinguinal nerve travel? |
Runs out of psoas muscle, below the iliohypogastric nerve. Crosses quadratus lumborum and iliacus muscle before entering transversus abdominus muscle near iliac crest. Crosses inguinal canal posterior to spermatic cord & then emerges with the spermatic cord from the superifical ring, where it becomes cutaneous, providing sensory innervation to the root of the penis
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Where does the iliohypogastric nerve travel? |
Passes out of psoas muscle & onto anterior surface of quadratus lumborum
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Where does the genitofemoral nerve arise from? |
L1 & L2
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Where does the genitofemoral nerve travel? |
Runs out of psoas muscle & down on its anterior surface & then onto external iliac artery.
Divides into 2 branches at the inguinal ligament |
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What two branches does the genitofemoral nerve divide into at the inguinal ligament? |
1)Genital branch – passes through deep ring to supply the cremaster muscle2)Femoral branch – passes under inguinal ligament & on front of femoral artery. This pierces fascia in the thigh to supply the skin on the front of the thigh |
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Where does the lateral femoral cutaneous nerve of the thigh arise? |
L2 & L3
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Where does the lateral femoral cutaneous nerve of the thigh travel? |
Passes out of the psoas & goes directly onto the iliacus muscle. At the ASIS, it passes into the thigh beneath the inguinal ligament to supply the skin on the lateral aspect of the thigh
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What is the obturator nerve? |
Anterior division of ventral rami of L2-L4
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Where does the obturator nerve travel? |
Appears at the medial border of the psoas muscle & then runs along the lateral wall of the pelvis, lateral to the internal iliac artery, vein & ureter.
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How does the obturator nerve leave the pelvis? |
Through the obturator foramen, just beneath the superior pubic ramus
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Where does the femoral nerve travel? |
Runs in the groove between the iliacus & psoas muscles and passes out into the thigh under the inguinal ligament
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