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75 Cards in this Set
- Front
- Back
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Renal Fascia
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Connective tissue of extraperitoneal connective tissue that surrounds the kidneys and suprarenal glands.
Anterior and posterior lamellas fuse laterally, medially, and superiorly, but not inferiorly. |
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Perirenal fat
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Adjacent to the kidney within renal fascia
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Pararenal fat
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Posterior to the posterior lamella of the renal fascia.
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Nephroptosis
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A dropped kidney. Can cause kinking of ureters. Laying down relieves pain.
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Right suprarenal gland shape and borders
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Smaller and triangular shaped.
Medial: Inferior vena cava Posterior: Right crus of diaphragm Anterior: Liver |
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Left suprarenal gland shape and borders
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Larger, cresent shaped.
Medial: Aorta Posterior: Left crus of diaphragm Anterior: Stomach |
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Blood supply of suprarenal glands
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Superior suprarenal artery: branches of inferior phrenic
Middle suprarenal artery: Branch off aorta Inferior suprarenal artery: Branch off renal artery |
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Venous drainage of suprarenal gland
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RIght side: Suprarenal vein drains directly into inferior vena cava.
Left side: joins inferior phrenic and drains into left renal vein which drains into inferior vena cava. Usually much longer than right. |
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Autonomic innervation of suprarenal glands
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EGS come from lesser and least splanchnic nerves, go through celiac ganglion or superior mesentaric ganglion, do not symapse, and synapse in suprarenal gland on chromaffin cells > causes secretion of catecholamines.
No para. innervation. |
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Renal sinus of kidney contents
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Renal vessels
Nerves Lymphatics Major and minor calyces Renal pelvis Fat |
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Hilus of kidney
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Indentation of medial part of kidney leading into renal sinus
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Minor Calyces
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First repository of urine from collecting ducts. Join to form major calyces
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Major calyces
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Formed by multiple minor calyces. Join to form renal pelvis
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Renal pelvis
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Formed by the major calyces. Is the upper swelling of the ureter.
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Inner medulla of kidney
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Contains pyramids whose apexes project as a papilla into a minor calyx.
Contains medullary rays - collecting ducts of the pyramids which extend into the cortex. |
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Outer cortex of kidney
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Cortical tissue called renal columns seperate pyramids.
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Location and relationships of right kidney
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Extends from TV 12 to LV 3
Anterior: Liver, duodenum, right colic flexure, jejunum Posterior: Diaphragm, Psoas, quadratus lumborum, transversus abdominis Medial: Suprarenal gland |
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Location and relationships of left kidney
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Extends from TV 11-LV 2.
Anterior: Stomach, spleen, pancreas, jejunum, colon. Posterior: Diaphragm, Psoas, quadratus lumborum, transversus abdominis Medial: Suprarenal gland |
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Blood supply of kidney
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Renal artery comes off aorta at level of LV1-2 and splits into 5 segmental branches. Left is shorter than right. Segmental arteries have no anastomoses.
Anterior: -Apical -Upper anterior -Lower anterior -Inferior Posterior: -Posterior |
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Differentiating between left and right kidney
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On side of ureter with 4 arteries = anterior. Direction of ureter = posterior.
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Venous drainage of kidney
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Left Renal vein: Passes anterior to aorta and inferior/posterior to superior mesentaric artery. Left inferior phrenic, left suprarenal, and left gonadal vein empty into left renal.
Right renal vein has no other branches. Both connect to inferior vena cava. |
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Nutcracker Syndrome
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Caused by blockage of left renal vein possibly by a superior mesentaric artery aneurism.
Females get pain on left side b/c cant drain ovaries. Males get pain in left testicle because cant drain testicles. |
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Superior mesenteric artery syndrome
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Compression of the third part of duodenum by the abdominal aorta and the superior mesenteric artery.
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Autonomic nerve supply of kidney and ureter
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EGS from lesser splanchnic nerve synapse @ aorticorenal ganglia.
EGS from least splanchnic synapse @ renal ganglia. EGS from first lumbar splanchnic synapse @ renal ganglion. All OGS reach kidneys via renal plexus. No para. innervation. |
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Relationships of left and right ureters
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Ureters lie on psoas muscle for most of their course. Are first crossed anteriorly by by gonadal artery. Then pass anteriorly over common iliac artery bifurcation.
Left ureter crossed by branches of inferior mesentaric vessels and crosses pelvic brim with sigmoid mesocolon. Right ureter is crossed by branches of the superior mesentaric vessels and the root of mesentery proper. |
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Blood supply of ureters
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-Renal vessels
-Gonadal vessels -Aorta and common Iliac vessels -Vesicle vessels (branch of internal iliac) |
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3 constriction points of ureter
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1) Renal pelvis
2) Bifurcation of common iliac artery 3) Where ureter opens into bladder |
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5 components of all plexuses
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-EGS fibers
-OGS fibers -EGP fibers -OGS cell bodies in a ganglia -Visceral Sensory (afferent) fibers Exception is hepatic plexus which does not contain the cell bodies. |
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Start and end of abdominal arota
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Aorta enters abdomen via aortic hiatus of diaphragm at TV12. Ends at bifurcation of left and right common iliac arteries at LV4
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Unpaired branches off anterior surface of abdominal aorta
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-Celiac artery (upper border of LV1)
-Superior mesenteric artery (lower border of LV1) -Inferior mesenteric (LV3) |
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Paired branches off lateral side of abdominal aorta
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-Inferior phrenic arteries
-Middle suprarenal arteries -Renal arteries (LV1-2 just below superior mesenteric) -Gonadal arteries (testicular/ovarian) -Common Iliac arteries (LV 4) |
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Paired branches off dorsolateral side of abdominal aorta
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First - forth lumbar arteries.
Fifth lumbar artery is the iliolumbar artery - branch of internal iliac artery |
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Median Sacral Artery
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Branches off on posterior surface of abdominal artery just above the bifurcation into the common iliacs.
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3 constriction points of ureter
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1) Renal pelvis
2) Bifurcation of common iliac artery 3) Where ureter opens into bladder |
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Relationships of the abdominal aorta
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Posterior - Thoracic duct, anterior longitudinal ligament, left lumbar veins, retroaortic lymph nodes, beginning of azygos vein.
Right side: Right crus of diaphragm and inferior vena cava Left side: left crus of diaphragm and left suprarenal gland Anterior: preaortic plexuses, stomach, left renal vein, uncinate process of pancreas, third part of duodenum, loops of small intestine. |
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5 components of all plexuses
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-EGS fibers
-OGS fibers -EGP fibers -OGS cell bodies in a ganglia -Visceral Sensory (afferent) fibers Exception is hepatic plexus which does not contain the cell bodies. |
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Start and end of abdominal arota
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Aorta enters abdomen via aortic hiatus of diaphragm at TV12. Ends at bifurcation of left and right common iliac arteries at LV4
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Start and end of inferior vena cava
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Begins at the confluence of the left and right common iliac veins at LV5. Ends as it passes through diaphragm at level of TV8.
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Tributaries of Inferior vena cava
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-Common iliac veins
-Lumbar veins -Right gonadal veins -Renal veins -Right suprarenal vein -Right inferior phrenic vein -Hepatic veins |
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Unpaired branches off anterior surface of abdominal aorta
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-Celiac artery (upper border of LV1)
-Superior mesenteric artery (lower border of LV1) -Inferior mesenteric (LV3) |
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Paired branches off lateral side of abdominal aorta
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-Inferior phrenic arteries
-Middle suprarenal arteries -Renal arteries (LV1-2 just below superior mesenteric) -Gonadal arteries (testicular/ovarian) -Common Iliac arteries (LV 4) |
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Paired branches off dorsolateral side of abdominal aorta
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First - forth lumbar arteries.
Fifth lumbar artery is the iliolumbar artery - branch of internal iliac artery |
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Median Sacral Artery
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Branches off on posterior surface of abdominal artery just above the bifurcation into the common iliacs.
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Relationships of the abdominal aorta
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Posterior - Thoracic duct, anterior longitudinal ligament, left lumbar veins, retroaortic lymph nodes, beginning of azygos vein.
Right side: Right crus of diaphragm and inferior vena cava Left side: left crus of diaphragm and left suprarenal gland Anterior: preaortic plexuses, stomach, left renal vein, uncinate process of pancreas, third part of duodenum, loops of small intestine. |
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Start and end of inferior vena cava
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Begins at the confluence of the left and right common iliac veins at LV5. Ends as it passes through diaphragm at level of TV8.
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Tributaries of Inferior vena cava
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-Common iliac veins
-Lumbar veins -Right gonadal veins -Renal veins -Right suprarenal vein -Right inferior phrenic vein -Hepatic veins |
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Collateral Routes between Inferior and Superior vena cava
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Thoraco-epigastric veins - Lateral thoracic vein on anterior abdominal wall and superficial epigastric vein
Superior and Inferior Epigastric Veins Ascending lumbar-Azygos veins - Ascending lumbar veins receive blood from lumbar veins. vertebral plexuses - internal vertebral venous plexus, external vertebral venouse plexus, and intervertebral veins. |
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Diaphragm Muscle
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Origin: Sternal portion from the xiphoid process, costal portion from costal margin, lumbar portion from the arcuate ligaments and the crura.
Inserts: Central Tendon Action: Inspiration Innervation: Phrenic Nerve |
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Cisterna Chyli
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Inferior end of thoracic duct. Lies on bodies of LV 1-2, receives lymph from lower half of body.
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Path of thoracic duct
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Leaves abdomen via aoritc Hiatus. Travels between aorta and azygos vein.
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Crura
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Righr crus arises from bodies and disks of upper three lumbar vertebrae.
Left crus arises from bodies and disks of upper two vertebrae. |
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Arcuate Ligaments
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Median arcuate ligament - Ligament under diaphragm that connects right and left crura.
Medial Arcuate ligament - Extends laterally from crura, over psoas muscle, to insert on transverse process of LV1 Lateral Arcuate ligament - Arches from medial arch, over quadratus lumborum, to the tip of 12th rib. |
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Aortic Aperature: locations and structures passing through
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At level of TV 12:
-Aorta -Thoracic Duct -Azygos and hemiazygos |
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Esophageal Aperature: locations and structures passing through
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At level of TV10:
-Esophagus -Vagus Nerves -Esophageal branch of left gastric vessels. |
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Vena caval aperature: locations and structures passing through
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At level of TV8:
-Inferior vena cava -Branches of right phrenic nerve (left phrenic passes through junction of muscle and tendon. -lymphatics |
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Medial Lumbocostal arch: structures passing through
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-Psoas muscle
-sympathetic trunk -least splanchnic nerve |
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Lateral lumbocostal Arch: structures passing through
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-Quadratus lumborum
-Subcostal vessels and nerves |
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Sternocostal aperature: structures passing through
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-Superior epigastric vessels
-lymphatics |
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Blood supply of diaphragm
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-Musculophrenic - terminal branch of internal thoracic
-Pericardiacophrenic - branch of internal thoracic -Superior Phrenic - branch of thoracic aorta -Inferior phrenic - Branch of abdominal aorta |
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Psoas Major muscle
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Origin: Body of TV12 and bodies, disks, and transverse processes of of all lumbar vertebrae.
Inserts: Lesser trochanter of the femur Action: Primary flexor of hip joint Innervation: Anterior primary rami of L2-4 |
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Psoas minor muscle
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Origin: Bodies and disks of TV12-LV5 and the upper fibers of psoas major.
Inserts: Psoas fascia, pelvic brim, iliopubic eminence and pectineal line. Action: Weak flexor of lumbar column. |
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Quadratus Lumborum Muscle
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Origin: Iliolumbar ligament and adjacent part of iliac crest
Insertion: Transverse processes of lumbar vertebrae and rib 12. Action: Flexes 12th rib for diaphragm and laterally flexes trunk. Innervation: T12-L4 |
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Iliacus Muscle
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Origin: Iliac fossa
Inserts: On lesser trochanter with psoas major. Action: Flexes hip Joint Innervation: Femoral Nerve |
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Lumbar plexus nerves and branches
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Is formed by the anterior primary rami of L1-4.
-Iliohypogastric nerve -Ilioinguinal nerve -Genitofemoral nerve -Lateral femoral cutaneous nerve -Femoral nerve -Obturator nerve -Lumbosacral trunk |
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Nerves lateral and medial to psoas muscle
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Lateral: Iliohypogastric, ilioinguinal, lateral femoral cutaneous nerve, and femoral nerve.
Medial: Obturator and lumbosacral trunk. |
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Iliohypogastric Nerve
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(L1) Motor to transversus abdominis and internal oblique.
Sensory to gluteal region and lower abdominal wall |
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Ilioinguinal Nerve
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(L1) Sometimes exits through superficial inguinal ring. Sensory to anterior perineum, medial thigh, and external genitalia.
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Genitofemoral Nerve
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(L1-2) Only nerve which passes through psoas major. Genital branch supplies cremaster muscle. Femoral branch is sensory for upper thigh.
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Lateral Femoral Cutaneuous Nerve
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(Posterior divisions of L2-3) Passes under inguinal ligament next to ASIS. Sensory to lateral thigh
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Femoral Nerve
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(Posterior division L2-3) Runs medial to psoas between psoas and iliacus muscles. Passes under inguinal ligament lateral to femoral artery. Supplies motor to anterior compartment of thigh and pectineus muscle. Is sensory to anterior thigh, middle thigh, and leg to foot.
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Obtrurator nerve
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(Anterior divisions of L2-4) Runs medial to psoas muscle, enters pelvis, and passes through obtrurator canal. Supplies motor to medial compartment of thigh. Supplies sensory to medial thigh and knee.
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Lumbosacral Trunk
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Formed from fibers of L4 which join anterior primary rami of L5 medial to psoas major.
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Anterior v.s. posterior divisions of lumbar plexus
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Anterior = preaxial (flexors)
Posterior = postaxial (extensors) |
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Abdominal/pelvis non gut lymphatics
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External Iliac node (lower limbs) > Internal iliac node (plevis) > Common iliac node (above) > Lumbar nodes > Cisterna chyli
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Gut lymphatics
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Intestinal lymph trunk can either go left lumbar lymph trunk or cristerna chyli (lower intercostal spaces)
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