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27 Cards in this Set
- Front
- Back
what ribs are associated with the kidneys location?
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11 and 12
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describe the structures of the diaphragm
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-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 |
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describe psoas and iliacus muscles
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-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) |
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describe quadratus lumborum
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-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 |
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describe abdominal aorta and its branches
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-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 |
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describe tributaries of IVC
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-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 |
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describe lumbar plexus
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-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 |
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describe sympathetic trunk
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-meet at ganglion impar
-cell bodies only in lateral horns of spinal cord between T1 and L2 |
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describe splanchnic nerves
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-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 |
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describe parasympathetic innervation to abdominal viscera
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-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 |
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describe relationship of renal art/vein
describe structures in renal sinus |
-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 |
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describe calyces
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-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) |
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describe blood supply to kidneys; what is resultant consequence of structure of vasculature of kidney?
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-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 |
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describe ureters; what is blood supply
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-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 |
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describe autonomic nerve supply of kidney
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-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 |
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describe afferent fibers in kidney and ureter
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-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 |
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describe adrenal glands- shapes and intra or retroperitoneal
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-retroperitoneal; not attached to kidneys
-left- crescent shaped, lower, medial aspect of kidney -right- pyramid shaped, posterior to IVC, superior |
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describe adrenal blood supply
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-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 |
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describe the organ structure and what is produced in each section
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-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 |
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describe kidney and adrenal development in terms of its location
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-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 |
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describe adrenal nerve supply
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-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 |
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describe specific secretions of the cortex
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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 |
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describe cells of adrenal medulla and overall blood supply structures
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-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 |
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describe the position of the organs of the posterior wall
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-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 |
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describe the renal fat and fascia
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-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 |
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describe the ant relationships of the adrenal gland and ureter
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-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 |
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describe lymphatic drainage
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-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 |