S2 Anatomy Exam 1: Abdomen & Kidney Dissector

Front 1

The renal fascia presents a barrier to the spread
of infection, except in what direction?

Back 1

in an inferior direction

Front 2

Because there is no inferior barrier, a perinephric infection may spread along the ____________________ to reach the pelvis.

Back 2

ureter

Front 3

The lack of inferior support by the renal fascia also means that an abnormally mobile kidney may descend more than usual when the body is in what position?

Back 3

when the body is erect (nephroptosis, or dropped kidney)

*most commonly in young, thin white females.

Front 4

In a case of nephroptosis, how is the resulting intermittent pain from traction on renal vessels and kinking of the proximal ureter relieved?

Back 4

by lying down

Front 5

The left renal vein differs from the right renal vein in that it has connections w the ascending lumbar & upper lumbar veins. What is the clinical significance of this?

Back 5

This is significant because it may allow the left renal vein to be ligated near the midline without obstructing venous drainage from the kidney


(e.g., venous blood in the ligated left renal vein may drain through the ascending lumbar vein into the azygos system)

Front 6

The left renal vein passes toward the right between the _______________ and ___________ and, rarely, may be compressed there in renal vein entrapment syndrome (nutcracker syndrome).

Back 6

superior mesenteric artery and aorta

Front 7

What does nutcracker syndrome result in?

Give an example of how it might occur

Back 7

results in hematuria and left flank pain

e.g., renal vein becomes compressed btwn superior mesenteric artery & aorta by an aneurysm of one vessel or the other

Front 8

Accessory renal arteries commonly branch from the aorta, and an extrahilar artery entering the
kidney near the inferior pole may compress and obstruct the ___________ or ________________

Back 8

renal pelvis or ureter

Front 9

Name each of the five segments of the kidney—

Back 9

superior
anterior superior
anterior inferior
inferior
posterior

Front 10

Each of the five segments of the kidney typically receives only one segmental artery. Why is this important?

Back 10

That is important because renal segmental arteries are end arteries with no significant anastomoses

Front 11

T/F

Each segment of the kidney is surgically resectable

Back 11

TRUE

* but each segment is also subject to tissue death and necrosis if its artery is compromised.

Front 12

Give the 3 normal sites of constriction of the ureter that predispose it to obstruction during the passage of a kidney stone

Back 12

1. where the ureter crosses the pelvic brim
near the bifurcation of the common iliac arteries
2. at the junction of the renal pelvis and ureter
(ureteropelvic junction)
3. at the ureter’s passage through the wall of the bladder

Front 13

The afferent nerve supply to the ureter is via GVA fibers accompanying sympathetic
preganglionic fibers to spinal cord segments ________

Back 13

T11-L2

Front 14

Ureter pain is referred to the corresponding dermatomes, usually in a ______________ pattern during passage of a kidney stone.

Back 14

loin-to-groin

Front 15

In children and thin adults the lower abdominal aorta can be compressed where to control bleeding in the pelvis or lower limbs?

Back 15

against the body of Lv4 by pressure on the anterior
abdominal wall over the umbilicus

Front 16

The abdominal aorta below the level of the renal arteries is frequently the site of what?

Back 16

an abdominal aortic aneurysm (AAA)

Front 17

How may the presence of an AAA first be indicated in thin individuals?

Back 17

by pulsations of the relaxed anterior abdominal wall when the patient is lying supine.

Front 18

Surgical graft repair of an AAA is common, what is a newer approach that doesn't require a large abdominal incision?

Back 18

Endovascular aneurysm repair

Front 19

During surgical repair of an aneurysm with a prosthetic graft, the wall of the aorta is sewn back over the graft to prevent development of what?

Back 19

an aorticoenteric fistula

Front 20

If the inferior mesenteric artery arises from the involved area, the viability of the hindgut depends on the patency of the _____________ or replantation of the inferior mesenteric artery into the aortic graft

Back 20

marginal artery

Front 21

When the vagus nerves are surgically sectioned (vagotomy) to control gastric acid secretion in patients with peptic ulcers that don’t respond to medical therapy, an effort is made to spare the branches to _________________
Why?

Back 21

the pylorus (selective vagotomy)

Otherwise, a pyloroplasty or bypass surgery may have to be performed (e.g., gastrojejunostomy)

Front 22

The GVA fibers accompanying (sympathetic/parasympathetic) fibers are responsible for pain referred from thoracic and abdominal viscera to the body wall.

Back 22

Sympathetic

*the source of preganglionic sympathetic nerve fibers supplying an organ, can predict the dermatomes to which its pathology will refer pain.

Front 23

For example, disease or injury within the distribution of the celiac trunk will refer pain to dermatomes ______ because the preganglionic sympathetic fibers to foregut derivatives arise from those spinal cord levels (greater splanchnic nerve).

Back 23

T5-9

Front 24

In general pain from the abdominal foregut is referred to the _________________,
from the midgut to the _________________, and from the hindgut to the _______________.

Back 24

epigastric region (foregut)

umbilical region (midgut)

pubic (hypogastric) region (hindgut)

Front 25

an inflamed gallbladder (cholecystitis) may refer pain to the (right/left) shoulder, and a ruptured spleen
may refer pain to the (right/left) shoulder.

Back 25

right

left

Front 26

T/F

A carelessly performed splenic or liver biopsy may contaminate the pleural cavity and damage the lung

Back 26

TRUE

Front 27

The psoas fascia covering the psoas major allows for infections (e.g., tuberculosis, septic discitis) from the lumbar spine deep to the psoas fascia to enter the ___________.

Back 27

upper thigh

Front 28

A number of visceral organs are closely related to the ___________ muscle (e.g., kidneys, ureters, cecum and appendix ).

Back 28

iliopsoas


*Inflammation of one of these organs usually results in pain if the patient is asked to flex the thigh against resistance or if it is passively extended (positive iliopsoas/psoas sign

Front 29

The_______________ nerve is sensory to skin of the anterolateral thigh. The nerve may be
compressed in obese individuals or people who wear heavy tool belts, producing pain,
paresthesia, and sensory loss (meralgia paresthetica).

Back 29

lateral femoral cutaneous nerve