Kidneys, Diaphragm, Posterior Abdominal Wall and other neglected topics

29 March 2011

Musculoskeletal structures of posterior abdominal wall

· Vertebral column

· Psoas major

· Quadratus lumborum

· Thoracolumbar fascia

· Lateral muscle layers

· Diaphragm

– Medial and lateral arcuate ligaments arch over psoas & quadratus Lumborum (respectively) and provide attachment for lumbar part of diaphragm

-.Median arcuate ligament passes over aorta - it is part of the crural diaphragm

Netter, 2011 pl. 256; Netter, 2006 pl. 263

Diaphragm

· Sternal diaphragm

· Costal diaphragm

· Lumbar diaphragm

– Medial arcuate lig.

– Lateral arcuate lig.

· Crural diaphragm

– Median arcuate ligament

· Inferior phrenic aa.

Netter, 2011 pl. 189; Netter, 2006 pl. 195

Liver

· Largest visceral organ in the body

· Attached to inferior surface of diaphragm by peritoneum

– Coronary ligaments

· Reflection of visceral peritoneum onto diaphragm

– Falciform ligament

· Remnant of visceral peritoneum

· Four lobes

– Right

– Left

– Caudate

– Quadrate

Liver & Gallbladder

· Gallbladder covered in peritoneum and attached to inferior surface of liver.

· Bile produced in liver, stored in gallbladder.

· Comes from liver in common hepatic duct

· Backs up in gallbladder through cystic duct.

· Bile flows to duodenum through common bile duct.

· Liver receives oxygenated blood through proper hepatic a.

· Liver receives nutrient-rich blood through hepatic portal vein.

· Blood leaves liver through hepatic vein.

– Common hepatic duct

– Cystic duct

– Common bile duct

– Pancreatic duct

– Hepatopancreatic ampulla

– Major duodenal papilla

Netter, 2011 pl. 277, 280, 283; Netter, 2006 pl. 287, 294, 299

Kidneys - relationships

· Primarily retroperitoneal on posterior abdominal wall.

· Surrounded in perirenal fat, enclosed within renal fascia

· Pararenal fat on posterior wall outside renal fascia.

· Right kidney inferior to liver, posterior to ascending colon

· Left kidney inferior to stomach & spleen, posterior to tail of pancreas & descending colon.

Kidneys and Associated Vasculature

· Renal arteries, paired branches from aorta

· Renal veins, paired tributaries to inferior vena cava

· Veins superficial to arteries

– Left renal vein runs under superior mesenteric a.

· Gonadal aa. branch from aorta

· Right gonadal v. to vena cava

· Left gonadal v. to left renal

· Ureters emerge from hilum of kidney posterior to arteries

Netter, 2011 pl. 308; Netter, 2006 pl. 329

Suprarenal Glands

· Two-part endocrine and exocrine glands

· Receive blood from superior, middle and inferior suprarenal aa.

· Drained by single suprarenal v.

· Cortex receives postganglionic sympathetic innervation

· Medulla receives both pre- and post-ganglionic sympathetic innervation

Netter, 2011 pl. 310; Netter, 2006 pl. 332

The Nutcracker

· Due to gut rotation during development, the left renal vein and 3rd part of the doudenum pass posterior to the superior mesenteric a.

Gross Structures of Kidneys

· Fibrous capsule

· Cortex

· Medulla

· Papilla

· Minor calyx

· Major calyx

· Renal pelvis

· Ureter

Netter, 2011 pl. 311; Netter, 2006 pl. 324

Peritoneal Relationships of the Posterior Abdominal Wall.

· Pancreas & duodenum in retroperitoneal position.

· Kidneys, suprarenals, ureters, major vessels & ganglia all primarily retroperitoneal.

Netter, 2011 pl. 308; Netter, 2006 pl. 274

Nerves of Posterior Abdominal Wall

· Autonomic

– Sympathetic trunks

– Aortic ganglia

– Hypogastric nerves

· Somatic

– Subcostal (T-12)

– Iliohypogastric(L1)

– Ilioinguinal (L1)

– Lateral femoral cutaneous (L2,3; sensory)

– Genitofemoral (L1,2; sensory)

– Femoral (L2,3,4)

Netter, 2011 pl. 260; Netter, 2006 pl. 267