Posterior Abdominal Wall, Kidneys, Ureters & Suprarenal Glands – Review Flashcards

These question-and-answer flashcards cover the key anatomical facts, relations, blood supply, innervation, clinical correlations and surface anatomy of the kidneys, ureters, suprarenal glands, major vessels, lymphatics, muscles and nerves of the posterior abdominal wall as outlined in the lecture notes.

At which vertebral levels do the kidneys lie in an adult when the patient is supine?

Retroperitoneally opposite T12–L3 (right kidney slightly lower than left).

Which surface landmark indicates the hilum of the left kidney?

The transpyloric plane (L1) about 5 cm from the midline.

Why is the right kidney lower than the left?

Because of the large size and superior position of the liver on the right side.

Name the four coverings of the kidney from inside-out.

Fibrous capsule → Perirenal (perinephric) fat → Renal fascia (Gerota anterior, Zuckerkandl posterior) → Pararenal fat.

What structures pass through the renal hilum from anterior to posterior?

Renal vein, renal artery, renal pelvis/ureter (mnemonic: VAU).

List the anterior relations of the right kidney.

Right suprarenal gland, liver, 2nd part duodenum, right colic flexure, coils of jejunum.

List the anterior relations of the left kidney.

Left suprarenal gland, stomach, spleen, pancreas, left colic flexure, coils of jejunum.

Which ribs contact the posterior surfaces of the kidneys?

Right kidney – rib 12; Left kidney – ribs 11 and 12.

Name the three posterior abdominal wall muscles lying posterior to each kidney.

Diaphragm (superiorly), psoas major (medial), quadratus lumborum (intermediate) and transversus abdominis aponeurosis (lateral).

Define Morris’ parallelogram.

A surface marking on the back bounded by T11 and L3 spines horizontally and two vertical lines 2.5 cm and 9 cm from the midline; the kidney lies within it.

Describe the pathway of urine from the renal papilla to the bladder.

Renal papilla → minor calyx → major calyx → renal pelvis → ureter → urinary bladder.

How many segmental arteries usually enter each kidney?

Five segmental arteries.

What is the arterial order from renal artery to glomerulus?

Renal artery → segmental arteries → lobar → interlobar → arcuate → interlobular → afferent arteriole → glomerulus.

Which renal artery is longer and why?

The right renal artery; it must pass posterior to the IVC to reach the right kidney.

Which renal vein is longer and how does it travel?

The left renal vein; it crosses anterior to the aorta just below the origin of the SMA.

Explain Nutcracker syndrome.

Compression of the left renal vein between SMA and aorta causing hematuria, flank pain, and left-sided varicocele/pelvic congestion.

What is the clinical significance of accessory (polar) renal arteries?

They supply a renal segment directly; if they cross anterior to the ureter they can cause obstruction and hydronephrosis (back flow).

Where is a transplanted kidney usually placed and why?

In the iliac fossa (greater pelvis) because of easy access to iliac vessels and bladder and to avoid traction on vascular anastomoses.

Describe the standard vascular anastomoses in renal transplantation.

Renal artery to internal iliac artery (end-to-end) and renal vein to external iliac vein (end-to-side); ureter implanted in bladder.

List the three physiological constrictions of the ureter.

Pelvi-ureteric junction (PUJ), crossing the pelvic brim (over common iliac artery bifurcation), and entry through the bladder wall (uretero-vesical junction).

What is the typical referral pattern of pain from ureteric stones?

‘Loin to groin’ pain carried by T12–L2 sympathetic afferents.

Give the segmental arterial supply of the ureter.

Upper – renal artery; middle – gonadal artery; pelvic segment – superior (and inferior) vesical arteries.

Which artery crosses ureter and can be clamped alongside during a hysterectomy?

Uterine artery (water under the bridge).

What is the posterior relation of the ureter?

It crosses in front of the bifurcation of the common iliac artery.

What are the lymphatic drainage for the kidneys?

lateral aortic and iliac lymph nodes.

Name the zones and principal hormones of the suprarenal cortex.

Zona glomerulosa – mineralocorticoids; zona fasciculata – glucocorticoids; zona reticularis – sex hormones.

Which catecholamines are produced by the adrenal medulla?

Epinephrine (adrenaline) and norepinephrine (noradrenaline).

Compare the shapes of the suprarenal glands.

Right gland is pyramidal; left gland is crescentic/semilunar.

List the arterial sources to each suprarenal gland.

Superior suprarenal (from inferior phrenic), middle suprarenal (direct from aorta), inferior suprarenal (from renal artery).

Into which veins do the suprarenal veins drain?

Right suprarenal vein → IVC; left suprarenal vein → left renal vein.

What type of nerve fibres reach the adrenal medulla?

Preganglionic sympathetic fibres from thoracic splanchnic nerves (especially least splanchnic).

At what vertebral level does the abdominal aorta bifurcate?

L4 (approximately at the level of the umbilicus).

Name the four sets of branches of the abdominal aorta.

(1) Ventral unpaired visceral (celiac, SMA, IMA); (2) Lateral paired visceral (suprarenal, renal, gonadal); (3) Posterolateral paired parietal (subcostal, inferior phrenic, 4 lumbar); (4) Terminal branches (common iliac arteries, median sacral).

Which branches of the abdominal aorta arise at L1?

Celiac trunk (T12), superior mesenteric artery (L1), renal arteries (L1), suprarenal arteries (middle) at L1; gonadal arteries arise at L2.

State the origin, course and termination of the thoracic duct.

Begins at the cisterna chyli (L1–L2), ascends through the aortic hiatus, passes through posterior mediastinum, crosses to left at T5, and empties at the junction of left internal jugular and subclavian veins.

Where does the IVC begin and where does it pierce the diaphragm?

Begins at L5 by union of common iliac veins; pierces diaphragm at T8 (caval opening).

List the major tributaries of the IVC.

hepatic veins, right suprarenal, renal, gonadal, inferior phrenic, 1st–4th lumbar veins, common iliac, and median sacral.

Which structures cross anterior to the IVC?

Root of mesentery, 1st part duodenum, 3rd part duodenum, head of pancreas.

Which artery crosses posterior to the IVC?

Right renal artery.

Which lymph node groups drain the kidneys and suprarenal glands?

Lateral aortic (para-aortic or lumbar) lymph nodes.

Which vessel ndrain into the pre-aortic LN?

Celiac, SMA and IMA

Name the three main muscles of the posterior abdominal wall.

Psoas major, iliacus, quadratus lumborum (collectively iliopsoas when psoas major & iliacus act together).

What is the action and nerve supply of iliopsoas?

Main hip flexor and trunk stabiliser; psoas major – anterior rami L1-L3; iliacus – femoral nerve (L2-L4).

Describe the psoas sign and its significance in appendicitis.

Pain on passive extension of the right hip or active flexion of right thigh due to irritation of the psoas major by an inflamed retro-cecal appendix.

List the branches of the lumbar plexus.

Subcostal (T12), iliohypogastric (L1), ilioinguinal (L1), genitofemoral (L1-L2), lateral femoral cutaneous (L2-L3), femoral (L2-L4), obturator (L2-L4), lumbosacral trunk (L4-L5), occasionally accessory obturator (L3-L4).

What sensory area is supplied by the genitofemoral nerve?

Upper anterior thigh and genital region (scrotum/labia majora); also motor to cremaster muscle in males (cremasteric reflex).

Which nerve crosses the iliacus and passes deep to the ASIS under the inguinal ligament?

Lateral femoral cutaneous nerve of thigh (L2-L3).

At what level does the cisterna chyli lie and what does it receive?

Opposite L1–L2; receives intestinal trunk and right & left lumbar lymphatic trunks.

Where can an accessory renal artery cause ureteric obstruction?

When an upper or lower polar artery crosses anterior to the ureter near the pelvi-ureteric junction, producing hydronephrosis.

Which gonadal vein drains into the left renal vein and what syndrome is associated with its obstruction?

The left testicular or ovarian vein; obstruction of LRV leads to ‘nutcracker’ phenomenon causing left varicocele or pelvic congestion.

Why is the suprarenal gland not removed with the kidney during transplantation?

A weak septum of renal fascia separates the adrenal from the kidney, allowing kidney removal without adrenal damage.

Identify the three unpaired anterior midline branches of the abdominal aorta and their vertebral levels.

Celiac trunk (T12), superior mesenteric artery (L1), inferior mesenteric artery (L3).

Which nerve roots contribute to the femoral nerve and what muscles does it supply in the abdomen?

L2-L4; supplies iliacus (and passes to anterior thigh).

Give the vertebral level of aortic hiatus, caval opening and esophageal hiatus of the diaphragm.

Aortic hiatus – T12; caval opening – T8; esophageal hiatus – T10.