B5: Anatomy Exam 2 (The Final Countdown)

adding lectures as we go

intraperitoneal

__________ structures are completely covered by visceral peritoneum

retroperitoneal

__________ structures are behind the peritoneal cavity, external to parietal peritoneum (covered only on anterior surface w/ parietal peritoneum)

1. surparenal glands
2. abdominal aorta (+ IVC)
3. duodenum
4. pancreas head + body
5. ureters
6. colon
7. kidneys
8. esophagus
9. rectum

What are the retroperitoneal structures?

hint: SADPUCKER

subperitoneal

What type of structures are found below the peritoneal cavity, external to the parietal peritoneum and covered only on their superior surface w/ parietal peritoneum?

adrenal glands

What organ:
-retroperitoneal endocrine organs
-superior pole of kidneys (between kidney + diaphragm)
-surrounded by perinephric fat + enclosed by renal fascia (separated from kidney by thin fascial septum)
-R = more pyramidal, partially posterior to IVC
-L = crescent-shaped, extends medial from superior half of kidney

cortex

What part of the adrenal gland:

-outer portion

-derived from MESODERM

-secretes HORMONES --> corticosteroids, androgens

-disorders of excess or deficient secretion of above hormones can occur

medulla

What part of the adrenal gland:

-inner part

-derived from neural crest cells

-secretes catecholamines --> epinephrine + norepinephrine

-some adrenal tumors secrete catecholamines

catecholamines (epinephrine and norepinephrine)

What does the medulla of the adrenal gland secrete?

neural crest cells

What is the medulla of the adrenal gland derived from?

hormones corticosteroids and androgens

What does the cortex of the adrenal gland secrete?

mesoderm

What is the cortex of the adrenal gland derived from?

superior, middle, & inferior suprarenal aa.

What are the arteries that supply the adrenal glands?

R & L suprarenal vv.

What is the venous drainage from the adrenal glands?

inferior phrenic a.

What is the origin of superior suprarenal a.?

abdominal aorta

What is the origin of middle suprarenal a.?

renal a.

What is the origin of inferior suprarenal a.?

IVC

What does the R suprarenal v. drain into?

L. renal v.

What does the L suprarenal v. drain into?

greater (majority) and lesser splanchnic nn. (thoracic splachnic nn.)

What supplies sympathetic innervation to the adrenal gland?

adrenal glands

Pre-synaptic sympathetic fibers to the _________ pass through both paravertebral and prevertebral ganglia WITHOUT synapsing. They end DIRECTLY ON THE CHROMAFFIN CELLS in the adrenal medulla (which act like post-synaptic sympathetic neurons), stimulating them to release catecholamines

chromaffin cells

What act like post-synaptic sympathetic neurons in the adrenal gland?

→ suprarenal lymphatic vessels
→ R and L lumbar lymph nodes (R = caval lymph nodes, L = aortic lymph nodes)
→ cisterna chyli

Describe the lymphatic drainage of the adrenal glands.

kidney

What organ:
-retroperitoneal
-capsule, cortex, medulla, and collecting system
-functions to filter blood + produce urine, regulate BP via renin, role in RBC production via erythropoietin, vitamin D activation
-often impalpable!!!!!! may feel lower pole of R kidney in lean adults, L kidney ONLY if enlarged or displaced by retroperitoneal mass

T12-L3 levels

At what spinal levels are the kidneys found within the superior posterior abdominal wall?

right

The (right/left) kidney is slightly more inferior w/ its lower pole just superior to iliac crest

costovertebral angle

Tenderness at the _____________ is associated w/ renal pathology

anterior

R lobe of the liver is ____________ to the R kidney, thus free fluid collects within the heptorenal recess. Duodenum and ascending colon also has the same relation to the kidney as the R lobe of the liver.

anterior

Spleen is ________ to the superior pole of the L kidney (as well as pancreas, jejunum, descending colon, and stomach)

posteromedial

Where is the psoas mm. in relation to the kidney?
Hint: has similar vertical axis to kidneys

cortex

What part of the kidney parenchyma:
-periphery of kidneys
-extends centrally as renal columns

medulla

What part of the kidney parenchyma:
-multiple fan-shaped medullary (renal) pyramids
-apex of pyramid = renal papilla

minor calyx

What collects urine from a SINGLE renal papilla?

major calyx

2-3 minor calyces come together to form a(n) __________

renal pelvis

What is a funnel-shaped structure hat receives urine from major calyces and continues w/ the ureter?

renal hilum

What is the medial cleft where structures enter/exit the renal sinus?

renal sinus

What is the space containing fat (perinephric fat), neurovasculature, and collecting system?

perirenal space

What is the space containing perinephrix fat around kidneys and adrenals, is enclosed by renal fascia (other than the inferior surface)?

perinephrix abscess or hematoma

What can extend inferiorly into the pelvis through the inferior opening in the perirenal space?

nephroptosis

What is abnormal drooping of the kidney, even very low into the abdominal cavity causing a very long ureter that is coiled?

pararenal space + fat

What is the space containing paranephric fat superficial to renal fascia?

R & L renal aa.

What supplies blood to the kidneys?

L1/L2

At what spinal levels are the renal aa. found?

right

The ____ renal a. travels posterior to IVC

left

The _____ renal a. is shorter b/c it does not have to run behind the IVC

posterior

The right & left renal aa. travel ______ to renal vv.

left

the ____ renal v. is longer because the IVC is on the R side of the body

hilum

Where do the renal aa. divide into 5 segmental aa. to supply non-overlapping areas of the kidneys?
Note: these segments are surgically resectable! :)

left

the _____ renal v. receives infow from L adrenal v. & gondal v.

left

the ____ renal v. courses over the aorta, under the SMA and is vulnerable to entrapment ("nutcracker" syndrome)

vagal trunks

What supplies parasympathetic innervation to the kidneys?

thoracic splanchnic nn.

What supplies sympathetic innervation to the kidneys?

T10-L1

Pain fibers (visceral afferents) travel to ________ spinal levels and are sensitive to over -distension of the ureter

→ lumbar lymph nodes
→ cisterna chyli

Describe the lymphatic flow from the kidneys.

horseshoe kidney

What kidney pathology:
-lower poles fused or connected by fibrous bridge
-usually ~L3-L5 b/c of IMA root

ectopic kidney

What kidney pathology:
-kidney located outside of renal fossa
-usually in pelvis
-SHORT ureter (diff from nephroptosis)

UL renal agenesis

What kidney pathology:
-one kidney congenitally absent

renal transplantation

What is the preferred treatment for selected cases of chronic renal failure in which the kidney is removed from the donor WITHOUT the adrenal gland and a new kidney is placed into the iliac fossa (provides support and ease of access to anastomosis for grafting to external iliac vessels and bladder)?

renal v. entrapment ("nutcracker") syndrome

What disorder:
-L renal v. traverses midline to reach IVC crossing under acute angle between SMA and aorta
-traction on SMA can compress L renal v.
-Sx = hematuria or proteinuria, abdominal (L flank) pain, n/v, and L testicular pain in men (L-sided varicocele may occur in rare cases)

costodiaphragmatic recess

What recess is located posterior to the superior poles of the kidneys?

iliohypogastric and inguinal nn.

What nerves can become injured because they cross the lower poles of the kidneys?

renal and uretic calculi

What disorder:
-stones of slats of inorganic/organic acids or of other materials
-may pass from kidney into renal pelvis then into ureter
-ureteric may cause over-distension of the tube --> severe intermittent pain ("ureteric colic") w/ peristalsis as moved
-partial or complete obstruction of urinary flow
-level = level of referred pain in lumbar/inguinal regions (T11-L2)
-pain passes inferioanteriorly from loin to groin
-pain accompanied by digestive upset and generalized sympathetic response that can mask specific Sx
-hydronephrosis can also occur if blood supply to ureter disturbed

ureters

What are muscular tubes coursing from the renal pelvis to the urinary bladder, located proximal to the retroperitoneal abdomen and distal to the subperitoneal pelvis?

ureter

What function to propel urine to the bladder from the kidney?

intrinsic pacemakers

What regulate peristalsis within the ureter?

1. ureteropelvic junction
2. crossing iliac vessels/pelvic brim
3. ureterovesicle junction

What are the 3 anatomic constrictions of the ureter (common sites for stones to lodge)?

• anterior part of psoas mm.

• close to gonadal vessels

• same sagittal plane as tips of lumbar transverse processes

Describe the relations of the ureter in the abdomen.

ductus deferens

The ureter crosses inferior to the __________ in males
Hint: on posterior portion of the bladder

uterine a.

The ureter crosses inferior to the __________ in females
Hint: "water under the bridge", possible injury during hysterectomy

ureter

What runs with the ovarian a. at the pelvic brim in females?
Hint: possible injury during ophorectomy

renal aa., gonadal aa., abdominal aorta, common iliac aa.

What supplies blood to the ureter in the abdomen?

renal and gonadal vv.

What drains the ureter in the abdomen?

internal iliac aa. and their branches

What supplies blood to the ureter in the pelvis?

internal iliac vv.

What drains the ureter in the pelvis?

renal, abdominal aortic, and superior hypogastric plexuses

What innervates the ureters?

T11-L2

What spinal levels does pain from the ureters travel to?
Hint: dermatomes overlying loin + groin, sensitive to overdistension

back, flank, or groin

Where is pain referred to when pts have a ureteral stone?

1. Depends on specific level:

• proximal --> lumbar nodes

• mid --> common iliac nodes

• distal --> internal and external iliac nodes

2. then all to cisterna chyli

Describe the lymphatic drainage of the ureter.

bifid ureter

What disorder:
-2 proximal ureters on same side that converge before the bladder

duplicated ureter

What disorder:
-2 ureters on same side remaining separate the entire way to the bladder
-upper pole prone to obstruction
-lower pole prone to reflux

retrocaval ureter

What disorder:
-R ureter courses posterior to IVC then descends along its medial and anterior aspect

subperitoneal

The bladder is a(n) __________ organ, stores urine prior to micturition, and is made up of the apex, body, fundus, and neck

trigone

What is a triangular area between the ureteric orifices and the internal urethra orifice formed by the incorporation of mesonephrix ducts into the bladder wall?

ureteric orifices

What are openings of the ureters that is encircled by detrusor mm. which acts as a sphincter?

hydronephrosis

occlusion of the ureteric orifices leads to:

intramural part

What part of the distal ureters courses obliquely to the ureteric orifice (through wall that acts as a one-way valve)?

intermediate mesoderm

What does the urinary system develop from?
Hint: during folding, it moves ventrally and forms the urogenital ridge

urogenital ridge

What part of the intermediate mesoderm is a longitudinal elevation of mesoderm on either side of the dorsal aorta + forms the nephrogenic cord?

pronephros

What set of kidneys during development:
-regresses, non-functional
-first kidney to form (early week 4)
-tubes are rudimentary and non-functional around the cervical region
-degenerates late week 4

mesonephros

What set of kidneys during development:

-functional in embryo

-does NOT give rise to adult kidney

-second kidney to form (late week 4)

-functions starting week 5

-regresses week 9/10

-glomeruli, mesonephric tubules, mesonephric duct (10-50 glomeruli per kidney)

-after it regresses, some components will be incorporated into structures of reproductive system

metanephros

What set of kidneys during development:

-functional in embryo

-gives rise to adult kidney

-develops from the outgrowth of the mesonephric duct to the ureteric bud

-condensation of mesoderm within nephrogenic cord (metanephric mesoderm)

-begins to form week 5, functional in fetus ~week 10

-fetal kidney is divided into lobes (adult kidney has a smooth contour)

-2 parts: collecting + filtration system

week 4

During what week of development:
-urogenital ridge differentiates into nephrogenic cord (urinary system) and gonadal ridge

week 5

During what week of development:
-medial portion of undifferentiated cells will form gonadal ridge (forms gonads)

pronephric duct

what runs from the pronephros to the cloaca and becomes the mesonephric duct?

collecting

The (collecting/filtration) system of the metanephros:
-ureteric bud widens to form renal pelvis
-1st gen = major calyces
-buds continues to subdivide until 12 or more generation of tubules formed
-collecting tubules will eventualyl fuse to metanephric tubules

filtration

The (collecting/filtration) system of the metanephros:

Week 8:

• metanephric diverticulum induces formation of small nephrogenic vesicles in nephrogenic cord from metanephric blastema

• nephrogenic vesicles --> metanephric tubules

• metanephric tubules fuse w/ arached collecting ducts

Week 10-18:

• glomeruli increase gradually

Week 18-36:

• glomeuli increase rapidly

near cloaca (S1/S2)

Around week 6, where are the kidneys located?

mid abdomen (T12-L3)

around week 9, where are the kidneys located?

bladder

What structure (in the adult) is developed from the allantois and cloaca?