Posterior Abdominal Wall - Part2

Subcostal nerve – T12 Lumbar Plexus – L1-L5 - located in Psoas muscle Iliohypogastric – L1 Ilioinguinal – L1 Genitofemoral – L1-2 Lateral femoral cutaneous – L2-3 Femoral – L2-4 Obturator – L2-4 Lumbosacral trunk - L4-5

T12

Right Kidney Thin fibrous capsule

Urinary bladder

Renal capsule

-glomeruli Renal column - glomeruli

Hilum

Renal sinus fat calices pelvis renal a.s & v.s autonomics

Renal calculi

Urinary bladder

Renal medulla Renal papilla – apex of pyramid - capped by a minor calix

Kidney – Retroperitoneal, embedded within layers of fatty connective tissue and fascia Cross section at level of L1

Parietal

Aorta

Pararenal fat

Gerota’s capsule Continuous with transversalis fascia And psoas fascia

Renal capsule

Surgical Approach to a kidney – Posterior-lateral

L1

Suprarenal glands = Adrenal glands Positioned on superior pole of kidney Right suprarenal is pyramidal shaped Left suprarenal is semilunar shaped Each is surrounded by a thin fibrous capsule that is continuous with the renal fascia surrounded by fatty connective tissue “Two endocrine glands in one” Subdivided into Cortex and Medulla Cortex – outer region, produces steroids Medulla – inner region, produces epinephrine and norepinephrine modified postgangionic sympathetic neurons - innervated by preganglionic sympathetic neurons – Splanchnics

Arterial blood supply Superior suprarenal arteries Middle suprarenal arteries Inferior surprarenal arteries

Venous drainage Right suprarenal vein > IVC Left suprarenal vein > Left renal vein

Right kidney is positioned lower than left kidney

• Anterior abdominal Wall • • • • • • • •

Quadrants vs. regions 4 major muscles Inguinal ligament, Inguinal canal Hernias and hydroceles Spermatic cord Testes and epididymus Scrotum

• Peritoneal cavity and major vessels • • • • • •

Greater sac vs lesser sac Greater omentum vs lesser omentum Interperitoneal vs retroperitoneal, secondarily – Peritoneal gutters and their borders - mesenteries Blood flow to and from each abdominal organ Portal system and portal anastamosis

• Abdominal Viscera • • •

Individual anatomy Position relative to adjacent organs Biliary tree and effects of blockage at different positions along the tree

• Posterior Abdominal Wall • • • • •

Muscles and skeleton Fascia Vasculature Organs Lymph flow in the abdomen