Anatomy Lab 5 Module PDF

Anatomy Lab Posterior Abdominal Wall and Pelvic Viscera th Moore’s COA 8 ed. 1 Moore 8th ed Lab Station Topics Chapter Page 1 Inguinal region 5 424 2 Subdivisions of peritoneal cavity & Retroperitoneal organs 5 438 3 Kidneys, ureters, and suprarenal glands 5 515 4 Renal vasculat...

Anatomy Lab Posterior Abdominal Wall and Pelvic Viscera th Moore’s COA 8 ed. 1 Moore 8th ed Lab Station Topics Chapter Page 1 Inguinal region 5 424 2 Subdivisions of peritoneal cavity & Retroperitoneal organs 5 438 3 Kidneys, ureters, and suprarenal glands 5 515 4 Renal vasculature and circulation through the kidney 5 519 5 Diaphragm and diaphragmatic hiatuses 5 533 6 Posterior abdominal wall 5 537 7 Pelvic nerves 6 583 8 Features of bladder, distal ureters, and constrictions 6 589 9 Male reproductive system 6 602 10 Female reproductive system 6 2 609 Information for each station includes: • Station topic with objectives listed for that station relative to gross anatomy • Slides for each section include relevant information likely to be discussed in the lab • Quizzes are composed of 5 numbered structures from slides with purple backgrounds and 1 relevant bonus structure that can be from any part of this module • Unlabeled cadaveric images (also purple background) are provided as a study tool • An asterisk may mark the relative location of structures not visible on cadaveric images Useful tips for Moore’s Essential Clinical Anatomy 7th ed. • Chapter 1 provides an overview of basic anatomy concepts • Clinical Box topics are highlighted in blue at the end of each section. • Most sections provide useful images of surface anatomy relative to the deeper structures of interest • Moore is organized by body region and functionally-related content may be found in multiple chapters • When beneficial, I have included images from Moore’s Clinically Oriented Anatomy (COA) and noted that This module was constructed from the following resources: Agur AM, Dalley AF. Moore’s Essential Clinical Anatomy, 7th ed. Wolters Kluwer Publishing; 2024. Hansen, JT. Netter’s Anatomy Coloring Book, 3rd ed. Elsevier, Inc; 2022. Kibble JD, Halsey CR. The Big Picture Medical Physiology. McGraw-Hill Publishing; 2009. Lab Station 1 Inguinal Region 4 Inguinal Region p. 264 Inguinal canal What is the deep (internal) inguinal ring? The abdominal entrance to the inguinal canal What is the superficial (external) inguinal ring? The external opening to the inguinal canal The vas deferens or round ligament enter the inguinal canal through this opening p 264 Inguinal hernias Inguinal hernias account for what % of abdominal hernias? 75% What is an inguinal hernia? Protrusion of parietal peritoneum and viscera (eg small intestine) through a normal or abnormal opening from a cavity where they belong What does reducible mean? Able to be returned to normal placement with manipulation Are most inguinal hernias direct or indirect? ? >2/3 are indirect Indirect hernias occur lateral to the inferior epigastric vessels – pass through deep inguinal ring Direct hernias occur medial to the inferior epigastric vessels – pass through the posterior wall 5 of inguinal canal- are separate from the spermatic cord Posterior aspect of the anterolateral abdominal wall of a male Figure 5.13 Formations of the inguinal region Figure 5.14 6 Inguinal Region 1. Inguinal ligament 2. Medial crus of superficial inguinal ring 3. Lateral crus of superficial inguinal ring 4. Suspensory ligament of penis or clitoris 5. Aponeurosis of external oblique 5 Contents of male inguinal canal Spermatic cord Ilioinguinal nerve 1 3 4 2 Contents of female inguinal canal Round ligament of uterus Ilioinguinal nerve 7 Inguinal Region 1. Inguinal ligament 2. Medial crus of superficial inguinal ring 3. Lateral crus of superficial inguinal ring 4. Suspensory ligament of penis or clitoris 5. Aponeurosis of external oblique Contents of male inguinal canal Spermatic cord Ilioinguinal nerve Contents of female inguinal canal Round ligament of uterus Ilioinguinal nerve 8 Lab Station 2 Subdivisions of peritoneal cavity & Retroperitoneal organs 9 Subdivisions of The Peritoneal Cavity and Retroperitoneal Organs Objective: Identify subdivisions of the peritoneal cavity and retroperitoneal organs p. 439 Describe the relationship of these viscera to the peritoneum Intraperitoneal organs – are almost completely covered with visceral peritoneum Retroperitoneal organs- are outside the peritoneal cavity – lie between the parietal peritoneum and posterior abdominal wall – peritoneum is only located on their anterior surface Where are the kidneys located? retroperitoneally p. 441- What is a mesentery? A double layer of peritoneum that occurs as a result of the invagination of the peritoneum by an organ – constitutes a continuity of the visceral and parietal peritoneum p. 441- What is an omentum? A double-layered extension or fold of peritoneum that connects and covers viscera p. 443 Subdivisions of the Peritoneal Cavity What are the two divisions of the peritoneal cavity? Greater sac Lesser sac What is the greater sac? The main and larger part of the peritoneal cavity – anterolateral abdominal incisions are into the greater sac 10 What is the lesser sac? The omental bursa (lesser sac) lies posterior to the stomach and lesser omentum Transverse section of abdomen at level of omental bursa Figure 5.23 11 Greater sac 1. Greater omentum 2. Liver Lesser sac 2 Intraperitoneal Structures 3. Transverse colon 4. Stomach Retroperitoneal Structures 5. Kidney 6. Ureter 4 5 3 6 1 Secondarily retroperitoneal- started with mesentery Ascending colon Descending colon 12 Greater sac 1. Greater omentum 2. Liver Lesser sac Intraperitoneal Structures 3. Transverse colon 4. Stomach Retroperitoneal Structures 5. Kidney 6. Ureter Secondarily retroperitoneal- started with mesentery Ascending colon Descending colon 13 Lab Station 3 Kidneys, ureters, and suprarenal glands 14 Lab Station 3- Kidneys, ureters, and suprarenal glands Objective: Identify renal structures p. 526 The Bottom Line Where are the kidneys found? Retroperitoneal space The kidneys are located between which vertebrae? T12 and L3 Do the kidneys move with excursion? Yes – move with diaphragm due to location Are suprarenal glands attached to kidneys? no What forms the renal pelvis? The minor then major calyces Where is urine excreted from the kidney? The papillae What exits the renal sinus? Vessels and renal pelvis What are the suprarenal glands attached to? Primarily to the diaphragmatic crura How are the suprarenal glands attached to the diaphragmatic crura? Renal fascia 15 External and internal appearance of kidneys Figure 5.80 16 Kidney, Ureters & Suprarenal Glands 1. Ureter 2. Renal pelvis 3. Major calyx 4. Minor calyx 5. Renal pyramid 6. Renal papilla 7. Renal column 8. Cortex 9. Medulla 10. Renal artery 11. Segmental artery 12. Renal vein 13. Adrenal 10 12 11 6 5 1 7 8 9 13 4 2 3 17 Kidney, Ureters & Suprarenal Glands 1. Ureter 2. Renal pelvis 3. Major calyx 4. Minor calyx 5. Renal pyramid 6. Renal papilla 7. Renal column 8. Cortex 9. Medulla 10. Renal artery 11. Segmental artery 12. Renal vein 13. Adrenal 18 Lab Station 4 Renal vasculature and circulation through the kidney 19 Lab Station 4- Renal Vasculature and Circulation through the Kidney Objective: Describe circulation to the kidney Arterial supply of the kidneys and ureters Figure 5.84 p. 526 The Bottom LineNeurovasculature At which lumbar level do the renal arteries arise? L1-L2 Use the image to list the branches of the renal arteries: 1. Renal arteries 2. Segmental arteries 3. Interlobar arteries 4. Arcuate arteries 5. Interlobular (radial) arteries 20 Renal Vasculature 1. Renal artery 2. Segmental artery artery 3. Location of Interlobar artery 4. Location of Arcuate artery 5. Location of Interlobular (Radial) artery 1 2 4 3 5 Renal Vasculature 1. Renal artery 2. Segmental artery artery 3. Location of Interlobar artery 4. Location of Arcuate artery 5. Location of Interlobular (Radial) artery Lab Station 5 Diaphragm and diaphragmatic hiatuses 23 Lab Station 5- Diaphragm and Diaphragmatic Hiatuses Objective: Identify the diaphragmatic hiatuses p. 533 What are the crura of the diaphragm? Musculotendinous band that arise from the anterior surface of the bodies of the superior three lumbar vertebrae, anterior longitudinal ligament, and the IV discs Where does the right crura arise? L1-L4 Where does the left crura arise? L1-L3 p. 535 What are the three diaphragmatic apertures? IVC – caval opening at T8 Esophagus – Esophageal hiatus - T10 Aorta – aortic hiatus – T12 24 Attachments, disposition, and features of the abdominal aspect of the diaphragm Figure 5.92 Apertures of the diaphragm Figure 5.95 25 Diaphragm and Diaphragmatic hiatuses 1. Caval hiatus (T8) 2. Esophageal hiatus (T10) 3. Aortic hiatus (T12) 4. Right crus 5. Left crus 1 2 4 3 5 Diaphragm and Diaphragmatic hiatuses 1. Caval hiatus (T8) 2. Esophageal hiatus (T10) 3. Aortic hiatus (T12) 4. Right crus 5. Left crus Lab Station 6 Posterior abdominal wall 28 Lab Station- Posterior Abdominal Wall Objective: Identify the structures of the posterior abdominal wall p. 537 The posterior abdominal wall is mainly composed of the following: Five lumbar vertebrae and IV discs Posterior abdominal wall muscles – psoas, quadratus lumborum, iliacus, transversus abdominis, and oblique muscles Diaphragm – contributes to the superior part of the posterior wall Fascia – including the thoracolumbar fascia Lumbar plexus – composed of the anterior rami of lumbar spinal nerves Fat, nerves, vessels (eg aorta and IVC) and lymph nodes 29 Muscles and nerves of the posterior abdominal wall Figure 5.98 30 Posterior Abdominal Wall 1. 2. 3. 4. 5. 6. 7. 8. 9. Psoas Major Iliacus Quadratus Lumborum Subcostal nerve Iliohypogastric nerve Ilioinguinal nerve Lateral femoral cutaneous Femoral nerve Genitofemoral nerve 4 3 5 6 2 9 1 7 8 31 Posterior Abdominal Wall 1. 2. 3. 4. 5. 6. 7. 8. 9. Psoas Major Iliacus Quadratus Lumborum Subcostal nerve Iliohypogastric nerve Ilioinguinal nerve Lateral femoral cutaneous Femoral nerve Genitofemoral nerve 32 Lab Station 7 Pelvic nerves 33 Lab Station 7- Pelvic Nerves Objective: Identify the nerves of the pelvis p. 586 Pelvic Autonomic Nerves enter the pelvic cavity via four routes: 1. Sacral sympathetic trunks provide sympathetic innervation to lower limbs 2. Peri-arterial plexuses: postsynaptic, sympathetic, vasomotor fibers to the superior rectal, ovarian, and internal iliac arteries and their branches 3. Hypogastric plexuses are the most important route sympathetic fibers are conveyed to the pelvic viscera 4. Pelvic splanchnic nerves are the pathway for parasympathetic innervation of the pelvic viscera and descending and sigmoid colon p. 587- What is the pelvic pain line? (Except for the alimentary canal), The pelvic pain line corresponds to the inferior limit of the peritoneum. Intraperitoneal visceral are superior to the pain line and transmit using sympathetic fibers; structures below 34 the pelvic pain line transmit sympathetic impulses using parasympathetic fibers. Lab Station 7- Pelvic Nerves Objective: Review pelvic innervation Nerves and nerve plexuses of pelvis Figure 6.21 Autonomic nerves of pelvis Figure 6.23 35 PS 5 1 S 2 3 4 Medial view left pelvis Pelvic Nerves 1. Lumbosacral trunk 2. S1 3. S2 4. S3 5. Obturator nerve * Sacral sympathetic trunk S= Sacrum PS= Pubic symphysis S * Medial view right pelvis 36 Pelvic Nerves 1. Lumbosacral trunk 2. S1 3. S2 4. S3 5. Obturator nerve * Sacral sympathetic trunk * 37 Lab Station 8 Features of bladder, distal ureters, and constrictions 38 Lab Station 8- Identify features of the bladder, distal ureters, and constrictions Objective: Identify features of the urinary system Normal constrictions of the ureters determined by retrograde pyelogram Figure 5.82 p. 517 Ureters demonstrate relative constrictions in three places: 1. Junction of ureters and renal pelvis 2. Where ureters cross the brim of the pelvic inlet 3.Passing through the wall of the urinary bladder p. 602- Clinically Significant Differences Between Male and Female Urethrae Is the passage of catheters and cystoscopes easier in men or women? Women – more elastic tissue 39 Infections more common in women due to the short urethra, its distensibility, and its vestibular opening Urinary bladder and prostatic urethra Figure 6.28 p. 602 The Bottom Line Ureters pass behind what artery in females? Uterine artery Which part of the bladder is distensible? The body Which part is not distensible? The neck Where is the trigone? In the triangle between the ureteric orifices and the urethral orifice 40 1 2 Constrictions 3 st 1 Constriction- leaving renal pelvis 2nd constriction – where ureter crosses iliac vessels 3rd constriction- where ureter enters urinary bladder 41 Constrictions 1st Constriction- leaving renal pelvis 2nd constriction – where ureter crosses iliac vessels 3rd constriction- where ureter enters urinary bladder 42 Lab Station 9 Male reproductive system 43 Lab Station 9- Male Reproductive System Objective: Describe the functions of the male reproductive structures p. 609 The Bottom Line- What is the function of these male genital organs? Ductus (vas) deferens – primary part of spermatic cord – conducts sperm from epididymis to ejaculatory duct Seminal glands – produce and deliver seminal fluid needed for transport and delivery of sperm Ejaculatory ducts – formed by the termination of the ductus deferens at the seminal gland Prostate – produces prostate fluid that is added to semen to suspend sperm 44 Hemisected male pelvis and perineum Figure 6.34 Structures crossing male ureter in abdomen and pelvis Figure 6.35 45 1. 2. 3. 4. 5. 5 Ductus deferens Testis Epididymis Prostate gland Seminal vesicle 4 2 1 5 1 4 3 2 46 1. 2. 3. 4. 5. Ductus deferens Testis Epididymis Prostate gland Seminal vesicle 4 2 47 Lab Station 10 Female reproductive system 48 Lab Station 10- Female Reproductive System Objective: Identify the structures of the female reproductive system and structures of the perineum, and discuss their function and relationships p. 627 The Bottom Line- Identify the basic function of these structures Ovaries – female gonads – produce female germ cells and secrete estrogen and progesterone Uterine tubes – fallopian tubes – capture the ovulated oocyte Uterus – protects and nourishes a developing fetus Vagina – musculomembranous passage connecting the uterine cavity to the exterior 49 Internal female genital organs Figure 6.39 50 3 1 2 1 3 1. 2. 3. 4. 5. 6. 7. 8. 9. Uterine tube Ovary Uterus Vagina Clitoris Urethral opening Labia minora Labia majora Vaginal opening 4 5 6 7 9 8 51 1. 2. 3. 4. 5. 6. 7. 8. 9. Uterine tube Ovary Uterus Vagina Clitoris Urethral opening Labia minora Labia majora Vaginal opening 52