RACK 7 LOWER LIMB

Clinical Relevance: Congenital Abnormalities of the Kidneys

Pelvic Kidney

In utero, the kidneys develop in the pelvic region and ascend to the lumbar retroperitoneal area. Occasionally, one of the kidneys can fail to ascend and remains in the pelvis – usually at the level of the common iliac artery.

Horseshoe Kidney

A horseshoe kidney (also known as a cake kidney or fused kidney) is where the two developing kidneys fuse into a single horseshoe-shaped structure.

In the Thigh and Gluteal Region

Femoral Artery

The main artery of the lower limb is the femoral artery. It is a continuation of the external iliac artery (terminal branch of the abdominal aorta). The external iliac becomes the femoral artery when it crosses under the inguinal ligament and enters the femoral triangle.

Anatomical Position

The spleen is located in the upper left quadrant of the abdomen, under cover of the diaphragm and  the ribcage – and therefore cannot normally be palpated on clinical examination (except when enlarged). It is an intraperitoneal organ, entirely surrounded by peritoneum (except at the splenic hilum).

The isthmus of thyroid gland which crosses the trachea between the second and fourth tracheal cartilages. The inferior thyroid arteries are located superior to the isthmus. The pretracheal fascia, inferior thyroid veins and thymus are located inferior to the isthmus. Pretracheal lymph nodes.

The thyroid gland is an endocrine structure located in the neck. It plays a key role in regulating the metabolic rate of the body.

Anatomical Relations

The kidneys sit in close proximity to many other abdominal structures which are important to be aware of clinically:

Anterior

Posterior

Left

• Suprarenal gland
• Spleen
• Stomach
• Pancreas
• Left colic flexure
• Jejunum
• Diaphragm
• 11th and 12th ribs
• Psoas major, quadratus lumborum and transversus abdominis
• Subcostal, iliohypogastric and ilioinguinal nerves

Right

The muscles acting on the foot can be divided into two distinct groups; extrinsic and intrinsic muscles.

Clinical Relevance: Disorders of the Stomach

Gastro-Oesophageal Reflux Disease

 This is a digestive disorder affecting the lower oesophageal sphincter. It refers to the movement of gastric acid and food into the oesophagus.

GORD is a common condition, affecting 5-7% of the population. Symptoms include dyspepsia, dysphagia, and an unpleasant sour taste in the mouth.

There are three main causes of reflux disease:

The kidney tissue is protected by three layers that entirely surround the kidney: The fibrous capsule (renal capsule) The perinephric fat (perirenal fat capsule) The renal fascia which besides the kidneys also encloses the suprarenal gland and its surrounding fat.

Kidney Structure

The kidneys are encased in complex layers of fascia and fat. They are arranged as follows (deep to superficial):

The small intestine is an organ located within the gastrointestinal tract. It is approximately 6.5m in the average person and assists in the digestion and absorption of ingested food.

It extends from the pylorus of the stomach to the ileocaecal junction, where it meets the large intestine at the ileocaecal valve. Anatomically, the small bowel can be divided into three parts: the duodenum, jejunum, and ileum.

The proximal and distal tibiofibular joints refer to two articulations between the tibia and fibula of the leg. These joints have minimal function in terms of movement but play a greater role in stability and weight-bearing.

In this article, we shall look at the anatomy of the proximal and distal tibiofibular joints – their structures, neurovascular supply and clinical relevance.

Adapted from work by OpenStax College [CC BY 3.0], via Wikimedia Commons