Thoracic Duct

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The thoracic duct is the major lymphatic duct of the body, draining the entire body except the right upper thorax and head and neck. The thoracic duct starts at the cisterna chyli at the L2 level. It enters the diaphragm at the T12 aortic opening. It eventually enters the internal jugular and/or left subclavian.

Kidney Stones

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Kidney stones, a condition called nephrolithiasis, occur at any of the anatomical restriction points in the ureter:

  • ureter-pelvic junction
  • pelvic brim
  • bladder entrance

Treatment: extracorporal shock wave lithotripsy (ECSW) treatment can be used to break up the stones and allow the patient to pass them with less pain. Severe cases may require surgery.

Comparison of the Heart Chambers

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Right atrium exclusives:

  • fossa ovalis
  • limbus of fossa
  • crista terminalis

Atria exclusives:

  • pectinate muscles

RV exclusive:

  • moderator band

Ventricular exclusives:

  • papillary muscles
  • chordae tendinae
  • trabeculae carnae

Referred Renal Pain

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The lumbar splanchic nerves supply part of the kidneys. When aggravated, they refer pain to the:

  • testis
  • labia major
  • L1 region

Vasculature of the Kidneys

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Arterial

The kidneys are supplied by the renal arteries which branch off the abdominal aorta just below the SMA.

On the left side, there may be more than one renal artery (supernumerary arteries)

On the right side, the renal artery splits into the upper, middle & lower branches.

Venous

The right side may have more than one renal vein (supranumerary or accessory veins).

The left renal vein is supplied by tributaries of: gonadal, body wall, diaphragm & adrenal glands.

Kidney Anatomical Landmarks & Structure

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The body has a right and left kidney. The left kidney is longer and larger. This is because the liver restricts the amount of space on the right side. The liver is retroperitoneal. It lies against the psoas major muscle and is covered by a fibrous capsule. When supine, the kidneys are found at the T12-L3 levels and when standing, the kidneys move down to L1-L4 levels.

The fascia of the kidneys consists of a capsule, perirenal fat, renal fascia and pararenal fat.

The kidneys are supported by pararenal fat and renal vessels. When this support is limited, the resulting pathology is nephrotosis (a slouching/sagging liver).

Behind the kidneys, one will find the diaphragm, psoas major muscle, quadratus lumborum muscle, 12th rib and the lateral part of erector spinae.

The hilum of the kidney consists of: parasympathetic nerves, ureter, renal arteries, sympathetic nerves and renal veins.

The urine flows into the papillary ducts (in the pyramid) into the minor calyx to the major calyx to the renal pelvis to the ureter and finally into the bladder.

Omental Bursa

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Also known as the lesser peritoneal sac, the omental bursa is formed by the lesser and great omentum.

Anterior margins:

  • caudate of right lobe of liver
  • stomach
  • greater omentum

Characteristics of Large Intestine

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  1. epiploicae appendices
  2. teniae coli
  3. haustra

epiploicae- small masses of fat on the colon. These are projections of the omentum on the colon

tenia coli- 3 bands of longitudinal muscle seen prominent in cecum and ascending colon

haustra- sac-like bulges. LI is not smooth.

Mesenteric Arteries

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Superior Mesenteric Artery (SMA)

  • Runs from root of mesentery to ileocecal junction
  • starts at L1 level
  • supplies from lower duodenum to 2/3 of transverse colon and pancreas
  • Branches form loops called arcades which become vasa recta

Superior Mesenteric Vein (SMV)

  • drains jejunum & ileum
  • unites w/ splenic vein behind pancreatic neck to form hepatic portal vein
  • tributaries drain: stomach, large intestine, pancreas, appendix

Inferior Metsenteric Artery (IMA)

  • supplies from left colic flexure to rectum

Inferior Mesenteric Vein (IMV)

  • drains blood from small intestine
  • dumps into splenic vein
  • tributaries drain: large intestine, sigmoid colon, rectum

Celiac Trunk

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Branches off aorta between the stomach and pancreas. The celiac trunk has 3 main branches:

  • Left gastric artery
  • Splenic artery
  • Common hepatic artery

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