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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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.


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

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