Prelab Images - Kidneys & Retroperitoneum

Prelab should consist of reading the lab manual and dissector answers and viewing the dissection video. To begin your study, you may find it useful to look over the Netter's or LWW Atlas images listed below.

Step 1. Review the bony landmarks. (Play movie)

Plate N248 or TG5-03 shows the 11th and 12th ribs and the iliac crest. Plate N330 or TG5-30 shows the relation of the kidneys to the 11th and 12th ribs. Plate N273 or TG5-29 shows the posterior body wall and the disposition of the peritoneum. Plate N307 or TG5-31 shows the relation of the kidney deep to the colon. Reflect the descending colon and its neurovascular supply inferiorly to reveal the kidneys (plate N329 or TG5-30).

Step 2. Remove the pararenal fat from around the kidney, try to identify renal fascia. (Play movie)

Plate N342 or TG5-42 shows two views of the kidney surrounded by pararenal fat, the renal fascia (Gerota's fascia), and perirenal fat (from superficial to deep). Plate N342 or TG5-42 shows the renal fascia fusing as it moves superiorly, but remaining separate as it travels inferiorly. Plate N342 or TG5-42 shows the renal fascia traveling medially towards the inferior vena cava and the aorta. Remove the pararenal fat to identify the renal fascia. Break through the renal fascia laterally and lift the kidney and perirenal fat out of the paravertebral gutter (formed by psoas major and quadratus lumborum in plates N263 or TG5-33, N342 or TG5-42, and plate N329 or TG5-30). The posterior renal fascia will either be attached to the perirenal fat as you pull the kidney out or it will remain in the paravertebral gutter attached to the pararenal fat (N342 or TG5-42). Plates N273, N329 or TG5-31, N330, N342, and N331 or TG5-42 all show different views of the kidneys and their relationship to other viscera.

Step 3. Remove perirenal fat to expose kidney and suprarenal gland and examine the parts and blood supply of both organs. (Play movie)

Remove the perirenal fat from the kidney to expose the kidney and suprarenal gland (N332 or TG5-31 and N341). Plate N342 or TG5-31 labels the renal (fibrous) capsule. Plate N332 or TG5-31 shows the renal veins traced to the kidney. Plate N265 or TG5-34 labels the lumbar veins and plate N332 or TG5-31 shows the 2nd lumbar vein on the left side draining into the renal vein. Plate N332 or TG5-31 shows the renal arteries. Plate N333 (top, left) shows supernumerary renal arteries. Plate NN318 or TG5-39 shows the renal plexus of nerves lying along each renal artery. Plate N341 or TG5-30 shows the course of the gonadal arteries and veins. Plates N400 and N401 or TG5-30 trace the gonadal arteries to the ovaries (N400) or to the testes (N401). Plates N341 or TG5-30 and N401 trace the ureters. Plate N340 or TG5-29 shows the relationship of the left ureter to the left colic vessels. Plate N400 or TG5-29 shows the right ureter traveling deep to the root of the mesentery. Plate N341 or TG5-30 shows the aorta, renal, gonadal, and common iliac arteries sending branches to supply the ureter with blood.

Step 4. Examine the left kidney and incise it in the frontal plane to examine its internal structure. (Play movie)

Plate N346 or TG5-32 shows the fibrous capsule and hilum of the kidney. The renal pelvis is labeled at the hilum of the kidney. Incise the left kidney in the frontal plane (plate N346 or TG5-32). Plate N335 or TG5-32 shows the renal artery dividing into anterior and posterior divisions and segmental branches. Plate N346 or TG5-32 labels the cortex, renal columns, medulla, renal pyramids, and renal papillae. Plate N335 or TG5-32 labels interlobar arteries. Plate N346 or TG5-32 shows the major and minor calyces (with a renal papilla draining into each minor calyx). Plates N332 or TG5-31 and N341 or TG5-30 show the relationship of the suprarenal gland to the kidney and inferior vena cava. Plate N332 or TG5-31, TG5-32 shows the blood supply to the suprarenal gland via superior, middle, and inferior suprarenal arteries. Plates N332 or TG5-31 and N341 or TG5-30 show the suprarenal glands being drained by a single suprarenal vein. Plates N318 or TG5-39 and N346 or TG8-16 show branches of the greater thoracic splanchnic entering the suprarenal gland. Plate N347 or TG5-32 shows a cross section through the suprarenal gland with the cortex and medulla labeled.

Step 5. Clean and examine the diaphragm, its parts, apertures and the nerves, vessels and other structures passing through or behind it. (Play movie)

Plate N253 or TG5-07 shows the diaphragm lined with transversalis fascia and peritoneum. Remove the peritoneum and fascia from the diaphragm. Plates N195 and 263 or TG5-33 identify the median, medial, and lateral arcuate ligaments. Plate N195 shows fibers from the diaphragm with sternal, costal, and lumbar origins. Plate N263 or TG5-33 labels the central tendon and the right and left crus (crura) of the diaphragm. Plates N194, N195, 263 or TG5-33, and N270 (bottom) show the aortic hiatus and the esophageal hiatus. Plate N195 labels the lumbocostal triangle. The lumbocostal triangle can also be seen in plate N263 or TG5-33, but is unlabeled. Plate N195 shows the phrenic nerve distributing on the inferior surface of the diaphragm and plate N193 (bottom) shows a schema of the phrenic nerve innervating the diaphragm. Plates N195, N263 or TG5-33, and N266 or TG5-38 all give views of the caval hiatus.

Step 6. Examine the preaortic autonomic nerve plexuses of the abdomen and the branches of the abdominal aorta. (Play movie)

Plate N318 or TG5-39 (and N266 or TG8-16, TG8-17) shows the celiac ganglia and the celiac plexus (nerve fibers on the trunk of the celiac artery. The greater thoracic splanchnic nerve is shown in plate N318 or TG5-39, TG8-16 passing through the crus of the diaphragm to the celiac ganglion. Plates N318 or TG5-39 and N319 or TG8-17 show branches from the posterior vagal trunk going to the celiac ganglion. Plate N318 or TG5-39, TG8-16 also shows the aorticorenal ganglion, the lesser thoracic splanchnic nerve, the superior mesenteric ganglion, the intermesenteric plexus, and the superior hypogastric plexus. Plates N322 and N323 or TG8-16, TG8-17 identify many of these nerve plexuses also. Cut through the diaphragm on the left side to trace the entire course of the thoracic splanchnic nerves (plates N209 or TG5-38 and N318). Plates N209 or TG5-38 and N318 or TG5-39 show the thoracic sympathetic trunk passing into the abdomen. Plate N195 shows how the sympathetic trunk gets into the abdomen. Plate N318 or TG5-39 follows the sympathetic trunk until it disappears behind the common iliac artery. Lumbar ganglia and lumbar splanchnic nerves are labeled in plate N318 or TG5-39. Plates N319 or TG8-16, TG8-17 organize the innervation of the stomach. Plates N322 and N323 or TG8-16, TG8-17 organize the innervation of the large and small intestines. Plate N344 or TG5-39 organizes the innervation of the kidneys.

Plate N264 or TG5-34 shows the course of the abdominal aorta. Plate N264 or TG5-34 also identifies the median sacral and lumbar segmental arteries. Slit open the aorta and examine the way the in which the segmental arteries leave the aorta. Plate N265 or TG5-34 traces the inferior vena cava from its formation by the union of the left and right common iliac veins. The right gonadal (ovarian/testicular), renal, right suprarenal, and lumbar segmental veins are all labeled in plate N265 or TG5-34 .

Plate N266 or TG5-37 identifies the lumbar lymph nodes, lumbar lymph trunks, and the intestinal lymph trunk. The intestinal lymph trunk receives lymph from the GI tract (plates 304-307) and the lumbar lymph trunks receive lymph from the lower limb (plate 528). The cisterna chyli and the thoracic duct are also labeled in plate N266 or TG5-37 .

7. Fragment and remove the left psoas major (and minor if present) and examine the lumbar plexus of nerves and white and gray rami of the lumbar sympathetic trunk. (Play movie)

Plate N263 or TG5-33 shows the psoas major muscle. Plate N266 or TG5-38 shows the left psoas major muscle fragmented so you can identify rami coomunicantes passing from the sympathetic trunk to the lumbar nerves. Plate N266 or TG5-38 and N498 or TG5-40, TG5-41 label gray and white rami communicantes. Plate N167 reminds you that gray and white rami exist from T1-L2 vertebral levels and only gray rami communicantes exist at other vertebral levels. Plates N266 or TG5-38, N497 or TG3-25 and N498 show the lumbar plexus of nerves. In plate N266 or TG5-38 you can identify the subcostal, iliohypogastric, and ilioinguinal nerves (all laying on quadratus lumborum). The genitofemoral nerve pierces psoas major (N266 or TG5-38). The lateral femoral cutaneous nerve emerges from in between psoas major and quadratus lumborum and travels on the iliacus muscle (N266 or TG5-38). The femoral nerve is deep to psoas major on the iliacus muscle (N266 or TG5-38). The obturator nerve is medial to psoas major as it heads for the obturator foramen (N266 or TG5-38). Clean the quadratus lumborum and iliacus muscles (N263 or TG5-33).

Plate N263 or TG5-33 traces the course of the iliacus and psoas major muscles under the inguinal ligament. Plate N491 or TG3-13 shows the insertion of the iliopsoas muscle. Plates N266 or TG5-38 and N538 or TG3-63 show the iliopsoas muscle being innervated by the femoral nerve. Plates N264 or TG5-34 and N265 or TG5-34 show the external iliac vessels passing beneath the inguinal ligament before they become the femoral vessels. The femoral ring is labeled in plate N259 or TG5-08 and is shown to contain deep inguinal lymph nodes in plate TG5-37.

 

 

Updated: 11 January 2012