Prelab Images - Kidneys & Retroperitoneum

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 Atlas images listed below.
Step 1. Review the bony landmarks. (Play movie)
Plate 248 shows the 11th and 12th ribs and the iliac crest. Plate 330 shows the relation of the kidneys to the 11th and 12th ribs. Plate 273 shows the posterior body wall and the disposition of the peritoneum. Plate 307 shows the relation of the kidney deep to the colon. Reflect the descending colon and its neurovascular supply inferiorly to reveal the kidneys (plate 329).
Step 2. Remove the pararenal fat from around the kidney, try to identify renal fascia. (Play movie)
Plate 342 shows two views of the kidney surrounded by pararenal fat, the renal fascia (Gerota's fascia), and perirenal fat (from superficial to deep). Plate 342 (bottom) shows the renal fascia fusing as it moves superiorly, but remaining separate as it travels inferiorly. Plate 342 (top) 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 263, 342, and the top picture in plate 343). 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 (354, top). Plates 273, 329, 330 (top), 342, and 331 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 (332 and 341). Plate 342 labels the renal (fibrous) capsule. Plate 332 shows the renal veins traced to the kidney. Plate 265 labels the lumbar veins and plate 332 shows the 2nd lumbar vein on the left side draining into the renal vein. Plate 332 shows the renal arteries. Plate 333 (top, left) shows supernumerary renal arteries. Plate 318 shows the renal plexus of nerves lying along each renal artery. Plate 341 shows the course of the gonadal arteries and veins. Plates 400 and 401 trace the gonadal arteries to the ovaries (400) or to the testes (401). Plates 341 and 401 trace the ureter. Plate 340 shows the relationship of the left ureter to the left colic vessels. Plate 400 shows the right ureter traveling deep to the root of the mesentery. Plate 341 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 334 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 334 bottom). Plate 335 shows the renal artery dividing into anterior and posterior divisions and segmental branches. Plate 334 labels the cortex, renal columns, medulla, renal pyramids, and renal papillae. Plate 335 labels interlobar arteries. Plate 334 shows the major and minor calyces (with a renal papilla draining into each minor calyx). Plates 332 and 341 show the relationship of the suprarenal gland to the kidney and inferior vena cava. Plate 332 shows the blood supply to the adrenal gland via superior, middle, and inferior suprarenal arteries. Plates 332 and 341 show the suprarenal glands being drained by a single suprarenal vein. Plates 308 and 334 show branches of the greater thoracic splanchnic entering the suprarenal gland. Plate 347 (bottom left) 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 253 shows the diaphragm lined with transversalis fascia and peritoneum. Remove the peritoneum and fascia from the diaphragm. Plates 195 and 263 identify the median, medial, and lateral arcuate ligaments. Plate 195 shows fibers from the diaphragm with sternal, costal, and lumbar origins. Plate 263 labels the central tendon and the right and left crus (crura) of the diaphragm. Plates 194, 195, 263, and 270 (bottom) show the aortic hiatus and the esophageal hiatus. Plate 195 labels the vertebrocostal trigone (labeled lumbocostal triangle). The vertebrocostal trigone can also be seen in plate 263, but is unlabeled. Plate 195 shows the phrenic nerve distributing on the inferior surface of the diaphragm and plate 193 (bottom) shows a schema of the phrenic nerve innervating the diaphragm. Plates 195, 263, and 267 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 318 (and 267) 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 318 passing through the crus of the diaphragm to the celiac ganglion. Plates 318 and 319 show branches from the posterior vagal trunk going to the celiac ganglion. Plate 318 also shows the aorticorenal ganglion, the lesser thoracic splanchnic nerve, the superior mesenteric ganglion, the intermesenteric plexus, and the superior hypogastric plexus. Plates 322 and 323 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 209 and 318). Plates 209 and 318 show the thoracic sympathetic trunk passing into the abdomen. Plate 195 shows how the sympathetic trunk gets into the abdomen. Plate 318 follows the sympathetic trunk until it disappears behind the common iliac artery. Lumbar ganglia and lumbar splanchnic nerves are labeled in plate 318. Plates 319 and 310 organize the innervation of the stomach. Plates 322 and 323 organize the innervation of the large and small intestines. Plate 344 organizes the innervation of the kidneys.

Plate 264 shows the course of the abdominal aorta. Plate 264 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 249 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 249.

Plate 267 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 266.
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 263 shows the psoas major muscle. Plate 267 shows the left psoas major muscle fragmented so you can identify rami coomunicantes passing from the sympathetic trunk to the lumbar nerves. Plate 267 and 498 (bottom) label gray and white rami communicantes. Plate 160 reminds you that gray and white rami exist from T1-L2 vertebral levels and only gray rami communicantes exist at other vertebral levels. Plates 267, 497 and 480 show the lumbar plexus of nerves. In plate 267 you can identify the subcostal, iliohypogastric, and ilioinguinal nerves (all laying on quadratus lumborum). The genitofemoral nerve pierces psoas major (267). The lateral femoral cutaneous nerve emerges from in between psoas major and quadratus lumborum and travels on the iliacus muscle (267). The femoral nerve is deep to psoas major on the iliacus muscle (267). The obturator nerve is medial to psoas major as it heads for the obturator foramen (267). Clean the quadratus lumborum and iliacus muscles (263).

Plate 263 traces the course of the iliacus and psoas major muscles under the inguinal ligament. Plate 491 shows the insertion of the iliopsoas muscle. Plates 267 and 538 show the iliopsoas muscle being innervated by the femoral nerve. Plates 264 and 265 show the external iliac vessels passing beneath the inguinal ligament before they become the femoral vessels. The femoral ring is labeled in plate 546 and is shown to contain deep inguinal lymph nodes.