Paraortic lymph nodes and areas of drainge

2 chains of lymph nodes on both sides of abdominal aorta.

They drain the organs supplied by paired arteries.

They drain: The deep layers of the abdominal wall, while the
superficial layers drained axillary and superficial inguinal lymph
nodes.

kidneys, abdominal part of ureters, uterine tube, upper uterus and
gonads ( direct drainage).

Ovaries or testes.

They receive also from pelvic lymph nodes (common, internal,
external iliac and sacral).

Their efferent form the right and left lumbar lymph trunks that open at
cisterna chyli.
 Definition:
Umbilicus
It is a depressed scar in the skin of anterior abdominal wall and in the
linea alba resulted by separation of umbilical cord stump after birth.
 Site :
It is found in the median plane at the level of the disc between
3rd and 4th lumber vertebra in young adults, but it is lower in
infants and it’s level change according to age and tone of
abdominal muscles.
 Importance :
1- The umbilicus is one of the famous sites for hernia.
2- The umbilicus is normally inverted but if it becomes everted,
it is diagnosed for adult para-umbilical hernia.
3- Embryologically, the umbilicus is the site of meeting three
systems: digestive (vitello-intestinal duct), urinary (urachus),
vascular (umbilical vessels).
4- Clinically, the umbilicus is the site of congenital anomalis :
vitelline duct anomalies like fistula.
5- It is the site of attachment of umbilical cord during fetal life.
6- T10 segment of spinal cord supply both appendix and
umbilicus. So appendicitis may lead to referred pain in the
umbilicus.
7- Posterior surface gives attachment to :
a) Median umbilical ligament (obliterated urachus).
b) Apex of falciform ligament.
c) Ligamentum teres of the liver (obliterated umbilical vein).
d) Right and left lateral umbilical ligaments (obliterated distal
parts of umbilical arteries).
Position, peritoneal covering, relations, blood supply,
stability and congenital anomalis of kidneys.
 Site:
 It is a retroperitoneal organ loies on the posterior abdominal
wall opposite 12th thoracic and upper 3 lumber vertebrae.
 The right kiney is 1/2 inch lower than the left kidney.
 The left kidney reaches up to 11th rib while the right kidney
reaches only to 11th space.
The hilum of the kidney:
 It is directed medially at the level of L1 vertebrae.
 It lies in the transpyloric plane two inches from the middle
line. The transpyloric plane passes through the lower part of
left hilum and the upper part of right hilum.
 It contains renal vein (anterior), renal artery (middle) and
pelvis of ureter (posterior) . (VAP).
 Relations:
1- Posterior relations:
Both kidneys the same: ( 4 muscles of posterior abdominal wall
with neurovascular structures in between.
1) Diaphragm and it’s medial and lateral arcuate ligaments
2) Psoas major.
3) Transversus abdominis.
4) Quadratus lumborum.
The 4 neurovascular structures intervening between the kidney
and the latter 2 muscles:
1) Subcostal vessels.
2) Subcostal nerve
3) Ilio-hypogastric nerve
4) Ilio-inguinal nerve.
2- Anterior relations: differ in both sides
Right kidney
1) right suprarenal gland
2) Second part of the duodenum
3) Right lobe of liver
4) Right colic flexure
5) Ascending branch of right
Colic artery
6) Loops f jejunum
 Peritoneal relations:
Left kidney
1) left suprarenal
2)Stomach
3)Spleen
4)End of transverse
colon and beginning
of descending colon
5) Ascending branch
of superior left colic
artery
6)Loops of Jejunum
7)Body of pancreas and
Splenic vessels.
 Right kidney: the anterior surface is covered by peritoneum
at the hepatic and jejunal areas.
The areas for the right suprarenal , duodenum and right colic
flexure are not covered by peritoneum and these viscera in direct
contact with kidney.
 Left kidney: the anterior surface is covered by peritoneum at
the splenic, stomach and jejunal areas.
The areas for the left suprarenal, pancreas and descending colon
are not covered by peritoneum and these viscera in direct
contact with kidney.
 Arterial supply:
1) Renal artery:
 It arises from the side of aorta opposite the upper border of
2nd lumber vertebra.
 It runs laterally to enter the hilum of the kidney
 The right artery is longer than the left artery as aorta aorta
lies more to the left side.
2) Accessory renal artery:
 It may be found in 30% of cases. It arises from the aorta just
above or below the renal artery.
 It commonly enters the upper or lower poles of the kidney.
 Venous drainage:
 Renal veins which run in front of renal arteries to open into
inferior vena cava.
 The left vein is longer than the right one as IVC lies more to
the right side.
 Stability of kidneys:
1) Its position in paravertebral gutter
2) Coverings of kidneys ( true fibrous capsule- perirenal fatrenal fascia (Zukercandle fascia)- Pararenal fat).
3) intra-abdominal pressure
4) Apposition of neighbouring viscera
 Congenital anomalies:
1) congenital polycystic kidney
2) Pelvic kidney
3) Horse-shoe kidney
4) Renal agenesis
5) Wilms’ tumor
6) Bifid ureter - Ectopic ureter