Requirements for completion Department of Anatomy

Subject: Anatomy 2
Year of study, Term: First, ST
Study programme: General Medicine
In order to successfully complete the subject and obtain credits, it is necessary to:
- Active participation in lectures (three absences without giving a reason are allowed).
- 100% active mandatory participation in practical lessons. If a student misses a practical lesson (maximum 3 times) due to
serious health or family reasons, his/her absence must be excused by the teacher and the compensation of the missing practical
lesson completed at the Department of Anatomy within ongoing practical lessons/seminars of other groups until the end of summer
term. Compensation is not allowed one week before the practical test.
- Theoretical and methodical mastery of practical tasks.
The student:
is required to pass all theoretical (written) and practical tests
must reach at least 60% i.e., 72 points from 120 points obtained by the sum of 3 theoretical tests
must reach at least 60% i.e., 36 points from 60 points obtained by the sum of 3 practical tests
is entitled to participate in retaken tests in the examination period of the ST from the curriculum of the entire semester under the
condition that: he/she has achieved min. 30% of 120 points i.e., 36 points obtained by the sum of 3 theoretical tests and at the same
time 30% of 60 points i.e., 18 points obtained by the sum of 3 practical tests.

Other conditions:
- student who does not justify his/her non-participation in writing tests in accordance with the established rules, does not achieve at
least 60% of the written and practical tests and does not succeed even in the retaken term, will automatically be graded X -
"unclassified".
- Continuous control tests are evaluated based on the number of points achieved (%) with evaluation according to the Study
Regulations of the UPJŠ in Košice, Faculty of Medicine, II. part, Art. 13, paragraph 4.
- Student who fulfilled conditions, is allowed to register for the final exam
- Final exam: evaluation according to the table attached "A to E"
- The final assessment takes into account the results of the interim assessment
Evaluation of the final exam:
100 – 93 /A/ excellent
92 – 85 /B/ very good
84 – 77 /C/ good
76 – 69 /D/ satisfactory
68 – 60 /E/ sufficient
59 and below /FX/ fail
 1

3
cranial
 Retroperitoneal
space

Faculty of Medicine, UPJŠ

Dept. of Anatomy
Ingrid Hodorová/Silvia Rybárová

Lecture N.1 - GM2 AY 2022/2023

 Borders and communications
- narrow space behind parietal peritoneum
- dorsally – posterior abdominal wall covered by transversalis
fascia, dorsal and lateral group of abdominal mm. + back mm.

Communications:
Cranial – with posterior mediastinum through lumbocostal trigone
(spreads of kidney inflammations to thoracic cavity)
Caudal – with subperitoneal space of lesser pelvis
 Content of retroperitoneal space
• Fat, soft tissue = „beds“ for organs

• Organs: kidneys, suprarenal glands, ureters, part of renal pelvis

• Other structures:
• Blood vessels
• abdominal aorta + branches
• inferior vena cava + branches
• portal vein
• Lymph nodes + vessels
• cisterna chyli + begining of thoracic duct
• lumbar lnn. (lymph nodes)
• Nerves
• Somatic: lumbar plexus
• Autonomic:
Sympathetic – sympathetic trunk
Parasympathetic
Autonomic nerve plexuses
 Kidneys – ren (nephros)
Description of organ
- Paired, bean shaped organ, 130-170 g
- between T12 – L3, renal hilum – L1
- the right kidney – 3 cm above iliac crest
(in half vertebra lowerthan the left one)
- the left kidney – 4 cm above iliac crest
- 12 x 6 x 3 cm
- surfaces - anterior, posterior
- medial margin (renal hilum, renal sinus, lips),
lateral margin
- superior extremity (end) - suprarenal gland,
inferior extremity
Coverings
- fibrose capsule
- adipose capsule (corpus adiposum perirenale)
- renal fascia (prerenal lamina et retrorenal
lamina) (ren migrans)

- pararenal adipose body (it is not typical covering, pararenal

absceses → spreading through diaphragm to pleura and thoracic
cavity)
 Syntopic relations of kidneys

adrenal glands
spleen
liver stomach

pancreas
duodenum
right colic
left colic flexure
flexure
jejunum
jejunum

Right kidney – anterior surface Left kidney – anterior surface

Left kidney - Right kidney –

posterior surface posterior surface
Suprarenal (adrenal) glands
- on superior end of kidney Th11
Right – triangular in shape, close to inferior v. cava,
in front is the liver
Left – semilunar in shape, 1 - 2 cm from abdominal aorta,
in front - pancreas
Cortex and medulla
Cortex – mineralocorticoids, glukocorticoids, androgens
Medulla – adrenalin (epinefrin) and noradrenalin
(norepinefrin) (sympathetic ganglion)
 Ureter
• 25-30 cm, S-shaped muscle tube, continuation of renal pelvis
(renal pelvis is located: 1/3 intrarenal and 2/3 extrarenal) – paired organ
• Left one is longer than the right one in 1 - 2 cm
• According to course it has 3 parts:
1. Abdominal part (13 – 15 cm)
2. Pelvic part (13 – 15 cm)
3. Intramural part (cca 1 cm)

Topografy – right ureter:

- Behind ureter are:
- genitofemoral n. (on psoas major), right external iliac vessels
- In front of ureter are:
- root of mesentery, right ovarian (testicular) a. + v., right colic a.,
uterine a., deference duct
- runs close to inf. v. cava, cranially touches inf. v. cava

Topografy – left ureter:

- Behind ureter are:
- genitofemoral n. (on psoas major), left common iliac vessels
- In front of ureter are:
- Left colic a., mesosigmoid, left ovarian (testicular) a. + v.
- Runs appr. 2 – 2,5 cm to the left of the abdominal aorta
- Between big vessels and ureters are located lumbar lnn.
 Abdominal aorta
Topografy:
T12 – L4 – bifurcation of aorta:
Right common iliac a.
Left common iliac a.
- Aortic hiatus
- Median sacral a.

In front of the aorta:

- pancreas (L2), horizontal part of
duodenum (L3), splenic v.,
left renal v., preaortal lnn.
- under the aortic hiatus
is located coeliac plexus, along
the entire aorta – aortic abdominal plexus
On the left side:
- left sympathetic trunk
(ganglia), lateroaortic lnn.
On the right side:
- inferior vena cava, interaortocaval lnn.
Behind the aorta:
- retroaortal lnn., left lumbar vv.
In front of bifurcation:
- superior hypogastric plexus
Branches of the abdominal aorta

Paired parietal:
1. inferior phrenic aa.→ superior suprarenal aa.
2. lumbar aa. (4 pairs)

Paired visceral:
1. middle suprarenal aa.
2. renal aa. → inferior suprarenal aa.
3. ovarian (testicular) aa.

Unpaired visceral:
1. coeliac trunk → left gastric a.,
splenic a.., common hepatic a.
2. superior mesenteric a.
→ inferior pancreaticoduodenal a.,
jejunal aa. + ileal aa., ileocolic a.,
right colic a., middle colic a.
3. inferior mesenteric a.
→ left colic a., sigmoid aa.,
superior rectal a.

Unpaired parietal:
1. median sacral a.
Unpaired visceral branches:
1. coeliac trunk → left gastric a., splenic a.., common hepatic a.
2. superior mesenteric a. → inferior pancreaticoduodenal a.,
jejunal aa. + ileal aa., ileocolic a., right colic a., middle colic a.
3. inferior mesenteric a. → left colic a., sigmoid aa.,
superior rectal a.
- Anastomosis magna (Halleri, Riolani)
Common iliac arteries
 Inferior vena cava
- junction of right and left common iliac veins
L4 –T8 (caval foramen)
- cranially is wider (from 2 cm to 3 cm)
- has no valves
- tributaries from all paired organs of abdominal
cavity, from liver, ovaries and testes,
from abdominal walls
(right ovarian/ testicular v. – directly,
left ones through left renal v.)
In front of inferior v. cava:
- precaval lnn.,
- under the diaphragm - head of pancreas,
horizontal part of duodenum,
root of mesentery
Behind inferior v. cava:
- retrocaval lnn., right sympathetic trunk + ganglia,
- all right parietal and visceral branches
of abdominal aorta except right ovarian/testicular a.
- it is in front of inferior v. cava
On the right side:
- laterocaval lnn.
 Tributaries of inferior vena cava

- Common iliac veins

- Median sacral v.

- Lumbar veins – ascending lumbar v.

- Renal veins

- Right ovarian / testicular vein

- Rright suprarenal veins

- Inferior phrenic veins

- Hepatic veins
 Cavo-caval anastomoses

Venous connections between inferior v. cava and

superior v. cava on periphery

- right and left lumbar vv. (1 - 4) = tributaries to inferior v. cava

- between 1st and 2nd = vertical connections → right and left
ascending lumbar v.
- 3rd and 4th → inferior v. cava
- right ascending lumbar v. + right subcostal v. = azygos v.
- left ascending lumbar v. + left subcostal v. = hemiazygos v.
- azygos v. + hemiazygos v. = tributaries to superior v. cava
- origin behind the head of pancreas – L2
Portal vein
- 1. superior mesenteric v.(+ all its tributaries + right gastroomental v., +
pancreatic vv. + superior pancreaticoduodenal vv.)
- + 2. splenic v. (+ all its tributaries)
- inferior mesenteric → v. splenic v. (+ all its tributaries)
- 6 – 7 cm in hepatoduodenal lig. → porta hepatis → liver
Next tributaries (branches):
- right and left gastric vv.
- cystic v.
- prepyloric v.
- paraumbilical vv.
 Porto-caval anastomoses
Venous connections between caval vv. (superior and inferior) with portal v. on periphery

1. gastric vv. (left and right) → portal v.

+ oesophageal vv. → azygos → superior v. cava

2. paraumbilical vv. + subcutaneous vv. of abdominal wall

3. rectal venous plexus

- between them - connections

 Lymph nodes and vessels in retroperitoneum
Lymph nodes – parietal (in retroperitoneum)
– visceral (close to organs)
Parietal = lumbar lnn. – 7 groups around aorta and inferior v. cava

Around aorta: preaortic lnn.

lateroaortic lnn. Left lumbar trunk
retroaortic lnn.

Around inf. v. cava: precaval lnn.

laterocaval lnn.
retrocaval lnn. Right lumbar trunk
interaortocaval lnn.
Visceral lnn. = from the organs

Instestinal trunk – receives the lymph from the organs

- coeliac lnn.
- superior mesenteric lnn.
- ileocolic lnn.
- colic lnn.
- inferior mesenteric lnn.

Cisterna chyli
Lumbar trunks (right + left) + intestinal trunk →
cisterna chyli (L1) → thoracic duct

Tributary area:
- LL, most abdominal wall, pelvic walls and organs
- direct tributaries from testes and ovaries,
from kidneys and suprarenal glands

- others through common iliac lnn. (external and internal

iliac lnn.)
- from efferent vessels of cranial nodes → right and left
lumbar trunks → cisterna chyli + intestinal trunk →
thoracic duct (Th12)

- anterior abdominal wall – inferior epigastric lnn.

along inferior epigastric vessels → external iliac lnn.
- diaphragm and upper surface of liver →
inferior phrenic lnn. → lumbar lnn.
sinister
 Innervation
Somatic innervation = lumbar plexus
Autonomic innervation = 2 parts - sympathetic and parasympathetic

Autonomic: A. sympathetic part

B. parasympathetic part

A. Sympathetic part (thoracolumbar system):

1. ganglia (clusters of bodies of neurons)

2 types according to localization:
- paraverebral - 4-5 pairs of lumbar ganglia (ggl)
(sympathetic trunk)
- prevertebral –
in front of branches of abdominal aorta, in abdominal cavity, only:
- coeliac ganglion (right, left)
- superior mesenteric ggl.
- aorticorenal ggl. (right, left)
- inferior mesenteric ggl.

2. Nerve fibers (projections of bodies of neurons)

- lumbar splanchnic nerves - 4 pairs
- 1st + 2nd → aortic abdominal plexus
- 3rd + 4th → superior hypogastric plexus
A. Parasympathetic part (craniosacral system):
1. ganglia (clusters of bodies of neurons)
2 types according to localization:
- on the head (4 pairs)
- intramural (microscopic, in the walls of organs)

2. nerve fibers (projections of bodies of neurons)

- vagus n. (X. cranial nerve)
- splanchnic pelvic nerves

Vagus n. – parasympathetically innervates

all organs of thoracic cavity, digestive tract
until left colic flexure, other organs od abdominal cavity
+ ovaries and testes
Splanchnic pelvic nerves –
innervate parasympathetically digestive tract
caudally to left colic flexure + all pelvic organs
(except ovaries and testes)
 Autonomic plexes in retroperitoneum and
abdominal cavity
All are mixed - sympathetic + parasympathetic fibers

• Aortic abdominal plexus

• Celiac plexus (pl.) →

gastric plexus (left)
hepatic pl.
splenic pl.
phrenic pl.
suprarenal pl.
renal pl.

• Superior mesenteric plexus –

along arteries to organs

• Inferior mesenteric plexus –

along arteries to organs

• Superior hypogastric plexus

• Inferior hypogastric plexus
 Function of ANS
• Organ Sympathetic Parasympathetic
Intestinal peristalsis decrease (slow down) increase (acceleration)
Secretion of intestinal decrease increase
glands
Sfincters contraction relaxation
Production of saliva decrease increase
Production of urine decrease increase
Genital organs vasoconstriction vasodilation
Adrenal gland production of NA no effect

Sympathetic and parasympathetic parts = adverse effect!

 Lumbar plexus – T12 - L4
• In psoas major m. –
Short nerve fibers for muscles:
psoas major, psoas minor,
quadratus lumborum,
intertransversarii
laterales lumborum mm.

• Main branches:

• Iliohypogastic n.
• Ilioinguinal n.
• Lateral femoral cutaneus n.
• Femoral n.
• Genitofemoral n.
• Obturator n.
Thank you for your attention