c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Left-Sided Abdominal Relationships: 4

A D V E R T I S E M E N T

   
 

The abdominal aorta lies to the left of midline along the ridge of lumbar vertebrae. This anterior location, just centimeters from the anterior abdominal wall in thin individuals, makes it vulnerable to anterior penetrating injury, such as from a laparoscopic trochar. The celiac trunk lies at the upper border of the first lumbar vertebra, just below the arcuate ligament. The superior mesenteric artery (SMA) originates at the lower border of the first lumbar vertebral body. The left renal vein crosses the aorta in the angle formed by the SMA. The third portion of the duodenum also crosses beneath the SMA. The inferior mesenteric artery (IMA) arises about the level of the L3-L4 disk. The lower border of the third portion of the duodenum lies just above the IMA.    

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Left-Sided Abdominal Relationships: 5

A D V E R T I S E M E N T

   
 

The kidneys (see renal anatomy) lie alongside the upper lumbar vertebrae, with the lower poles angled lateral and anteriorly by the slope of the underlying psoas muscles. The kidneys are cushioned by perinephric fat within the anterior and posterior layers of Gerota's fascia. The renal arteries lie posterior to the renal veins. The left renal vein receives the left gonadal vein and the left adrenal adrenal vein (see adrenal anatomy). The ureters, the most posterior of the renal hilar structures, lie along the anterior borders of the psoas muscles before crossing the common common iliac bifurcations. The major retroperitoneal lymphatic channels are bounded by the ureters on each side (see extraperitoneal lymph node dissection).    

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Left-Sided Abdominal Relationships: 6

A D V E R T I S E M E N T

   
 

The left adrenal gland is crescent shaped, and lies in the groove between the upper pole of the left kidney and the root of the diaphragm. It lies beneath the upper border of the tail of the pancreas, and adjacent to the aortic hiatus.       

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This page was last modified on 4/30/2002.