Lymphatic drainage of the ureters follows a pattern similar to that of the arterial supply. Lymph from: the upper part of each ureter drains to the lateral aortic (lumbar) nodes, the middle part of each ureter drains to lymph nodes associated with the common iliac vessels, and the inferior part of each ureter drains to lymph nodes associated with the external and internal iliac vessels.
Ureteric innervation is from the renal, aortic, superior hypogastric, and inferior hypogastric plexuses through nerves that follow the blood vessels.
Visceral efferent fibers come from both sympathetic and parasympathetic sources, whereas visceral afferent fibers return to T11 to L2 spinal cord levels. Ureteric pain, which is usually related to distention of the ureter, is therefore referred to cutaneous areas supplied by T11 to L2 spinal cord levels. These areas would most likely include the posterior and lateral abdominal wall below the ribs and above the iliac crest, the pubic region, the scrotum in males, the labia majora in females, and the proximal anterior aspect of the thigh.
The suprarenal glands are associated with the superior pole of each kidney (Fig. 4.163). They consist of an outer cortex and an inner medulla. The right gland is shaped like a pyramid, whereas the left gland is semilunar in shape and the larger of the two.
Anterior to the right suprarenal gland is part of the right lobe of the liver and the inferior vena cava, whereas anterior to the left suprarenal gland is part of the stomach, pancreas, and, on occasion, the spleen. Parts of the diaphragm are posterior to both glands.
The suprarenal glands are surrounded by the perinephric fat and enclosed in the renal fascia, though a thin septum separates each gland from its associated kidney.
The arterial supply to the suprarenal glands is extensive and arises from three primary sources (Fig. 4.163):
As the bilateral inferior phrenic arteries pass upward from the abdominal aorta to the diaphragm, they give off multiple branches (superior suprarenal arteries) to the suprarenal glands.
A middle branch (middle suprarenal artery) to the suprarenal glands usually arises directly from the abdominal aorta.
Inferior branches (inferior suprarenal arteries) from the renal arteries pass upward to the suprarenal glands.
In contrast to this multiple arterial supply is the venous drainage, which usually consists of a single vein leaving the hilum of each gland. On the right side, the right suprarenal vein is short and almost immediately enters the inferior vena cava, while on the left side, the left suprarenal vein passes inferiorly to enter the left renal vein.
The suprarenal gland is mainly innervated by preganglionic sympathetic fibers from spinal levels T8-L1 that pass through both the sympathetic trunk and the prevertebral plexus without synapsing. These preganglionic fibers directly innervate cells of the adrenal medulla.
The abdominal aorta begins at the aortic hiatus of the diaphragm as a midline structure at approximately the lower level of vertebra TXII (Fig. 4.164). It passes downward on the anterior surface of the bodies of vertebrae LI to LIV, ending just to the left of midline at the lower level of vertebra LIV. At this point, it divides into the right and left common iliac arteries. This bifurcation can be visualized on the anterior abdominal wall as a point approximately 2.5 cm below the umbilicus or even with a line extending between the highest points of the iliac crest.
As the abdominal aorta passes through the posterior abdominal region, the prevertebral plexus of nerves and ganglia covers its anterior surface. It is also related to numerous other structures: