Term
| What vessels merge together to form the SVC |
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Definition
| The R and L Brachiochephalic vein |
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Term
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Definition
Unpaired vein Arises from the IVC and drains into SVC. Returns blood from the thorax and the abdomen. |
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Term
| Where is the Azygous arch |
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Definition
Found at the level of the 4th and 5th thoracic vertebra where the azygos slightly deviates to the right and back,curves around the posterior surface of the root of the lung and at the level of the body of the third thoracic vertebra turnes around. Having formed an arch with an upward convexity the vena azygos crosses the right bronchus and immmediately empties into the SVC. |
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Term
| What is the cardiac skeleton? |
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Definition
collection of dense, fibrous connective tissue (anulus fibrosus) in the form of four rings with interconnecting areas in a plane between the atria and the ventricles that surround two atrioventricular orifices, the aortic orifice and opening of the pulmonary trunks |
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Term
| What are the interconnected areas of the cardiac skeleton? |
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Definition
- right fibrous trigone, which is a thickened area of connective tissue between the aortic ring and right atrioventricular ring;
- left fibrous trigone, which is a thickened area of connective tissue between the aortic ring and the left atrioventricular ring
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Term
| What is the purpose of the Cardiac Skeleton? |
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Definition
- maintain the integrity of the openings it surrounds provides points of attachment for the cusps
- separates the atrial musculature from the ventricular musculature
- serves as a dense connective tissue partition that electrically isolates the atria from the ventricles (The atrioventricular bundle, which passes through the anulus, is the single connection between these two groups of myocardium)
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Term
| Where does the artial and ventricular Myocardium originate from? |
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Definition
- atrial myocardium originates from the upper border of the rings of the cardiac Skeleton.
- ventricular myocardium originates from the lower border of the ringof the cardiac Skeleton
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Term
| How many coronary arteries are there and when do they have their maximum blood flow? |
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Definition
- Arise from the ascending aorta and are filled with blood during the ventricular diastole.
- Have maximal blood flow during diastole and minimal blood flow during systole because of compression of the arterial branches in the myocardium during systole.
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Term
| What is the Path of the Right Coronary Artery? |
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Definition
| anterior (right) aortic sinus of the ascending aorta ----> runs between the root of the pulmonary trunk and the right auricle ---> runs between the right auricle and the pulmonary trunk ----> descends in the right coronary sulcus ----> supplies the right atrium and ventricle |
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Term
| What are the branches of the R coronary art. |
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Definition
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Term
| What areas are supplied by the R. Coronary Art? |
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Definition
- right atrium and right ventricle
- sinu-atrial and atrioventricular nodes
- interatrial septum
- a portion of the left atrium
- the posteroinferior one-third of the interventricular septum
- portion of the posterior part of the left ventricle
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Term
Where does the L. Coronary artery originate. Describe its Path? What are its Branches? |
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Definition
- left aortic sinus of the ascending aorta,just above the aortic semilunar valve
- It passes between the pulmonary trunk and the left auricle before entering the coronary sulcus. While still posterior to the pulmonary trunk, the artery divides into its two terminal branches, the anterior interventricular and the circumflex
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Term
| Describe the branches of the L. Coronary Art.? |
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Definition
- Anterior IV (left anterior descending) artery
- Continues around the left side of the pulmonary trunk and descends obliquely toward the apex of the heart in the anterior interventricular sulcus Generally supplies anterior aspects of the right and left ventricles and is the chief source of blood to the IV septum and the apex.
- Circumflex artery
- Runs in the coronary sulcus, gives off the left marginal artery, supplies the left atrium and left ventricle, and anastomoses with the terminal branch of the right coronary artery.
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Term
| What does the L Coronary Art supply? |
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Definition
| most of the left atrium and left ventricle, and most of the interventricular septum, including the atrioventricular bundle and its branches |
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Term
| What are the variations in the distribution Patterns of the Coronary arteries? |
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Definition
These occur due to competing dominence of the R and L Coronary aretery and includes: - Right dominant coronary artery:Posterior interventricular branch arises from the right coronary artery. The right coronary artery therefore supplies a large portion of the posterior wall of the left ventricle and the circumflex branch of the left coronary artery is relatively small.
- Left dominant coronary artery:Posterior interventricular branch arises from an enlarged circumflex branch and supplies most of the posterior wall of the left ventricle
- SA and AV nodes:these two structures are supplied by the right coronary artery. However, vessels from the circumflex branch of the left coronary artery occasionally supply these structures
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Term
| How many cardiac veins are there and list them? |
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Definition
4 coronary sinus receives four major tributaries: the great, middle, small, and posterior cardiac veins Note that there are also twio additional group of veins: - anterior veins of right ventricle (anterior cardiac veins)
- venae cordis minimae or veins of Thebesius
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Term
| Describe the path of Great Cardiac Vein? |
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Definition
Begins at the apex of the heart---> ascends along with the IV branch of the left coronary artery--->Turns to the left to lie in the coronary sulcus--->Continues onto the base/diaphragmatic surface of the heart--->Associates with the circumflex branch of the left coronary artery--->Moves along its path in the coronary sulcus--->Enlarges to form the coronary sinus ----->Enters the right atrium |
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Term
| Describe the Path of the Middle Cardiac Vein (posterior interventricular vein)? |
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Definition
Begins at the apex of the heart--->ascends in the posterior IV groove,accompanying the posterior IV branch of the right coronary artery----->Drains into the right end of the coronary sinus |
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Term
Describe the path of the Small Cradiac Vein?
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Definition
Begins in the lower anterior section of the coronary sulcus between the right atrium and right ventricle--->Continues in this groove onto the base/diaphragmatic surface of the heart where it enters the coronary sinus at its atrial end. It is a companion of the right coronary artery throughout its course and may receive the right marginal vein. Note:If the right marginal vein does not join the small cardiac vein, it enters the right atrium directly |
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Term
| Describe the path of the Posterior cardiac vein? |
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Definition
- lies on the posterior surface of the left ventricle just to the left of the middle cardiac vein
- either enters the coronary sinus directly or joins the great cardiac vein
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Term
| Describe the path of venae cordis minimae or veins of Thebesius |
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Definition
- Group of smallest cardiac veins
- Begin in the wall of the heart and empty directly into its chambers
- Numerous in the right atrium and right ventricle, are occasionally associated with the left atrium, and are rarely associated with the left ventricle
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Term
| Describe the path of anterior veins of right ventricle (anterior cardiac veins) |
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Definition
| Drains the anterior right ventricle, crosses the coronary groove, and ends directly in the right atrium |
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Term
| Describe the Coronary sinus? |
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Definition
- Is the largest vein draining the heart and lies in the coronary sulcus, which separates the atria from the ventricles.
- Opens into the right atrium between the opening of the IVC and the AV opening
- Has a one-cusp valve at the right margin of its aperture.
- Receives the great, middle, and small cardiac veins; the oblique vein of the left atrium; and the posterior vein of the left ventricle.
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Term
| What does the Coronary Lyphatics drain into? |
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Definition
Lymphatic vessels of the heart follow the coronary arteries and drain mainly into - brachiocephalic nodes, anterior to the brachiocephalic veins; and
- tracheobronchial nodes, at the inferior end of the trachea
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Term
| What are the 4 basic components of the Cardiac conduction system? |
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Definition
- the sinu-atrial node;
- the atrioventricular node;
- the atrioventricular bundle with its right and left bundle branches;
- the subendocardial plexus of conduction cells (the Purkinje fibers).
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Term
Where is the SA node found? Where is the AV node found? |
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Definition
- Superior end of the crista terminalis at the junction of the superior vena cava and the right atrium
- located near the opening of the coronary sinus, close to the attachment of the septal cusp of the tricuspid valve, and within the atrioventricular septum
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Term
Where is the AV bundle found? Describe it? |
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Definition
| Follows along lower border of interventricular septum splits into: - Right bundle branch right side of interventricular septum to apex of right ventricle, enters septomarginal trabecula to base of anterior papillary muscle, divides and is continuous with Purkinje fibres, spreads through ventricle to supply ventricular musculature - Left bundle branch from left side of muscular interventricular septum, descends to left ventricle apex, branches and is continuous with Purkinje fibers |
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Term
| Describe the Pulmonary Trunk? |
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Definition
Arises from the conus arteriosus of the right ventricle, passes obliquely upward and backward across the origin and on the left side of the ascending aorta within the fibrous pericardium, and bifurcates into the right and left pulmonary arteries in the concavity of the aortic arch. |
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Term
| What is the Origin of the ascending Aorta? |
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Definition
- Takes its origin from the left ventricle within the pericardial sac which is level with the lower edge of the third left costal cartilage, posterior to the left half of the sternum and ascends behind the sternum to end at the level of the sternal angle.
- Lies in the middle mediastinum, has three aortic sinuses located immediately above the cusps of the aortic valve, and gives off the right and left coronary artery.
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Term
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Definition
- INFERIOR HALF LOCATED IN THE pericardial sac
- Passes through the fibrous pericardium at the level of the 2nd costal carilage and enters the right atrium at the level of the 3rd costal cartilage.
- Portion in pericardial sac covered with serous pericardium.
- Is formed by the union of the right and left brachiocephalic veins and returns blood from all structures superior to the diaphragm, except the lungs and heart.
- Descends on the right side of the ascending aorta, receives the azygos vein, and enters the right atrium. Its upper half is in the superior mediastinum, and its lower half is in the middle mediastinum.
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Term
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Definition
| Pierces fibrous pericardium at level of T8 after enetring from the diaphram. Within the pericardial sac, it is covered by serous pericardium except for a small portion of its posterior surface |
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Term
| List the structures contained in the superior mediastinu? |
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Definition
- thymus,right and left brachiocephalic veins,
- left superior intercostal vein,
- superior vena cava,
- arch of the aorta with its three large branches,
- trachea,esophagus,
- phrenic nerves,vagus nerves,
- left recurrent laryngeal branch of the left vagus nerve,
- thoracic duct, and
- other small nerves, blood vessels, and lymphatics
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Term
What structure is the most anterior in the superior mediastinum and describe it. What are its venous,arterial and lymphatic connections? |
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Definition
Thymus 1.Immediately posterior to the manubrium. 2. It is an asymmetric, bilobed structure 3. Can reach into the neck as high as the thyroid gland 4. Lower portion typically extends into the anterior mediastinum over the pericardial sac 5. Involved in the early development of the immune system- large in child,atrophy after puberty, and barely identifiable as an organ in elderly. 6. Arteries -small branches originating from the internal thoracic arteries 7. Venous drainage- left brachiocephalic vein and possibly into the internal thoracic veins 8. Lymphatic drainage-internal thoracic arteries (parasternal);tracheal bifurcation (tracheobronchial);in the root of the neck |
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Term
| Right and left brachiocephalic veins |
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Definition
1.Located immediately posterior to the thymus. 2.Form on each side at the junction between the internal jugular and subclavian veins 3.Right brachiocephalic vein begins posterior to the medial end of the right clavicle and passes vertically downward, forming the superior vena cava when it is joined by the left brachiocephalic vein. Venous tributaries include the vertebral, first posterior intercostal, and internal thoracic veins. The inferior thyroid and thymic veins may also drain into it. 4.Left brachiocephalic vein begins posterior to the medial end of the left clavicle. It crosses to the right, moving in a slightly inferior direction, and joins with the right brachiocephalic vein to form the superior vena cava posterior to the lower edge of the right first costal cartilage close to the right sternal border.Venous tributaries include the vertebral, first posterior intercostal vain, left superior intercostal, inferior thyroid, and internal thoracic veins. It may also receive thymic and pericardial veins
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Term
| Left superior intercostal vein | |
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Definition
| - receives 2nd, 3rd and 4th posterior intercostals veins, the left bronchial veins and the left pericardiacophrenic vein - passes over left side of aortic arch, lateral to left vagus nerve, medial to left phrenic nerve, enters left brachiocephalic vein - inferiorly can connect with accessory hemiazygos vein (superior hemiazygous vein) |
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Term
SVC Origin? Location? Connections? |
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Definition
ORIGIN: Vertically oriented superior vena cava begins posterior to the lower edge of the right first costal cartilage, where the right and left brachiocephalic veins join LOCATION: Terminates at the lower edge of the right third costal cartilage, where it joins the right atrium.Lower half of the superior vena cava is within the pericardial sac and is therefore contained in the middle mediastinum CONNECTION: Receives the azygos vein immediately before entering the pericardial sac and may also receive pericardial and mediastinal veins
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Term
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Definition
- Divided into ascending aorta,arch of aorta,descending aorta by the horizontal plane that joins the sternal angle to the IV disc of T4/T5.
- Only the arch of the aorta is in the superior mediastinum
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Term
| Brachiocephalic trunk ORIGIN? PATH? |
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Definition
-- first branch of arch of aorta and largest of the three ORIGIN: behind manubrium of sternum, anterior to the other branches PATH:ascends poserterior and to right, at level of right sternoclavicular join it divides into: i) right common carotid artery which supplies the right side of head and neck and ii) right subclavian artery which supplies the upper right limb.Sometimes the trunk has a small branch, the thyroid ima artery, contributes to vascular supply of thyroid gland |
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Term
left common carotid artery Origin? Path? WHAT IT SUPPLIES |
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Definition
| ORIGIN: second branch of arch of aorta PATH:arises from arch to left and posterior of brachiocephalic trunk,ascends through superior mediastinum along left side of trachea SUPPLIES: left side of head and neck |
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Term
| Left subclavian artery ORIGIN? PATH? SUPPLIES? |
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Definition
| ORIGIN: third branch of arch of the aorta PATH: left of and posterior to left common carotid artery, ascends through superior mediastinum along left side of trachea SUPPLIES: major blood supply to left upper limb |
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Term
| What crosses the Trachea and the Oesphagus |
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Definition
| Tthey are crossed laterally by the azygos vein on the right side and the arch of aorta on the left side |
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Term
| Describe the path of the R vagus N. ? |
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Definition
- Enters the superior mediastinum and lies between the right brachiocephalic vein and the brachiocephalic trunk---> descends in a posterior direction toward the trachea---> crosses the lateral surface of the trachea --->passes posteriorly to the root of the right lung to reach the esophagus.
- Just before the esophagus, it is crossed by the arch of the azygos vein.
- As it passes through the superior mediastinum, it gives branches to the esophagus, cardiac plexus, and pulmonary plexus
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Term
Describe the path of the L Vagus N.? ENTRANCE INTO MEDIASTINUM? BRANCHES ? |
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Definition
ENTRANCE:Enters the thorax between the left common carotid and subclavian arteries and behind the left brachiocephalic vein and descends on the arch of the aorta. BRANCHES:Left recurrent laryngeal nerve, which hooks around the arch of the aorta to the left of the ligamentum arteriosum. It ascends through the superior mediastinum and the neck in a groove between the trachea and esophagus.Gives off the thoracic cardiac branches, breaks up into the pulmonary plexuses, continues into the esophageal plexus, and then forms the anterior vagal trunk |
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Term
Phrenic Nerves? ORIGIN? INNERVATIONS? |
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Definition
ORIGIN:cervical region mainly from the 4th, but also from the 3rd and 5th cervical spinal cord segments INNERVATIONS:Descend through the thorax to supply motor and sensory innervation to the diaphragm and its associated membranes. As they pass through the thorax, they provide innervation through somatic afferent fibers to the mediastinal pleura, fibrous pericardium, and parietal layer of serous pericardium. |
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Term
Right Phrenic Nerves ENTRANCE? PATH? INNERVATION? |
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Definition
ENTRANCE:Enters the superior mediastinum lateral to the right vagus nerve and lateral and slightly posterior to the beginning of the right brachiocephalic vein. PATH:Moves inferiorly along the right side of the Brachiocephalic vein and the right side of the superior vena cava---->in the middle mediastinum, the right phrenic nerve descends along the right side of the pericardial sac (in fibrous pericardium), anterior to the root of the right lung---> leaves the thorax by passing through the diaphragm with the IVC |
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Term
Left Phrenic Nerves ENTRANCE? PATH? |
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Definition
ENTRANCE:In the superior mediastinum it lies lateral to the left vagus nerve and lateral and slightly posterior to the beginning of the left brachiocephalic vein PATH:In the posterior mediastium it descends across the left lateral surface of the arch of aorta, passing superficially to the left vagus nerve and the left superior intercostal vein.In middle mediastium the left phrenic nerve follows the left side of the pericardial sac, within the fibrous pericardium, anterior to the root of the left lung, and is accompanied by the pericardiacophrenic vessels. It leaves the thorax by piercing the diaphragm near the apex of the heart. |
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Term
| Describe the path of the Thoracic duct in the Superior Mediastium |
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Definition
- Passes through the posterior portion of the superior mediastinum
- Enters the superior mediastinum inferiorly, slightly to the left of the midline, having moved to this position just before leaving the posterior mediastinum opposite vertebral level TIV/V
- Continues through the superior mediastinum, posterior to the arch of aorta, and the initial portion of the left subclavian artery, between the esophagus and the left mediastinal part of the parietal pleura
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Term
| What are the Boarders of the Posterior mediastium? |
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Definition
- Superior -a transverse plane passing from the sternal angle to the intervertebral disc between vertebra TIV-V;
- Inferior - diaphragm;
- Laterally- mediastinal part of parietal pleura on either side;
- Superiorly-continuous with the superior mediastinum
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Term
| List the structures found in the Posterior mediastium? |
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Definition
- esophagus and its associated nerve plexus,
- thoracic aorta and its branches,
- azygos system of veins,
- thoracic duct and associated lymph nodes,
- sympathetic trunks, and
- thoracic splanchnic nerves
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Term
Where does the oesphagus begin and end? Describe its path through the Mediastium? |
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Definition
It begins at the inferior border of the cricoid cartilage, opposite vertebra CVI, and ends at the cardiac opening of the stomach, opposite vertebra TXI. Descends on the anterior aspect of the bodies of the vertebrae, generally in a midline position as it moves through the thorax. As it approaches the diaphragm, it moves anteriorly and to the left, crossing from the right side of the thoracic aorta to eventually assume a position anterior to it. It then passes through the esophageal hiatus, an opening in the muscular part of the diaphragm, at vertebral level TX.
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Term
| Describe the oesphagus's relationship with othe structures? |
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Definition
- Right side is covered by the mediastinal part of the parietal pleura
- Left side of the esophagus is the thoracic aorta
- Posterior to the esophagus, the thoracic duct is on the right side inferiorly, but crosses to the left more superiorly
- Anterior to the esophagus, below the level of the tracheal bifurcation, are the right pulmonary artery and the left main bronchus
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Term
| What are the constrictions of the oesphagus? |
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Definition
Has 4 constrictions: - one at the level of the sixth cervical vertebra, where it begins;
- one at the crossing of the left main stem bronchus
- one at the tenth thoracic vertebra, where it pierces the diaphragm
- one where the esophagus is crossed by the arch of aorta
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Term
| Describe the Arterial,Venous and Lymphatic drainage of the esophagus. |
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Definition
- Arterial:Receives blood from three branches of the aorta (the inferior thyroid, bronchial, and esophageal arteries) and from the left gastric and inferior phrenic arteries
- Venous: Involves small vessels returning to the azygos vein, hemiazygos vein, and esophageal branches to the left gastric vein in the abdomen.
- Lymphatic: In the posterior mediastinum returns to posterior mediastinal and left gastric nodes
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Term
| Describe the Innervation of the Oesphagus? |
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Definition
1.Esophageal branches arise from the vagus nerves and sympathetic trunks
2.Striated muscle fibers in the superior portion of the esophagus originate from the branchial arches and are innervated by branchial efferents from the vagus N.
3.Smooth muscle fibers are innervated by components of the parasymp pt of the autonomic division of the PNS, visceral efferents from the vagus nerves. These are preganglionic fibers that synapse in the myenteric and submucosal plexuses of the enteric nervous system in the esophageal
3.Sensory innervation of the esophagus involves visceral afferent fibers originating in the vagus nerves, sympathetic trunks, and splanchnic nerve
5.Visceral afferents from the vagus nerves are involved in relaying information back to the central nervous system about normal physiologic processes and reflex activities. They are not involved in the relay of pain 6.Visceral afferents that pass through the sympathetic trunks and the splanchnic nerves are the primary participants in detection of esophageal pain and transmission of this information to various levels of the central nervous system |
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Term
| Describe the oesophageal plexus? |
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Definition
- After passing posteriorly to the root of the lungs, the right and left vagus nerves approach the esophagus and divides into esophageal plexus (mixture of fibers), just above the diaphragm, the fibers converge to 2 trunks, which extend into abdomen:
- Anterior vagal trunk: mainly from fibers originally in the left vagus nerve
- Posterior vagal trunk: mainly from fibers originally in the right vagus nerve
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Term
| Where is the thoracic aorta found and describe its path? |
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Definition
- Begins at the lower edge of vertebra TIV, where it is continuous with the arch of aorta and ends anterior to the lower edge of vertebrae TXII, where it passes through the aortic hiatus posterior to the diaphragm
- Situated to the left of the vertebral column superiorly, it approaches the midline inferiorly, lying directly anterior to the lower thoracic vertebral bodies
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Term
| What are the branches of the thoracic aorta? |
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Definition
- Pericardial branches
- Bronchial branches (1 Right and 2 left)
- Esophageal branches
- Mediastinal branches
- Posterior intercostal arteries (9 pairs)
- Superior phrenic arteries
- Subcostal artery (1 pair)
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Term
| What is the function of the Azygos system of veins and what does it consist of? |
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Definition
Function: drain blood from the body wall & move it superiorly to empty into the superior vena cava. Serves as anastomotic pathway, can return venous blood from the lower part of the body to the heart if inferior vena cava is blocked Constituents: - the azygos vein, on the right; and
- the hemiazygos vein and the accessory hemiazygos vein, on the left
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Term
Azygos vein Origin? Tributaries? Path? |
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Definition
- Is formed by the union of the right ascending lumbar and right subcostal veins opposite vertebra LI or LII. Its lower end is connected to the IVC.
- Enters the thorax through the aortic opening of the diaphragm.
- Receives the right superior intercostal vein (a single vessel formed by the junction of the second, third, and fourth intercostal veins),fifth to eleventh right posterior intercostal veins,the hemiazygos vein,the accessory hemiazygos vein,esophageal veins,mediastinal veins,pericardial veins, and right bronchial veins
- Arches over the root of the right lung at TIV and empties into the SVC, of which it is the first tributary
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Term
Accessory hemiazygos vein Origin Path Tributaries? | |
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Definition
| Begins at the 4th or 5th intercostal space; descends, receiving the 4th or 5th to 8th intercostal veins; turns to the right; passes behind the aorta; and terminates in the azygos vein |
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Term
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Definition
- Begins in the abdomen at the cisterna chyli, which is the dilated junction of the intestinal, lumbar, and descending intercostal trunks.Is usually beaded because of its numerous valves and may often be double or even triple.
- Drains the lower limbs, pelvis, abdomen, left thorax, left upper limb, and left side of the head and neck.
- Passes through the aortic opening of the diaphragm and ascends through the posterior mediastinum between the aorta and the azygos vein.
- After being joined, in most cases, by the left jugular trunk, which drains the left side of the head and neck, and the left subclavian trunk, which drains the left upper limb, the thoracic duct empties into the junction of the left subclavian and left internal jugular veins
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Term
| Where does the thoracic duct recieve its contents from? |
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Definition
- the confluence of lymph trunks in the abdomen;
- descending thoracic lymph trunks draining the lower six or seven intercostal spaces on both sides;
- upper intercostal lymph trunks draining the upper left five or six intercostal spaces;
- ducts from posterior mediastinal nodes;
- ducts from posterior diaphragmatic nodes
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Term
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Definition
- important component of the sympathetic part of the autonomic division of the PNS
- consists of two parallel cords punctuated by 11 or 12 ganglia -- connected to adjacent thoracic spinal nerves by white and gray rami communicantes
- trunks are covered by parietal pleura
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Term
| What are the branches of the ganglia of the sympathetic trunk of the Thorax? |
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Definition
Two types of medial branches are given off by the ganglia: - the first type includes branches from the upper five ganglia which are Small, consist mainly of postganglionic sympathetic fibers -- supply the various thoracic viscera, also contain visceral afferent fibers.
- the second type includes branches from the lower seven and are large, consists mainly of preganglionic sympathetic fibers --- supply the various abdominal and pelvic viscera. also carry visceral afferent fibers
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Term
| What are Thoracic Splanchic Nerves ? |
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Definition
Contain sympathetic preganglionic GVE fibers with cell bodies located in the lateral horn (intermediolateral cell column) of the spinal cord and GVA fibers with cell bodies located in the dorsal root ganglia |
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Term
| How many Thoracic splanchnic nerves are there and describe them. |
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Definition
- 3
Greater splanchnic nerve -Arises usually from the 5th through 9th thoracic sympathetic ganglia, perforates the crus of the diaphragm or occasionally passes through the aortic hiatus, and ends in the celiac ganglion.
Lesser splanchnic nerve Is derived usually from the 9th and 10th or 10th and 11th thoracic ganglia, pierces the crus of the diaphragm, and ends in the aorticorenal ganglion. Least splanchnic nerve Is derived usually from the 12th thoracic ganglion, pierces the crus of the diaphragm, and ends in the ganglia of the renal plexus.
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