Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Latest Kidney Ureter and Suprarenal Gland Lecture PPT
OBJECTIVES
-Anatomical features of the kidneys:
position, extent, relations, hilum, peritoneal
coverings.
-Internal structure of the kidneys:
Cortex, medulla and renal sinus.
-The vascular segments of the kidneys.
-The blood supply and lymphatics of the kidneys.
POSITION OF KIDNEY
Kidneys are retroperitoneal paired
organs.
? Each kidney lies , on the posterior
abdominal wall, lateral to the
vertebral column
? In the supine position, the kidneys
extend from approximately T12 toL3.
? The right kidney is slightly lower
than the left kidney because of the
large size of the right lobe of the liver.
? With contraction of the diaphragm
during respiration, both kidneys
move downward in a vertical
direction (high of one vertebra, 1
inch,2.5 cm).
COLOUR, SHAPE & DIMENSIONS
? The kidney is a reddish brown, bean-sh
aped organ with the dimensions 12 x 6 x
3cm.
? Although they are similar in size and
shape, the left kidney is slightly longer
and more slender than the right kidney,
and nearer to the midline.
? Each kidneys has:Convex upper & lower
ends.
Convex lateral border &Convex medial
border at both ends, but its middle shows
a vertical slit called the hilum.Internally
the hilum extends into a large cavity called
the renal sinus.
HILUM & RENAL SINUS
? The hilum transmits, from ant
erior to posterior, the renal vei
n, renal artery & the ureter (VAU).
? Lymph vessels & sympathetic
fibers also pass through the hilum.
? The renal sinus contains the upper
expanded part of the ureter called
the renal pelvis.
? Perinephric fat is continues into the
hilum and the sinus and
surrounds all these structures.
COVERINGS
1. Fibrous capsule:
Is closely adherent to its surface
2. Perirenal fat:
covers the fibrous capsule.
3. Renal fascia:
Condensation of areolar connecti
ve tissue that lies outside the
Perirenal fat and encloses the
kidney and the suprarenal gland.
4. Pararenal fat:
Lies external to the renal fasci
a, is part of the retroperitoneal fat.
ANTERIOR RELATIONS
The anterior surface of
both kidneys are related to
numerous structures, some
with an intervening layer of
peritoneum and others lie
directly against the kidney
without peritoneum.
LEFT KIDNEY
? A small part of the superior
pole,along the medial border , is
covered by left suprarenal gland.
? The rest of the superior pole is
covered by the intraperitoneal
stomach and spleen
.
? The retroperitoneal pancreas
covers the middle part of the kidney.
? Its lower lateral part is directly
related to the left colic flexure and
beginning of descending colon.
? Its lower medial part is covered by
the intraperitoneal jejunum.
RIGHT KIDNEY
? A small part of the upper pole
is covered by right suprarenal gland.
? The rest of the upper part of
anterior surface is related to the
liver and is separated by a layer of
peritoneum.
? The 2nd part of duodenum lies
directly in front of the kidney
close to its hilum.
? The lower lateral part is directly
related to the right colic flexure and,
on its lower medial side, is related to
the intraperitoneal small intestine
POSTERIOR RELATIONS
Posteriorly, the right and left kidneys are almost related to similar structures.
Left kidney:
Diaphragm
Right kidney:
Costodiaphragmatic rec
? Diaphragm
ess of the pleura
? Costodiaphragmatic
11th & 12th ribs; last int
recess, of the pleur
ercostal space
a
Psoas major
? 12th rib, last interco
Quadratus lumborum tr
stal space
ansversus abdomini
? Psoas major
s.
? Quadratus lumboru
Subcostal (T12),
m, transversus abd
iliohypogastric & ilioin
ominis.
guinal nerves.
? Subcostal (T12), ili
ohypogastric & ilioi
nguinal nerves.
Vertebrocostal & Renal Angles
? The angle between
the last rib and the
lateral border of erector
spinae muscle is
occupied by kidney and
is called the `Renal
angle'
? The Vertebrocostal
angle is occupied by the
lower part of the pleural
sac.
INTERNAL STRUCTURE
INTERNAL STRUCTURE
? Each kidney consists of an
outer renal cortex and an
inner renal medulla.
? The renal cortex is a
continuous band of pale tissue
that completely surrounds the
renal medulla.
? Extensions of the renal
cortex,the renal columns
project into the inner aspect of
the kidney,dividing the renal
medulla into discontinuous
aggregations of triangular-
shaped tissue, the renal
pyramids.
The bases of the renal pyramids are
directed outward, toward the cortex,
while the apex of each renal pyramid
projects inward, toward the renal
sinus.
? The apical projection (renal
papilla) is surrounded by a minor
calyx
? In the renal sinus, several
minor calices unite to form a major
calyx, and two or three major calices
unite to form the renal pelvis, which
is the funnel-shaped superior end of
the ureters
ARTERIAL SUPPLY
The renal artery arises from the aorta
at the level of the second lumbar
vertebra.
? Each renal artery divides into 5
segmental arteries that enter the hilum
of the kidney, 4 in front of the renal
pelvis and one behind it.
? They are distributed to the different
segments of the kidney.
? Each segmental artery gives rise to
number of lobar arteries, each supplies
a renal pyramid.
? Before entering the renal substance,
each lobar artery gives off two or three
interlobar arteries.
? The interlobar arteries run
toward the cortex on each side
of the renal pyramid.
? At the junction of the cortex
and the medulla, the Interlobar
arteries give off the arcuate
arteries, which arch over the
bases of the pyramids.
? The arcuate arteries give off
several interlobular arteries
that ascend inthe cortex and
give off the afferent glomerular
arterioles
Segmental branches &
vascular segments of
kidneys(e.g. Left)
Each kidney has 5
segmental branches and is
divided into 5 vascular
segments:
1. Apical.
2. Caudal/Lower
3. Anterior
Superior/Upper
4. Anterior Inferior/Middle
5. Posterior.
BLOOD SUPPLY
Abdominal
aorta
? Inferior
? Renal artery
vena cava
? Segmental
? Renal vein
arteries
? Interlobar
? lobar arteries
veins
? Interlobar
? Arcuate
arteries
? Arcuate
veins
arteries
?Interlobular
? Interlobular
veins
arteries
? Afferent
glomerular
arterioles
Venous Drainage
Both renal veins drain to the inferi
or vena cava.
? The right renal vein is behind the 2nd p
art of the duodenum and sometimes
behind the lateral part of the head of t
he pancreas
? The left renal vein is three times longer t
han the right (7.5 cm and 2.5 cm).
? So, for this reason the left kidney is the pr
eferred side for live donor nephrectomy.
? It runs from its origin in the renal hilum,
posterior to the splenic vein and the bod
y of pancreas, and then across the anteri
or aspect of the aorta, just below the ori
gin of the superior mesenteric artery.
? The left gonadal vein enters it from belo
w and the left suprarenal vein, usually re
? The right renal vein is behind the 2nd p
ceiving one of the left inferior phrenic vei
art of the duodenum and sometimes
ns, enters it above but nearer the midline
behind the lateral part of the head of the
? The left renal vein enters the inferior vena pancreas.
cava a little above the right vein.
Lymphatic
Drainage:
? The lymph
vessels follow the arteries.
? Lymph drains to the
lateral aortic lymph nodes
around the origin of the
renal artery.
Nerve Supply:
The nerve supply is the
renal sympathetic plexus.
The afferent fibers that
travel through the renal
plexus enter the spinal
cord in the
10th, 11th, and 12th
thoracic nerves.
URETER
INTRODUCTION
? The ureter is a narrow, thick
walled, expansile muscular
tube.
? Conveys urine from the kidney
to the urinary bladder.
? The urine is propelled from the
kidney to the urinary bladder
by the peristaltic contractions
of the smooth muscle of the
wall of the ureter.
Measurements
? Length: 25 cm (10 inches).
? Diameter: 3 mm.
COURSE IN ABDOMINAL PART
? The ureter begins as a
downward continuation of a
funnel shaped renal pelvis at
the medial margin of the
lower end of the kidney.
? The ureter passes
downward and slight medially
on the psoas major, which
separates it from the
transverse processes of the
lumbar vertebrae.
? Enters the pelvic cavity by
crossing in front of the
bifurcation of the common
iliac artery at the pelvic brim
in front of the sacroiliac joint.
COURSE IN PELVIS
? In the pelvis, the ureter first runs
downward, backward, and laterally
along the anterior margin of the
greater sciatic notch.
? Opposite to the ischial spine, it
turns forward and medially to reach
the base of the urinary bladder.
? Where it enters the bladder wall
obliquely.
? Within the bladder wall, it narrows
down,takes a sinuous course, and
opens into the cavity of the bladder
at the lateral angle of its trigone as
ureteric orifice.
PARTS AND RELATIONS
? The ureter is generally divided into two parts: abdominal
and pelvic.
? Each part is about the same length, i.e., 12.5 cm (5 inches).
? The abdominal part of ureter extends from the renal pelvis
to the bifurcation of the common iliac artery.
? The pelvic part of the ureter extends from the pelvic brim
(at the level of bifurcation of the common iliac artery) to the
base of the urinary bladder.
RELATIONS OF ABDOMINAL PART
Medially the right ureter is related to inferior vena
cava and left ureter is related to left gonadal vein
and inferior mesenteric vein.
RELATIONS OF PELVIC PART
? The pelvic part of the ureter crosses in front of
all the nerves and vessels on the lateral pelvic wall
except vas deferens, which crosses in front of it.
? Near the uterine cervix, the uterine artery lies
above and in front of it, a highly important surgical
relationship.
SITES OF ANATOMICAL
NARROWINGS/CONSTRICTIONS
The lumen of the ureter is not uniform throughout and presents three
constrictions at the following sites.
1. At the pelviureteric junction where the renal pelvis joins
the upper end of ureter. It is the upper most constriction,
found approximately 5 cm away from the hilum of kidney.
2. At the pelvic brim where it crosses the common iliac artery.
3. At the uretero-vesical junction (i.e., where ureter enters
into thebladder).
? In addition to above
three sites of
constrictions, two more
sites of constrictions
are described by the
surgeons.
1. At juxtaposition of
the vas
deferens/broad
ligament.
2. At the ureteric orifice.
ARTERIAL SUPPLY
? The ureter derives its arterial
supply from the branches of all the
arteries related to it. The
important arteries supplying
ureter from above downward are:
1. Renal.
2. Testicular or ovarian.
3. Direct branches from aorta.
4. Internal iliac.
5. Vesical (superior and inferior).
6. Middle rectal.
7. Uterine.
? VENOUS DRAINAGE
The venous blood from the ureter is drained into
the veins corresponding to the arteries.
? LYMPHATIC DRAINAGE
The lymph from the ureter is drained into lateral
aortic and iliac nodes.
? NERVE SUPPLY
1. The sympathetic supply of the ureter is derived
from T12?L1 spinal segments through renal, aortic,
and hypogastric plexuses.
2. The parasympathetic supply of ureter is derived
from S2?S4 spinalsegments through pelvic
splanchnic nerves.
Clinical correlation
? Mobilization of ureter: Branches of the arteries supplying
the ureter form an anastomosis in the fat and fascia around the ureter.
Therefore, surgeons should bear in their mind that stripping off this
fascia, while mobilizing the ureter for transplantation, will hamper the
blood supply of the ureter and may cause its necrosis.
? Identification of ureter: Ureter is a muscular structure, and
in life waves of muscular contractions produce a worm-like rhythmic
movement (peristalsis) thus milking urine toward the bladder. The
ureter is readily identified in life by its thick muscular wall which is
seen to undergo worm-like writhing movements, especially when it is
gently stroked or Squeezed.
Clinical correlation
? Ureteric calculus is likely to lodge at one of the sites of anatomical
narrowings of the ureter particularly:
(a) At the pelvic ureteric junction.
(b) Where it crosses the pelvic brim.
(c) In the intramural part--the narrowest part.
? Injury to ureters: According to Kenson and Hinman, the ureter may
be injured at one of the following four dangerous sites:
(a) Point where the ureter crosses the iliac vessels.
(b) In the ovarian fossa.
(c) Where the ureter is crossed by the uterine artery (most dangerous
site) as damage is likely at this site during hysterectomy.
(d) At the base of the bladder.
THE ADRENAL
GLAND(SUPRARENAL GLAND)
Position and location
- The adrenal glands located on the upper poles of
each kidney on the right and left sides.
-They are covered by peritoneum on the posterior
abdominal wall they are embeddedinto pre renal
fat.
- The left one is larger and higher than the right
Location:
Rest superiorly to
kidneys
Hormones Produced:
~30 steroid hormones!
The right adrenal gland
-It is triangular in shape located on the upper pole
of the right kidney behind the inferior vena
cava.
-It is related anterior to the inferior vena cava and
the right lobe of the liver.
-Posterior it is related to the right crus of diaphragm
The right adrenal gland
The left adrenal gland
-It is crescent in shape located on the upper pole of
the left kidney behind the stomach
-Anterior it is related to the stomach, the tail of
pancreas and the lesser sac
- Posterior it is related to the left crus of diaphragm
Relation of the left gland
The blood supply
Each adrenal gland supply by three arteries superior ,middle and inferior
supra renal arteries.
The superior supra renal artery branch from inferior phrenic artery
which is branch from the aorta, the middle supra renal artery branch
from the aorta and the inferior supra renal artery branch from the renal
artery
The venous drainage by the supra renal vein on the
right side at the inferior vena cava and on the left side
at the left renal vein
Structure of adrenal gland
--The adrenal gland formed of outer cortex which is yellow
forming the main mass of the gland
and inner medulla completely enclosed by the cortex except
at the hilum the gland enclosed by capsule of connective
tissue.
-The cortex has mesoderm development while the medulla
developed from the neural crest
The cortex and capsule
This post was last modified on 30 November 2021