WINDSOR UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF ANATOMY ABDOMEN Dr. SREEKANTH THOTA

Kidneys Ureters Suprarenal gland

Kidneys Functions The ovoid kidneys remove excess water, salts, and wastes of protein metabolism from the blood while returning nutrients and chemicals to the blood.

Location and Description They lie retroperitoneally on the posterior abdominal wall One on each side of the vertebral column at the level of the T12 toL3 vertebrae. The right kidney somewhat lower than the left because of its relationship with the liver Hila of Kidneys related to Transpyloric plane 10 cm in length, 5 cm in width, and 2.5 cm in thickness.

Kidneys Coverings of Kidney and Supra renal gland Renal or fibrous capsule: This surrounds the kidney and is closely applied to its outer surface Perinephric fat : This covers the fibrous capsule. Renal fascia :it is continuous laterally with the fascia transversalis. Paranephric fat : This lies external to the renal fascia and is often in large quantity

Relations of Kidney Right Kidney Anteriorly: The suprarenal gland, the liver, the second part of the duodenum, and the right colic flexure Posteriorly: The diaphragm; the costodiaphragmatic recess of the pleura; the 12th rib; and the psoas, quadratus lumborum, and transversus abdominis muscles. The right kidney is separated from the liver by the hepatorenal recess.

Left Kidney Anteriorly: The suprarenal gland, the spleen, the stomach, the pancreas, the left colic flexure, and coils of jejunum. Posteriorly: The diaphragm; the costodiaphragmatic recess of the pleura; the 11th (the left kidney is higher) and 12th ribs; and the psoas, quadratus lumborum, and transversus abdominis muscles

External and internal appearance of kidneys 2 Surfaces 2 Borders 2 Poles

Renal Structure Each kidney has a dark brown outer cortex and a light brown inner medulla. Medulla: renal pyramids, renal papilla Cortex: renal columns The hilum transmits, from the front backward, the renal vein, two branches of the renal artery, the ureter, and the third branch of the renal artery (VAUA).

Internal appearance of kidneys

Blood supply of kidneys Renal artery Renal vein

Renal artery The renal artery arises from the aorta at the level of the first-second lumbar vertebra. Right renal artery Is longer than the Left Passes posterior to the IVC-- This relationship is important Each renal artery usually divides into five segmental arteries that enter the hilum of the kidney.

Renal vein The renal vein emerges from the hilum in front of the renal artery and drains into the inferior vena cava. Left renal vein Is longer than the right Passes anterior to the aorta just below the origin of the SMA Receives the terminations of the Lt. Suprarenal vein and Lt gonadal vein Right renal vein Is shorter than the left Passes posterior to the second part of the duodenum and head of the pancreas

Ureters Location and Description The ureters are muscular ducts (25cm long). The ureter emerges from the hilum of the kidney and runs vertically downward behind the parietal peritoneum (adherent to it) on the psoas muscle. It enters the pelvis by crossing the bifurcation of the common iliac artery in front of the sacroiliac joint and turns forward to enter the lateral angle of the bladder.

The ureters are normally constricted to a variable degree in three places At the junction of the ureters and renal pelves Where the ureters cross the brim of the pelvic inlet During their passage through the wall of the urinary bladder . These constricted areas are potential sites of obstruction by ureteric (kidney) stones

Arterial supply of ureters Abdominal portion of the ureter arise consistently from the renal arteries. 1- Upper end Renal artery 2- Middle  Gonadal artery 3- In pelvis  Superior vesicle artery Venous drainage ( as above)

Supra renal gland

The suprarenal (adrenal) glands, yellowish in living persons The pyramidal right gland is more apical (situated over the superior pole) relative to the right kidney The crescent-shaped left gland is medial to the superior half of the left kidney and is related to the spleen, stomach, pancreas, and the left crus of the diaphragm

Each suprarenal gland has two parts: the suprarenal cortex and suprarenal medulla. cortex (outer) 1- Mineral corticoids 2- Glucocorticoids 3-Sex hormones Medulla (inner) Catecholamines

The Suprarenal Arteries and Veins Superior suprarenal arteries (6 to 8) from the inferior phrenic arteries. Middle suprarenal arteries (around 1) from the abdominal aorta near the level of origin of the SMA. Inferior suprarenal arteries ( around1) from the renal arteries. The short right suprarenal vein drains into the IVC, whereas the longer left suprarenal vein empties into the left renal vein.

Nerves of the suprarenal glands Myelinated presynaptic sympathetic fibers are mainly derived from the intermediolateral cell column (IML), or lateral horn, of gray matter of the spinal cord segments T10 to L1 and traverse both the paravertebral and the prevertebral ganglia, without synapse, to be distributed to the chromaffin cells in the suprarenal medulla

Kidney Stones

Pain Kidney stone passing thru’ the ureter, will cause pain traveling from loin to groin.