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

2. Kidneys Ureters Suprarenal gland

3. 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.

4. 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.

7. 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

9. 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.

11. 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

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

14. 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).

16. Internal appearance of kidneys

17. Blood supply of kidneys
Renal artery
Renal vein

19. 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.

22. 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

23. 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.

24. 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

26. 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)

28. Supra renal gland

29. 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

30. 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

32. 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.

34. 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

36. Kidney Stones

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