Kidneys and Adrenal Glands

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					Kidneys and Adrenal
       Glands

 Department of Regional Anatomy and
         Operative Surgery
Position,relation
Structure
Blood supply
Lymphatic drainage
Innervations
    Position
Retroperitoneal

Upper   poles
      T12 vertebra
 Lower poles
      L3 vertebra
Right   is lower than left
Cadaveric kidneys
Surface Projection of kidney
Renal Angle




Tenderness or percussing pain caused by kidney
           disease is localized here
Neighbor of Kidney
Anterior Surface
of the kidney
Posterior Surface
Costodiaphragmatic
recess of the pleural
       cavity
Renal hilum, Renal sinus and Renal pedicle
Renal pyramid                     cortex
                                  Renal column
   Renal sinus
                                  calyx

                                  Renal hilum



       papilla




                                 Renal pedicle
From anterior to posterior
     renal vein
     renal artery
     renal pelvis
From above downwards
     the renal artery
     renal vein
     renal pelvis
Hydronephrosis
renal artery




               T11
Renal
 artery
              Vascular renal segment
                     Superior (apical)




Anterior
superior
(upper)
                                         posterior


  Anterior
   inferior
  (middle)




                           Inferior
                           (lower)
variation of renal artery
Variation of Renal Artery
Renal veins
Aorta-renal artery-segmental artery-
lobar artery-interlobar artery-arcuate
artery-interlobulor artery-afferent
arteriole-glomerulus (capillaries)-
efferent arteriole-peritubular
capillaries and vasa recta-interlobular
vein-arcuate vein-interlobar vein-renal
vein-interior vena cava
    Renal Capsule

   Renal fascia
   Adipose capsule
   Fibrous capsule
Renal fascia
                   Fibrous
                   capsule




                 Adipose
                 capsule


 Perirenal fat



Pararenal fat
Fibrous

  Capsule
Ureter
Ureter is divided into 3 parts:
 ①abdominal       part
 ②pelvis   part
 ③intramural      part
28 to 34 cm
3 narrowing sites

    • the pelviureteric
      junction
    • crossing the
      pelvic brim
    • traversing the
      bladder wall
Horseshoe kidney
Suprarenal Gland
•Endocrine gland
•T11 level
•Right is triangular
•Left is semi-lunar
                      Relation

                            Left             right

           superior         stomach
anterior              tail of pancreas &     liver
           inferior
                         spleen vessel
                                           diaphrag
    posterior            diaphragm
                                              m
                                            Inferior
     medial            abdominal aorta
                                           vena cava
Artery of Adrenal Gland
Veins of adrenal gland

    Left suprarenal vein, into the
     left renal vein
    Right suprarenal vein, into the
     inferior vena cava
                           incision




                              Posterior retroperitoneal approach
Anterior transperitoneal
       approach
                Case A

A 55-year-old woman was found rolling on
her kitchen floor, crying out from agonizing
pain in her abdomen. The pain came in
waves and extended from the right loin to
the groin and to the front of the right thigh.
An anteroposterior radiograph of the
abdomen revealed a calculus in the right
ureter.
                 Question

a.   What causes the pain when a ureteral
     calculus is present?
b.   Why is the pain felt in such an extensive
     area?
c.   Where does one look for the course of
     the ureter in a radiograph?
d.   Where along the ureter is a calculus likely
     to be held up?
               Case B
An explorer in the Amazon jungle was found
alive after having lost contact with the
outside world for six months. On physical
examination, he was found to be in an
emaciated condition. On palpation of the
abdomen, a rounded, smooth swelling
appeared in the right loin at the end of
inspiration. On expiration, the swelling
moved upward and could no longer be felt.
What anatomical structure could produce
such a swelling?
                 Case C

An intravenous pyelogram revealed that a
patient’s left kidney was in its normal position,
but the right kidney was situated in front of
the right sacroiliac joint. Can you explain this
on embryological grounds?
              Case D

An examination of a patient revealed that
she had a horseshoe kidney. What
anatomical structure prevents a horseshoe
kidney from ascending to a level above the
umbilicus?
                Case E
An intravenous pyelogram revealed that the
calyces and pelvis of a patient’s right kidney
were grossly dilated (a condition known as
hydronephrosis). What embryological
anomaly may be responsible for this
condition?
               Case F

Which congenital anomaly of the ureter is
likely to present as a case of urinary
incontinence?
operation procedure
of kidney transplant
               nephrectomy
For a nephrectomy, the kidney commonly is
exposed in the loin. After an oblique incision
midway between the twelfth rib and the iliac crest,
the posterior free border of the external oblique is
identified, and divided to reveal the peritoneum,
which is pushed forward to reveal the renal fascia.
The subcostal nerve and vessels are preserved; the
renal fascia is opened; and the kidney exposed.
Care must be taken not to damage the pleura,
since it is separated from the upper pole of the
kidney only by the diaphragm.