Download 05-Kidney, Ureter

FUNCTIONAL ANATOMY
OF KIDNEYS, URETERS
&
SUPRARENAL GLANDS
By Prof. Saeed Abuel Makarem
KIDNEYS
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Its main function is to excrete most
of the waste products of
metabolism
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It control the water and electrolyte
balance of the body
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It maintain acid-base balance of
the blood
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The waste products leave the
kidneys as urine, which passes
down the ureters to the urinary
bladder
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The urine leaves the body through
the urethra
KIDNEYS
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Kidneys are reddish brown in
color
Lie behind the peritoneum of
the posterior abdominal wall
It lie high up on either side of
the vertebral column
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Are largely under cover of the
costal margin
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The right kidney lies slightly
lower than the left due to the
large size of right lobe of the
liver
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With contraction of the
diaphragm during respiration,
both kidneys move downward
in a vertical direction as much
as 2.5 cm
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On the medial border of each
kidney is a vertical slit called
the hilum
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The hilum extends into a large
cavity called the renal sinus
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The hilum transmits the renal
vein, two branches of renal
artery, ureter, and the third
branch of renal artery from the
front backward (V.A.U.A.)
KIDNEYS
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1- Fibrous capsule:
It surrounds the kidney
2- Perirenal fat:
It covers the fibrous capsule
3- Renal fascia:
it is a condensation of
connective tissue that
encloses the kidneys and
suprarenal glands,
it is continuous laterally with
the fascia transversalis
4- Pararenal fat:
it lies external to the renal
fascia, and forms part of the
retroperitoneal fat
COVERINGS
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Each kidney has a dark
brown outer cortex and a
light brown inner medulla
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Medulla is composed of
about a dozen renal
pyramids
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Each pyramid having its
base directed laterally
toward the cortex, and its
apex, (the renal papilla),
projecting medially
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The cortex extends into the
medulla between adjacent
pyramids as the renal
column
RENAL STRUCTURE
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Extending from the bases
of the renal pyramids into
the cortex are striations
known as medullary rays
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The renal sinus within the
hilum, contains the upper
expanded end of the
ureter, the renal pelvis
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Renal pelvis divides into
two or three major calyces,
which divides into two or
three minor calyces
RENAL STRUCTURE
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RIGHT KIDNEY
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Suprarenal gland
Liver,
Second part of the
duodenum,
Right colic flexure
Coils of small intestine
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LEFT KIDNEY
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Suprarenal gland,
Spleen,
Stomach,
Pancreas (body),
Left colic flexure,
Descending colon
Coils of jejunum
ANTERIOR RELATIONS OF
THE KIDNEYS
RIGHT KIDNEY
Diaphragm,
Costodiaphragmatic recess of the
pleura,
Twelfth rib & last intercostal
space,
Psoas major
Quadratus lumborum,
Transversus abdominis muscle
Subcostal nerve (T12)
Iliohypogastric nerve (L1)
Ilioinguinal nerve (L1)
LEFT KIDNEY
Same as the right except it
is higher it reaches up to the
11th rib.
Posterior Relations of the
Kidneys
BLOOD SUPPLY
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The renal artery arises from
the aorta at the level of the
second lumbar vertebra
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Each renal artery divides into
five segmental arteries that
enter the hilum of the kidney,
four infront and one behind
the renal pelvis
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Lobar artery arise from each
segmental artery, one for
each renal pyramid
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Each lobar artery gives two or
three interlobar arteries
The interlobar arteries run
toward the cortex on each
side of the renal pyramid
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Interlobar arteries give the
arcuate arteries at the
junction of the cortex and
medulla
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The arcuate arteries give
several interlobular arteries
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Afferent glomerular arterioles
arise as branches of
interlobular arteries
BLOOD SUPPLY
VEINS, LYMPH,
NERVE SUPPLY
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Renal vein emerges from the
hilum in front of the renal
artery and drains into the IVC
Left renal vein is longer than
the right renal vein
Lateral aortic lymph nodes lie
around the origin of the renal
artery
Renal sympathetic plexus:
afferent fibers that travel
through the renal plexus enter
the spinal cord in the 10th,
11th, and 12th thoracic nerves
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The two ureters are muscular
tubes that extend from the
kidneys to the posterior
surface of the urinary bladder
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The urine is propelled along
the ureter by peristaltic
contractions
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Each ureter measures about
25 cm long
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Each ureter has three
constrictions along its course,
1- Where the renal pelvis joins
the ureter,
2- As it crosses the pelvic brim,
3- Where it pierces the bladder
wall ( intra-mural part)
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URETERS
URETER
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The renal pelvis is the funnelshaped expanded upper end
of the ureter
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It lies within the hilum of the
kidney and receives the major
calyces
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It enters the pelvis by crossing
the bifurcation of the common
iliac artery in front of the
sacroiliac joint
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It runs downward & forward
on the lateral wall of the
pelvis to enter the lateral
angle of the bladder
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Anterior:
Duodenum,
Terminal part of the ileum,
Right colic vessels,
Iliocolic vessels,
Right testicular or ovarian
vessels, and the
Root of the mesentery.
Posterior:
Right psoas muscle,
Bifurcation of the right
common iliac artery
RELATIONS, RIGHT URETER
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Anterior:
Sigmoid colon,
Sigmoid mesocolon,
Left colic vessels,
Left testicular or
ovarian vessels
Posterior:
Left psoas muscle,
Bifurcation of left
common iliac artery
RELATIONS, LEFT URETER
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Upper end is supplied by
the renal artery
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Middle portion by
(gonadal) testicular or
ovarian artery
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In the pelvis is supplied
by the superior vesical
artery
The lymph drains to the
lateral aortic nodes and
the iliac nodes
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BLOOD SUPPLY
NERVE SUPPLY
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Renal, testicular (or
ovarian), and hypogastric
plexus (in the pelvis)
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Afferent fibers travel with
the sympathetic nerves
and enter the spinal cord
in the first and second
lumbar segments
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The two suprarenal glands
are yellowish retroperitoneal
organs that lie on the upper
poles of the kidneys
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They are surrounded by the
renal fascia
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Separated from the kidneys
by the perirenal fat
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Each gland has a yellow
cortex and a dark brown
medulla
SUPRARENAL GLANDS
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The cortex secretes
hormones include:
Mineral corticoids,
which control fluid and
electrolyte balance.
Glucocorticoids, which
control carbohydrates,
fats, and proteins.
Sex hormones, which
probably play a role in
the prepubertal
development of the sex
organs
The medulla secretes
the catecholamine,
epinephrine and
norepinephrine
SUPRARENAL GLANDS
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Left suprarenal gland is
crescentic in shape
Extends along the medial
border of the left kidney
from the upper pole to
the hilum
It lies behind the:
The pancreas,
The lesser sac,
The stomach
It rests posteriorly on the
diaphragm
LEFT SUPRARENAL GLANDS
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The right suprarenal
gland is pyramidal in
shap and caps the
upper pole of the right
kidney
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It lies behind the right
lobe of the liver and
extends medially
behind the IVC
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It rests posteriorly on
the diaphragm
RIGHT SUPRARENAL GLANDS
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Arteries:
Three arteries supplying each
gland,
1- Superior suprarenal artery:
from inferior phrenic artery
2- Middle suprarenal from aorta.
3- Inferior suprarenal from renal.
Veins:
A single vein emerges from the
hilum of each gland:
The right suprarenal vein drains
into the IVC .
The left suprarenal vein drains
into the left renal
BLOOD SUPPLY
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The suprarenal glands of the human fetus are 10 to 20 times larger than
the adult glands relative to body weight, and are large compared with the
kidneys.
These large glands result from the extensive size of the fetal cortex.
Dr. L. Tchakarov
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