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Kidneys and Adrenal GlandsDepartment of Regional Anatomy and Operative Surgery 1 1 Kidneys and Adrenal GlandsDepal lPosition,relationl lStructure l lBlood supply l lLymphatic drainagel lInnervations2 2 Position,relation2 PositionuRetroperitonealuUpper poles T12 vertebra Lower poles L3 vertebrauRight is lower than left3 3 PositionRetroperitoneal3 Cadaveric kidneys4 4 Cadaveric kidneys4 Surface Projection of kidney5 5 Surface Projection of kidney5 Renal AngleTenderness or percussing pain caused by kidney disease is localized here6 6 Renal AngleTenderness or percuNeighbor of Kidney7 7 Neighbor of Kidney7 8 8 8 Anterior Surface of the kidney9 9 Anterior Surface of the kidne1010 10 Posterior Surface1111 Posterior Surface11 Costodiaphragmatic recess of the pleural cavity1212 Costodiaphragmatic recess of tRenal hilum,Renal sinus and Renal pedicleRenal hilumRenal sinusRenal pediclecortexRenal columnRenal pyramidcalyxpapilla1313 Renal hilum,Renal sinus and R1414 14 1515 15 renal vein renal vein renal artery renal artery renal pelvis renal pelvis From above downwardsFrom above downwards the renal artery the renal artery renal vein renal vein renal pelvis renal pelvisFrom anterior to posteriorFrom anterior to posterior1616 renal veinFrom anterHydronephrosis1717 Hydronephrosis17 renal artery T111818 renal artery T1118 Renal artery1919 Renal 19 Vascular renal segmentSuperior(apical)Anterior superior(upper)Anterior inferior(middle)Inferior(lower)posterior2020 Vascular renal segmentSuperiorvariation of renal artery!2121 variation of renal artery!21 Variation of Renal Artery2222 Variation of Renal Artery22 Renal veins2323 Renal veins23 2424 24 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 cava2525 Aorta-renal artery-segmental aRenal Capsule Renal fascia Adipose capsule Fibrous capsule2626 Renal Capsule Renal fascia26 Renal fascia2727 Renal fascia27 2828 28 Fibrous capsuleAdipose capsulePerirenal fatPararenal fat2929 Fibrous capsuleAdipose capsule3030 30 3131 31 Fibrous Capsule 3232 Fibrous Capsule Ureter3333 Ureter33 Ureter is divided into 3 parts:l labdominal partl lpelvis partl lintramural part 3434 Ureter is divided into 3 partl l28 to 34 cm 28 to 34 cm l l3 narrowing sites3 narrowing siteslthe pelviureteric the pelviureteric junctionjunctionlcrossing the crossing the pelvic brimpelvic brimltraversing the traversing the bladder wallbladder wall3535 28 to 34 cm 35 3636 36 3737 37 Horseshoe kidney3838 Horseshoe kidney38 Suprarenal Gland3939 Suprarenal Gland39 Endocrine glandT11 levelRight is triangularLeft is semi-lunar4040 Endocrine gland40 LeftLeftrightrightanterioranteriorsuperiorsuperiorstomachstomachliverliverinferiorinferiortail of pancreas&tail of pancreas&spleen vesselspleen vesselposteriorposteriordiaphragmdiaphragmdiaphragdiaphragmmmedialmedialabdominal aortaabdominal aortaInferior Inferior vena cavavena cavaRelation4141 Leftrightanteriorsuperiorstoma4242 42 Artery of Adrenal Gland 4343 Artery of Adrenal Gland 43 4444 44 4545 45 Veins of adrenal gland Left suprarenal vein,into the left renal vein Right suprarenal vein,into the inferior vena cava 4646 Veins of adrenal gland Left su4747 47 4848 48 incisionAnterior transperitoneal approachPosterior retroperitoneal approach4949 incisionAnterior transperitoneA 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.Case A5050 A 55-year-old woman was found a.a.What causes the pain when a ureteral calculus is present?b.b.Why is the pain felt in such an extensive area?c.c.Where does one look for the course of the ureter in a radiograph?d.d.Where along the ureter is a calculus likely to be held up?Question5151 What causes the pain when a urAn 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 B5252 An explorer in the Amazon jungAn intravenous pyelogram revealed that a patients 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 C5353 An intravenous pyelogram reveaAn 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 D5454 An examination of a patient reAn intravenous pyelogram revealed that the calyces and pelvis of a patients right kidney were grossly dilated(a condition known as hydronephrosis).What embryological anomaly may be responsible for this condition?Case E5555 An intravenous pyelogram reveaWhich congenital anomaly of the ureter is likely to present as a case of urinary incontinence?Case F5656 Which congenital anomaly of thoperation procedure of kidney transplant5757 operation procedure 57 nephrectomyFor a nephrectomy,the kidney commonly is For a nephrectomy,the kidney commonly is exposed in the loin.After an oblique incision exposed in the loin.After an oblique incision midway between the twelfth rib and the iliac crest,midway between the twelfth rib and the iliac crest,the posterior free border of the external oblique is the posterior free border of the external oblique is identified,and divided to reveal the peritoneum,identified,and divided to reveal the peritoneum,which is pushed forward to reveal the renal fascia.which is pushed forward to reveal the renal fascia.The subcostal nerve and vessels are preserved;the The subcostal nerve and vessels are preserved;the renal fascia is opened;and the kidney exposed.renal fascia is opened;and the kidney exposed.Care must be taken not to damage the pleura,Care must be taken not to damage the pleura,since it is separated from the upper pole of the since it is separated from the upper pole of the kidney only by the diaphragm.kidney only by the diaphragm.5858 nephrectomyFor a nephrectomy,
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