RELATIONS Stperior xprrerOrteter Blood suoolv: {f Afterial Supply: - 3 arteries for each gland. - Arteries do not enter through the hilum: 1)Superior suprarenal artery from the inferior phrenic artery. 2)Middle suprarenal artery from the abdominal aorta (main supply). 3) lnferior suprarenal artery from the renal artery. Venous Drainage: single vein leaves through the hilum. lr#dor ilrs|.r riBry mrk!,tnaearra 1)Rt. suprarenal v. + IVC Lt. suprarenalv. -+ Lt renalv. Formed by union of 3 major calyces to form the pelvis of ureter, which is either: 1. lnternal. Causing renal type of hydronephrosis 2. External: Causing pelvic type of hydronephrosis Lenqth: 25 - 3o cm Dtameter: G mm Sites Of Ureteric Constrictions (Stone Imoaction): Diameter is 3 mm with 5 sites of cgnstrictions: 1 ) Pelvi-ureteric junction (L2). 2) Inlet of pelvis (bifurcation of common iliac).

 

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I ABDOMEN

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ABDOMEN

EmbryOlOgyl fusion of mesonephric with metanephric ducts.

*t Secretinq part: from metanephros.

'ffF. Collectinq svstem: from ureteric bud of mesonephric duct.

Points of Surqica! lmportance:

. Failure of fusion of mesonephric with metanephric ducts ) polycystic kidney.

. ln non rotated kidney, the hilum is directed anteriorly.

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I ABDOMEN

Size: lpx6X 3 cm.

Position:

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the Lt. by 0.5 inch because of the pressure of the

1. Upper pole I Lower border of T12 | Upper border of T12

2. Lower pole I lower border of Lg I Upper border of Lg

Pedicle: ln the hitum we have (vAP)

. Renal vein ) anterior t Renal artery ) middle

. Pelvis of the ureter ) posterior

Surgical Importance:

nephrectomy, we open the anterior surface.

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ABDOMEN I

Relations

Anterior Relations

o Left Kidnev (stomach bed)

-Suprarenal: above & medial.

- Spleen: above & lateral.

- Stomach: between suprarenal, spleen & splenic a.

- Pancreas & splenic vessels.

- Splenic flexure: below & Iateral.

-Small intestine: below & medial.

. Riqht Kidnev

- Suprarenal: above & medial.

- Second part of duodenum: in front of hilum.

- Rt. colic flexure: below & lateral.

-Small intestine: below & medial.

- Rt. lobe of liver: above & lateral.

-L *" peritoneum

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Posterior Relations

o Both Rt. & Lt. Kidney.

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1 ) Diaphragm: superior.

2) Psoas major: lower medial.

3) Quadratus lumborum: lower intermediate.

4) Transversus abdominis: lower lateral.

4,sltuctates separatinq muscles riar sq"r,f:?Oe of kidOe-y

1) Subcostal vessels & nerve.

2) 11'h & 12th ribs in Lt. kidney (only 12th rib in Rt.).

3) llio-hypogastric nerve.

4) llio-inguinal nerve.

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I ABDOMEN

Blood Supolv of the Kidnev:

tiArterial supply: renal artery (branch of abdominat aorta atLlrL2).

o Rt. renal artery is longer than Lt renal a. & it passes b-ehind lVC.

o Blood supply to the kidney is segmental ) end arteries.

o Accessory renal arteries:

> Are of common occurrence.

> Usually arise from the abdominal aorth.

> Can cause ureteric obstruction. ) Ligation ) infarctibn of the part supplied by them.

2)Venous drainage: renal vein (drains into IVC).

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Caosule of the Kidnev:

A- Fascia Of Ziiker-candle (Gerota) (Peri-renal capsule)

The fascia transversalis reachinq the kidnev splits into:

oAnterior layer ) attached to aorta.

oPosterior layers ) attached to vertebral fascia.

-T. h.e. -tw s. i ay.e. .rs i

oAbove ) fuse above.

.oBelow ) no fusion.

{Sf.f .g. Gerota fascia encloses the kidney BUT NOT the adrenatgland.

B- Fibrous Gapsule.

C- Peri-nephric fat.

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ABDOMEN I

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Stability of the kidnev:

a- lts position in the para-vertebral gutter.

b- lts fascial & fatty capsules.

c- The renal vessels connecting the kidney to Aorta & lVC.

d- The intra-abdominal pressure.

Surface Anatomv of the Kidnev:

A. Posterior surface marking of

the kidney: bounded by 4 lines

(Morris' parallelogram):

F2 vertical lines: 3 & I cm from

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B. Anterior surface marking of the kidney:

SURGICAL NOTES

- Lt. kidney is higher than Rt. ) rib resection may be needed in Lt. kidney operations.

- Rt Nephrectomy is mre dangerous than the Lt. due to its relation to the biliary duct,

2"d partof the duodenum & ampulla of vater, aslo short Rt. Renal v.

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I ABDOMEN

On the upper pole of the kidney.

Shape:

{F o The Rt. suprarenalgland is pyramidat.

o The Lt. suprarenal gland is semi-lunar.

RELATIONS

Stperior xprrerOrteter

Blood suoolv: {f Afterial Supply:

- 3 arteries for each gland.

- Arteries do not enter through the hilum:

1)Superior suprarenal artery from the inferior phrenic artery.

2)Middle suprarenal artery from the abdominal aorta (main supply).

3) lnferior suprarenal artery from the renal artery.

Venous Drainage: single vein leaves through the hilum.

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1)Rt. suprarenal v. + IVC

Lt. suprarenalv. -+ Lt renalv.

Formed by union of 3 major calyces to form the

pelvis of ureter, which is either:

1. lnternal. Causing renal type of hydronephrosis

2. External: Causing pelvic type of hydronephrosis

Lenqth: 25 - 3o cm

Dtameter: G mm

Sites Of Ureteric Constrictions

(Stone Imoaction):

Diameter is 3 mm with 5 sites of cgnstrictions:

1 ) Pelvi-ureteric junction (L2).

2) Inlet of pelvis (bifurcation of common iliac).

3) lschial spine.

4) lntramural part.

5) Meatus (orifice).

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I ABDOMEN

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Parts of the Ureter:

1) Abdominal part: 12.s cm

o lt enters the pelvis by crossing in front of the bifurcation of common iliac artery

(at the sacroiliac joint).

o lt runs downwards & backwards on the side of pelvic wall till it reaches ischial

spine with the following relations:

- Anterior: peritoneum (it is retro-peritoneal).

- Posterior: internal iliac vessels.

- Lateral: obturator nerve & vessels & the umbilical artery.

o At the level of ischial spine, it curves antero-medially crossing over the levator

ani muscle to open into the postero-superior angle of urinary bladder.

Here, its course is different in d & ?:

- ln r1: crossed by the vas deferens from lateral to medial.

- ln ?: it crosses posterior to the uterine artery 2 cm lateral to the cervix.

3) lntramural part:

It is 2 cm long, runs on oblique course in the bladder wall.

BIood Supply: (Segmental)

- UPPER T" ) renal artery.

- MIDDLE Ts ) gonadal, aorta & common iliac.

- LOWER % ) vesical in male & uterine in female.

Each ureter descends vertically behind the peritoneum of the posterior

abdominal wall opposite the tips of transverse processes of lower 4

lumbar vertebrae (the same @urse in both d & ?)

a Medial border of psoas major & genito-femoral nerve on it.

a Tips of transverse processes of the lower 4 lumbar vertebrae

. 3d part of the duodenum

. 3 arteries: Rt. gonadal, Rt.

colic & ileo-colic.

. 3 arteries: Lt. gonadal, upper

& lower Lt. colic.

3 structures related to mesentry:

. its root

o sup. mesentric vessels

o coils of ileum

. lt passes behind the fossa

intersigmoidae

. Sigmoid mesocolon

o Coils of sigmoid colon

IVC lnferior mesenteric v,

2) Pelvic part: 12.s cm

ABDOMEN I

Identification Of Ureter In X-Ray

It runs in front of:

1. Tips of the transverse processes of lumbar vertebrae.

2. llio-sacraljoint.

3. lschial spine.

Identification durino ooeration

Anatomical site:

. Lies on psoas major & seen crossing:

. The bifurcation of common iliac.

. The ischial spine.

It is not an artery: since the pulsations are not continuous but peristalsis.

It is not Psoas minor:

. Psoas Minor: Flat shining tendon.

. Ureter: white cord-like (tubular).

It is not a colon:

. Colon: Blood vessels run circular.

. Ureter: Blood vessels run longitudinally.

Abdominal ureter should be mobilized medially.

Pelvic ureter should be mobilized laterally (receives its blood supply from

lateral side).

The ureter remains attached to the undersurface of the peritoneum when

the latter is reflected at surgery.

The stone is the best quide for the Ureter

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