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.
iltr- .3r ...*...,.".*&i[r6rye6dry
-.^.) They are in the para-vertebral gutter.
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
nephrectomy, we open the anterior surface.
- Stomach: between suprarenal, spleen & splenic a.
- Splenic flexure: below & Iateral.
-Small intestine: below & medial.
- Second part of duodenum: in front of hilum.
- Rt. colic flexure: below & lateral.
-Small intestine: below & medial.
- Rt. lobe of liver: above & lateral.
EeoCugur $rd |.fl grrbic Ftery
3) Quadratus lumborum: lower intermediate.
4) Transversus abdominis: lower lateral.
4,sltuctates separatinq muscles riar sq"r,f:?Oe of kidOe-y
2) 11'h & 12th ribs in Lt. kidney (only 12th rib in Rt.).
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.
> 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).
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.
{Sf.f .g. Gerota fascia encloses the kidney BUT NOT the adrenatgland.
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
F2 vertical lines: 3 & I cm from
) 2 horizontal lines: at level of T11
B. Anterior surface marking of the kidney:
- 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.
On the upper pole of the kidney.
{F o The Rt. suprarenalgland is pyramidat.
o The Lt. suprarenal gland is semi-lunar.
Blood suoolv: {f Afterial Supply:
- 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.
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
Sites Of Ureteric Constrictions
Diameter is 3 mm with 5 sites of cgnstrictions:
1 ) Pelvi-ureteric junction (L2).
2) Inlet of pelvis (bifurcation of common iliac).
o lt enters the pelvis by crossing in front of the bifurcation of common iliac artery
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.
It is 2 cm long, runs on oblique course in the bladder wall.
- 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
. 3 arteries: Rt. gonadal, Rt.
. 3 arteries: Lt. gonadal, upper
3 structures related to mesentry:
Identification Of Ureter In X-Ray
1. Tips of the transverse processes of lumbar vertebrae.
Identification durino ooeration
. Lies on psoas major & seen crossing:
. The bifurcation of common iliac.
It is not an artery: since the pulsations are not continuous but peristalsis.
. Psoas Minor: Flat shining tendon.
. Ureter: white cord-like (tubular).
. 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
The ureter remains attached to the undersurface of the peritoneum when
the latter is reflected at surgery.
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