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Anatomy of kidney and ureter, Lecture notes of Anatomy

Anatomy kidney and ureter with surface markings and relations and some clinical notes

Typology: Lecture notes

2016/2017

Uploaded on 04/30/2017

B.alharthi
B.alharthi 🇸🇦

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2. Anatomy of the Renal System
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RENAL
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Kidney: Anatomy
A. OVERVIEW
Bean-shaped
Right kidney is lower than left kidney
Kidneys are retroperitoneal in posterior abdominal region, extending levels T12 L3
Above each kidney is a suprarenal gland, separated from kidney by a layer of fascia
B. RELATIONSHIPS WITH OTHER STRUCTURES
Anterior surface of each kidney is related to numerous structures
(1) Directly OR (2) With an intervening layer of peritoneum
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RENAL

Kidney: Anatomy

A. OVERVIEW

 Bean-shaped  Right kidney is lower than left kidney  Kidneys are retroperitoneal in posterior abdominal region, extending levels T12 – L  Above each kidney is a suprarenal gland, separated from kidney by a layer of fascia

B. RELATIONSHIPS WITH OTHER STRUCTURES

 Anterior surface of each kidney is related to numerous structures (1) Directly OR (2) With an intervening layer of peritoneum

RENAL

 Posterior surface of each kidney is related to similar structures

C. RENAL FAT and FASCIA From innermost to outermost:

  1. Renal capsule
  2. Perinephric fat: - Extraperitoneal fat - Completely surrounds kidneys
  3. Renal fascia: - Membranous condensation of Extraperitoneal fascia
  4. Paranephric fat: - Accumulates posterior and posterolateral to kidneys

RENAL

 Renal artery divides into 5 separate Segmental arteries:

  • Supply different segments of kidneys
  • Do not anastomose with each other
  • I.e. Result in distinct vascular segmentation of kidney, with each being surgically resectable

 Renal vasculature follows the following pathway

RENAL

F. RENAL INNERVATION

  1. OUTPUT: Visceral efferent fibres  Sympathetic nervous system : via Renal plexus
    • Formed by filaments from: (1) Coeliac plexus (2) Aorticorenal ganglion (3) Aortic plexus
    • Joined by the least splanchnic nerve
    • Enter kidney alongside renal artery
    • Triggers renal vasoconstriction, reducing renal blood flow

Parasympathetic nervous system

  1. INPUT: Visceral afferent fibres  Parasympathetic nervous systemSensory Input :
    • Follow sympathetic fibres, entering spinal cord at T11-L

G. RENAL LYMPHATICS

Most renal lymphatic drainage is into Lumbar lymph nodes (which surround abdominal aorta)

RENAL

C. URETERIC VASCULATURE

Ureters receive arterial branches from adjacent vessels as they pass towards the bladder: (1) Upper end: Supplied by renal arteries (2) Middle part: Supplied by - abdominal aorta - testicular/ovarian arteries - common iliac arteries (3) In pelvic cavity: Supplied by internal iliac arteries

D. URETERIC INNERVATION

 Involves (1) Renal (2) Aortic (3) Superior Hypogastric (4) Inferior Hypogastric plexuses  Visceral efferent fibres : From sympathetic and parasympathetic sources  Visceral afferent fibres : Return to T11-L2 spinal cord I.e. Ureteric pain is referred to cutaneous area supplied by T11-L2, including:

  • Posterior & Lateral abdominal wall (below ribs and above iliac crest)
  • Pubic region - Scrotum in males/Labia majora in females
  • Proximal anterior aspect of the thigh

RENAL

SUPRARENAL GLANDS: ANATOMY

A. OVERVIEW

 Associated with superior pole of each kidney

 Structure: (1) Outer cortex (2) Inner medulla

 Right gland is pyramidal, left gland is semilunar and larger

 Suprarenal gland is surrounded by Perinephric fat , enclosed in Renal fascia

B. SUPRARENAL VASCULATURE

 Arterial Supply: Arises from 3 primary sources: (1) Superior suprarenal arteries : From Inferior phrenic arteries (2) Middle suprarenal artery: From Abdominal aorta (3) Inferior branches: From Renal arteries  Venous Drainage: (1) Right suprarenal vein: - Short - Almost immediately enters IVC (2) Left suprarenal vein: - Passes inferiorly to enter left renal vein

GLOSSARY

Resection: Surgical removal of structures, organs Retroperitoneal: Situated behind the peritoneum