Anatomy of the Kidney PDF

ANATOMY OF THE KIDNEY  Objectives: Describe anatomy of the kidneys regarding their shape, surfaces, borders and state factors of fixation. Describe the relations of the kidneys Describe the blood supply, lymphatic drainage and nerve supply of kidneys List and locate vascular segmen...

ANATOMY OF THE KIDNEY  Objectives: Describe anatomy of the kidneys regarding their shape, surfaces, borders and state factors of fixation. Describe the relations of the kidneys Describe the blood supply, lymphatic drainage and nerve supply of kidneys List and locate vascular segments of the kidneys and explain its clinical significance. Describe the surface anatomy of the kidney. State location and formation of the renal angle. Identify the side of right and left kidneys List the coverings of the kidneys and describe renal fascia and mention the clinical significance of the latter Size: -It is one on each side (12x6x3 cm) Position: - It lies in the posterior abdominal wall -It extends from T.V 12……L.V 3 -The right kidney is lower than the left due to the presence of the liver -It is a retroperitoneal structure Hilum: It is the point of entry and exit of the renal vessels and ureter, it contains: 1.Renal vein (anterior) 2.Renal artery (intermediate) 3.Renal pelvis ( posterior & directed downwards) Sinus of the kidney: A central recess occupied by renal vessels and renal pelvis Identification of the side: 1.The hilum is directed medially 2.The renal vessels are anterior to the renal pelvis 3.The renal pelvis is directed downwards Borders: 1.Lateral border convex 2. medial border convex and has the concave hilum in its middle Surfaces: 1. anterior surface 2. posterior surface Relations of the anterior surface of the right kidney: -Right suprarenal gland (anterior to upper pole and upper part of the medial border) -2nd part duodenum (anterior to the medial border and hilum) -Right lobe of the liver (wide area lateral to the duodenum and below the suprarenal) -Right colic flexure (lower& lateral part) -Coils of small intestine and ascending branch of right colic artery (lower& medial part) Relations of the anterior surface of the left kidney: - Left suprarenal gland (anterior to upper pole and upper part of the medial border) - Spleen (at the upper part of the lateral border) - Body of the pancreas and splenic vessels (middle part of the anterior surface) - Stomach (triangular area bounded by the spleen, left suprarenal & pancreas) - Descending colon (lower part of the lateral border) - Coils of small intestine and ascending branch of left colic artery (lower & medial part) Relations of the posterior surface of the kidneys I: four muscles -Diaphragm (behind the upper pole and separates the kidney from pleura) (on right side, it separates the kidney from the last rib and last intercostal space. On the left side, it separates the kidney from the last rib, last intercostal space& eleventh rib) -Psoas major muscle( behind medial part) -Quadratus lumborum muscle( behind the intermediate part) -Transversus abdominis muscle(behind the lateral part) II: four neurovascular Lt structures: -They lie between posterior surface of the kidney& quadratus lumborum muscle from above downwards: -Subcostal vessels Rt -Subcostal nerve -Iliohypogastric nerve -Ilioinguinal nerve Coverings of the kidney: -the kidney is surrounded by four coverings from inside outwards: 1.True capsule: which is closely applied to the kidney 2.Fatty capsule: which is the peri-nephric fat 3.Fascial capsule (renal fascia) which is a thick sheet of connective tissue 4. Para-renal fat (paranephric fat): It is condensation of retro-peritoneal fat situated behind the kidney. Stability of the kidney: 1. Attachments of the renal fascia to the capsule of the kidney by numerous trabeculae. This fascia is also attached to: Upwards: to the diaphragmatic fascia Medially: to the fascia covering psoas major muscle and CT in front of abd. Aorta and IVC. 2. Apposition of the neighboring viscera. 3- Vessels of the kidney 4- Intra-abdominal pressure Longitudinal section of the kidney Blood supply: A. Arterial supply: -The renal artery arises from abdominal aorta at right angle at level of L.V 2, at the hilum it divides into anterior and posterior divisions, each one gives a number of segmental arteries, each segmental artery gives a number of lobar arteries B. Venous drainage: -The kidney is drained by veins corresponding to the arteries -They finally collect to form the renal veins which drain in the inferior vena cava Lymphatic drainage: Into para-aortic LNs Vascular segments of the kidney: Apical Superior Middle Inferior Posterior Anterior division of renal artery divides into branches to apical, superior, middle and inferior segments Posterior division supplies the posterior segment There is a relatively avascular plane between the posterior segment and other segments called bloodless line of Brodel Nerve Supply of the kidney The nerve supply is through the renal plexus. The plexus extends around the branches of the renal artery to the glomeruli, nephrons and tubules. Its main fibers are sympathetic which are vasomotor. The afferent sympathetic fibers that travel through the renal plexus enter the spinal cord in the T10 to T12th thoracic nerves. Surface anatomy: Anterior surface anatomy: Upper end: at a point midway between the xiphi-sternum and trans-pyloric plane (one inch from midline Hilum: the hilum of the left kidney lies on the trans-pyloric plane 2 inches from the midline, but the hilum of the right kidney is ½ inch lower Lower end: it lies on the subcostal plane 3 inches from the midline Surface anatomy: Posterior surface anatomy (Morris’s parallelogram): -the kidney lies in a rectangular area on the posterior abdominal wall which is bounded by: Upper horizontal line: at the level of spine of T.V 11 Lower horizontal line: at the level of the spine of L.V 3 Medial vertical line: 1 inch lateral to the median plane Lateral vertical line: 3.5 inches lateral to the median plane -In this position the lower pole of the kidney lies 1 inch above the iliac crest  Renal angle An area located on either side of the human back between the lateral borders of the erector spinae muscles and inferior borders of the twelfth rib, so called because the kidney can be felt at this location. Tenderness at the renal angle is suggestive of a renal pathology.