THE ABDOMEN SUPRARENAL GLANDS KIDNEY URETERS URINARY BLADDER

THE ABDOMEN SUPRARENAL GLANDS KIDNEY URETERS URINARY BLADDER

THE SUPRARENAL GLANDS The suprarenal (adrenal) glands lie immediately superior and slightly anterior to the upper pole of either kidney. Golden yellow in colour, each gland possesses two funcfonally and structurally disfnct areas, an outer cortex and an inner medulla. The glands are surrounded by connecfve Fssue containing perinephric fat, enclosed within the renal fascia, and separated from the kidneys by a small amount of fibrous Fssue. The right gland is pyramidal in shape. The lek gland has a more semilunar form. At birth the glands are larger and are approximately one-third the size of the ipsilateral kidney.

THE SUPRARENAL GLANDS RIGHT SUPRARENAL GLAND lies posterior to the inferior vena cava, posterior to the right lobe of the liver anterior to the right crus of the diaphragm anterior to the superior pole of the right kidney Its inferior surface is referred to the anterosuperior aspect of the superior pole of the right kidney. LEFT SUPRARENAL GLAND The lek suprarenal gland lies closely applied to the lek crus of the diaphragm The anterior surface has a large superior area covered by peritoneum on the posterior wall of the lesser sac, which separates it from the cardia of the stomach and somefmes from the posterior aspect of the spleen.

ARTERIAL SUPPLY The suprarenal glands have an extensive vascular supply Each suprarenal gland is supplied by the: superior - from the inferior phrenic artery middle from the abdominal aorta inferior - from the renal arteries suprarenal arteries THE SUPRARENAL GLANDS VEINS - THE SUPRARENAL VEIN The right vein is very short, passing directly and horizontally into the posterior aspect of the inferior vena cava. The led suprarenal vein descends medially, anterior and lateral to the lek coeliac ganglion. It passes posterior to the pancreafc body and drains into the lek renal vein.

SUPRARENAL GLANDS KIDNEY URETERS URINARY BLADDER

THE KIDNEYS THE KIDNEYS They are situated posteriorly behind the peritoneum on each side of the vertebral column and are surrounded by adipose Fssue. Each kidney has anterior and posterior surfaces, medial and lateral margins, and superior and inferior poles. The lateral margin of each kidney is convex, and the medial margin is concave where the renal sinus and renal pelvis are located. Perinephric fat (perirenal fat capsule) surrounds the kidneys and their vessels as it extends into their hollow centers, the renal sinuses.

RELATIONS The right kidney is related to the liver, duodenum, and ascending colon. THE KIDNEYS The led kidney is related to the stomach, spleen, pancreas, jejunum, and descending colon. Superiorly, the posterior aspects of the kidneys are associated with the diaphragm The posterior surfaces of the kidney are related to the psoas major muscles medially, the quadratus lumborum muscle and aponeurosis of the transversus abdominis. At the hilum, the main hilar structures are the: renal vein (anterior), renal artery (intermediate) pelvis of the kidney (posterior).

THE KIDNEYS The kidney can be divided into an internal medulla and external cortex. The renal medulla consists of pale, striated, conical renal pyramids, their bases peripheral, their apices converging to the renal sinus. At the renal sinus, renal pyramids project into calyces as papillae. The renal cortex is subcapsular, arching over the bases of the pyramids and extending between them towards the renal sinus as renal columns.

THE KIDNEYS RENAL ARTERIES The paired renal arteries take about 20% of the cardiac output to supply organs that represent less than one-hundredth of total body weight. The renal arteries arise at the level of the IV disc between the L1 and L2 vertebrae THE RIGHT RENAL ARTERY The longer right renal artery passes posterior to the IVC. It is longer and oken higher, passing posterior to the: inferior vena cava, right renal vein, head of the pancreas, descending part of the duodenum.

THE LEFT RENAL ARTERY It is a lizle lower and passes behind the: lek renal vein, body of the pancreas, splenic vein. It may be crossed anteriorly by the inferior mesenteric vein. THE KIDNEYS THE RENAL ARTERIES Each artery divides close to the hilum into five segmental arteries that are end arteries.

THE KIDNEYS THE RENAL ARTERIES The segmental arteries do not anastomose significantly with other segmental arteries, so that the area supplied by each segmental artery is an independent, surgically resectable unit or renal segment. THE RENAL ARTERIES The segmental arteries are distributed to the renal segments as: superior (apical) segmental artery anterosuperior and antero-inferior segmental arteries inferior segmental artery posterior segmental artery

THE KIDNEYS THE RENAL VEINS The large renal veins lie anterior to the renal arteries and open into the inferior vena cava almost at right angles. The lek is three Fmes longer than the right and for this reason, the lek kidney is the preferred side for live donor nephrectomy. THE LEFT RENAL VEIN It runs from its origin in the renal hilum, posterior to the splenic vein body of pancreas, Then across the anterior aspect of the aorta, just below the origin of the superior mesenteric artery. The lek gonadal vein enters it from below and the lek suprarenal vein, usually receiving one of the lek inferior phrenic veins. THE RIGHT RENAL VEIN It is behind the descending duodenum and somefmes the lateral part of the head of the pancreas.

URINE: renal pyramids papilla (1) minor calyces (2-3) major calyces (2-3) renal pelvis apex of the renal pelvis is confnuous with the ureter. THE KIDNEYS

SUPRARENAL GLANDS KIDNEY URETERS URINARY BLADDER

THE URETER THE URETER is confnuous superiorly with the renal pelvis and opens into the base of the urinary bladder. In the abdomen the ureter descends posterior to the peritoneum on the medial part of psoas major. Anterior to psoas major it crosses in front of the genitofemoral nerve and is obliquely crossed by the gonadal vessels. It enters the lesser pelvis anterior to either the end of the common iliac vessels or at the origin of the external iliac vessels. THE URETER - MALES In males, the only structure that passes between the ureter and the peritoneum is the ductus deferens. The ureter lies posterolateral to the ductus deferens and enters the posterosuperior angle of the bladder, just superior to the seminal gland.

THE URETER THE URETER - FEMALES In females, the ureter passes medial to the origin of the uterine artery and passes close to the lateral part of the fornix of the vagina and enters the posterosuperior angle of the bladder. THE URETER The inferior vena cava is medial to the right ureter while the lek ureter is lateral to the aorta. THE URETER The ureters normally demonstrate relafve 3 constricnons: 1. At the juncfon of the ureters and renal pelves, 2. Where the ureters cross the brim of the pelvic inlet, 3. During their passage through the wall of the urinary bladder.

THE ARTERIAL SUPPLY The ureter is supplied by branches from the renal, gonadal, common iliac, internal iliac, vesical and uterine arteries, and abdominal aorta THE URETER THE VEINS OF URETERS Veins draining the abdominal part of the ureters drain into the renal and gonadal (tesfcular or ovarian) veins

THE URINARY BLADDER THE URINARY BLADDER The urinary bladder is a reservoir. Its size, shape, posifon and relafons all vary according to its content. The urinary bladder has a base (fundus), neck, apex, a superior and two inferolateral surfaces. When the bladder is empty, it lies enfrely in the lesser pelvis. In males the fundus is separated from the rectum centrally by only the fascial rectovesical septum and laterally by the seminal glands and ampullae of the ductus deferentes. In females the fundus is directly related to the superior anterior wall of the vagina. It is separated from these bones by the potenfal retropubic space (of Retzius).

THE URINARY BLADDER THE URINARY BLADDER It lies mostly inferior to the peritoneum, resfng on the pubic bones and pubic symphysis anteriorly and the prostate (males) or anterior wall of the vagina (females) posteriorly. The bladder neck is essenfally the internal urethral orifice, which lies in a constant posifon, independent of the varying posifons of the bladder and rectum. In males the neck rests on, and is in direct confnuity with, the base of the prostate. In females it is related to the pelvic fascia, which surrounds the upper urethra. The median umbilical ligament (urachus) ascends behind the anterior abdominal wall from the apex to the umbilicus, covered by peritoneum to form the median umbilical fold.

THE URINARY BLADDER THE URINARY BLADDER The bladder neck is held firmly by the lateral ligaments of bladder and the tendinous arch of the pelvic fascia - especially its anterior component, the puboprostafc ligament in males and the pubovesical ligament in females. The walls of the bladder are composed chiefly of the detrusor muscle. The muscle fibers form the involuntary internal urethral sphincter. Some fibers run radially and assist in opening the internal urethral orifice. The ureteric orifices and the internal urethral orifice are at the angles of the trigone of the bladder. THE ARTERIAL SUPPLY The bladder is supplied principally by the superior and inferior vesical arteries, from the internal iliac arteries.

THE URINARY BLADDER VEINS In males, the vesical venous plexus is confnuous with the prostafc venous plexus. In females, the vesical venous plexus envelops the pelvic part of the urethra and the neck of the bladder. NERVES The nerves supplying the bladder arise from the pelvic plexuses, which are a mesh of autonomic nerves and ganglia on the lateral aspects of the rectum, internal genitalia and bladder base. They consist of both sympathefc and parasympathefc components, each of which contains both efferent and afferent fibres.