Last's Anatomy (MRCS Study Guides) by Sinnatamby Chummy S

Author:Sinnatamby, Chummy S. [Sinnatamby, Chummy S.]
Language: eng
Format: epub
ISBN: 9780702033957
Publisher: Elsevier Health
Published: 2011-04-18T23:00:00+00:00

Figure 5.48 Relationship of the pleural sacs to the upper poles of the kidneys, from behind. The ureters lie medial to the tips of the lumbar transverse processes.

The suprarenal glands surmount the superior poles of both kidneys and overlap a small part of their anterior surfaces. The rest of the upper halves of each kidney lie in contact with peritoneum, which on the right kidney is the peritoneum of the hepatorenal pouch (part of the greater sac), and on the left is the peritoneum of the lesser sac (part of the stomach bed) medially, and the peritoneum of the greater sac laterally (between the kidney and the spleen), with the splenorenal ligament passing forwards between these areas (Fig. 5.49). The hilum is separated from the peritoneum, on the right side by the second part of the duodenum and on the left side by the body of the pancreas and splenic vessels (Fig. 5.26). The lateral part of the lower pole is separated from peritoneum by the hepatic and splenic flexures of the colon on the right and left sides respectively. The medial part of the lower pole, on each side, lies in contact with peritoneum which separates it from coils of jejunum; between peritoneum and kidney are ascending branches of the right and left colic arteries.

The perinephric fat lies outside the renal capsule (Fig. 5.49) and plays a part in retaining the kidney in position. Nephroptosis (‘floating kidney’) may develop after severe loss of weight. The renal fascia (of Gerota) surrounds the perinephric fat. It is not a very obvious membrane in the living, but appears more convincingly in the embalmed cadavre. It is a condensation of the areolar tissue between the parietal peritoneum and the posterior abdominal wall and restrains the extension of a perinephric abscess. It ascends as a dome over the upper pole of the kidney and the suprarenal. However, a fascial septum separates the two organs, which explains why in nephrectomy the latter gland is not usually displaced (or even seen). At the lateral renal border the anterior and posterior layers fuse, while at the hilum the fascia is attached to the renal vessels and the ureter. When traced downwards, the fascia fades into the extraperitoneal tissue around the ureter. Pus in the perinephric space and injections into it do not usually track downwards, but increasing pressure may force the fascia to rupture and allow such contents to flow downwards retroperitoneally towards the pelvis.

The renal pelvis is the funnel-shaped commencement of the ureter, and is normally the most posterior of the three main structures in the hilum (though an arterial branch or venous tributary may lie behind it). The capacity of the average pelvis is less than 5mL.

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