KIDNEY

Anatomical location Size Shape Upper posterior part of abdominal cavity, on each side * right kidney is lower than the left kidney about 1-2 inches (presence of liver in the right side pushing right kidney lower down) 12 cm length x 6cm width x 3 cm thick (about the size of a clenched fist) - bean-shaped 2 borders - outer/lateral convex - inner/medial with 3 convexities (upper & lower are more convex) * depression at the middle of inner border hilum Structures present at the hilum -renal Vein (most anterior ) -renal Artery (in the middle) - renal Pelvis (most posterior) 2 poles 2 surfaces Vertebral level of the kidneys supine position - upper - anterior -lower -posterior

URINARY BLADDER = hollow muscular organ acting as a reservoir for urine infants & children up to 3 years it is an abdominal organ (due to small pelvis) children above 3 years up to adult age the bladder starts to enter the pelvic cavity adults it is a pelvic organ
In infant: Fusiform shape

In adults: (1) Distended bladder: it is spherical or ovoid in shape. (2)Empty bladder: it has a shape of tri-sided pyramid. 4 surfaces superior, two inferolateral, posterior (base 4 angles anterior (apex), inferior (neck) and two posterosuperior 3 attached tubular structures two ureters, urethra 1 ligament median umbilical ligament *each surface is triangle in shape

erect position full aspiration Surface anatomy of the kidney

- extend from T12 to L3 - hilum lies at L1 - upper pole (left side) : reaches the lower border of 11th rib (right side) : reaches upper border of the 12 rib descend about 1 inch (2.5cm) descend about 2-3 inches (5-8cm) within the pelvic cavity, urinary bladder is situated in the following position; 1. apex, facing anteriorly, related to the upper border of symphysis pubis 2. base, facing posteriorly

On the front of the abdomen upper 5 cm from midway between pole middle line plane of the lower end of body of the sternum + transpyloric plane hilum 5 cm from on the transpyloric plane middle line lower 7.5 cm from midway between pole middle line transpyloric plane + intertubercular planes On the back of the abdomen The rectangle of Morris is used: 2 vertical lines 2.5 cm and 9 cm from the midline respectively 2 horizontal lines drawn at spinous process of T11 and L3 respectively The hilum is 5 cm from the middle line at the level of the spinous process of the first lumbar vertebra (L1)

Anterior relation

(see diagram above) above hilum opposite hilum below hilum Right suprarenal, liver second part of doudenum small intestine and large intestine Left suprarenal, stomach and spleen splenic artery on top of pancreas small intestine and large intestine

Superior surface - covered by peritoneum and related to superior vesical artery and coils of ileum - other relations differ between males and females males females - rectovesical pouch of peritoneum - uterovesical pouch of peritoneum, - pelvic colon - anterior wall of fundus and body of uterus. Inferolateral surface anteriorly - pubic bone - retropubic space [fat + ligament; pubovesical (female) or puboprostatic (male)] Posterior surface (base of bladder) males - rectum - 2 ampulla of vas deferens - 2 seminal vesicles - Rectovesical pouches of peritoneum (to the uppermost part of the base)

Posterior relation

posteriorly - obturator internus muscle - obturator vessels and nerve - levator ani muscle

females - vagina - anterior vaginal fornix - cervix

4 muscles 1. Diaphragm. 2. Psoas major. 3. Quadratus lumborum. 4. Transversus abdominis

4 structures 1. Subcostal vessels. 2. Subcostal nerve. 3. Iliohypogastric nerve. 4. Ilioinguinal nerve.

Peritoneal covering

The kidney is a retroperitoneal structure.

Angles of Urinary Bladder anterior (apex) attached to the median umbilical ligament (obliterated urachus which is a tubular structure present during development of the bladder and become fibrosed in adult age) * other end of median umbilical ligament is attached to umbilicus - lies 1 inch behind the lower border of symphysis pubis - urethra gets exit from this point. - surrounded by the base of the prostate in males and pelvic fascia in females ureters enter the baldder at these angles

inferior (neck)

2 posterosuperior

Bare areas of the kidneys = (areas not covered by the peritoneum) are the white areas in diagram. areas related to are covered by -liver peritoneum of the greater sac -small intestine on both sides -stomach on left side peritoneum of the lesser sac -spleen Renal Capsule Fibrous (true) Fatty (perinephric fat) Fascial (Renal fascia) intimately adherent to the kidney tissue fat surrounding the fibrous capsule - It is a condensation of the areolar tissue between the peritoneum and the posterior abdominal wall -surrounds the perinephric fat

Ligaments attached to bladder to apex median umbilical ligament to neck ligament anterior attachment posterior attachment pubovesical posterior surface of - neck of bladder (female) body of pubic bone, - upper urethra near the midline puboprostatic - neck of bladder (male) - base of prostate tp posterosuperior angle lateral ligament of the urinary bladder * is a dense pelvic fascia, extending from lateral pelvic wall to the two posterosuperior angles Fascia surrounding the bladder vesical fascia - loose areolar CT surrounding the bladder - allow bladder distension - a part of pelvic fascia Peritoneal relation of bladder

Attachments of renal fascia superiorly inferiorly medially laterally blends with subdiaphragmatic fascia anterior and posterior layers joins together to close the space blends with the fascia over the renal vessels blends with fascia transversalis

1. In empty bladder : - peritoneum covers the superior surface - in males it covers additionally the upper 1/2 inch of the base of the bladder 2. in full bladder : * urinary bladder ascends upwards towards abdominal cavity, peeling off the peritoneum from anterior abdominal wall and the side wall of pelvis uribary bladder will be in direct relation to anterior abdominal wall

Clinical importance of renal fascia: 1) Sudden loss of weight may cause descent (ptosis) of the kidney. 2) Pus spread does not occur downward due to obliteration of the space inferiorly.

Arterial supply

renal artery (from abdominal aorta at the level of L2)

Venous drainage

renal vein drains to the IVC para-aortic lymph nodes at L2 (origin of the renal artery) Sympathetic plexus surrounding renal artey from T12 and L1 Parasympathetic from vagus nerve and reach the kidney *renal pain is referred to the dermatomes of the T12 and L1 segments (lumbar region and radiating to the anterior abdominal wall and external genitalia)

Lymph drainage Nerve supply

1. superior vesical the superior surface. 2. inferior vesical (in males) or vaginal (in females), the base and trigone. 3. middle rectal (in males) 4. obturator 5. inferior gluteal vesical venous plexus (surrounding the bladder) drains to the vesicoprostatic venous plexus (surrounding the vesicoprostatic groove) drain to the internal iliac vein lymphatic vessels travel with BVs internal iliac lymph nodes para-aortic lymph nodes 1. motor supply: Sympathetic preganglionic nerve cells lie in the L1,2 spinal cord segments Parasympathetic from S2,3,4 nerves and reach the ureter through pelvic splanchnic nerves 2. sensory supply: urinary bladder pain is carried by afferent pain nerve fibers, which ascends with the sympathetic system * referred pain is felt in the dermatome of L1,2 (pubic region, groin, anterior external genital area and anterior thigh) The Interior of bladder In empty bladder, the mucosa is thick and has folds (rugae) In full bladder, it is thin and smooth Trigone: - a triangular area, can be seen in the mucosa of the posterior wall of the bladder, between three openings; 2 ureters and internal urethral meatus - has smooth surface even in empty bladder, due to its embryonic origin (mesoderm not endoderm like other mucosa) - more vascular, sensitive and elastic than other mucosa - contains special smooth muscle called superficial trigonal muscle that: may help in closure of ureteric orifice during bladder contraction extends to the proximal part of urethra in both sexes Factors preventing urine reflux to the ureter during bladder contraction: - Very oblique course of the intramural part of the ureter. - Valve like flap of mucosa at ureteric orifice. Interureteric bar: - it is raised transverse ridge between the two ureteric orifices Uvula vesicae: - it is a small rounded elevation that lies immediately behind internal urethral opening - caused by protrusion of underlying middle lobe of the prostate

Kidney segmentation

- segmentation of the kidney according to its blood supply. - 5 segments: apical, anterior superior, anterior inferior, posterior and inferior segments