KIDNEY URINARY BLADDER = hollow muscular organ acting as a reservoir for urine

Anatomical Upper posterior part of abdominal cavity, on each side infants & children up to 3 years it is an abdominal organ (due to small pelvis)
location * right kidney is lower than the left kidney about 1-2 inches children above 3 years up to adult age the bladder starts to enter the pelvic cavity
(presence of liver in the right side  pushing right kidney lower down) adults it is a pelvic organ
Size 12 cm length x 6cm width x 3 cm thick (about the size of a clenched fist)
Shape - bean-shaped
2 borders - outer/lateral convex In infant: Fusiform shape
- inner/medial with 3 convexities (upper & lower are more
convex)
* depression at the middle of inner border  hilum In adults:
Structures present at the hilum (1) Distended bladder: it is spherical or ovoid in shape.
-renal Vein (most anterior ) (2)Empty bladder: it has a shape of tri-sided pyramid.
-renal Artery (in the middle) 4 surfaces superior, two inferolateral, posterior (base
- renal Pelvis (most posterior) 4 angles anterior (apex), inferior (neck) and two posterosuperior
3 attached tubular structures two ureters, urethra
2 poles - upper -lower 1 ligament median umbilical ligament
2 surfaces - anterior -posterior *each surface is triangle in shape

Vertebral level
of the kidneys supine - extend from T12 to L3
position - hilum lies at L1
- upper pole
(left side) : reaches the lower border of 11th rib
(right side) : reaches upper border of the 12 rib
erect position descend about 1 inch (2.5cm)
full aspiration descend about 2-3 inches (5-8cm)

Surface On the front of the abdomen within the pelvic cavity, urinary bladder is situated in the following position;
anatomy of the upper 5 cm from midway between 1. apex, facing anteriorly, related to the upper border of symphysis pubis
kidney pole middle line plane of the lower end of body of the 2. base, facing posteriorly
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 (see diagram above) Superior surface
relation Right Left - covered by peritoneum and related to superior vesical artery and coils of ileum
above hilum suprarenal, liver suprarenal, stomach - other relations differ between males and females
and spleen males females
opposite second part of splenic artery on top of - rectovesical pouch of peritoneum - uterovesical pouch of peritoneum,
hilum doudenum pancreas - pelvic colon - anterior wall of fundus and body of uterus.
below hilum small intestine and small intestine and
large intestine large intestine Inferolateral surface
anteriorly posteriorly
Posterior - pubic bone - obturator internus muscle
relation - retropubic space [fat + ligament; - obturator vessels and nerve
pubovesical (female) or puboprostatic (male)] - levator ani muscle

Posterior surface (base of bladder)

males females
- rectum - vagina
- 2 ampulla of vas deferens - anterior vaginal fornix
- 2 seminal vesicles - cervix
- Rectovesical pouches of peritoneum
(to the uppermost part of the base)

4 muscles 4 structures
1. Diaphragm. 1. Subcostal vessels.
2. Psoas major. 2. Subcostal nerve.
3. Quadratus lumborum. 3. Iliohypogastric nerve.
4. Transversus abdominis 4. Ilioinguinal nerve.
Peritoneal The kidney is a retroperitoneal structure. Angles of Urinary Bladder
covering
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
inferior (neck) - 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
2 posterosuperior ureters enter the baldder at these angles

Ligaments attached to bladder

Bare areas of the kidneys to apex median umbilical ligament
= (areas not covered by the peritoneum) are the white areas in diagram. to neck ligament anterior attachment posterior attachment
areas related to are covered by pubovesical posterior surface of - neck of bladder
-liver peritoneum of the greater sac (female) body of pubic bone, - upper urethra
-small intestine on both sides puboprostatic near the midline - neck of bladder
-stomach on left side peritoneum of the lesser sac (male) - base of prostate
-spleen tp posterosuperior angle lateral ligament of the urinary bladder
* is a dense pelvic fascia, extending from lateral pelvic wall to the
Renal Capsule Fibrous (true) intimately adherent to the kidney tissue two posterosuperior angles
Fatty (perinephric fat) fat surrounding the fibrous capsule
Fascial (Renal fascia) - It is a condensation of the areolar tissue Fascia surrounding the bladder
between the peritoneum and the posterior  vesical fascia
abdominal wall - loose areolar CT surrounding the bladder
-surrounds the perinephric fat - allow bladder distension
- a part of pelvic fascia
Attachments of renal fascia
Peritoneal relation of bladder
superiorly blends with subdiaphragmatic fascia
inferiorly anterior and posterior layers joins together to close the space 1. In empty bladder :
medially blends with the fascia over the renal vessels - peritoneum covers the superior surface
laterally blends with fascia transversalis - in males it covers additionally the upper 1/2 inch of the base of the bladder

Clinical importance of renal fascia: 2. in full bladder :

1) Sudden loss of weight may cause * urinary bladder ascends upwards towards abdominal cavity, peeling off the peritoneum from
 descent (ptosis) of the kidney. anterior abdominal wall and the side wall of pelvis
2) Pus spread does not occur downward  uribary bladder will be in direct relation to anterior abdominal wall
 due to obliteration of the space inferiorly.
Arterial supply renal artery (from abdominal aorta at the level of L2) 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
Venous drainage renal vein  drains to the IVC vesical venous plexus (surrounding the bladder)  drains to the vesicoprostatic venous plexus
(surrounding the vesicoprostatic groove)  drain to the internal iliac vein
Lymph drainage para-aortic lymph nodes at L2 (origin of the renal artery) lymphatic vessels travel with BVs internal iliac lymph nodes  para-aortic lymph nodes
Nerve supply 1. motor supply:
Sympathetic plexus surrounding renal artey from T12 and L1 Sympathetic preganglionic nerve cells lie in the L1,2 spinal cord segments
Parasympathetic from vagus nerve and reach the kidney Parasympathetic from S2,3,4 nerves and reach the ureter through pelvic splanchnic nerves
*renal pain is referred to the dermatomes of the T12 and L1 segments
(lumbar region and radiating to the anterior abdominal wall and external 2. sensory supply: urinary bladder pain is carried by afferent pain nerve fibers, which ascends with
genitalia) the sympathetic system
* referred pain is felt in the dermatome of L1,2
(pubic region, groin, anterior external genital area and anterior thigh)
Kidney - segmentation of the kidney according to its blood supply. The Interior of bladder
segmentation - 5 segments: In empty bladder, the mucosa is thick and has folds (rugae)
apical, anterior superior, anterior inferior, posterior and inferior segments 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