ANATOMY LECTURE- DOC CHIU
RETROPERITONEAL SPACE
- Lies on the posterior abdominal wall behind the
parietal peritoneum
- Extends to the 12th thoracic vertebra
- 12th rib to the sacrum and the iliac crest below
- Posterior wall of the space is formed from:
o medial to lateral by the psoas and
o quadratus lumborum muscles
o origin of the transversus abdominis muscle.
- Each of these muscles is covered on the anterior
surface by the definite layer of fascia
- IN FRONT of the fascial layers is a variable amount of
FATTY CONNECTIVE TISSUE that forms a bed for the
o Suprarenal glands
o Kidneys
o Ascending and descending parts of the colon
o Duodenum
- Also contains the:
o Ureters
o Renal blood vessels
o Gonadal blood vessels
URINARY TRACT
- Two kidneys function to excrete most of the waste
products of metabolism
- Play a major role:
o Controlling the water
o Electrolyte balance within the body
o Maintaining the acid-base balance of the
blood.
- Waste products leave the kidney as URINE
- URINE
o Passess down the ureters to the urinary
bladder located within the pelvis
o Urine leaves the body in the urethra
KIDNEYS
- Reddish brown
- lie behind the peritoneum high up on the posterior
abdominal wall on either side of the vertebral column
- RIGHT KIDNEYS lies slightly lower than the left kidney
o because of the large size of the right lobe of
the liver.
- Medial concave border of each kidney is a vertical slit
that is bounded by thick lips of the renal substance
and is called the hilum.
- The hilum extends into a large cavity called the renal
sinus
- The hilum transmits, from the front backward, the
renal vein, two branches of the renal artery, the
URETER
COVERINGS OF THE KIDNEY
- The kidneys have the following coverings:
- FIBROUS CAPSULE
o Surrounds the kidney and is closely applied
to its outer surface
- PERIRENAL FAT
o covers the fibrous capsule
- RENAL FASCIA
o Condensation of connective tissue that lies
outside the perirenal fat
o Encloses the kidney and suprarenal glands
o Continuous laterally with the fascia
transversalis
- PARARENAL FAT
o Lies ecternal to the renal fascia and is often
in large quantity
o Forms part of the retroperitoneal fat
- The perirenal fat, renal fascia, and pararenal fat
support the kidneys and hold them in position on the
posterior abdominal wall.
 LEFT KIDNEY

- ANTERIORLY
o Suprarenal glands
o Spleen
o Stomach
o Pancreas
o Left colic flexure
o Coils of jejunum
- POSTERIORLY
o Diaphragm
o Costodiaphragmatic recess of the pleura
o 11TH and 12th ribs
o Psoas
o Quadratus lumborum
RENAL STRUCTURE o Transversus abdominis muscle

- RENAL SINUS-
o which is the space within the hilum
- RENAL PELVIS
o contains the upper expanded end of the
ureter, the RENAL PELVIS
o Divides into two or three MINOR CALYCES
o Each minor calyx is indented by the apex of
the renal pyramid, the RENAL PAPILLA

RIGHT KIDNEY

- ANTERIORLY:
o Suprarenal gland ARTERIES
o Liver
- RENAL ARTERY
o Second part of the duodenum
o Arises from the aorta
o Right colic flexure
o Level of the 2nd LUMBAR VERTEBRA
- POSTERIORLY
o Each renal artery:
o Diaphragm
 Divides into 5 segmental arteries
o Costodiaphragmatic recess of the pleura
that enter the hilum of the kidney
o 12th rib
o Distributed to different segments or areas of
o Psoas
the kidney
o Quadratus lumborum
- LOBAR ARTERY
o Transversus abdominis muscle
o Arise from each segmental artery
o One for each renal pyramid
 o Before entering the renal substance, each RENAL PELVIS
lobar artery gives off  INTERLOBAR
- Funnel shaped expanded upper end of the ureter.
ARTERIES
- Lies within the HILUM of the kidney
- INTERLOBAR ARTERIES
- Receives the MAJOR CALYCES
 Run toward the cortex on each side
of the renal pyramid BLOOD SUPPLY OF THE URETER

- ARCUATE ARTERIES - ARTERIES

o Originates from the INTERLOBAR ARTERIES o Upper end: Renal Artery
o Arch over the bases of the pyramids o Middle portion: Testicular or Ovarian Artery
o ARCUATE ARTERIES  INTERLOBULAR o Lower portion: Superior vesical artery
ARTERIES
o INTERLOBULAR ARTERIES- ascend in the - VEINS
cortex o Venous blood drains into the veins that
o AFFERENT GLOMERULAR ARTERIOLES corresponds to the arteries
 Arise as branches of the
LYMPH DRAINAGE OF THE URETER
interlobular arteries
- Lateral aortic nodes
VEIN
- Iliac nodes
- RENAL VEIN
NERVE SUPPLY OF THE URETER
o Emerges from the hilum in front of the renal
artery - Renal
o Drains into the inferior vena cava - Testicular ( or Ovarian)
- Hypogastric plexuses (in the pelvis)
LYMPHATICS
SUPRARENAL GLANDS
- Drains to the lateral aortic lymph nodes around the
origin of the renal artery - 2 suprarenal glands are yellowish retroperitoneal
organs that lie on the UPPER POLES OF KIDNEY
NERVE SUPPLY
- Surrounded by the RENAL FASCIA
- Renal sympathetic plexus - Separated from the kidneys by the PERIRENAL FAT
- Afferent fibers that travel through the renal plexus  - Each gland has
enter the spinal cord in the 10th, 11th, and 12th thoracic o yellow cortex
nerves o brown medulla
- Cortex of the suprarenal glands secretes HORMONES
URETER - Hormones included:
o Mineral corticoids
- Two ureters are muscular tubes that extend
 Concerned on the control of fluid
- from the kidneys  posterior surface of the urinary
and electrolyte balance
bladder.
o Glucocorticoids
- Urine is propelled along the ureter by the peristaltic
 Concerned with the control of the
contractions of the muscle coat, assisted by the
metabolism of carbohydrates, fat,
filtration pressure of the glomeruli.
and proteins
- Measures about 10 inches (25 cm)
o Sex Hormones (small amount)
- Resembles esophagus in having 3 constrictions along
 Play a role in the prepubertal
its course where:
development of the sex organs
o Renal pelvis joins the ureter
o Kinked as it crosses the pelvic brim
- MEDULLA of the SUPRARENAL GLANDS
o Pierces the bladder wall
o Secretes:
- Emerges from the hilum of the kidney
 Cathecolamines
- Runs vertically downward behind the parietal
 Epinephrine
peritoneum
 Norepinephrine
- Ureter enters the pelvis by crossing the bifurcation of
the COMMON ILIAC ARTERY in front of the RIGHT SUPRARENAL GLAND
SACROILIAC JOINT
- Pyramidal in shape
 - Caps the upper pole of the right kidney - Composed of FIVE LATERAL ABDOMINAL WALL
- Lies behind the right lobe of the LIVER BRANCHES
- Extends medially behind the INFERIOR VENA CAVA o Inferior phrenic artery
- Rest posteriorly on the diaphragm o Four lumbar arteries
- THREE TERMINAL BRANCHES
LEFT SUPRARENAL GLAND
o Two common Iliac arteries
- Crescentic in shape o Median sacral artery
- Extends along the medial border of the left kidney
from the upper pole of the hilus - COMMON ILIAC ARTERIES
- Lies behind the pancreas o Right and left common iliac arteries-
- Rest posteriorly on the diaphragm terminal branches of the AORTA
o Arise at the L4
ARTERIES OF THE SUPRARENAL GLAND o Run downward and laterally along the
medial border of the psoas muscle
- Inferior phrenic artery
- Aorta
- EXTERNAL ILIAC ARTERY
- Renal artery
o Runs along the medial border of the psoas
VEINS OF THE SUPRARENAL GLAND o Follows the pelvic br4im
o Gives off
- Single vein emerges from the hilum of each gland  Inferior epigastric
- Drains into the IVC on the RIGHT  Deep circumflex iliac
- Drains into the RENAL VEIN on the LEFT o Enters the thigh by passing under INGUINAL
LYMPH DRAINAGE OF THE SUPRARENAL GLAND LIGAMENT
o Passes upward and medially along the
- Lateral aortic nodes medial margin of the deep inguinal ring and
enters the rectus sheath behind the rectus
NERVE SUPPLY OF THE SUPRARENAL GLAND
abdominis muscle.
- Preganglionic sympathetic fibers
o Derived from the SPLANCHNIC NERVES - INTERNAL ILIAC ARTERY
o Some nerves end at the medulla of the gland o Passess down into the pelvis to the upper
margin of the greater sciatic foramen
AORTA o it divides into anterior and posterior
- Enters the abdomen through the aortic opening of divisions
the diaphragm o Branches of this division supply the:
- Enters in front of the 12th thoracic vertebra  pelvic viscera
- Descends behind the peritoneum on the anterior  the perineum
surface of the bodies of the LUMBAR VERTEBRAE  the pelvic walls
- At the level of the 4th lumbar vertebra  buttocks
o Divides into 2 common iliac arteries
o RIGHT SIDE
 INFERIOR VENA CAVA
 CISTERNA CHYLI
 Beginning of the AZYGOUS VEIN
o LEFT SIDE
 LEFT SYMPHATETIC TRUNK
- Composed of THREE ANTERIOR VISCERAL BRANCHES
o Celiac artery
o Superior Mesenteric Artery
o Inferior Mesenteric Artery
- Composed of THREE LATERAL VISCERAL
o Suprarenal artery
o Renal artery
o Testicular or Ovarian Artery

VEINS ON THE POSTERIOR ABDOMINAL WALL
INFERIOR VENA CAVA
- conveys most of the blood from the body below the
diaphragm to the right atrium of the heart
- formed by the union of the COMMON ILIAC VEINS
behind the RIGHT COMMON ILIAC ARTERY at L5
- ascends on the right side of the aorta, pierces the
central tendon of the diaphragm at T8
- drains into the right atrium of the heart.
TWO ANTERIOR VISCERAL TRIBUTARIES
- hepatic veins
THREE LATERAL VISCERAL TRIBUTARIES
- Behind the neck of the pancreas
- Joins the splenic vein to form the portal vein
- Receives tributaries that correspond to the branches
of the superior mesenteric artery
- Also receives the inferior pancreaticoduodenal vein
and the right gastro-epiploic vein.
PORTAL VEIN
- 2 inches long
- Formed behind the neck of the pancreas by the union
of the superior mesenteric and splenic veins
LYMPH NODES
- Closely related to the aorta
- Form a preaortic and right and left lateral aortic (para-
aortic or lumbar) chain

- Right suprarenal vein LATERAL AORTIC LYMPH NODES

o Left vein drains into the left renal vein
- Drain lymph from:
- Renal veins
o the kidneys and suprarenals
- Right testicular or ovarian vein
o testes in males
o Left vein drains into the left renal vein
o ovaries in females
INFERIOR MESENTERIC VEIN o uterine tubes
o fundus of the uterus
- Tributary of the portal circulation o deep lymph vessels of the abdominal walls
- Begins halfway down the anal canal as the superior o common iliac nodes
rectal vein - efferent lymph vessels form the right and left lumbar
- Passes up the posterior abdominal wall on the left trunks
side of the INFERIOR MESENTERIC ARTERY and the
duodojejunal flexure and joins the splenic vein behind THORACIC DUCT
the pancreas
- commences in the abdomen as an elongated lymph
- Receives tributaries that correspond to the branches
sac called CISTERNA CHYLI
of the artery
- Lies below the diaphragm, in front of the first 2
SPLENIC VEIN LUMBAR VERTEBRAE and on the right side of the
aorta
- Tributary of the portal circulation - CISTERNA CHYLI
- Begins at the hilum of the spleen o Receives the:
- Union of several veins and is then joined by the short  intestinal trunk
gastric and left gastroepiploic pancreas  the right and left lumbar trunks
- Passes to the right within the SPLENICORENAL  small lymph vessels that descend
LIGAMENT and runs behind the pancreas from the lower part of the thorax
- Joins the superior mesenteric vein behind the neck of
the pancreas to form the portal vein. LUMBAR PLEXUS
- Joined by veins from the pancreas and the inferior
- one of the main nervous pathways
mesenteric vein.
- supplies the lower limb
SUPERIOR MESENTERIC VEIN - formed in the psoas muscle
- from the anterior rami of the upper four lumbar
- Tributary of the portal circulation nerves
- Begins in the ileocecal junction and runs upward on
the posterior abdominal wall within the root of the
mesentery of the small intestine and on the right side
of the superior mesenteric artery
- Passes in front of the third part of the duodenum