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IE URO-GENITAL SYSTEM.

By A. FRANCIS Dixon.

THE URINARY ORGANS.

ys, or glands which secrete the urine, are a pair of almost symmetric| organs, situated in the posterior part of the abdominal cavity, one de of the lower movable portion of the vertebral column. The fluid, creted by the kidneys is received into the upper expanded portions of ong tubes, the ureters, and by them it is conducted to the bladder, laced within the pelvic cavity. From the bladder the urine is passed, turition, along a passage called the urethra to the exterior. În the ethra is a relatively long passage, and traverses the prostate gland and ength of the penis; in the female it is a short tube, and opens on the above the vaginal orifice.

THE KIDNEYS. aney (ren), when removed from a fresh subject, presents a bean-shaped t is of a dark brown-red colour, and is surrounded by a thin glistening

tunica fibrosa, which gives to the whole organ a uniformly smooth he kidney is not a solid body, but contains a cavity called the sinus opening into which, termed the hilum renale, is situated on the medial r part of the organ. Each kidney measures about 41 inches in length,

width, and about 14 inches in thickness, and is placed so that its s nearly vertical. The weight of the adult kidney is about 41

the freshly removed kidney the superior and inferior ,ends are unded, and the extremitas superior or superior end is usually a little than the extremitas inferior or inferior end. The margo lateralis or er, which is opposite the hilum, is rounded and convex, while the lis or medial border, on which the hilum is placed, is concave from above

These two borders separate the facies anterior or anterior surface es posterior or posterior surface of the kidney. sule, which envelops the whole organ, divides in the region of the two layers, one of which is continued over the lips of the hilum terior of the kidney, and lines the walls of the renal sinus. yer is prolonged to form a tubular sheath for the vessels and nerves zy before they pass through the hilum to enter the sinus, within break up into branches. These branches, piercing the wall of the the substance of the kidney. The upper expanded portion of the the sinus, through the hilum, in company with the blood vessels and of the Kidneys.—The precise level of the kidney in the abdominal ject to a considerable amount of variation, and, further, it is usual to ence in the level of the right and left kidney in the same individual. htly the left kidney is on a somewhat higher level than the right,

cases the kidneys are found to occupy the same level, or, the more on being reversed, the right kidney is a little higher than the left.

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If a line is drawn round the body at the level of the lowest part of the thoracic wall, the whole, or almost the whole, of the left kidney will be found to lie above the level of the subcostal plane so determined. It is, therefore, situated in the subcostal zone of the abdominal cavity. The right kidney, however, although it lies for the most part in the subcostal zone, usually projects at its inferior part somewhat below the subcostal plane, and hence lies to some extent in the umbilical zone. It is often stated that the kidneys are placed on a somewhat lower level in the female than in the male subject.

By far the greater part, usually two-thirds or more, of the kidney lies to the medial side of a line drawn vertically upwards through the middle point of the inguinal ligament.

The posterior aspect of the kidney is closely applied against the muscles attached to the bodies of the last thoracic and upper three lumbar vertebræ, and is placed in front of the last rib and of the transverse processes of the upper three

Hepatic artery

Left suprarenal gland
Inferior vena cava

Splenic artery
Right suprarenal gland

Spleen
Portal vein

Bile-duct
Descending part

of duodenum
Right
kidney

sa whole cariis look

& more uner on scarcely vi

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The ki art of the tie, ofte 2 greater fuit of ar hey enter arough tt y the vess

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Right flexure

of colon

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Left kidney
Right ureter Spermatic vein

Inferior Left ureter

mesenteric vein Fig. 979.-DISSECTION TO SHOW THE RELATIONSHIPS OF THE KIDNEYS. The greater part of the stomach

has been removed by an incision made close to the pylorus. The transverse colon has been taken away and the small intestine has been cut across close to the duodeno-jejunal flexure.

A model prepared by the late Professor Birmingham has been made use of in this drawing. lumbar vertebræ. In some cases, more frequently on the left side of the body, the eleventh rib also lies behind the upper part of the kidney. The relationship of the kidney to the lower two ribs is, however, very inconstant, owing partly to the great variability in size and inclination of these bones.

The inferior end of the kidney is usually situated from 11 to 2 inches above the highest part of the crest of the ilium; the interval between the kidney and the ilium being usually greater on the left side of the body.

Sometimes the inferior end of the kidney lies on the same level as, or only a short distance above, the iliac crest; this condition is sometimes due to the crest rising to a higher level than usual, the kidney occupying its normal position in relation to the vertebral column. It is important to remember that during life the kidney moves upwards and downwards, following the respiratory movements of the part of the diaphragm against which it rests.

The long axis of each kidney is somewhat oblique, its superior end approaching nearer to the median plane than the inferior. The surface of the kidney which is applied against the muscles forming the posterior wall of the abdomen looks,

the media ing layer eotering of the separate, the kidne poin the “tunica true en the term heath

le, backwards ånd medially, and that which projects into the abdominal voks forwards and laterally. Hence it happens that the lateral border lies re posterior plane than the medial border. The kidney is rotated in this on its long axis to such a degree that the medial margin and hilum are visible from behind, and only a limited view of the lateral border can be

from the front (Figs. 979 and 980). kidneys are placed behind the peritoneum, and project into the posterior he abdominal cavity. Each is surrounded by a considerable amount of loose ften loaded with fat; the fatty tissue, or capsula adiposa, being present r quantity round the margins of the kidney, and only to a less extent in and behind the organ. The renal vessels and nerves lie in this fat before er the kidney, and the adipose tissue is continued, along with the vessels, the hilum into the renal sinus, where it fills up all the space unoccupied :ssels and nerves. edded in the soft fatty tissue surrounding the kidney is a layer of fibrous

Head of Pancreas
Liver (left lobe)

Transverse colon just below right flexure

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Ascending colon just below right flexure

Liver (right lobe)

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1th rib anephric fat"

Intervertebral fibro-cartilage Perinephric fat

Crus of diaphragm

Quadratus lumborum
Cartilage of 12th rib Body of pancreas
TRANSVERSE SECTION THROUGH THE BODY OF A CHILD. The position and relationships of the
ce well seen, and the arrangement of the fascia renalis is indicated. The fascia is coloured green.

which the term fascia renalis is applied. This fascia surrounds the nd a considerable amount of its fatty capsule in the form of a loose

which may be distinguished anterior and posterior walls. The sheath nferiorly and medially, but closed above and to the lateral side of the y the apposition of its walls. Laterally, the anterior and posterior he sheath come into contact and are connected with the retro-peritoneal Iedially they remain distinct, and the anterior wall is continued across n plane, in front of the renal vessels and the aorta, to join the correspond

of the opposite side, while the posterior wall fuses with the fascia the psoas and quadratus lumborum muscles. Inferiorly, below the level kidney, the anterior and posterior layers of the renal fascia remain and can be traced downwards into the iliac fossa. Above the level of ey and the suprarenal gland the layers of the renal fascia unite and fascia covering the diaphragm. It has been suggested that the terms diposa” and “perinephric fat” should be restricted to the loose fatty losed along with the kidney within the sheath of renal fascia, and that paranephric body," or "fat," should be used to denote the tissue outside the The fibrous capsule of the kidney is joined to the loose sheath formed by

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the renal fascia by numerous connective tissue strands. These traverse the perinephric fat and undoubtedly assist in fixing the kidney in its place. The paranephric fat is present in greatest quantity behind the inferior part of the kidney, and in this position the layer of fibrous tissue, separating the two masses of fat and forming the posterior layer of the sheath of renal fascia, is usually well marked.

Fixation of the Kidney.—The kidney is not held in its place by any distinct ligaments, or special folds of peritoneum, but its fixation depends, to a large extent, on the pressure and counter-pressure which is exerted upon it by neighbouring structures, and on its connexions with the fascia renalis above described.

Posterior Relations and the Posterior Surface of the Kidney.-The muscles of the posterior abdominal wall on which the kidney rests are the psoas major, the

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Pleura
Crus of
diaphragın

Ist lumber
( vertebra
12th rib
Lateral

lumbo-
costal arch
Diaphragin
Kidney
Liver

Area for
Caths

Fat behind
colon

Quadratos
lumborun

Iliac crest

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FIG. 981.—THE POSTERIOR RELATIONSHIPS OF THE KIDNEYS. The dotted lines indicate the contours of the

kidneys. The drawing is made from a model prepared by the late Professor Cunningham.

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quadratus lumborum, the diaphragm and the tendon of the transversus abdominis The abdominal surfaces of these muscles do not lie on the same plane, but slope towards one another, and thus the bed on which the kidney rests is not flat. When but little fat is present, the posterior aspect of the kidney adapts itself to the inequalities of the surface against which it is placed, and so we may find on a kidney which has been carefully fixed and hardened before it has been disturbed, areas marked off for the different planes of these muscles. When such a kidney is in position, slight ridges or elevations separating these areas correspond to the angles along which the different muscular planes meet. These ridges can be observed in the hardened kidney, after its removal from the body, but usually they are not sharply defined, the angles between the muscular planes being very obtuse.

A kidney removed from the body after having been hardened in situ (Fig. 982)

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sents an area along the medial part of its posterior surface adapted to the erior aspect of the psoas major muscle. This part of the posterior surface is medially and slightly posteriorly. More laterally there is a larger area ch rests against the quadratus lumborum and looks more directly backwards. se two areas are separated by a rounded ridge which fits into the angle bein the muscles mentioned. Beyond the area in contact with the quadratus porum is the thick lateral border of the kidney, which rests for the most on the tendon of the transversus abdominis and on the diaphragm. 'owards the superior end of the kidney the posterior surface slopes somewhat rds and rests upon the diaphragm. Indeed the superior part of the kidney

a whole, bent slightly forwards, following that part of the arch of the ragm on which it rests, and thus a narrow interval is left, in which the pleural passes down behind the superior end of the kidney (Fig. 981). This relation

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E POSTERIOR ASPECT OF THE KIDNEYS. Same specimen as Fig. 981. The dotted lines mark
t the areas in contact with the various muscles forming the posterior abdominal wall.
Depression corresponding to the transverse process of the first lumbar vertebra.
Depression corresponding to the transverse process of the second lumbar vertebra.
Depression corresponding to the twelfth rib.

pleural cavity to the kidney is of great importance in connexion with rations performed through a lumbar incision. The portions of the o which the kidney is applied are the crus and the parts arising from und lumbo-costal arches. erior relationships of the kidney are well seen in Fig. 981. to these surfaces, or "facets,” for the muscles with which it is in contact, the or lateral border of the kidney often shows a groove for the last rib, another for po-costal arch, and two or three depressions for the tips of the transverse processes

or three lumbar vertebræ. In some cases also faint narrow grooves are to be rves which pass downwards and laterally between the kidney and quadratus nely, the last thoracic nerve and the ilio-hypogastric and ilio-inguinal nerves. e that some at least of the depressions on the posterior aspect of the kidney are eath, and are caused by the weight of the other abdominal organs pressing the Is against the more resisting structures of the abdominal wall, at a time when nd the kidney have become flaccid. When much fat is present the posterior ney is more uniformly convex.

border in its middle and inferior part is rather a surface than a ks for the most part directly backwards. It rests on the diaphragm terior surface of the tendon of the transversus abdominis, to the

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