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Figure 2.60.

Posterior abdominal
wall showing great vessels,
kidneys, and suprarenal glands.
Most of the fascia has been
removed in this view. The ureter
crosses the external iliac artery
just beyond the common iliac
bifurcation. In males, the
testicular vessels cross anterior
to the ureter and join the ductus
deferens to enter the inguinal
canal. The renal arteries are not
seen because they lie posterior to
the renal veins. The left renal
vein is compressed between the
aorta posteriorly and the superior
mesenteric artery anteriorly, the
latter being pulled inferiorly by
the weight of the intestine.

Figure 2.61. Lumbar approach to


kidney and relationships of kidney to muscles and fascia. A. The external aspect of the right posterior abdominal wall is
shown. On dividing the posterior aponeurosis of the transverse abdominal muscle between the subcostal and the
iliohypogastric nerves, and lateral to the oblique lateral border of the quadratus lumborum, the retroperitoneal fat
surrounding the kidney is exposed. The renal fascia is within this fat. The fat inside the renal fascia is termed the perirenal
fat capsule (perinephric fat); the fat outside the capsule is the pararenal fat body (paranephric fat). See Figure. 2.76A for
an earlier stage of this dissection. B. This transverse section of the kidney shows the relationships of the muscles and
fascia. Because the renal fascia surrounds the kidney as a separate sheath, it must be incised in any surgical operation on
the kidney, whether from an anterior or a posterior approach.
Figure 2.66. Blood vessels of suprarenal glands, kidneys, and superior
part of ureters. The celiac plexus of nerves and ganglia that surrounds
the celiac trunk has been removed. The IVC has been transected, and its
superior part has been
elevated from its normal
position to reveal the
arteries that pass
posterior to it. The renal
veins have been cut so
that the kidneys could be
moved laterally. For the
normal relationships of
the kidneys and
suprarenal glands with
the great vessels, see
Figure 2.60. Observe the
gross structure of the
suprarenal glands and
their rich arterial supply.
The cross section of the
suprarenal gland (inset)
shows that it is
composed of two distinct
parts: the cortex and
medulla, which are two
separate endocrine
glands that became
closely related during
embryonic development.
Multiple suprarenal
arteries arise from the
inferior phrenic artery; one or more inferior suprarenal arteries often arise from the renal artery, and a middle suprarenal
artery arises from the abdominal artery. The number and patterns of arrangement of the suprarenal arteries are very
variable. The endocrine function of the suprarenal glands make their abundant blood supply necessary.