 This is going to be demonstration of the kidney in situ So we have completely removed all the abdominal organs and we can see this is the right kidney This is the left kidney. I'm standing on the right side of the cadaver and the camera person is also on the right side Or towards the legged. This location of the kidney is in a depression and that is referred to as the parovertibular cutter Because it's on either side of the lumbar vertebra and this itself has got an important clinical implication When a person is Recombed for a long period of time He really tends to collect in the pelvic calcium system because of the Orientation and the location of the kidney and that leads to stasis or recompensate calculus precipitated by Infection of the pelvic calcium system. I would draw your attention to this facial here This is the continuation of the facial transversalis Covered of course by the peritoneum peritoneum This is one which forms the anterior layer of renal fascia or the gerotas fascia and if I were to lift it up We can see that the same facial transversalis splits to form another layer posteriorly And that is the posterior layer of renal fascia and the posterior layer of renal fascia as you can see it continues Immediately and it becomes continuous with the teeth over the so-called major muscle All the camera persons on the left side and we're showing the same facial sheets on the left side also So this one which I picked up again is the anterior layer of left renal fascia The gerotas fascia and if you were to trace it, we say that this is the posterior layer Between the anterior the posterior layers completely encircling the kidney was a perinephric fat both on both the sides And this perinephric fat not only encircles the whole kidney But it also goes inside the renal sinus through the renal hyalum behind the posterior layer of the renal fascia We see yet one more fat layer that is called the pararenal fat and If you were to come back again to the right side We will see that behind the posterior renal fascia. We see fatty layer That is the pararenal fat and just like on the right side Even on the left side We can see that the posterior layer of the renal fascia becomes continuous immediately with the fascia of the so-as major muscle That is the so-as sheet So this about the facial relationships of the kidney the extent of the kidney is approximately from T12 to L3 The right kidney is slightly lower than the left kidney because of the presence of the liver on the right side The margins of the kidney and the borders where my instrument has gone in that is the superior pole of the kidney This is the inferior pole same thing. We can see on the left side also This is the medial margin of the kidney which is concave Strictly speaking because of the orientation it is supposed to be anterior medial And this is the lateral margin of the kidney which is convex It is not strictly lateral but it is posterior lateral because of the same orientation the kidney This is the anterior surface. This is the posterior surface This is the region of the high limb of the kidney and we can see the same thing on the left side also We have delivered the right kidney out We can see that it's got a slightly low belated appearance This is nothing but just a persistence of the fetal Lobulation just to bring you up to speed We have removed the fascia transversalis and the parietal pediatria over the posterior abdominal wall in this region Just to show you this is the abdominal outer and Just to the right of that. This is the inferior vena cava And here we can see the L2 cable lymph nodes some of them We can see one lymph node here another one here another one here. These are also referred to as the lumbar nodes arising from the error we have the renal arteries and Draining into the inferior vena cava. We have the renal veins The left renal vein is longer on the left side Compared to the right side why because the inferior vena capers on the right side and contrary wise The right renal artery is longer on the right side because the air ties on the left side So let's take a look at the neuro vascular structures entering the hyalum of the right kidney Then we should see the same thing on the left side So I have lifted up the right kidney here and I've turned it this structure, which I picked up here This is the right renal vein And we can see that it's thin walled and it is a little it is anterior to the right renal artery We just posterior to that. Let's take a look at the renal artery This is the renal artery one branch of the renal artery in this another part of the renal artery in this particular cadaver We have not one, but we have two renal arteries coming out from the aorta and to see it better We will retract the renal vein and we can see that this is the renal artery The renal artery or arteries in this case once they enter the hyalum of the kidney they divided to Typically they divided into five branches and each of those branches are referred to as the segmental arteries And there should be typically five segmental arteries So let's take a look at the five segmental arteries person is on the right side of the cadaver towards the headed to show you the Neuro vascular structures entering the hyalum and we can see that as I mentioned a little while earlier There are not one but two renal arteries This is one renal artery here and this is another renal artery here So let's take a look at the branches The anterior one they are all part of the same artery is dividing into two branches This is one branch and this another branch So this is referred to as the anterior superior and this is referred to as the anterior inferior segmental artery Now we have picked up the other renal artery the posterior renal artery in this case as we mentioned they were to We can see one branch here which I have lifted up with my instrument this one Then we can see another branch here Which I've lifted up with the instrument and finally we have this renal artery itself is going inside so therefore there are three Posterior segmental arteries on the posterior side and two on the anterior side So therefore there are total five segmental arteries and in sequence. They are labeled as anterior superior anterior inferior superior polar This is the inferior polar and this is the posterior the significance of these five segmental arteries is that this allows us to do What is known as segmental nephrectomy next thing I would draw your attention to is where my finger is gone in That is known as the renal sinus the renal sinus is the space Which extends from the hyalum into the substance of the kidney between the anterior and the posterior layers of the kidney and This renal sinus is filled by four structures. It is filled with fat Which is a continuous to the perinephric fat that is number one It is filled with the branches of the renal arteries which you have seen already to be trees of the renal veins And it is also filled by the pelvic aliceal cyst So that brings me to the pelvic aliceal system this structure which I've picked up here and we can see it here This is the renal pelvis in most cases in 80% of the population The pelvis renal pelvis is inside and that is referred to as intra renal pelvis in 20% of the population The pelvis may be outside and that is known as extra renal pelvis So in this case it is intra renal pelvis and extending from the renal pelvis. We have this structure here. This is the Urator now we are showing the left kidney and the camera person is on the right side so again, we can see the Pedicle the arteries in the veins and this is the hyalum of the kidney the anterior structure is the renal vein and We can see that the renal vein is long. It's coming from the inferior vena cava and this is the renal vein Let's focus on the renal artery Here also we have two renal arteries just like on the right side and we can see the two renal arteries one of them is this one here and The other one is this one here and Here also we can see the renal arteries are dividing into five branches We can see one branch here. We can see the second branch here. That's on the anterior side So this is the anterior superior and this is the anterior inferior Now I will turn the kidney to see the branches on that side now We are seeing the left kidney the posterior aspect and I have completely Delivered the kidney out and I've turned it so that we can see it and the camera person is on the left side of the cadaver So we can see the posterior renal artery in this case and we can see one branch here We can see another branch here and we can see a third branch here So these are the other three branches segmental branches of the left kidney So this is the superior polar branch This is the inferior polar branch and this is the posterior branch So just like on the right side, there are five segmental arteries on this side And that's what enables us to do what is known as segmental nephrectomy This again is the region of the renal sinus and emerging from the renal sinus I'm going to turn the kidney to show the origin of the Pelvis and the ureter. This is the renal pelvis coming out Here also the pelvis is intra renal and we can see the ureter emerging Having mentioned that since we are already on the left side I would draw your attention to an abnormality that we noticed in this kidney We can see the soft area here This is a renal cyst that we can see here And I'm going to puncture the renal cyst to show you the content inside and we have punctured it And we can see that Watery fluid and these things are draining out. So this is a renal cyst, a solitary renal cyst There's another cyst on the left side and that is the location Here, this is a small renal cyst that you can see here. Renal calculus, ureteric calculus is the most common problem worldwide And therefore Some of the very common investigations of the urinary system are One, plain x-ray of the domain KUB KUB stands for kidney ureter bladder. The next important investigation, which is also done very frequently is intravenous pylogram Where we inject the dye and we wait for the dye to be excreted through the kidney through the pelvis to the ureters And we take sequential films. The third investigation is called retrograde pylogram Where we cannulate the urethra and we inject the dye through the bladder into the ureters And we see the pelvic ureteric system. And of course ultrasound of the kidney is also a very useful modality of investigation And not forgetting that if you want to see the vascular structures, especially the renal artery and its distribution Prior to segmental diffractomy or otherwise, we can do what is known as a renal angiogram By cannulating through the femoral artery into the aorta and then injecting the dye through the renal arteries So these are some of the common investigations which are done to investigate a urinary tract That's all for now. We shall in the subsequent section open up the kidney and we'll show the structures inside and till then Stay tuned for the next video. Thank you very much for watching. Dr. Sandesh Sanyal signing out. David is the camera person Have a nice day