 Good day ladies and gentlemen, welcome to our next dissection. This is Dr. Sanjay Sanya going to demonstrate the kidney in the supraenial glands Welcome to our second Dissection in the series now. I'm going to demonstrate the kidney the ureters and the supraenial glands These are also retroperitoneal structures first of all the location of the kidney as you can see the right kidney is Situated slightly lower than the left kidney and that is because of the right lobe of the liver We all know that the approximate location of the kidney is from T3 T11 to L3 But there's a one centimeter one vertebral segment mobility up and down depending on posture for the right kidney But here we will see something more interesting, which I'll tell you later. So this Is the location of the right kidney and this location is called the para vertebral gutter This depression that you see here is called the para vertebral gutter and this is the right side and this is the left side So therefore the orientation of the kidney is slightly oblique This is the upper pole of the kidney. There's a lower pole and this is the region of the High lobe and this space that you see between the anterior and posterior surface is called the renal sinus Similarly, we can see the same things here and it is filled with fat It was covered by perinephric fat, which I have removed here and this fat that you see on the posterior This is the para renal fat, which is outside the renal fascia. I have removed the renal fascia I removed the perinephric fat Now let's take a look at the high lobe and see what are the structures which are entering or leaving the high lobe So this is the high lobe of the right kidney So as we had mentioned previously, this is the renal vein. So this is the right renal vein Let's just remove these fascia and you can see this is the right renal vein The right renal vein as we had mentioned is smaller than the left renal vein and it's very thin. This is the anterior most structure Just behind the right renal vein We see the renal artery here The renal artery right side is longer than the left side for obvious reasons and After that, we had already mentioned in class that the renal artery divides into five Segmental arteries and some of those segmental arteries you can already see here You can see one of the segments here. You can see another segment here You can see a third segment here We had mentioned five segmental arteries of the right renal artery depending on the five segments of the kidney Now let's take a look at the third structure and that is this one This is the pelvic Kalecial system and we can see emerging posterior to the renal vein renal artery is the renal pelvis and If you dig deeper, you will see that it is the pelvis is dividing into major calyx and it will divide further into minor calyxes And this is the pelvic uretric junction. Let's trace the ureter down The ureter goes down approximately five centimeters from the tips of the lumbar vertebrae and it goes down So this is one side of narrowing at the pelvic uretric junction as it descends down if you notice it crosses The common iliac artery at the pelvic brim. So that is another side of narrowing And after that it goes into the pelvis and there is also a third side of narrowing when it enters the urinary bladder Okay, so that is about the right side Now let's take a look at the left side Again, we see the same structures. We can see this is the renal vein here anterior left renal vein is obviously longer And just behind that this structure that you see here is the left renal artery Which is smaller because the ureta is on the left side and the same thing if you dig deeper you'll find that it divides into its segmental branches and posterior to all these two structures you will find that this is the pelvis Renal pelvis continuing down as the ureter. I have removed the uretric fascia I told you you can see a little bit of the uretric fascia here and I told you that the blood vessels of the ureter are in a peri uretric fascia and We have to preserve the fascia in real life. Otherwise, we will get ischemic necrosis Here also it follows the same course along the tips of the lumbar vertebrae and then it crosses The common iliac artery here at the pelvic brim the left common iliac and then it enters into the pelvis and to the Okay, so that's about the kidney and the ureter In this kidney incidentally you can notice that it is slightly lobulated, which is a common occurrence You can see that the kidney is not exactly being shaped as we mentioned the classical It is slightly lobulated some some of these actually are persistence of the fetal lobulations Okay, now I would like you to notice something very interesting. You're naturally wondering where is the supra renal? Remember the right supra renal is pyramidal in shape. The left supra renal is more like a French cocked hat. This is the Left supra renal it is located on and it is situated more medially It is in relation is very close to the left renal vein So this is the left supra renal vein and you can see that this is the Left supra renal gland and you can see this is the left supra renal vein draining into the left renal vein This is the supra renal gland. This is the supra renal gland this one So those of you who have not seen this is the supra renal gland and We have already seen that this communicates with the left inferior phrenic vein and you can see a communication going and that is the communication with the left inferior phrenic vein. So this is the left supranial vein which is draining into the left renal vein. So this is the left supranial gland. It is situated in the upper pole of the left kidney. Let's take a look at the interesting thing about the right kidney. We notice that the right kidney there is no supranial gland. Clear? So you're wondering where it is. It is stuck to the under surface of the diaphragm and here it is. This is the right supranial gland and I did mention in class that sometimes when the kidney descends down there is a septum between the kidney and the supranial. So therefore if the kidney descends down the supranial remains in place. Here the kidney has gone down a little bit and so therefore the supranial gland is still in place. It is stuck to the under surface of the diaphragm and this is the right supranial gland and this is roughly pyramidal in shape and incidentally you can see that the right supranial gland is also draining and this is the right supranial vein which is draining into the inferior vena cava and you can see that here. This is the right supranial gland. So both the supranial glands are attached to the under surface of the diaphragm by Mr. Fascia and they're separated by means of a septum from the respective kidneys. In this case there's a distinct gap between the two because the right kidney has descended down a little bit. So these are the salient points I wanted to show you about the kidney. Now before I conclude because the kidney is located in the paravartibral gutter it is located slightly obliquely. There is a tendency for urinary stasis to occur within the pelvic licea system and the patient is recumbent for a long period of time and that tendency for recumbency produces what is known as urinary stasis and that stasis needs to urinary calculus formation and when the calculus fills up the pelvic licea system it forms what is known as staghorn calculus. So it is this oblique position of the kidney in the paravartibral gutter which predisposes to formation of stasis and urinary calculus formation. I'm opening the right kidney along its convex lateral border to show the pelvic licea system. Now I've cut through the cortex. I'm deepening with finger dissection and I'm opening out the pelvic licea system. There you go and this is the interior of the right kidney. Okay let me just mop it up and we will see the parts of the interior of the kidney. So we can see that these are the medullary rays, the medullary, this is the pyramid, this is the pyramid and in between this is the renal columns of Bertini. These are the medullary rays which contain the collecting ducts of Bellini. This is the medulla and this outer portion that you see is the renal cortex which contains the nephrons, the proximal convoluted tubules, distal convoluted tubules, the loops of Henley and these medullary rays are the collecting ducts. The tips of the pyramids are known as the papilla and the papilla then communicate by this concave structure here which is the minor calyx and that is where filtration of urine takes place from the pyramids papilla into the pelvic licea system. These are some of the fat structures which are also present inside the renal sinuses and if you remove them we should be able to see the pelvic licea system and here we go. We can see the pelvic licea system on this side. We can see the minor calyx here, we can see another minor calyx here, we can see some more, we can see they're uniting to form the major calyx and more major calyxes will unite and they will form the and this is finally coming out as the the renal pelvis here. So this is the renal pelvis there. This is where it is forming the renal pelvis. This is the pelvic licea system and you can see it very clearly here. That is the point I wanted to emphasize and about this particular kidney. Thank you very much for watching ladies and gentlemen. Have a nice day. Thank you.