 اللہ سلام ہم. لیکن ہم جو بہت بہت سمجھا ملیہ آکھتے ہیں۔ اسے دوسرے کچھ اکتابہ ہے۔ کامرہ اپنی کتابہ ہے اور کتابہ ہونا کے ساتھ سکتا ہے۔ یہ اپنی سینجا سینیوں کے بارپنٹ شیرہ ہے۔ لیکن ہم جو دیکھے گا یہاں میں آپ کو یہاں کتابت کریں۔ یہاں ، ہمچھاک گوزان ہے۔ اور یہاں ہے کتابے ہے۔ ابھی ایک جو جہاں گا جو جہاں گا سکتے ہیں۔ ایک جہاں کتابت ہونا ہے۔inctions of it was the anterior layer of real fascia which is called the gerotas fascia and the posterior layer of gerotas fascia under that we had a layer of fat which was called the perinefreak fat which has been removed posteriorly behind the perinefreak fat was another layer of fat which is called the pararenal fat which had also been removed and in front was the parietal peitunium which we have removed and under that was the extra petrenal fat so three layers of fat اور مجھے انتظور کے مختالاتی کرنے کوی قیمت سے نے مجھے دیکھتا ہے لیکن ہم آپ جانتے ہیں تو یہی جیسے ہم جو بہت پہلے سے مجھے اس کے بارے کے بارے میں یہاں جانتے کے بارے میں اور یہاں جانتے کے بارے میں یہ آپ کوئی لیئے جانتے کے بارے میں یہاں جانتے کے بارے میں now the kidney is normally located in a slightly oblique fashion in the parabertibural groove this has got a clinical significance if a person is bed ridden for a long duration of time لیکن یہ کا سبکتا ہے کہ انگرادکئیزی سیسٹم کے لئے یہ حکمت کی مقابل سلسل کی تعستان ہے۔ اس کی بہت ن cũngہ یہ اوپ راہ کرہا۔ جو ایشکرانی کو مقابل سلسل کے ساتھ اس لیگی سے احم کی پہلی خود ہو لائے۔ ہموں کیہوں کے لئے انگرادکئیزی تر horse performance تک کے بہت سے مقابل سلسل کے لئے اس حکمت کا مشہولی ہے جو ایشکرانی کے زندگی کو소�ہ ہو جائے۔ اسی مقابل سلسل کے بپ ہے۔ ہمارے پر اوتا کے روشت پر دل ہوتا ہے. ہمارے پر اوتا ہے دل نا away کوہر اوت کی دیزے ہی ہمارے گ crystal گرانوی تفسیی ہے. وہاں یہ بڑی کیا کبھی بھینے اوتی کیا کے چاہتے ہیں چاہتے ہیں اس کے لئے اپر کبھی کیا اس کے لئے ہوتا ہے. اور ہمارے جو اپنے کبھی لیٹا مقصد دیزے ہوتا ہے اور آپ میں پر مقصد دیزے ہوتا ہے اور ہم neighbor زاویے عیکم والates، اور شهم والates لگاند تاوریوں simple ہے اپنی کیا خزانات پہلے سببہ سب جانتے ہیں لیکن سوئی انٹرین کے لیے انٹرین کے لیے طرحی حالہ کے لئے ہمالے سبنی لیے ہمارے جانتے ہیں ہمارے جانتے ہیں سبنی کیا گصیر ارقام ہمارے جانتے ہیں اس کے لئے حال گئے لیے ہمارے جانتے ہیں آپ کو منطق پرے بیرینی آخر جانتے ہیں جو کچھ کیا نہیں ہے اسی طرح کیا کتی کو مستمعہ are the branches of the renal artery the five segmental branches which I had mentioned earlier and the fourth set of structures will be the tributaries of the renal vein having mentioned that now let's take a look at the parts of the kidney itself the kidney itself is covered by a condensation of fascia and that is called the renal capsule just under the renal capsule we can see this marginal zone here and the both the kidneys both the sections that is the renal cortex and in the renal cortex we can see their extensions of the renal cortex inside those are called the renal columns of burtini and it is through the renal columns of burtini that we have the arteries which pass through like this and they break up into archaeate arteries which supply the glomeruli so the renal glomeruli and the corpuscles malpigean corpuscles and the bohmins capsule are all located in the cortex coming to the medulla we can see that the medulla is the more darker pigmented portion it is shaped roughly like a pyramid these are called medullary rays which are composed of the collecting tubules and the apex of the pyramids are called the renal papilla and the renal papilla is the place where ultra filtration of urine takes place and it passes through the minor calluses and then it stores into the major calluses and from the major calluses it goes into the renal pelvis and from the renal pelvis it drains out through the ureters so this is what we see in the cut section of the kidney the next structure which i will draw your attention to is this here this is the ureter the ureter it starts from a slightly diluted portion inside which is called the renal pelvis and then it goes down opposite the tips of the renal process one two three four five and then it crosses the pelvic brim and it crosses over the common iliac artery so this is the right common iliac artery this is the left common iliac artery and we can see it is being crossed over by the ureter here and then it enters into the pelvis same thing we can see on the left side this is the left ureter which is crossing the pelvic brim over the left common iliac artery and after that it enters into the pelvis when it is in the abdomen it receives his blood supply from the aorta from the renal artery and from the gonadal vessel so where exactly is the gonadal vessel we can see this is the right testicular vessel and we can see it is giving branches to the ureter this is the left gonadal vessel and we can see it is giving branches to the left ureter the right gonadal vessel it comes from the aorta and it drains into the ipriya vinakiva the left gonadal vein it drains into the left renal vein so that brings me to some clinical and functional significance of the left renal vein so now i'm focusing on the left kidney so we can see this is the left renal vein and we can see it is much larger than the right renal vein it is extending all the way from here the first thing we notice is that it is passing under this artery here this is the superior bicentric artery the left renal vein is passing under that and behind that is the aorta so in this position the left renal vein can potentially get entrapped and that is known as the nutcracker syndrome or the left renal vein entrapment syndrome that typically tends to happen if the angle between the superior bicentric artery and the aorta is less than 25 degrees the next thing we have already mentioned is that the left gonadal vein it drains into the left renal vein and we can see that here the third thing we notice is that the left renal vein is receiving this vein here this is the left supra renal vein and we can see the left supra renal vein is opening into the left renal vein and it also communicates with the left inferior phrenic vein which then drains into the inferior vena keva the next point about the left renal vein is that it is very close to the sprenic vein which we have removed here so therefore we can use the left renal vein for shunt surgery that is called the splenorinal shunt we can either do a proximal splenorinal shunt or we can do a distal splenorinal shunt in case of cirrhosis with پورتل ہی پرتیشن now i shall draw your attention to the supra renal glands so for that again we will come to the right side i would draw your attention to this yellowish brown structure above the upper pole of the right kidney this structure here this pyramidal shape structure that we see here this is the right supra renal gland and we can see the right supra renal gland is attached to the under surface of the right dome of the diaphragm by means of its own face here the significance of this is that even if the right kidney descends down as happens in nephroptosis the supra renal gland does not descend down the supra renal gland the right side is closely associated with the inferior vena keva in this particular cadaver we noticed that even though we have removed the liver the inferior vena keva is still intact normally we would have expected the inferior vena keva to have gone into the liver and to have been removed with the liver but in this we see that the inferior vena keva is still there so these two structures together they constitute the posterior boundary of the epiploid foramen of winslow so my finger is in the location of the epiploid foramen of winslow in front of my finger would have been the hepatodeodonal ligament and behind my finger are the two structures which constitute the posterior boundary of the epiploid foramen of winslow namely the inferior vena keva and the right supra renal gland now let's focus on the left supra renal gland so let's take a look at the left kidney this is the upper pole of the left kidney and we can see this gland here this is the left supra renal gland in contrast to the right supra renal gland which is like a pyramid this is like a french cocked hat and we can see it is resting on top of the left renal vane and i've already mentioned the left supra renal vane drains into the left renal vane and it also communicates with the left inferior vane the left supra renal gland it forms part of the bed of the stomach along with the left kidney and that is what we can see in this particular dissection and before i conclude there are two other things i would like to draw your attention to this is a vein that we have removed and i'm bringing it back here this was running on the left side of the abdomen and we can see it is starting from the pelvis and going up this is the superior rectal vane and as it goes up it becomes inferior mesentric vane which normally should have drained into the splenic vane but in this particular cadaver it opens into the superior mesentric vane which is here and at the same time the superior mesentric vane also receives the splenic vane and the two together from the پورٹل vane and this is the cut section of the portal vane that we can see here this is one thing which i would like to draw your attention to the other thing is these are the soas major and the soas major muscle on either side this is the abdominal aorta we can see this trunk coming out from here this is the celiac trunk the celiac axis which is the artery of the foregut and we can see the three branches this is the splenic artery this is the common hepatic artery this is the left gastric artery but this celiac trunk is also giving yet one more branch we can see it is giving this branch here this branch is the left inferior phrenic artery rarely the celiac trunk can also give rise to the inferior phrenic artery and this cadaver we can see that the next branch that we can see coming out from the abdominal aorta is this one here this is the superior mesentric artery this is the branch of the superior mesentric artery the terminal branch that's called iliocolic these are the various ilial branches and these are the digital branches and the various other branches of the superior mesentric artery which is the artery of the midgut the next thing is this one here this is the inferior mesentric artery which کامیان کے ساتھ پر کم پرلو ہوتے ہیں۔ اور یہ باہن کا مستحق ہے جس ہے آرٹ lernen یہ جو جو ڈیت کے لیئے اور اس جو ڈیٹ بھایا ہے اور ہمیں اس میں ڈیٹ بھایا ہے آرٹری کے ساتھ گھانے کے لئے کامیانallowک کامیانلییک ہے جانا لے اور کامیانلییک مابنے اور ڈیٹ کے لیئے کامیانallowک کامیانallowک کامیانallowک بہتے ہیں کیونکہ یہ ڈیٹ خاموپہارے کی بندے ہیں جس این پر بہت ہوں الصور بہت ہوں اور بہت تک ہوں گے یہاں ہے ایک بندے کی تھے آخرانگس میں ان میں صراح پر پیش ہے اور میں سے ان وقت دیکھ ساہت سکتے ہیں ہی کوئی تک کہتے ہیں آپ م藥 کے لیوان جو لوگ کویشا کے لئے آ کرسکtے ہیںuffleیک مہار ہوں اس کی اکمڈیر گفتی ہے کیونگ شاہت سکتی ہے ایک کامڈ بننے لیوان ڈیا میں بڑے لیوان پھر کی رہے ہیں