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Surgical Anatomy of Adrenal Gland and Kidney
Surgical Anatomy of Adrenal Gland and Kidney
• Anatomic Relationships
– 3-5 cm in transverse dimen
– Weight- 5 g
– Grossly- yellow orange
– Enclosed within the Gerota’s fascia
– Rt Adrenal-more superior, pyramidal shape, directly cranial
to upper pole of kidney, surrounding structures- liver,
duodenum, IVC, retrocaval extension of one wing
– Lt. Adrenal- more crescentic, medial to upper pole of K,
upper & ant relations- stomach, tail of pancreas, splenic
vessels
Composition
• Embryologically the adrenals are distinct from kidney,
• Developmental anomalies of one do not affect the other
• Histologically, medulla & cortex
• Medulla- chromaffin cells (neural crest origin)-secrete
catecholamines under sympth control
• Cortex - 90% of gland, mesodermal origin
– 3 layers (Zona glomerulosa-mineralocorticoids,Zona
fasciculata-glucocorticoids, Zona reticularis-sex
steroids)
Adrenal Vessels
• Arterial- 3 sources: Inferior phrenic A, Aorta, Renal A
• Venous drainage-single adrenal vein
– Rt vein drains to IVC
– Lt vein joins inf. Phrenic vein and drains to left R. vein
• Lymphatic drainage- follows course of vessels and empties
into para-aortic LN.
KIDNEY
• Gross & Microscopic anatomy
• Relations & Investing fascia
• Renal Vasculature
• Renal Lymphatics
• Renal Collecting System
• Renal Innervation
Introduction
• It serves a no. of important functions required to maintain
normal physiologic function
• Maintain fluid & electrolyte balance
• Maintain acid-base balance
• Produce Renin (BP), Erythropoietin (RBC production), calcium
metabolism( Vit D 1,25 dihydroxyvitamin D)
Gross anatomy
• b/l paired reddish brown organs
• Weight-150 g (M), 135g (F)
• Dimensions :10-12 cm Vertical, 5-7cm Transverse, 3cm AP
• Rt kidney-shorter & wider
• Children-relatively larger, fetal lobulations
• Dromedary hump-due to downward pressure from spleen or
liver
Microscopic Anatomy
• Renal sinus-vascular structures & collecting system coalesce,
surrounded by fat
• Renal sinus narrows to hilum medially
• Renal parenchyma-cortex & medulla
• Medulla-not contiguous layer, has multiple, distinct, conically
shaped areas (pyramid)
• Apex of pyramid is papilla which is cupped by minor calyx
• Cortex-lighter colour, covers pyramids peripherally and extends
between pyramids as columns of Bertin
• Surgical importance of Columns of Bertin- renal vessels traverse
from r. sinus to cortex- so avoid in percutaneous access to
collecting system
Relations and Investing Fascia