43 



APPLIED ANATOMY. 



should be made only when the organ is freely accessible, preferably when out on the 

 surface, and in the manner described on page 426. The frequent existence of an 

 additional artery supplying the lower (or other) portion of the kidney should be 

 borne in mind. If it is desired to open the pelvis it should be sought on the poste- 

 rior surface, because the veins and arteries are in front of it. 



The Suprarenal Glands. The right gland is more on the upper anterior 

 surface of the kidney, while the left is more on the upper inner surface above the 

 hilum. The gland rests on the adipose capsule and is not attached to the kidney, 

 so that when the fatty capsule is stripped off in removal of the kidney the supra- 

 renal gland is left behind. They lie opposite the eleventh and twelfth dorsal ver- 

 tebrae and are 5 to 6 cm. (2 to 2^ in.) apart. A needle thrust into the eleventh 

 interspace close to the spine would penetrate the suprarenal. The right one lies 

 behind the foramen of Winslow. 



Ureter, and Renal Pelvis. The pelvis of the kidney is the upper expanded 

 end of the ureter. It is not simply funnel-shaped, but it branches like a tree. The 

 lower portion joining the ureter is called the common pelvis, and this divides into 



Pelvis 



Upper constriction 

 Inferior vena cava 

 Iliohypogastric and ilio-inguinal nerves 



Right common iliac artery 



External cutaneous nerve 



Genitocrural nerve 



Middle constriction 

 External iliac artery , 



Internal iliac artery 

 Vas deferens 



Opening into bladder, lower 

 constriction 



FIG. 437. The ureter, showing its course and relations. 



the superior and inferior pelves; these latter divide into eight or nine calyces which 

 embrace the apices of the pyramids. The deposition of salts in the pelvis causes 

 the formation of renal calculi, which are of the shape of the pelvis in which they 

 occur. The arteries and veins which enter the kidney do so on the anterior surface 

 of the pelvis; hence the incision for the removal of calculi which is sometimes made 

 in the pelvis itself instead of through the kidney substance, is made posteriorly 

 instead of anteriorly. In making the incision care is to be taken to avoid any un- 

 usual veins or arteries which may cross the pelvis, especially at its lower portion. 



In front of the pelvis of the right kidney is the duodenum, and in front of the 

 left is the pancreas. 



The ureters are 25 cm. (10 in.) long when in the body, and 27.5 to 32.5 

 cm. (n to 13 in.) long when removed from the body (A. Francis Dixon, 



