ABDOMEN. 



259 



purpose of aiding the memory, call the visceral relation that of the three 

 elbows : the hepatic elbow, the duodenal elbow, the colic elbow. Now demon- 

 strate as follows : Carefully pull the hepatic flexure of the colon downward, and 

 notice that this is made up of the upper end of the ascending and the proximal 

 end of the transverse colon, and rests approximately on the lower third of the 

 kidney. (Fig. 182.) Next trace down the second part of the duodenum (inflated), 

 and see that it forms a flexure where it joins the transverse duodenum. Turn 

 this off and call it the duodenal elbow, observing that it occupies the middle third 

 of the kidney. Lastly, observe the anterior border of the liver come down and 

 suddenly recede backward and upward. It covers the upper third of the anterior 

 surface of the kidney, and forms the hepatic elbow. 



Notice, too, that the areas occupied by the duodenal and colic elbows have 

 lost their peritoneum, in accordance with a law explained under the head of peri- 

 toneum. The left kidney has two non-peritoneal areas. 



Anterior Relations of the Left Kidney. The first relation is the fatty cap- 

 sule. Then the following viscera you will remove in this order : (i) The fundus 



DUODENAL AREA HEPATIC AREA GASTRIC AREA 



(NON-PERITONEAL) (NON-PERITONEAL) CAVAL AREA (PERITONEAL) 



DUODENAL AREA 

 (NON-PERITONEAL) A\ 



PANCREATIC AREA 

 (NON-PERITONEAL) 



COLIC AREA 

 (NON-PERITONEAL) 



COLIC AREA OF 

 SPLEEN 



COLIC AREA 

 (NON-PERITONEAL) 



PERITONEAL AREA WITH RIGHT 

 COLIC VESSELS 



PERITONEAL AREA WITH LEFT 

 COLIC VESSELS 



FIG. 182. DIAGRAM SHOWING ANTERIOR RELATIONS OF KIDNEYS AND SUPRARENAL BODIES. 



of the stomach ; (2) the tail of the pancreas ; (3) the descending colon ; (4) 

 the last part of the duodenum. 



Posterior Relations of Each Kidney. Carefully remove the kidney from 

 its bed of fat and connective tissue, and turn the same to the mid-line with all 

 its root-structures attached. Great care must be taken in handling the left one 

 not to injure the left spermatic vein (ovarian, if a female), which discharges into 

 the left renal vein. Then, having removed the posterior part of the fatty capsule, 

 you will find three nerves: (i) The last thoracic; (2) the ilio-hypogastric ; (3) 

 the ilio-lumbar. Then you will be able to make out the (i) quadratus lumborum 

 muscle, covered by the anterior lamella of the lumbar fascia; (2) the diaphragm ; 

 (3) the psoas magnus muscle ; and (4) the lowest intercostal artery. 



The Root-structures of the Kidney (Fig. 183). These are, from before back- 

 ward, as met in your dissection : (i) The vein ; (2) the renal artery and its sym- 

 pathetic nerves ; (3) the expansion of the ureter, known as the pelvis of the kid- 

 ney. You will find these structures loosely bound together by connective tissue, 

 like the capsule of Glisson or the mesenteric connective tissue. This you must 

 divide in the direction of the structures. You will now puncture the ureter in 



