Relations of Kidneys 343 



The duct leaves the substance of the gland at its head, and joins 

 with the common bile-duct to open into the duodenum. 



The arteries come from the splenic, and from the pancreatico-duo- 

 denal loop of the hepatic and superior mesenteric. Its venous blood 

 enters the portal circulation. The nerves come from the coeliac plexus 

 of the sympathetic. 



In enlargement of the pancreas, especially if the patient be thin, 

 the pulsations of the aorta are distinctly conveyed to the surface of the 

 body in the epigastric region. 



THE KIDNEYS 



The kidneys (each 5 oz.) are not quite on the same level, the right 

 being depressed half an inch by the intervention of the liver between 

 it and the diaphragm. On the under surface of the right lobe of the 

 liver there is a depression for the kidney and supra-renal capsule. 

 The kidneys lie against the outer border of the psoas, behind the peri- 

 toneum, in a bed of loose connective tissue and fat, and they rest upon 

 the slope of the diaphragm, the twelfth rib, and the quadratus lumborum. 

 Thus, they are about on a level with the last dorsal and the first and 

 second lumbar vertebrae. (See illustrations on pp. 164 and 333.) 



Kidneys, ureters, ascend- 

 ing and descending 

 colon, from behind. 

 (HOLDEN.) 



In front of the right kidney are the descending piece of duodenum 

 and ascending colon ; the descending colon lying on the front of the 

 left. The tail of the pancreas may also just touch the front of the 

 left kidney above, whilst the great end of the stomach is in anterior 

 relationship with it ; the spleen is above and to the outer side. 



A horizontal line through the umbilicus passes just below the 

 normal kidneys, and a line drawn upwards from the middle of 

 Poupart's ligament parallel to the linea alba runs nearly through the 

 middle of each. On the posterior surface of the body their situation 

 can be marked a little way from thespinous processes, from just above 

 the last rib nearly to the iliac crest, the right being a little lower, and 

 the notch of each being directed towards the spine. Renal abscess 

 and calculi may escape through the loin. 



Fissures and indentations of the surface of the kidney are often 



