THE ABDOMINAL CAVITY 353 



torn away from the vena cava during the manipulations necessary 

 in excision of the right kidney. The left renal vein lies behind 

 the pancreas, and crosses in front of the aorta and behind the 

 superior mesenteric artery. It receives the left suprarenal and 

 the left spermatic veins (p. 264). 



Movable Kidney. Under normal conditions the kidney 

 cannot be palpated, although it moves slightly with respiration. 

 Sometimes the movement may become so increased in amount 

 as to give rise to distressing symptoms from kinking of the 

 ureter. When this condition is suspected, the patient should 

 first be examined in the recumbent and then in the semi- 

 recumbent -or in the sitting posture. The surgeon places one 

 hand in the interval between the last rib and the iliac crest 

 and the other on the anterior abdominal wall, and the patient 

 is then instructed to take a deep breath. As the abdominal 

 wall collapses with expiration, the surgeon gently presses the 

 tips of his fingers in below the costal margin and attempts to 

 catch the kidney between his two hands. In minor degrees of 

 mobility only the lower pole of the kidney may be felt, as it 

 slips upwards from the tips of the fingers, but when the condition 

 is marked, the whole kidney may be caught, or the fingers may 

 even be made to meet above its upper pole. 



The right kidney is more often at fault than the left, and a 

 movable right kidney must not be confused with an enlarged 

 gall-bladder (p. 313). On either side an ovarian cyst which 

 possesses a long pedicle may be mistaken for a movable kidney. 

 This is owing to the fact that the surgeon, on examination, is 

 able to manipulate the tumour into the position which the 

 kidney normally occupies. When a movable kidney has been 

 replaced in this way, it tends to maintain its position, but an 

 ovarian cyst soon sinks down again towards the pelvis. 



The Ureter is about ten inches long. It commences at the 

 renal pelvis and is somewhat constricted at its point of origin. 

 It descends on the anterior surface of the psoas major, which 

 separates it from the tips of the transverse processes of the 

 lumbar vertebrae, and enters the pelvis by crossing the bifurcation 

 of the common iliac, or the external iliac artery near its com- 

 mencement. 



On the right side, the ureter lies behind the peritoneum of 

 the right infra-colic compartment, but before it enters the 

 pelvis it is crossed by the root of the mesentery and the terminal 

 part of the ileum. At its upper end it lies behind the second 



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