THE KIDNEYS 



1009 



ligaments, which give origin to a large portion of the posterior fibres, are attached 

 to the tip of the transverse process of tlie second lumbar vertebra instead of that 

 of the first. 



Tlie pleura has an indirect but important relation to the kidney besides the more 

 direct relation at the ' hiatus diaphragmaticus ' referred to above. The inferior 

 limit of the pleural sac extends almost horizontally outwards from the lower lK)rder 

 of the twelfth thoracic vertebra, crossing the last lib near its neck, and the eleventh 

 rib about two inches farther outwards. As a rule, the incision in renal oi)erations 

 may be carried safely to the lower lK)rder of the last rib; l>ut, should this boiK; l)e 

 absent or very short, the eleventh ril) may be mistaken for it, and the serous mem- 

 brane would then be in danger. It is probalile, too, that the pleura reaches to a 

 lower point in tliose cases where the arcuate ligaments are attached to the second 

 lumbar transverse process. The presence of a thirteenth rib would involve a con- 

 traction of the space available for the surgical exploration of the organ. 



The upper extremity of each kidney is crowned by the suprarenal body (figs 

 611, 612), which encroaches also upon its anterior surface and inner border, and 

 is fixed to it by connective tissue derived from the subperitoneal fascia. 



The anterior or visceral surface (fig. 612) is moulded to the contiguous 



Fig. 612. — Diagram showing Axtekior Kelatkjxs of Kidneys and Suprarenal Bodies. 



DUODENAL AREA HEPATIC AREA GASTRIC AREA 



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



DUODENAL AREA 

 (NON-PERITONEALl 



COLIC AREA 

 (NON-PERITONEAL 



PERITONEAL AREA WITH RIGHT 

 COLIC VESSELS 



PERITONEAL AREA WITH LEFT 

 COLIC VESSELS 



PANCREATIC AREA 

 (NON-PERITONEAL) 



COLIC AREA OF 

 SPLEEN 



COLIC AREA 

 (NON-PERITONEAL) 



organs. The right kidney is in contact in about its ui)i)er half with the renal 

 impression on the liver (page 978), and below with the ascending colon and 

 duodenum; the hepatic area being covered with peritoneum, while the second stage 

 of the duodenum and more externally the ascending colon are directlv attached to 

 the surface ])y subperitoneal tissue; but the two non-peritoneal areas" vary consid- 

 erably in their relative ])roi»ortions, not only in different sul)jects. but in the same 

 subject under different con<litions of distension of the duod(^num and the colon. 

 The second stage of the duodcnmn is also more or less in relation with the right 

 renal vessels. 



The left kidney lies behind the stomach, the pancreas, the s]ilenic vessels, the 

 descending colon, and the colic vessels. Its anterior surface may lie divided into 

 three portions: an upper or gastric area, separated from the stomach by the 

 peritoneum of the lesser sac; a middle or pancreatic area, attached to the pan- 

 creas by suliperitoneal connective tissue, and crossed also by the sjdenic vein 

 behind the upper border of the pancreas, and by the splenic artery, which runs in 

 a ser])entine course immediately above the vein; and an inferior or colic area, 

 the outer portion of which is covered by the splenic flexure and up))er ])art of the 

 descending colon; the inner by a layer of peritoneum (of the greater sac) and the 

 colic vessels. 

 64 



