526 ABDOMEN 



omental bursa, and it forms a portion of the stomach bed. 

 The lower portion of the anterior surface is covered by the 

 pancreas and crossed by the splenic vessels, and is not in 

 relation to the peritoneum. Occasionally the spleen extends 

 so far medially that it lies in relation to the upper part of the 

 anterior surface of the left suprarenal gland, but this con- 

 dition is rare. The posterior surface is subdivided into two 

 areas, as on the right side, by a curved ridge. The upper 

 area is flat, and applied to the left crus of the diaphragm ; the 

 lower area is hollowed out and is in relation to the kidney, a 

 considerable amount of fat intervening. 



The student has already observed the abundant nerve supply to the 

 suprarenal glands from the creliac plexus. Its blood supply is equally rich. 

 No fewer than three arteries enter its substance viz. the superior, middle, 

 and inferior suprarenal arteries. 



When a section is made through the suprarenal gland it is seen to 

 consist of an external firm portion termed the cortex, and of a soft pulpy 

 dark-coloured internal substance called the medullary part. 



Renes (Kidneys). The kidneys are situated behind the 

 peritoneum, against the posterior wall of the abdomen one 

 on either side of the vertebral column. They are enveloped 

 by a capsule of loose areolar tissue, the meshes of which are 

 at certain points loaded with soft pliable fat. Clear this 

 away, and be careful to preserve the suprarenal gland, which 

 lies upon the upper end of each kidney. 



Each kidney is placed opposite the bodies of the last dorsal 

 and the upper three lumbar vertebrae. It extends from the 

 upper border of the last dorsal vertebra to the middle of the 

 body of the third lumbar vertebra, and it lies obliquely its 

 upper end being somewhat nearer the medial plane than its 

 lower end. The kidneys lie for the most part in the hypo- 

 chondriac and epigastric regions. As a rule the left kidney 

 is entirely confined to these districts ; but the right kidney, 

 which generally occupies a slightly lower level, crosses the sub- 

 costal plane so that a small portion of its inferior extremity 

 comes to lie in the right lumbar and the adjoining part of the 

 umbilical region. This difference on the two sides is probably 

 due to the great bulk of the right lobe of the liver. The 

 twelfth rib lies behind both kidneys. The right kidney does 

 not, as a rule, extend beyond the upper border of this rib, but 

 the left kidney may reach the lower border of the eleventh 

 rib. The lower end of each organ is separated by a short 

 interval, of varying extent, from the crest of the ilium. 



