1244 



UROGENITAL SYSTEM 



hypogastric and ilio-inguinal nerves and the anterior divisions of the subcostal and 

 first lumbar vessels, all of which run obliquely downward and laterally in front 

 of the quadratus lumborum. 



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

 1007, 1009), which encroaches also upon its ventral surface and medial border 

 and is fixed to it by fibres derived from the subperitoneal tissue. 



The anterior surface of each kidney was primarily completely covered by 

 peritoneum that separated it from neighboring viscera, but, owing to secondary 

 changes whereby the ascending and descending colons, the duodenum and the 

 pancreas become retro-peritoneal organs, these come into direct relation with one 

 or the other of the kidneys and separate portions of them from actual contact 

 with the peritoneum. Thus, in the case of the right kidney (fig. 1009), the 



Fig. 1007. — The Abdominal Viscera, seen from Behind. 



(From the model of His.) 



The kidneys are somewhat lower than usual in their relations to the ribs. 



Caudate lobe of liver 



Aorta 



Outline of last rib 



Spleen 



Left kidney, with -1 



suprarenal body 



Duodenum 



Descending colon 



Cut edge of 



peritoneum 



Outline of iliac crest 



Termination of colon 



Suprarenal body 



Outline of last rib 

 Vena cava 



Right kidney with 

 ureter medially 



Small intestine 



Outline of iliac crest 

 Colon ascendeas 



Parietal peritoneum 

 with colic vessels 



Caecum 



Small intestine 



-Bladder 

 Ampulla of rectum 



portion of the anterior surface immediately adjacent to the medial border has the 

 descending portion of the duodenum in direct contact with it, and throughout a 

 zone extending downward and laterally from the middle of the duodenal area to 

 the lateral border the ascending colon and right colic flexure. Almost the entire 

 upper half, however, and a small portion of the lower pole are covered directly 

 by peritoneum, the upper peritoneal area having an indirect relation with the 

 lower surface of the liver, upon whic^h it produces the renal impression. 



Similarly the ant(!rior surface of the left kidney (fig. 1009) is in direct contact 

 with the i)ancreas throughout a broad transverse band situated a little above the 

 middle of the organ, and tiie sjjlcnic; artery pursues its tortuous course along the 

 upper border of this pancnsatic area, while the corresponding vein is interposed 

 between the pancreas and the surface of the kidney. The lateral portion of the 

 lower extremity is in direct contact with the descending colon and its splenic 



