Pasterior Abdominal wall, Kidneys,

Ureters and Suprarenal glands

Dr Tegene Gizaw
January 2018
The posterior abdominal wall

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Introduction
• The posterior abdominal wall consists
• Bones
– lumbar vertebrae
– sacrum
– ilium
• Muscles
– Psoas (Major and Minor)
– quadratus lumborum
– Iliacus

• The parietal peritoneum covers anterior part of the posterior

abdominal wall along with the retroperitoneal organs

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Bones

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Muscles
• Psoas major
– arises from the transverse processes and sides of the
bodies and intervertebral discs of the 5 lumbar vertebrae
– passes with iliacus (Iliacus arises from the inner surface of
ilium) under the inguinal ligament
– insert in to the lesser trochanter fusing with iliacus
(iliopsoas)
– innervated by L1, 2 and 3 inside the abdomen
– flexes the hip joint
– Because the muscle fills in the angle between the transverse
processes and the sides of the bodies of the vertebrae, it
covers the intervertebral foramina
– The lumbar plexus thus enters the psoas major and its
branches emerge from the surface of the muscle
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Iliacus
• O - iliac fossa
• I - lesser
trochanter of
femur
• A - hip flexion

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Iliopsoas
• Iliacus and psoas muscle
• Covered by dense layer of fascia so that
muscles and lumbar plexus are behind fascia
and iliac vessels are in front of it

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Psoas minor
• An occasional small
muscle belly with its long
tendon lying over the
psoas major
• O - transverse processes
and bodies of T12 and L1
• I – upper rim of
acetabulum
• A - flexes lumbar vertebrae

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Quadratus lumborum
• Lies lateral to psoas, running between the iliac
crest and R12
• It is a side flexor of the trunk
• Innervated segmentally by the adjacent
lumbar nerves

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Abdominal aorta:Location
• Continuation of thoracic aorta
• Lies in the midline against vertebral bodies
• It enters the abdomen through aortic hiatus
at T12
• Ends at L4, left of the midline by dividing into
the 2 common iliac arteries.
• The main continuation of the aorta is the
median or middle sacral artery

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Abdominal aorta: relations
• Superior: diaphragm
• Anterior: celiac trunk and plexus, pancreas, left renal
vein, duodenum, mesentry
• Posterior: bodies of L1-L4 vertebrae, cisterna chili
• Lateral: inferior vena cava (right), left ciliac ganglion,
sympathetic trunk

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Branches
• Inferior phrenic: T12 Vertebrae
• Celiac trunk: T12/L1
• SMA: L1
• Renal & Gonadals: L2
• IMA: L3
• Bifurcation: iliac L4

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Unpaired visceral branches
• Ventral branches; arise from anterior surface
– arteries to the fore-, mid- and hindgut respectively
• celiac trunk
• superior mesenteric
• inferior mesenteric
• Celiac trunk:
– Foregut oesophagus to D2
• Superior mesenteric
– Midgut D3 to distal 1/3 transverse colon
• Inferior mesenteric
– Hindgut distal 1/3 transverse colon to upper 2/3 of
rectum
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Paired visceral branches
• Arise from sides; lateral branches
• Supply the suprarenal glands, kidneys and the gonads
• Renal arteries
– Arise just below the superior mesenteric artery
– The right renal artery passes posterior to the inferior vena cava
– They also send branches to the suprarenal glands and the renal pelvis
– Pass to hilum of kidney between ureter and renal vein
• Gonadal (ovarian or testicular) arteries
– Arise from the aorta just below the renal arteries
– They descend lying anterior to the surface of the psoas to reach the ovary
or pass into the inguinal canal to go to the scrotum
• Middle suprarenal arteries
– Arise near the origin of SMA

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Paired parietal branches
• Arise from posterolateral surface
• Are branches to the body wall
• The inferior phrenic arteries
– Gives branch to the suprarenal gland
• The 4 lumbar arteries
– gives a posterior branch going through the back and giving
a spinal branch
– The anterior branch runs in the anterior abdominal wall
between the transversus and the internal oblique muscle

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Unpaired parietal branches
• Arise from posterior surface
• The median (middle) sacral artery
– in the midline, anterior to the sacrum
– from bifurcation of aorta

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 Inferior Vena Cava
• Returns blood from lower limbs, abdominal wall and
abdominopelvic viscera
• begins in front of the body of L5 by union of common
iliac veins
• ascends, on right psoas muscle right to aorta, to the
diaphragm
• pierce the central tendon at T8 forming vena caval
foramen

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Tributaries
• Ventral tributary: right testicular or ovarian
vein
• Lateral tributaries: renal and right suprarenal
and hepatic veins
• Correspond to the named arteries except on the left
where the suprarenal and gonadal veins open into the
left renal vein
• Tributaries from the body wall: the inferior
phrenic and lumbar veins
• the median sacral opens into the left common iliac vein
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 Lumbar plexus
• Lies in the psoas major
• Formed by the anterior primary rami of L1, 2, 3, and 4
• The sacral plexus is from L4, 5, S1, 2, 3 and 4
• L4 is also called the nervus furcalis or lumbosacral trunk
because it splits itself between the lumbar and sacral
plexuses
• The sacral and lumbar plexuses overlap substantially
• Since many of the fibers of the lumbar plexus
contribute to the sacral plexus via the lumbosacral
trunk, the two plexuses are often referred to as the
lumbosacral plexus
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Branches
• Its proximal branches innervate parts of the
abdominal wall and iliopsoas
• Major branches of the plexus descend to innervate
the medial and anterior thigh
• branches
– iliohypogastric nerve (L1)
– ilioinguinal (L1)
– The genitofemoral nerve (L1, L2)
– The lateral cutaneous nerve of the thigh (L2,L3)
– The femoral nerve (L2-L4)
– The obturator nerve (L2-L4)

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Branches
• Iliohypogastric nerve
• Supply skin of inguinal region
• Ilioinguinal
• This runs between the layers of the anterior abdominal
wall
• emerges from the superficial inguinal ring
• supplies the skin on the medial side of the thigh and the
scrotum or labium majus
• Genitofemoral nerve
• emerges from the anterior surface of the psoas major
• runs down deep to the psoas fascia
• supplies cremaster muscle via its genital branch and a
small area under the inguinal ligament by its femoral
branch

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• Lateral cutaneous nerve of the thigh
• emerges from the lateral border of the psoas
• sweeps around the iliac fossa and leaves the abdomen by passing
under the inguinal ligament
• Femoral nerve
• large and emerges from the lateral border of psoas
• may give branches to psoas and iliacus
• It lies outside of the fascia covering psoas and iliacus
• Obturator nerve
• emerges from the medial border of the psoas near the brim of the
pelvis
• lying posterior to the common iliac vessels
• It then travels anteriorly and inferiorly, anterior to obturator internus
and leaves the pelvis by passing through the superior part of the
obturator foramen

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Kidney
Location

• Each kidney lies in

paravertebral grooves on
posterior abdominal wall
retroperitoneally

• The kidneys extend from

the level of the T12 to L3

• They receive some

protection from ribs
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 Kidney: Location

• The right lies

somewhat lower than
left as it is positioned
under liver

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External Anatomy
• The adult kidney weighs about 150 g

• Size: 12 cm long, 6 cm wide, 3 cm thick

• Color: reddish-brown

• Shape: bean-shaped

• The lateral surface of each kidney is convex, while the

medial is concave

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 External Anatomy
• Medial surface has a
vertical cleft called the
renal hilus that leads
into the space within
the kidney called the
renal sinus

• Atop each kidney is an

adrenal gland 43
 External Anatomy
• Ureters, renal blood
vessels, lymphatics, and
nerves enter the kidney
at the hilus

• These structures occupy

the renal sinus

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 Position

• The kidneys are retroperitoneal, or behind the peritoneum

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 Supportive tissue
 Kidneys are supported by three layers of supportive tissue
1. The renal capsule
 The outer membrane that encloses, supports and protects
the kidney
 adheres directly to the kidney surface and isolates it
from surrounding region
2. The adipose capsule/Perinephric fat
 attaches the kidney to the posterior body wall and
cushions it against trauma
3. The renal fascia
dense fibrous connective tissue which surrounds the
kidney and anchors these organs to the surrounding
structures 47
Internal Anatomy
• The kidney has three distinct regions

– Cortex

– Medulla

– Pelvis

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Internal Anatomy: Cortex
• The outer layer of the kidney

• Light in color and has a granular appearance

• Contains most of the nephron; main site for filtration,

reabsorption and secretion

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Internal Anatomy: renal medulla
• Deep to the cortex; inner core of the kidney

• Darker tissue which exhibits cone shaped tissue masses

called medullary or renal pyramids

• Contains the pyramids, columns, papillae, and parts of

the nephron

• Used for salt, water and urea absorption

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Internal Anatomy: renal medulla
• Renal pyramid

– Triangular units in the medulla that house the loops

of Henle and collecting ducts of the nephron

– Each renal pyramid has a base which is convex, and an

apex which tapers toward its papilla

• Renal Papilla

– The tip of the renal pyramid that releases urine into a

calyx 51
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Internal Anatomy: renal pelvis
• Within the renal sinus is the renal pelvis

• This flat, funnel shaped tube is continuous with the ureter

leaving the hilus

• Branching extensions of the renal pelvis form 2-3 major

calyces, each of which sub-divides to form 2-3 minor calyces

• Calyx

– A collecting sac surrounding the renal papilla

– transports urine from the papilla to the renal pelvis

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Internal Anatomy: renal pelvis

• Renal pelvis collects urine from all of the calyces

• Urine flows through the renal pelvis into the ureter,

which transports it to the bladder

• The walls of the calyces, pelvis, and ureter contain

smooth muscle which contract to move urine

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Blood Supply
• Kidneys possess an extensive blood supply

• Under normal resting conditions, the renal arteries

deliver approximately one-fourth of the total systemic
cardiac output (1200 ml) to the kidneys each minute

• The renal arteries issue at right angles from the

abdominal aorta

• Each renal artery divides into segmental arteries that

enter the hilus
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 58 b
Figure 26.5a,
 59 d
Figure 26.5c,
Nephrons
• Each kidney contains over 1 million tiny blood
processing units called nephrons, which carry out the
processes that form urine

• Nephrons are the physiological unit of the kidney used

for

– filtration of blood and reabsorption and secretion of

materials

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 Nephrons
• The nephron is composed of

– Renal corpuscle

– Renal tubule

• Proximal convoluted tubule

• Loop of Henle

• Distal convoluted tubule

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 Nephrons - Renal Corpuscle

• The renal corpuscle comprises the enclosed glomerulus and the

capsule of the glomerulus called Bowman’s capsule 63
Nephrons - Renal Corpuscle
• The first part of the nephron, where the filtration occur
Spherical

• Consist of a tuft of capillaries called a glomerulus surrounded

by a cup shaped, hollow glomerular capsule (Bowman’s
capsule)

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A Renal Corpuscle
 Nephron - Renal Corpuscle
• Each nephron is served
with blood by the afferent
arteriole

• This vessel brings blood

into a capillary tuft called
the glomerulus

• Blood leaving the

glomerulus flows into the
efferent arteriole 66
 Renal Corpuscle: glomerulus
• A capillary tuft differs from a
capillary bed in that it does not
perfuse a tissue like a capillary bed
does
• Instead this capillary tuft is a
condensed mass of capillaries which
allows substances to escape by
filtration
• Space between capillary loops are
filled by specialized connective
tissue called mesangium
– Consists mesangial cells and ECM
– Provide support for capillary
loops
– phagocytic 67
 Renal Corpuscle: glomerulus
• The site for blood filtration

• Operates as a nonspecific filter; in that, it will remove both

useful and non-useful material

• The glomerulus endothelium is fenestrated (penetrated by many

pores), which make these capillaries highly porous

• The capillaries of this tuft are surrounded by specialized

epithelial cells which form the inner (visceral) layer of Bowman's
capsule
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 Renal Corpuscle: Bowman's capsule

• A sac that encloses the

glomerulus

• Transfers filtrate from the

glomerulus to the Proximal
Convoluted Tubule (PCT)

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Nephron: Bowman's capsule
• The outer parietal layer of the glomerular capsule is
composed of simple squamous cells with tight junctions
and serves to contain the filtrate in the capsular space

• It contributes to the structure of the capsule

• It plays no part in the formation of filtrate

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Filtration membrane
• Lies between the
blood and the
interior of the
glomerular
capsule
• It is a porous
membrane that
allows free
passage of water
and solutes
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Filtration membrane
• The filtration membrane is a double layered membrane
composed of

– the endothelial cells of the capillary wall

– the podocytes of the visceral layer of Bowman’s capsule

• It is a porous membrane that allows free passage of water and

solutes smaller that plasma proteins

• The capillary pores prevent passage of blood cells and proteins,

but plasma components are allowed to pass
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 Filtration membrane
• Consists of 3 layers
1. Capillary endothelium
– Numerous fenestrae with out diaphragm
2. Glomerular BM
– Thicker than other BM
– Fused common BM
3. Podocytes – visceral epithelial cells of Bowman’s capsule

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 Renal Tubules
• Extend from Bowman’s capsule to collecting duct
• Lined by single layer of epithelial cells
• Function
– Selective reabsorption of water and ions
– Secrete ions
• 4 zones
 Proximal convoluted tubule (PCT)
 Loop of Henle
 Distal convoluted tubule
 Collecting tubule

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Renal Tubules: summary
• The Bowman's capsule opens into the proximal
convoluted tubule which leads to the loop of Henle
• The loop of Henle has a descending limb which
passes into the medulla, recurves, and becomes the
ascending limb which leads back up to the distal
convoluted tubule in the cortex
• Distal convoluted tubules lead into collecting
tubules, which pass through the medullary pyramids
to the papillae

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Nephron types
• Cortical nephrons
– Most human nephrons are
cortical nephrons
– their corpuscles are located in
the mid to outer cortex and
their loops of Henle are very
short and pass only into the
outer medulla
• Juxtamedullary nephrons
– their loops travel deep into the
inner medulla
– These nephrons are important
in concentrating the urine by
increasing the amount of water
reabsorbed

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Histology of nephrons
• Proximal tubule cells
– have abundant mitochondria and brush border (microvilli) for extensive
reabsorption and secretion
• Distal tubule cells
– are less active and are therefore thinner
• Loop cells
– Thin segment cells in descending limb are modified simple squamous
epithelium for reabsorption of water by osmosis
– Thick segment ascending limb and DCT cells are similar to PCT but have
fewer microvilli and mitochondria - they also allow secretion and
reabsorption but not as much as in PCT
• Collecting duct cells
– cuboidal and allow minor amounts of secretion and absorption

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The juxtaglomerular apparatus (JGA)
• A place where the distal convoluted tubule lies close to the
glomerulus and to the afferent and efferent arterioles
– Specialization of afferent arteriole and DCT
• Involved in regulation of BP
• It consists of 3 components
1. Macula densa
– Area of closely packed, specialized cells lining DCT where it abuts to
vascular pole
– Sensitive to concentrations of sodium ion
2. Juxtaglomerular cells
– Specialized smooth muscle cells of afferent arteriole
– Secrete enzyme renin
3. Extraglomerular mesangeal cells
– Form conical mass
– Function unknown
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• Functions of the JGA
– Macula densa cells sense the glomerular filtration
rate via the salt (Na+) concentration in the distal
tubule
– Juxtaglomerular cells secrete renin into the blood
of the arterioles

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Lymphatic drainage and Innervation of kidneys

• Lymph vessels follow renal veins and drain

into lumbar lymph nodes

• Nerve supply is from Aorticorenalplexus

(lesser and lower splanchnic nerves)

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Ureters
• Thick walled muscular duct with narrow
lumina
• Carry urine from kidneys to urinary bladder
• It measures 25cm (10 in.)

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Ureters
• Histologically, the walls of the ureter is
trilayered
– An inner layer of transitional epithelium lines the
inner mucosa
– The middle muscularis layer is composed of an
inner longitudinal layer and an outer circular layer
– The outer layer is composed of fibrous connective
tissue

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Obstruction of ureter
• Obstruction results from ureteric calculus (kidney
stones)
• Ureters dilate if obstructed
– Excessive distension causes severe pain – ureteric colic,
results from hyperperistalsis in ureter
• Causes complete or intermittent obstruction of
urinary flow
• Occur any where along ureter, but often in the 3
narrow regions
– at the junction with the pelvis of the kidney
– where it crosses the brim of the pelvic bone
– as it enters the bladder 88
Arterial supply to Ureter

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• Arterial supply: It is well supplied by the renal
artery (mainly), aorta, gonadal arteries and various
pelvic vessels.
• Venous drainage: Renal vein (mainly), Testicular
and ovarian veins
• Lymphatic drainage: aortic, common iliac, external
iliac and internal iliac lymph nodes
• Innervation: Aorticorenal plexus, renal plexus

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Innervation of Ureter

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Suprarenal glands
• Pair of ductless glands on the upper poles of each kidneys
• Right suprarenal
– Triangular, partly covered with peritoneum
– Relations
• Posteriorly – diaphragm
• Postero-inferiorly – right kidney
• Anteriorly – liver and inferior vena cava
• Medial border- celiac ganglion
• Left suprarenal
– Semilunar, partly covered with peritoneum of the lesser sac
– Relations
• Posteriorly – diaphragm
• Anteriorly – stomach ( forms stomach bed) separated by lesser
sac
• Postero-inferiorly - left kidney
• Medial border- celiac ganglion
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Neurovasculature
• Arterial supply
Superior suprarenal arteries - from phrenic artery
Middle suprarenal arteries - from abdominal aorta
Inferior suprarenal arteries - from renal artery
• Veins – single vein from each
Left – drains into left renal vein
Right- directly into IVC
• Nerve supply
From celiac plexus

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 General structures
 Thick CT capsule
 bringing arteries to serve radial capillaries draining down towards the
venules and central vein of the medulla
 Arterioles also penetrate the cortex to serve a medullary capillary bed
 Cortex
 Polyhedral glandular cells, in cords usually two cells wide, run roughly
radially, along with sinusoidal capillaries
 Medulla
 thin strip of basophilic cells
 Embryologically and functionally distinct
 Mesodermal cells of coelomic mesothelium differentiate into
cortex
 Neural crest form the medulla

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Adrenal Cortex

• Cells of the adrenal cortex have the

characteristic structure of steroid synthesizing
cells
• The cortex has 3 layers, the zonae
glomerulosa, fasciculata, and reticularis

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Zona glomerulosa

• Outermost cortical, beneath the capsule and

constitutes 15% of adrenal volume
• cells form arched clusters (glomeruli)
surrounded by capillaries
• The secretory cells produce
mineralocorticoids e.g. Aldosterone

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 Zona fasciculata

• middle layer of the adrenal cortex, constitutes

65% of adrenal volume
• cells form straight cords (fascicles) that
run perpendicular to the organ surface
• produce glucocorticoids and some
adrenal androgens upon appropriate
stimulation

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 Zona reticularis
• Innermost layer of the adrenal cortex and constitutes
7% of adrenal volume
• Cells are arranged in irregular cords that form an
anastomotic network (reticulum)
• Its cells resemble those in the fasciculata but are
smaller and more acidophilic
• They produce Sex hormones

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Adrenal Medulla
• It contains 2 major cell types:
– Chromaffin cells
– ganglion cells
• Ganglion cells
– few parasympathetic ganglion cells
• Chromaffin cells
– the predominant medullary cell type
– modified postganglionic sympathetic neurons that have
lost their axons and dendrites
– Synthesize and release their catecholamines upon
neural stimulation, especially stress, mediated by
preganglionic sympathetic neurons

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