Part 150

FIG. 380.—DIAGRAMMATIC SCHEME OF URINIFEROUS TUBULES AND BLOOD-VESSELS OF KIDNEY.

Drawn in part from the descriptions of Golubew (Böhm, Davidoff, and Huber). ]

=Renal Tubules=—The parenchyma or proper substance of the kidney is composed of the small =renal= or =uriniferous tubules= (Tubuli renales), which are very close together and have a complicated course. Each tubule begins in a thin-walled, spherical dilatation or =capsule=, which is invaginated to receive a tuft of looped capillaries termed a =glomerulus=; these two structures constitute a =renal= (or Malpighian) =corpuscle=; the corpuscles are visible as minute red or dark spots in the convoluted part of the cortex. Succeeding this is a short narrow neck, beyond which the tubule becomes wide and convoluted, forming the proximal convoluted tubule, and enters the radiate portion of the cortex. It then gradually narrows and enters the intermediate zone; becoming very narrow and nearly straight, it descends for a variable distance into the medullary substance, turns sharply upon itself, and returns to the cortex, forming thus the loop of Henle, with its descending and ascending limbs. In the convoluted part of the cortex, it widens and becomes tortuous, constituting the distal convoluted tubule. The tubule then narrows, enters a medullary ray, and opens with other tubules into a straight collecting tubule; this passes axially through a pyramid, and unites with other collecting tubules to form the relatively large papillary ducts, which open into the renal pelvis.

=Stroma.=—The interstitial tissue forms a reticulum throughout which supports the tubules and blood-vessels. It is very scanty in the cortex, much more abundant in the medulla, in which it increases in amount toward the pelvis.

=Blood-supply.=—The kidneys receive a large amount of blood through the =renal arteries=. Branches of these enter at the hilus and on the ventral surface of the gland, and reach the intermediate zone, where they form anastomotic arches (Arteriæ arciformes). From these arciform arteries branches pass into the cortex and medulla. The cortical branches (Arteriæ interlobulares) have in general a radial course between the cortical lobules, and give off short lateral branches, each of which ends as the =afferent vessel= (Vas afferens) of a renal corpuscle. The blood is carried from the glomerulus by a smaller =efferent vessel=, which breaks up immediately into capillaries which form networks around the tubules. The medullary branches descend in the pyramids, forming in them bundles of straight twigs (Arteriolæ rectæ).

The =veins= correspond in general to the arteries. In the superficial part of the cortex the veins form star-like figures (Venæ stellatæ) by the convergence of several small radicles to a common trunk.

=Lymph Vessels.=—These may be divided into two sets, capsular or superficial, and parenchymatous or deep.

=Nerve-supply.=—The nerves are derived from the renal plexus of the sympathetic, and form a plexus around the vessels.

THE URETERS

The =ureters= are the narrow part of the excretory ducts of the kidneys. Each begins at the renal pelvis and terminates at the bladder. It is about ⅓ to ¼ inch (ca. 6 to 8 mm.) in diameter, and its average length is about 28 inches (ca. 70 cm.). The =abdominal part= (Pars abdominalis) of each ureter emerges ventrally from the hilus of the kidney, and curves backward and inward toward the lateral face of the posterior vena cava (right side) or the posterior aorta (left side). They then pass almost straight backward in the subperitoneal tissue on the surface of the psoas minor, cross the external iliac vessels, and enter the pelvic cavity. The =pelvic part= (Pars pelvina) passes backward and a little downward on the lateral wall of the pelvic cavity, turns inward, and pierces the dorsal wall of the bladder near the neck.

In the male the pelvic part enters the urogenital fold and crosses the vas deferens. In the female the ureter is situated in the greater part of its course in the dorsal part of the broad ligament of the uterus.

The wall of the ureter is composed of three coats. The outer =fibrous coat= (Tunica adventitia) is composed of loose fibrous tissue. The =muscular coat= (Tunica muscularis) consists of inner and outer layers of longitudinal fibers, with a stratum of circular fibers between them. The =mucous membrane= (Tunica mucosa) is covered with transitional epithelium; glands (Glandulæ mucosæ ureteris) resembling those of the renal pelvis occur in the first three or four inches of the ureter.

THE URINARY BLADDER

The =urinary bladder= (Vesica urinaria) (Figs. 270, 271, 272) differs in form, size, and position according to the amount of its contents. When empty and contracted, it is a dense, pyriform mass, about the size of a fist, lies on the ventral wall of the pelvic cavity, and does not reach to the inlet. When moderately filled, it is ovoid in form, and extends a variable distance along the ventral abdominal wall. Its physiological capacity varies greatly, but may be estimated approximately at about three or four quarts.

The anterior rounded blind end is termed the =vertex=; on its middle is a mass of cicatricial tissue (Centrum verticis), a vestige of the urachus, which in the fœtus forms a tubular connection between the bladder and the allantois. The =body= or middle part (Corpus vesicæ) is rounded, and is somewhat flattened dorso-ventrally, except when distended. It presents two surfaces, dorsal and ventral, the former being the more strongly convex, especially in its posterior part in front of the entrance of the ureters. The posterior narrow extremity, the =neck= (Collum vesicæ), joins the urethra.

The =relations= of the bladder vary according to the degree of fullness of the organ, and also differ in important respects in the two sexes. The ventral surface lies on the ventral wall of the pelvis, and extends forward on the abdominal wall as the bladder fills. The dorsal surface in the male is related to the rectum, the urogenital fold, the terminal parts of the vasa deferentia, the vesiculæ seminales, and the prostate; in the female it is in contact, instead, with the body of the uterus and the vagina. The vertex of the full bladder is related to coils of the small intestine and small colon, and to the pelvic flexure of the large colon.

=Fixation.=—Displacement of the bladder is limited chiefly by three peritoneal folds, termed the middle and lateral ligaments (Figs. 257, 272). The =middle ligament= (Plica umbilicalis media) is a median triangular fold, formed by the reflection of the peritoneum from the ventral surface of the bladder on to the ventral wall of the pelvis and abdomen. In the new-born animal it is extensive and reaches to the umbilicus; in the adult it is usually much reduced in length relatively. It contains elastic and muscular fibers in its posterior part. The =lateral ligaments= (Plicæ umbilicales laterales) stretch from the lateral aspects of the bladder to the lateral pelvic walls. Each contains in its free edge a round, firm band, the =round= or =umbilical ligament= (Lig. umbilicale s. teres); this is the remnant of the large fœtal umbilical artery, the lumen of which in the adult is very small. The retroperitoneal part of the bladder is attached to the surrounding parts by loose connective tissue, in which there is a quantity of fat. It is evident that the posterior part of the bladder has a definite fixed position, while its anterior part is movable.

=Structure.=—The wall of the bladder consists of a partial peritoneal investment, the muscular coat, and the mucous lining.

The =serous coat= (Tunica serosa) covers the greater part of the dorsal surface, from which it is reflected in the male to form the urogenital fold; in the female it passes on to the vagina, forming the vesico-genital pouch. Ventrally the peritoneum covers only the anterior half or less of the bladder, and is reflected posteriorly on to the pelvic floor.

The =muscular coat= (Tunica muscularis) is relatively thin when the bladder is full. It is unstriped, pale, and not clearly divided into layers, but has rather a plexiform arrangement. Longitudinal fibers occur on the dorsal and ventral surfaces, but laterally they become oblique and decussate with each other. A distinctly circular arrangement is found at the neck, where the fibers form a =sphincter= (Annulus urethralis).

The =mucous coat= (Tunica mucosa) is pale and thin. It is in general attached by a highly elastic submucosa to the muscular coat, and forms numerous folds when the organ is empty and contracted. It is modified dorsally in the vicinity of the neck over a triangular area, termed the =trigonum vesicæ=; the angles of this space lie at the orifices of the two ureters and the urethra, which are close together. Here the mucous membrane is closely attached and does not form folds. From each =ureteral orifice= (Orificium ureteris) a fold of mucous membrane (Plica ureterica) passes backward and inward, uniting with its fellow to form a median crest (Crista urethralis) in the first part of the urethra. The ureteral orifices are a little more than one inch (ca. 3 cm.) apart. The terminal part of the ureter, after piercing the muscular coat of the bladder, passes for a distance of about an inch (ca. 2 to 3 cm.) between the muscular and mucous coats before piercing the latter; this arrangement constitutes a valve which prevents absolutely the return of the urine from the bladder into the ureter. The =internal urethral orifice= (Orificium urethæ internum) lies at the apex of the trigonum, and is about an inch and a half (ca. 4 cm.) behind the ureteral orifices. The mucous membrane is covered with transitional epithelium like that of the ureter and renal pelvis. It contains lymph nodules.

=Blood-supply.=—This is derived chiefly from the vesico-prostatic branch of the =internal pudic artery=. It is also supplied by small twigs from the =obturator= and =umbilical arteries=. The =veins= terminate chiefly in the =internal pudic veins=. They form plexuses posteriorly.

=Lymph Vessels.=—These form plexuses on both surfaces of the muscular coat. They go to the internal iliac and lumbar glands.

=Nerves.=—The nerves are derived from the =pelvic plexus= (sympathetic and ventral branches of third and fourth sacral nerves). They form a plexus in the submucosa which presents microscopic ganglia.

In the fœtus and new-born animal the bladder is situated chiefly in the abdomen. It is long, narrow, and fusiform. Its abdominal end lies at the umbilicus, through which it is continued by the urachus to the extra-embryonic part of the allantois. As the pelvis increases in size and the large intestine grows, the bladder retracts into the pelvis and changes its form.

The urethra will be described with the genital organs.

THE ADRENAL BODIES

The =adrenal bodies= or =suprarenal glands= (Glandulæ suprarenales) are two small, flattened organs, which lie in contact with the anterior part of the inner border of the kidneys (Figs. 376, 377). They are ductless.