The Urinary System

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The Urinary System

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• ???

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• Composition
• Two kidney-form urine
• Two ureter-conduct urine from kidneys to bladder
• Bladder-receives and stores urine
• Urethra-conducts urine from bladder to exterior
  of body (discharged)

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Kidney ?

• General features
• Bean shaped, reddish-brown organs
• Superior extremity-broad and thin
• Inferior extremity-narrow and thick
• Anterior surface-convex
• Posterior surface-flat
• Lateral border-convex

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• Medial border-concave
• Renal hilum ??-a vertical slit on the medial
  border of kidney, the structures which enter and
  leave the renal hilum is called renal pedicle??,
  including the renal vein, renal artery, renal
  pelvis, lymphatic vessels and nerves
• Order of structures in the renal pedicle from
  anterior to posterior-V. A. P. from superior to
  inferior-A. V. P.

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• Renal sinus ??
• -which is the renal hilum leads into a space
  within the kidney, the rental sinus is occupied
  by the renal vessels, minor renal calices, major
  renal calices, renal pelvis and some adipose
  tissue

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• Structure of the kidney
• Renal cortex ???
• renal columns ??
• Renal medulla ???
• Renal pyramids ??? 1520
• Renal papilla ???
• Papillary foramina ???
• Minor renal calices ??? (7-8)
• Major real calices ??? (23)
• Renal pelvis ??

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• Coverings
• Fibrous capsule ??? -a strong fibrous capsule
  which strips easily from a normal kidney surface
  but adheres firmly to an organ that has been
  inflamed

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• Position
• Lie behind peritoneum one on each side of the
  vertebral column high up on the post abdominal
  wall, upper pole nearer to media plan than lower
  pole

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• Fatty renal capsule ??? -a thick adipose
  connective tissue capsule, surrounds the fibrous
  capsule. It acts as a shock absorber to protect
  the kidney from jolting and jarring
• Renal fascia ???-on outside, surrounds both the
  kidney and suprarenal gland, holding these organs
  in place

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• Left kidney lies at the level from the lower
  border of T11 to L2 the 12th rib is behind its
  middle part of the post surface
• Right kidney lies slightly lower than the left
  kidney, at the level from the lower border of T12
  to L3 the 12th rib is behind its upper part of
  the post surface
• Renal hilum at the level of L1, is about 5cm from
  the posterior median line
• Renal region-the area between 12th rib and the
  lateral margin of erector spinae

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Relationships of kidneys

• Superiorly-superarenal gland
• Posteriorly
• Three muscles
• Diaphragm (pleural cavity),
• Psoas major
• Quadratus lumborum
• Three nerves
• Subcostal
• Iliohypogastric
• Ilioinguinal
• Medial
• Left kidney-abdominal aorta
• Right kidney-inferior ceva vana

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• Anteriorly
• Left kidney
• Stomach (superior),
• Pancreas (middle),
• Loops of intestine and left colic flexure
  (inferiorly)
• Right kidney
• Right lobe of liver (superior)
• Right colic flexure (inferior)
• Descending part of duodenum (medially)

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• Renal segments
• The kidney is divided into five vascular segments
  and each is supplied by a branch of the renal
  artery between the segments there is no
  anastomosis.
• The segments are
• Superior segment
• Superior anterior segment
• Inferior anterior segment
• Inferior segment
• Posterior segment

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Ureters ???

• Muscular tube, about 25cm long
• Three parts
• Abdominal part-descend on the psoas major behind
  the peritoneum
• Pelvic part-in females, passes 2cm lateral to the
  neck of uterus and lies below the uterine artery
• Intramural part-passes obliquely through the
  bladder wall for 2cm long

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• Three constrictions
• At the pelvoureteric junction
• Where it crosses the pelvic inlet and iliac
  vessels
• Where it pierces the bladder wall obliquely (at
  intramural part)

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Stone in ureter
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• Relation of abdominal part of ureter
• Anterior to left ureter
• Descending part of duodenum
• Right colic vesseles
• Iliocolic vesseles
• Testicular vesseles
• Terminal part of ileum
• Right to left ureter
• Cecum
• Vermiform appendix
• Anterior to left ureter
• Duodenojejunal flexure
• Left colic vesseles
• Testicular vesseles

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Bladder ??

• General features
• Pyramidal in shape when empty, having
• Apex,
• Fundus
• Body of bladder
• Neck

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• Interior of bladder
• Mucous membrane folded, except for trigone of
  bladder
• Trigone of bladder ???? -smooth triangular
  area at inner surface of the funds of bladder,
  formed by internal urethral orifice anteriorly
  and two ureteric orifices laerally, in this area
  absents submucosal layer, where the mucous
  membrane is firmly adherent to the muscular coat,
  and is always smooth
• Interureteric fold ????? -muscular
  elevation, between ureteric orifices.

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• Location
• In the adult, it lies in the lesser pelvis,
  behind the pubic symphysis, in front of seminal
  vesicle, ampulla ductus deferentis and rectum in
  the male, and in front of uterus and vagina in
  the female.
• In the young child the empty bladder projects
  above the pelvic inlet

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Urethra ??

• Female urethra
• Relatively short (about 5cm long), wide and
  straight
• Opens into vaginal vestibule

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Retroperitoneal space and contents

• Position-it lies between the parietal peritoneum
  and transvers fascia of the posterior abdominal
  wall, from diaphragm to promontory of sacrum,
  continuation with extraperitoneal fascia.
• Contents-kidney, suprarenal gland, ureter,
  abdominal aorta, inferior vena cava, nervers and
  lymphatics, loose connective tissue

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Suprarenal gland ???

• Shape and position
• Right is pyramidal in shape, left one semilunar
  in shape, consisting of out cortex and inner
  medulla
• Located retroperitoneally, superomedial to
  superior poles of each kidney, enclose with the
  kidney by the renal fascia
• Blood supply
• Arteries
• Superior suprarenal a.
• Middle suprarenal a.
• Inferior suprarenal a.
• Venous drainge
• Right suprarenal v. drains into inferior vena
  cava
• Left suprarenal v. joins left renal v.

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Nervers of abdomen

• Lumbar plexus ??
• Formation formed by anterior rami of L1-L3, a
  part of anterior rami of T12and L4
• Position lies within substance of psoas major

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• Branches
• Iliohypogastric n. ?????Supplies lower part of
  anterior abdominal wall
• Ilioinguinal n. ??????Passes through inguinal
  canal to supply skin of the groin and scrotum
• Lateral femoral cutaneous ??????
• Femoral n. ???
• Obturator n. ????
• Genitofemoral n. ?????

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Lumbar sympathetic trunk ????

• Made up of paired chains with four to five lumbar
  ganglia anterolateral to vertebral column
• Enters abdomen via the diaphragm and as a
  continuation of he thoracic part
• Passes inferiorly behind common iliac vessels and
  terminations by joining to form unpaired ganglion
  impar, anterior to sacrum

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• Relations of abdominal aorta
• Anteriorly (from above downward)
• Pancreas
• Ascending part of duodenum
• Radix of mesentery
• Posteriorly
• Upper four lumber vertebrae
• On its right
• Inferior vena cava
• On its left
• Left lumbar sympathetic trunk

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• Relations of inferior vena cava
• Anteriorly (cranially to caudally)
• Liver
• Head of pancreas
• Horizontal part of duodenum
• Right testicular (or ovarian) a.
• Radix of mesentery
• Posteriorly
• Right crus of diaphragm
• Upper four lumber vertebrae
• Left sympathetic trunk
• Parietal branches of abdominal aorta
• On its right
• Psoas major
• Right kidney
• Right suprarenal gland
• On its left
• Abdominal aorta