Kidneys and Adrenal Glands Department of Regional Anatomy and Operative Surgery.
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Transcript of Kidneys and Adrenal Glands Department of Regional Anatomy and Operative Surgery.
Kidneys and Adrenal Kidneys and Adrenal GlandsGlands
Department of Regional Anatomy and
Operative Surgery
Position, relationPosition, relationStructure Structure Blood supply Blood supply Lymphatic Lymphatic drainagedrainage
InnervationsInnervations
PositionRetroperitoneal
Upper poles
T12 vertebra
Lower poles
L3 vertebra
Right is lower than left
Cadaveric kidneys
Surface Projection of kidneySurface Projection of kidney
Renal Angle
Tenderness or percussing pain caused by kidney disease is localized here
Neighbor of KidneyNeighbor of Kidney
Anterior Surface of the kidney
Posterior Surface
Costodiaphragmatic recess of the pleural
cavity
Renal hilum, Renal sinus and Renal pedicle
Renal hilum
Renal sinus
Renal pedicle
cortex
Renal column
Renal pyramid
calyx
papilla
renal veinrenal vein
renal artery renal artery
renal pelvisrenal pelvis
From above From above downwardsdownwards
the renal arterythe renal artery
renal vein renal vein
renal pelvisrenal pelvis
From anterior to From anterior to posteriorposterior
HydronephroHydronephrosissis
renal arteryrenal artery
T11
Renal artery
Vascular renal segmentVascular renal segmentSuperior (apical)
Anterior superior (upper)
Anterior inferior
(middle)
Inferior (lower)
posterior
variation of renal variation of renal arteryartery
!!
Variation of Renal Variation of Renal ArteryArtery
Renal veinsRenal veins
Aorta-renal artery-segmental artery-lobar artery-interlobar artery-arcuate artery-interlobulor artery-afferent arteriole-glomerulus (capillaries)-efferent arteriole-peritubular capillaries and vasa recta-interlobular vein-arcuate vein-interlobar vein-renal vein-interior vena cava
Renal CapsuleRenal Capsule
Renal fasciaRenal fascia Adipose capsuleAdipose capsule Fibrous capsuleFibrous capsule
Renal fascia
Fibrous capsule
Adipose capsule
Perirenal fat
Pararenal fat
FibrousFibrous
Capsule Capsule
Ureter
Ureter is divided into 3 parts:Ureter is divided into 3 parts:①①abdominal partabdominal part②②pelvis partpelvis part③③intramural part intramural part
28 to 34 cm 3 narrowing sites
•the pelviureteric junction
•crossing the pelvic brim
•traversing the bladder wall
Horseshoe kidneyHorseshoe kidney
Suprarenal Suprarenal GlandGland
•Endocrine gland
•T11 level
•Right is triangular
•Left is semi-lunar
LeftLeft rightright
anterioanteriorr
superisuperioror stomachstomach
liverliverinferiinferi
oror
tail of tail of pancreas & pancreas &
spleen vesselspleen vessel
posteriorposterior diaphragmdiaphragm diaphradiaphragmgm
medialmedial abdominal abdominal aortaaorta
Inferior Inferior vena vena cavacava
Relation
Artery of Adrenal Artery of Adrenal GlandGland
Veins of adrenal glandVeins of adrenal gland
Left suprarenal vein, into the
left renal vein
Right suprarenal vein, into the
inferior vena cava
incision
Anterior transperitoneal approach
Posterior retroperitoneal approach
A 55-year-old woman was found rolling on A 55-year-old woman was found rolling on her kitchen floor, crying out from agonizing her kitchen floor, crying out from agonizing pain in her abdomen. The pain came in pain in her abdomen. The pain came in waves and extended from the right loin to waves and extended from the right loin to the groin and to the front of the right thigh. the groin and to the front of the right thigh. An anteroposterior radiograph of the An anteroposterior radiograph of the abdomen revealed a calculus in the right abdomen revealed a calculus in the right ureter. ureter.
Case ACase A
a.a. What causes the pain when a ureteral What causes the pain when a ureteral calculus is present?calculus is present?
b.b. Why is the pain felt in such an extensive Why is the pain felt in such an extensive area?area?
c.c. Where does one look for the course of Where does one look for the course of the ureter in a radiograph?the ureter in a radiograph?
d.d. Where along the ureter is a calculus likely Where along the ureter is a calculus likely to be held up?to be held up?
QuestionQuestion
An explorer in the Amazon jungle was found An explorer in the Amazon jungle was found alive after having lost contact with the alive after having lost contact with the outside world for six months. On physical outside world for six months. On physical examination, he was found to be in an examination, he was found to be in an emaciated condition. On palpation of the emaciated condition. On palpation of the abdomen, a rounded, smooth swelling abdomen, a rounded, smooth swelling appeared in the right loin at the end of appeared in the right loin at the end of inspiration. On expiration, the swelling inspiration. On expiration, the swelling moved upward and could no longer be felt. moved upward and could no longer be felt. What anatomical structure could produce What anatomical structure could produce such a swelling?such a swelling?
Case BCase B
An intravenous pyelogram revealed that a An intravenous pyelogram revealed that a patient’s left kidney was in its normal patient’s left kidney was in its normal position, but the right kidney was situated in position, but the right kidney was situated in front of the right sacroiliac joint. Can you front of the right sacroiliac joint. Can you explain this on embryological grounds?explain this on embryological grounds?
Case CCase C
An examination of a patient revealed that An examination of a patient revealed that she had a horseshoe kidney. What she had a horseshoe kidney. What anatomical structure prevents a horseshoe anatomical structure prevents a horseshoe kidney from ascending to a level above the kidney from ascending to a level above the umbilicus?umbilicus?
Case DCase D
An intravenous pyelogram revealed that the An intravenous pyelogram revealed that the calyces and pelvis of a patient’s right kidney calyces and pelvis of a patient’s right kidney were grossly dilated (a condition known as were grossly dilated (a condition known as hydronephrosis). What embryological hydronephrosis). What embryological anomaly may be responsible for this anomaly may be responsible for this condition?condition?
Case ECase E
Which congenital anomaly of the ureter is Which congenital anomaly of the ureter is likely to present as a case of urinary likely to present as a case of urinary incontinence?incontinence?
Case FCase F
operation procedure of kidney transplant
nephrectomynephrectomy
For a nephrectomy, the kidney commonly is For a nephrectomy, the kidney commonly is exposed in the loin. After an oblique incision exposed in the loin. After an oblique incision midway between the twelfth rib and the iliac crest, midway between the twelfth rib and the iliac crest, the posterior free border of the external oblique is the posterior free border of the external oblique is identified, and divided to reveal the peritoneum, identified, and divided to reveal the peritoneum, which is pushed forward to reveal the renal fascia. which is pushed forward to reveal the renal fascia. The subcostal nerve and vessels are preserved; the The subcostal nerve and vessels are preserved; the renal fascia is opened; and the kidney exposed. renal fascia is opened; and the kidney exposed. Care must be taken not to damage the pleura, Care must be taken not to damage the pleura, since it is separated from the upper pole of the since it is separated from the upper pole of the kidney only by the diaphragm.kidney only by the diaphragm.