Transcript The Urinary System

The Urinary System
山东大学医学院 解剖教研室
李振华
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)
Kidney 肾
General features
 Bean shaped, reddishbrown 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
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Renal hilum 肾门－a
vertical slit on the medial
border of kidney, the
structures which enter and
leave the renal hilum is
called renal pedicle肾蒂,
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.

Renal sinus 肾窦
－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
Structure of the kidney
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Renal cortex 肾皮质
 renal columns 肾柱
Renal medulla 肾髓质
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Renal pyramids 肾锥体: 15～20
Renal papilla 肾乳头
Papillary foramina 乳头孔
Minor renal calices 肾小盏 (7
－8)
Major real calices 肾大盏 (2～3)
Renal pelvis 肾盂
Coverings
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Fibrous capsule 纤
维囊 －a strong fibrous
capsule which strips
easily from a normal
kidney surface but
adheres firmly to an
organ that has been
inflamed
Position
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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 脂肪囊
－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 肾筋膜－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
Relationships of kidneys
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
Superiorly－superarenal gland
Posteriorly
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Three muscles
 Diaphragm (pleural cavity),
 Psoas major
 Quadratus lumborum
Three nerves
 Subcostal
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Iliohypogastric

Ilioinguinal
Medial
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Left kidney－abdominal aorta
Right kidney－inferior ceva vana
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Anteriorly
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Left kidney
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Stomach (superior),
Pancreas (middle),
Loops of intestine and
left colic flexure
(inferiorly)
Right kidney
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Right lobe of liver
(superior)
Right colic flexure
(inferior)
Descending part of
duodenum (medially)
Renal segments
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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
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Superior segment
Superior anterior segment
Inferior anterior segment
Inferior segment
Posterior segment
Ureters 输尿管
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Muscular tube, about 25cm
long
Three parts
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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
Three constrictions
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At the pelvoureteric
junction
Where it crosses the
pelvic inlet and iliac
vessels
Where it pierces the
bladder wall obliquely (at
intramural part)
Stone in ureter
Relation of abdominal part of ureter
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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
Bladder 膀胱
General features
 Pyramidal in shape
when empty, having
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Apex,
Fundus
Body of bladder
Neck
Interior of bladder
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Mucous membrane folded,
except for trigone of bladder
Trigone of bladder 膀胱三角
－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 输尿管间襞
－muscular elevation, between
ureteric orifices.
Location
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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
Urethra 尿道
Female urethra
 Relatively short (about
5cm long), wide and
straight
 Opens into vaginal
vestibule
Retroperitoneal space and contents
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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
Suprarenal gland 肾上腺
Shape and position
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Right is pyramidal in shape, left one
semilunar in shape, consisting of out
cortex and inner medulla
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Located retroperitoneally,
superomedial to superior poles of
each kidney, enclose with the kidney
by the renal fascia
Blood supply
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Arteries
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Superior suprarenal a.
Middle suprarenal a.
Inferior suprarenal a.
Venous drainge
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Right suprarenal v. drains into inferior
vena cava
Left suprarenal v. joins left renal v.
Nervers of abdomen
Lumbar plexus 腰丛
 Formation: formed by
anterior rami of L1-L3,
a part of anterior rami
of T12and L4
 Position: lies within
substance of psoas
major
Branches
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Iliohypogastric n. 髂腹下神经
Supplies lower part of
anterior abdominal wall
Ilioinguinal n. 髂腹股沟神经
Passes through inguinal
canal to supply skin of the
groin and scrotum
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Lateral femoral cutaneous
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股外侧皮神经
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Femoral n. 股神经
Obturator n. 闭孔神经
Genitofemoral n. 生殖股神经
Lumbar sympathetic trunk 腰交感干
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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
Relations of abdominal aorta
 Anteriorly (from above
downward)
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Posteriorly
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Upper four lumber
vertebrae
On its right
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Pancreas
Ascending part of
duodenum
Radix of mesentery
Inferior vena cava
On its left
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Left lumbar sympathetic
trunk
Relations of inferior vena cava
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Anteriorly (cranially to caudally)
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Posteriorly
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Right crus of diaphragm
Upper four lumber vertebrae
Left sympathetic trunk
Parietal branches of abdominal aorta
On its right
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Liver
Head of pancreas
Horizontal part of duodenum
Right testicular (or ovarian) a.
Radix of mesentery
Psoas major
Right kidney
Right suprarenal gland
On its left
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Abdominal aorta