肾脏的局部解剖(英)

1、Kidneys and Adrenal GlandsDepartment of Regional Anatomy and Operative Surgery Position, relationStructure Blood supply Lymphatic drainageInnervationsPositionRetroperitonealUpper poles T12 vertebra Lower poles L3 vertebraRight is lower than leftCadaveric kidneysSurface Projection of kidneyRenal Angl

2、eTenderness or percussing pain caused by kidney disease is localized hereNeighbor of KidneyAnterior Surface of the kidneyPosterior SurfaceCostodiaphragmatic recess of the pleural cavityRenal hilum, Renal sinus and Renal pedicleRenal hilumRenal sinusRenal pediclecortexRenal columnRenal pyramidcalyxpa

3、pilla renal vein renal artery renal pelvis From above downwards the renal artery renal vein renal pelvisFrom anterior to posteriorHydronephrosisrenal artery T11Renal arteryVascular renal segmentSuperior (apical)Anterior superior (upper)Anterior inferior (middle)Inferior (lower)posteriorvariation of

4、renal artery!Variation of Renal ArteryRenal veinsAorta-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-

5、renal vein-interior vena cavaRenal Capsule Renal fascia Adipose capsule Fibrous capsuleRenal fasciaFibrous capsuleAdipose capsulePerirenal fatPararenal fatFibrous Capsule Ureter Ureter is divided into 3 parts:abdominal partpelvis partintramural part 28 to 34 cm 3 narrowing sitesthe pelviureteric jun

6、ctioncrossing the pelvic brimtraversing the bladder wallHorseshoe kidneySuprarenal GlandEndocrine glandT11 levelRight is triangularLeft is semi-lunarLeftrightanteriorsuperiorstomachliverinferiortail of pancreas & spleen vesselposteriordiaphragmdiaphragmmedialabdominal aortaInferior vena cavaRelation

7、Artery of Adrenal Gland Veins of adrenal gland Left suprarenal vein, into the left renal vein Right suprarenal vein, into the inferior vena cava incisionAnterior transperitoneal approachPosterior retroperitoneal approachA 55-year-old woman was found rolling on her kitchen floor, crying out from agon

8、izing pain in her abdomen. The pain came in waves and extended from the right loin to the groin and to the front of the right thigh. An anteroposterior radiograph of the abdomen revealed a calculus in the right ureter. Case AWhat causes the pain when a ureteral calculus is present?Why is the pain fe

9、lt in such an extensive area?Where does one look for the course of the ureter in a radiograph?Where along the ureter is a calculus likely to be held up?QuestionAn explorer in the Amazon jungle was found alive after having lost contact with the outside world for six months. On physical examination, h

10、e was found to be in an emaciated condition. On palpation of the abdomen, a rounded, smooth swelling appeared in the right loin at the end of inspiration. On expiration, the swelling moved upward and could no longer be felt. What anatomical structure could produce such a swelling?Case BAn intravenou

11、s pyelogram revealed that a patients left kidney was in its normal position, but the right kidney was situated in front of the right sacroiliac joint. Can you explain this on embryological grounds?Case CAn examination of a patient revealed that she had a horseshoe kidney. What anatomical structure p

12、revents a horseshoe kidney from ascending to a level above the umbilicus?Case DAn intravenous pyelogram revealed that the calyces and pelvis of a patients right kidney were grossly dilated (a condition known as hydronephrosis). What embryological anomaly may be responsible for this condition?Case EW

13、hich congenital anomaly of the ureter is likely to present as a case of urinary incontinence?Case Foperation procedure of kidney transplantnephrectomyFor a nephrectomy, the kidney commonly is exposed in the loin. After an oblique incision midway between the twelfth rib and the iliac crest, the posterior free border of the external oblique is identified, and divided to reveal the peritoneum, which is pushed forward to reveal the renal fascia. The subco