The Kidneys - Al-Mustansiriya University...diaphragm, suprarenal gland, and gonad. Blood Flow...
Transcript of The Kidneys - Al-Mustansiriya University...diaphragm, suprarenal gland, and gonad. Blood Flow...
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The Kidneys(L., ren; Gk, nephros; hence the adjectives renal and nephric)
&Suprarenal (Adrenal) Glands
Dr Maan Al-Abbasi PhD, MBChB
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Functions of Urinary System
• Regulate electrolytes (K+, Na+, etc)
• Regulate pH in blood
• Regulate blood pressure
• Regulate blood volume (removes excess fluid)
• Removing metabolic wastes
• Urea, uric acid, and creatinine
• This is the least important of the kidney’s functions. You can survive for a few weeks without
excreting waste products in the urine, but hour by hour, the other functions are more important.
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General relations of abdominal viscera
• In B, the position of the
kidneys and ureters is
shown.
• In C, which is a posterior
view, the kidneys and spleen
are represented.
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Location and External Anatomy of Kidneys
• Located retroperitoneally
• Lateral to T12–L3 vertebrae
• Average kidney• 12 cm tall, 6 cm wide, 3 cm thick
• Hilus• On concave surface
• Vessels and nerves enter and exit
• Renal capsule surrounds the kidney
L1
L2
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Anatomy of the kidneys• Superficial outer cortex and inner medulla
• The medulla consists of 6-18 renal pyramids• The cortex is composed of roughly 1.25 million nephrons
• Major and minor calyces along with the pelvis drain urine to the ureters
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Intravenous pyelogram
(Courtesy of Sir Thomas Lodge, Sheffield, England.)
Note the calices, some of which are seen from the side and others end-on, and the pelvis of the ureters, which differ in shape and level.
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Anterior relations of the kidneys
The areas covered by peritoneum are shown in blue.
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The attachments of the
peritoneum to the posterior
abdominal wall, viewed from in
front.
• HR, the hepatorenal pouch.
• R and L, right and left subphrenic spaces.
• X, the superior recess of the lesser sac.
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Urinary System in Gross Dissection
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Muscles of the posterior abdominal wall
The kidneys lie obliquely along the vertebral column, abutting the psoas major muscles.
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Horizontal section through the abdomen to show renal fascia• The RENAL CAPSULE surrounds the kidney,
made of dense fibrous connective tissue.
• A layer of adipose tissue surrounds the
capsule, called PARARENAL FAT (ADIPOSE).
It cushions and protects.
• Around that is a connective tissue layer
called the RENAL FASCIA, made of loose
connective tissue. It anchors the kidney to
the surrounding peritoneum and abdominal
wall. It is not very strong; jumping up and
down can cause tearing.
The arrow indicates the lumbar approach to the kidney.
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Vibration Platform Machine:No longer used in the USA because it damages kidneys!
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Renal vessels
A large area is drained by the left
renal vein, which receives tributaries
from the back, abdominal wall,
diaphragm, suprarenal gland, and
gonad.
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Blood Flow Through the Kidney
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Arterial segments of right kidney. The left is similar
• Interpretation of the posterior segment as two units (upper dorsal and lower dorsal) would provide a total of six arterial segments.
(After Fourman and Moffat.)
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The prevertebral plexus and
ganglia
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lymphatic pathways and nodes of the posterior abdominal wall
• CI, common iliac;• EI, external iliac;• II, internal iliac; • L, lumbar; • R, retro-aortic; • S, sacral
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The Ureters
• Pair of muscular tubes
• Extend from renal pelvis to the bladder
• Peristaltic contractions force urine from the kidneys to the urinary bladder
• Oblique entry into bladder prevents backflow of urine
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KIDNEY STONES
• They can block the ureter, causing the kidney to enlarge. As the
kidney stretches, the capsule stretches, causing excruciating pain in
cycles of hours. As pressure builds up from fluid accumulating around
the stone, urine can pass, and the kidney stone moves down the
urethra slowly.
• Symptomatic kidney stones may be pea sized or larger (up to 1 ½
inches).
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Where kidney stones get stuck?
Ureter
Urinary bladder & Ureter at
the Trigone
Common iliac
artery
Renal pelvis
& Ureter
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Kidney Stones
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Depending on the level of obstruction, the pain of renal (actually ureteric) colic may be
referred to the lumbar or the hypogastric region or to the external genitalia.
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The Suprarenal Glands
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Anterior Relations
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Relations
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Blood Supply