9.The Urinary System

1、The Urinary System泌尿系統(tǒng)泌尿系統(tǒng)The Urinary SystemCompositionnKidney 腎腎form urinenUreter 輸尿管輸尿管conduct urine from kidneys to bladdernBladder 膀胱膀胱receives and stores urinenUrethra 尿道尿道conducts urine from bladder to exterior of body (discharged) Kidney 腎腎General featuresnBean shaped, reddish-brown organsnSu

2、perior extremitybroad and thinnInferior extremitynarrow and thicknAnterior surfaceconvexnPosterior surfaceflatnLateral borderconvexKidney 腎腎nMedial borderconcaveqRenal hilum 腎門腎門a vertical slit on the medial border of kidneyqRenal pedicle腎蒂腎蒂 the structures which enter and leave the renal hilum，incl

3、uding the renal vein, renal artery, renal pelvis, lymphatic vessels and nervesqOrder of structures in the renal pedicle nFrom anterior to posteriorV. A. P.nFrom superior to inferiorA. V. P.Kidney 腎腎nRenal sinus 腎竇腎竇 qThe renal hilum extends into a large cavity within the kidneyqOccupied by the renal

4、 vessels, minor renal calices, major renal calices, renal pelvis and some adipose tissueRenal structurenRenal cortex 腎皮質腎皮質qrenal columns 腎柱腎柱nRenal medulla 腎髓質腎髓質 qRenal pyramids 腎錐體腎錐體 (1520)qRenal papilla 腎乳頭腎乳頭qPapillary foramina 乳頭孔乳頭孔nMinor renal calices 腎小盞腎小盞 (78)nMajor renal calices 腎大盞腎大盞

5、(23)nRenal pelvis 腎盂腎盂Coverings of kidneynFibrous capsule 纖維囊纖維囊 a strong fibrous capsule which strips easily from a normal kidney surface but adheres firmly to an organ that has been inflamed Coverings of kidneynFatty renal capsule 脂肪囊脂肪囊 a thick adipose connective tissue capsule, surrounds the fib

6、rous capsule. It acts as a shock absorber to protect the kidney from jolting and jarringnRenal fascia 腎筋膜腎筋膜 on outside, surrounds both the kidney and suprarenal gland, holding these organs in placePosition of KidneynLie behind the peritoneum high up on the posterior abdominal wall on either side of

7、 the vertebral column nUpper pole nearer to media plan than lower polePosition of KidneynLeft kidney lies at the level from the lower border of T11 to L2; the 12th rib is behind its middle part of the post surfacenRight kidney lies slightly lower than the left kidney, at the level from the upper bor

8、der of T12 to L3; the 12th rib is behind its upper part of the post surfacenRenal hilum at the level of L1, is about 5cm from the posterior median linenRenal regionthe area between 12th rib and the lateral margin of erector spinae Position of KidneyRelations of kidneysnSuperiorlysuperarenal glandnPo

9、steriorlyqThree musclesnDiaphragm (pleural cavity), nPsoas major nQuadratus lumborumqThree nervesnSubcostal n. nIliohypogastric n.nIlioinguinal n. nMedial qLeft kidneyabdominal aortaqRight kidneyinferior vena cavaRelations of kidneysnAnteriorlyqLeft kidneynStomach (superior)nTail of pancreas and spl

10、enic vessels (middle) nLoops of intestine and left colic flexure (inferior) qRight kidneynRight lobe of liver (superior)nRight colic flexure (inferior)nDescending part of duodenum (medially)Renal segmentsnThe kidney is divided into five vascular segments and each is supplied by a branch of the renal

11、 artery; between the segments there is no anastomosis. nThe segments are qSuperior segment qSuperior anterior segmentqInferior anterior segment qInferior segmentqPosterior segmentResin corrosion cast of human kidneys. Ureter, pelvis and calyces are yellow; aorta, renal arteries and their branches ar

12、e red. Coronal multislice CT scans of the right and left suprarenal glands.CT renal venogram. Acquired from a multislice CT examination and reconstructed as a 3D surface shaded reformat.Ureters 輸尿管輸尿管nMuscular tube, about 25cm longnThree partsqAbdominal partdescend on the psoas major behind the peri

13、toneum qPelvic partin females, passes 2cm lateral to the neck of uterus and lies below the uterine arteryqIntramural partpasses obliquely through the bladder wall for 2cm longThree constrictions of Ureters1. At the pelvoureteric junction2. Where it crosses the pelvic inlet and iliac vessels3. Where

14、it pierces the bladder wall obliquely (at intramural part)Multislice CT urogram. Coronal reformat showing the enhancing renal parenchyma and both ureters along their entire length. Multislice CT urogram. 3D-surface shaded reformat showing the kidneys, ureters, bladder and surrounding bony anatomy.St

15、one in ureterRelation of abdominal part of ureternAnterior to left ureterqDuodenojejunal flexureqLeft colic vesselsqTesticular vessels nAnterior to right ureterqDescending part of duodenumqRight colic vesselsqIliocolic vesselsqTesticular vesselsqTerminal part of ileum nRight to right ureter qCecumqV

16、ermiform appendix Bladder 膀胱膀胱General features pyramidal in shape when empty, having nApexnFundusnBody of bladder nNeckInterior of bladderTrigone of bladder 膀胱三角膀胱三角 qSmooth triangular area at inner surface of the funds of bladderqFormed by internal urethral orifice anteriorly and two ureteric orifi

17、ces laterallyqIn this area absents submucosal layer, where the mucous membrane is firmly adherent to the muscular coat, and is always smooth nInterureteric fold 輸尿管間襞輸尿管間襞 muscular elevation, between ureteric orifices.Location of bladdernIn the adult, it lies in the lesser pelvis, behind the pubic symphysis, in front of seminal vesicle, ampulla