泌尿系统 精选文档.ppt

泌尿系统 本讲稿第一页，共二十九页CompositionnTwo kidneyform urinenTwo ureterconduct urine from kidneys to bladdernBladderreceives and stores urinenUrethraconducts urine from bladder to exterior of body(discharged)本讲稿第二页，共二十九页 Kidney 肾肾General featuresnBean shaped,reddish-brown organsnSuperior extremitybroad and thinnInferior extremitynarrow and thicknAnterior surfaceconvexnPosterior surfaceflatnLateral borderconvex本讲稿第三页，共二十九页nMedial borderconcaveqRenal hilum 肾门肾门a vertical slit on the medial border of kidney,the structures which enter and leave the renal hilum is called renal pedicle肾蒂肾蒂,including the renal vein,renal artery,renal pelvis,lymphatic vessels and nervesqOrder of structures in the renal pedicle from anterior to posteriorV.A.P.;from superior to inferiorA.V.P.本讲稿第四页，共二十九页qRenal sinus 肾窦肾窦 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本讲稿第五页，共二十九页Structure of the kidney nRenal cortex 肾皮质肾皮质qrenal columns 肾柱肾柱nRenal medulla 肾髓质肾髓质 qRenal pyramids 肾锥体肾锥体:1520qRenal papilla 肾乳头肾乳头qPapillary foramina 乳头孔乳头孔nMinor renal calices 肾小盏肾小盏 (78)nMajor real calices 肾大盏肾大盏(23)nRenal pelvis 肾盂肾盂本讲稿第六页，共二十九页Coverings nFibrous capsule 纤维纤维囊囊 a strong fibrous capsule which strips easily from a normal kidney surface but adheres firmly to an organ that has been inflamed 本讲稿第七页，共二十九页Position nLie 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本讲稿第八页，共二十九页nFatty renal capsule 脂肪囊脂肪囊 a thick adipose connective tissue capsule,surrounds the fibrous capsule.It acts as a shock absorber to protect the kidney from jolting and jarringnRenal fascia 肾筋膜肾筋膜on outside,surrounds both the kidney and suprarenal gland,holding these organs in place本讲稿第九页，共二十九页nLeft 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 lower border 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 本讲稿第十页，共二十九页nSuperiorlysuperarenal glandnPosteriorlyqThree musclesnDiaphragm(pleural cavity),nPsoas major nQuadratus lumborumqThree nervesnSubcostal n Iliohypogastric n Ilioinguinal nMedial qLeft kidneyabdominal aortaqRight kidneyinferior ceva vana Relationships of kidneys本讲稿第十一页，共二十九页nAnteriorlyqLeft kidneynStomach(superior),nPancreas(middle),nLoops of intestine and left colic flexure(inferiorly)qRight kidneynRight lobe of liver(superior)nRight colic flexure(inferior)nDescending part of duodenum(medially)本讲稿第十二页，共二十九页Renal segmentsnThe 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.nThe segments are qSuperior segment qSuperior anterior segmentqInferior anterior segment qInferior segmentqPosterior segment本讲稿第十三页，共二十九页本讲稿第十四页，共二十九页Ureters 输尿管输尿管nMuscular tube,about 25cm longnThree partsqAbdominal partdescend on the psoas major behind the peritoneum 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 long本讲稿第十五页，共二十九页Three constrictionsnAt the pelvoureteric junctionnWhere it crosses the pelvic inlet and iliac vesselsnWhere it pierces the bladder wall obliquely(at intramural part)本讲稿第十六页，共二十九页Stone in ureter本讲稿第十七页，共二十九页Relation of abdominal part of ureternAnterior to left ureterqDescending part of duodenumqRight colic vesselesqIliocolic vesselesqTesticular vesselesqTerminal part of ileum nRight to left ureter qCecumqVermiform appendix nAnterior to left ureterqDuodenojejunal flexureqLeft colic vesselesqTesticular vesseles本讲稿第十八页，共二十九页Bladder 膀胱膀胱General featuresnPyramidal in shape when empty,having qApex,qFundusqBody of bladder qNeck本讲稿第十九页，共二十九页Interior of bladdernMucous membrane folded,except for trigone of bladder nTrigone of bladder 膀胱三角膀胱三角 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 nInterureteric fold 输尿管间襞输尿管间襞 muscular elevation,between ureteric orifices.本讲稿第二十页，共二十九页LocationnIn 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.nIn the young child the empty bladder projects above the pelvic inlet本讲稿第二十一页，共二十九页 Urethra 尿道尿道 Female urethranRelatively short(about 5cm long),wide and straightnOpens into vaginal vestibule本讲稿第二十二页，共二十九页Retroperitoneal space and contentsnPositionit lies between the parietal peritoneum and transvers fascia of the posterior abdominal wall,from diaphragm to promontory of sacrum,continuation with extraperitoneal fascia.nContentskidney,suprarenal gland,ureter,abdominal aorta,inferior vena cava,nervers and lymphatics,loose connective tissue本讲稿第二十三页，共二十九页Suprarenal gland 肾上腺肾上腺Shape and positionnRight is pyramidal in shape,left one semilunar in shape,consisting of out cortex and inner medullanLocated retroperitoneally,superomedial to superior poles of each kidney,enclose with the kidney by the renal fasciaBlood supplynArteries qSuperior suprarenal a.qMiddle suprarenal a.qInferior suprarenal a.nVenous drainge qRight suprarenal v.drains into inferior vena cavaqLeft suprarenal v.joins left renal v.本讲稿第二十四页，共二十九页Nervers of abdomen Lumbar plexus 腰丛腰丛nFormation:formed by anterior rami of L1-L3,a part of anterior rami of T12and L4nPosition:lies within substance of psoas major本讲稿第二十五页，共二十九页Branches nIliohypogastric n.髂腹下神经髂腹下神经Supplies lower part of anterior abdominal wallnIlioinguinal n.髂腹股沟神经髂腹股沟神经Passes through inguinal canal to supply skin of the groin and scrotum nLateral femoral cutaneous 股外侧皮神经股外侧皮神经nFemoral n.股神经股神经nObturator n.闭孔神经闭孔神经nGenitofemoral n.生殖股神经生殖股神经本讲稿第二十六页，共二十九页Lumbar sympathetic trunk 腰交感干腰交感干nMade up of paired chains with four to five lumbar ganglia anterolateral to vertebral columnnEnters abdomen via the diaphragm and as a continuation of he thoracic partnPasses inferiorly behind common iliac vessels and terminations by joining to form unpaired ganglion impar,anterior to sacrum本讲稿第二十七页，共二十九页Relations of abdominal aortanAnteriorly(from above downward)qPancreas qAscending part of duodenum qRadix of mesenterynPosteriorly qUpper four lumber vertebrae nOn its right qInferior vena cavanOn its left qLeft lumbar sympathetic trunk本讲稿第二十八页，共二十九页Relations of inferior vena cavanAnteriorly(cranially to caudally)qLiverqHead of pancreasqHorizontal part of duodenumqRight testicular(or ovarian)a.qRadix of mesenterynPosteriorly qRight crus of diaphragmqUpper four lumber vertebraeqLeft sympathetic trunkqParietal branches of abdominal aorta nOn its right qPsoas majorqRight kidneyqRight suprarenal glandnOn its left qAbdominal aorta本讲稿第二十九页，共二十九页