Transcript 肾的局部解剖 - China Medical University

Kidneys and Adrenal
Glands
Department of Regional Anatomy and
Operative Surgery
Position,
relation
Structure
Blood supply
Lymphatic drainage
Innervations
Position
Retroperitoneal
Upper
poles
T12 vertebra
Lower poles
L3 vertebra
Right
is lower than left
Cadaveric kidneys
Surface Projection of kidney
Renal Angle
Tenderness or percussing pain caused by kidney
disease is localized here
Neighbor of Kidney
Anterior Surface
of the kidney
Posterior Surface
Costodiaphragmatic
recess of the pleural
cavity
Renal hilum, Renal sinus and Renal pedicle
Renal pyramid
Renal sinus
cortex
Renal column
calyx
Renal hilum
papilla
Renal pedicle
From anterior to posterior
renal vein
renal artery
renal pelvis
From above downwards
the renal artery
renal vein
renal pelvis
Hydronephrosis
renal artery
T11
Renal
artery
Vascular renal segment
Superior (apical)
Anterior
superior
(upper)
posterior
Anterior
inferior
(middle)
Inferior
(lower)
variation of renal artery
Variation of Renal Artery
Renal veins
Aorta-renal artery-segmental arterylobar artery-interlobar artery-arcuate
artery-interlobulor artery-afferent
arteriole-glomerulus (capillaries)efferent arteriole-peritubular
capillaries and vasa recta-interlobular
vein-arcuate vein-interlobar vein-renal
vein-interior vena cava
Renal Capsule



Renal fascia
Adipose capsule
Fibrous capsule
Renal fascia
Fibrous
capsule
Adipose
capsule
Perirenal fat
Pararenal fat
Fibrous
Capsule
Ureter
Ureter is divided into 3 parts:
 ①abdominal
 ②pelvis
part
part
 ③intramural
part
28 to 34 cm
3 narrowing sites
• the pelviureteric
junction
• crossing the
pelvic brim
• traversing the
bladder wall

Horseshoe kidney
Suprarenal Gland
•Endocrine gland
•T11 level
•Right is triangular
•Left is semi-lunar
Relation
superior
anterior
inferior
posterior
medial
Left
right
stomach
tail of pancreas &
spleen vessel
liver
diaphragm
diaphrag
m
abdominal aorta
Inferior
vena cava
Artery of Adrenal Gland
Veins of adrenal gland

Left suprarenal vein, into the
left renal vein

Right suprarenal vein, into the
inferior vena cava
incision
Posterior retroperitoneal approach
Anterior transperitoneal
approach
Case A
A 55-year-old woman was found rolling on
her kitchen floor, crying out from agonizing
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.
Question
a.
b.
c.
d.
What causes the pain when a ureteral
calculus is present?
Why is the pain felt 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?
Case B
An explorer in the Amazon jungle was found
alive after having lost contact with the
outside world for six months. On physical
examination, he 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 C
An intravenous pyelogram revealed that a
patient’s 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 D
An examination of a patient revealed that
she had a horseshoe kidney. What
anatomical structure prevents a horseshoe
kidney from ascending to a level above the
umbilicus?
Case E
An intravenous pyelogram revealed that the
calyces and pelvis of a patient’s right kidney
were grossly dilated (a condition known as
hydronephrosis). What embryological
anomaly may be responsible for this
condition?
Case F
Which congenital anomaly of the ureter is
likely to present as a case of urinary
incontinence?
operation procedure
of kidney transplant
nephrectomy
For 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 subcostal nerve and vessels are preserved; the
renal fascia is opened; and the kidney exposed.
Care must be taken not to damage the pleura,
since it is separated from the upper pole of the
kidney only by the diaphragm.