肾脏的局部解剖(英).ppt

Kidneys and Adrenal GlandsDepartment of Regional Anatomy and Operative Surgery 2021/3/112021/3/111 1l lPosition, relationl lStructure l lBlood supply l lLymphatic drainagel lInnervations2021/3/112021/3/112 2PositionuRetroperitonealuUpper poles T12 vertebra Lower poles L3 vertebrauRight is lower than left2021/3/112021/3/113 3Cadaveric kidneys2021/3/112021/3/114 4Surface Projection of kidney2021/3/112021/3/115 5Renal AngleTenderness or percussing pain caused by kidney disease is localized here2021/3/112021/3/116 6Neighbor of Kidney2021/3/112021/3/117 72021/3/112021/3/118 8Anterior Surface of the kidney2021/3/112021/3/119 92021/3/112021/3/111010Posterior Surface2021/3/112021/3/111111Costodiaphragmatic recess of the pleural cavity2021/3/112021/3/111212Renal hilum, Renal sinus and Renal pedicleRenal hilumRenal sinusRenal pediclecortexRenal columnRenal pyramidcalyxpapilla2021/3/112021/3/1113132021/3/112021/3/1114142021/3/112021/3/111515 renal vein renal vein renal artery renal artery renal pelvis renal pelvis From above downwardsFrom above downwards the renal artery the renal artery renal vein renal vein renal pelvis renal pelvisFrom anterior to posteriorFrom anterior to posterior2021/3/112021/3/111616Hydronephrosis2021/3/112021/3/111717renal artery T112021/3/112021/3/111818Renal artery2021/3/112021/3/111919Vascular renal segmentSuperior (apical)Anterior superior (upper)Anterior inferior (middle)Inferior (lower)posterior2021/3/112021/3/112020variation of renal artery!2021/3/112021/3/112121Variation of Renal Artery2021/3/112021/3/112222Renal veins2021/3/112021/3/1123232021/3/112021/3/112424Aorta-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-renal vein-interior vena cava2021/3/112021/3/112525Renal CapsuleØ Renal fasciaØ Adipose capsuleØ Fibrous capsule2021/3/112021/3/112626Renal fascia2021/3/112021/3/1127272021/3/112021/3/112828Fibrous capsuleAdipose capsulePerirenal fatPararenal fat2021/3/112021/3/1129292021/3/112021/3/1130302021/3/112021/3/113131Fibrous Capsule 2021/3/112021/3/113232Ureter2021/3/112021/3/113333 Ureter is divided into 3 parts:l l①①abdominal partl l②②pelvis partl l③③intramural part 2021/3/112021/3/113434u28 to 34 cm u3 narrowing sites•the pelviureteric junction•crossing the pelvic brim•traversing the bladder wall2021/3/112021/3/1135352021/3/112021/3/1136362021/3/112021/3/113737Horseshoe kidney2021/3/112021/3/113838Suprarenal Gland2021/3/112021/3/113939•Endocrine gland•T11 level•Right is triangular•Left is semi-lunar2021/3/112021/3/114040LeftLeftrightrightanterioranteriorsuperiorsuperiorstomachstomachliverliverinferiorinferiortail of pancreas & tail of pancreas & spleen vesselspleen vesselposteriorposteriordiaphragmdiaphragmdiaphragdiaphragmmmedialmedialabdominal aortaabdominal aortaInferior Inferior vena cavavena cavaRelation2021/3/112021/3/1141412021/3/112021/3/114242Artery of Adrenal Gland 2021/3/112021/3/1143432021/3/112021/3/1144442021/3/112021/3/114545Veins of adrenal glandØ Left suprarenal vein, into the left renal veinØ Right suprarenal vein, into the inferior vena cava 2021/3/112021/3/1146462021/3/112021/3/1147472021/3/112021/3/114848incisionAnterior transperitoneal approachPosterior retroperitoneal approach2021/3/112021/3/114949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. Case A2021/3/112021/3/115050a.a.What causes the pain when a ureteral calculus is present?b.b.Why is the pain felt in such an extensive area?c.c.Where does one look for the course of the ureter in a radiograph?d.d.Where along the ureter is a calculus likely to be held up?Question2021/3/112021/3/115151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 B2021/3/112021/3/115252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 C2021/3/112021/3/115353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 D2021/3/112021/3/115454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 E2021/3/112021/3/115555Which congenital anomaly of the ureter is likely to present as a case of urinary incontinence?Case F2021/3/112021/3/115656operation procedure of kidney transplant2021/3/112021/3/115757nephrectomyFor a nephrectomy, the kidney commonly is For a nephrectomy, the kidney commonly is exposed in the loin. After an oblique incision exposed in the loin. After an oblique incision midway between the twelfth rib and the iliac crest, midway between the twelfth rib and the iliac crest, the posterior free border of the external oblique is the posterior free border of the external oblique is identified, and divided to reveal the peritoneum, identified, and divided to reveal the peritoneum, which is pushed forward to reveal the renal fascia. which is pushed forward to reveal the renal fascia. The subcostal nerve and vessels are preserved; the The subcostal nerve and vessels are preserved; the renal fascia is opened; and the kidney exposed. renal fascia is opened; and the kidney exposed. Care must be taken not to damage the pleura, Care must be taken not to damage the pleura, since it is separated from the upper pole of the since it is separated from the upper pole of the kidney only by the diaphragm.kidney only by the diaphragm.2021/3/112021/3/115858个人观点供参考，欢迎讨论。