肾脏的局部解剖英ppt课件.ppt

KidneysandAdrenalGlands DepartmentofRegionalAnatomyandOperativeSurgery Position relationStructureBloodsupplyLymphaticdrainageInnervations Position RetroperitonealUpperpolesT12vertebraLowerpolesL3vertebraRightislowerthanleft Cadaverickidneys SurfaceProjectionofkidney RenalAngle Tendernessorpercussingpaincausedbykidneydiseaseislocalizedhere NeighborofKidney AnteriorSurfaceofthekidney PosteriorSurface Costodiaphragmaticrecessofthepleuralcavity Renalhilum RenalsinusandRenalpedicle Renalhilum Renalsinus Renalpedicle cortex Renalcolumn Renalpyramid calyx papilla renalveinrenalarteryrenalpelvisFromabovedownwardstherenalarteryrenalveinrenalpelvis Fromanteriortoposterior Hydronephrosis renalartery T11 Renalartery Vascularrenalsegment Superior apical Anteriorsuperior upper Anteriorinferior middle Inferior lower posterior variationofrenalartery VariationofRenalArtery Renalveins Aorta renalartery segmentalartery lobarartery interlobarartery arcuateartery interlobulorartery afferentarteriole glomerulus capillaries efferentarteriole peritubularcapillariesandvasarecta interlobularvein arcuatevein interlobarvein renalvein interiorvenacava RenalCapsule RenalfasciaAdiposecapsuleFibrouscapsule Renalfascia Fibrouscapsule Adiposecapsule Perirenalfat Pararenalfat FibrousCapsule Ureter Ureterisdividedinto3parts abdominalpart pelvispart intramuralpart 28to34cm3narrowingsitesthepelviuretericjunctioncrossingthepelvicbrimtraversingthebladderwall Horseshoekidney SuprarenalGland EndocrineglandT11levelRightistriangularLeftissemi lunar Relation ArteryofAdrenalGland Veinsofadrenalgland Leftsuprarenalvein intotheleftrenalveinRightsuprarenalvein intotheinferiorvenacava incision Anteriortransperitonealapproach Posteriorretroperitonealapproach A55 year oldwomanwasfoundrollingonherkitchenfloor cryingoutfromagonizingpaininherabdomen Thepaincameinwavesandextendedfromtherightlointothegroinandtothefrontoftherightthigh Ananteroposteriorradiographoftheabdomenrevealedacalculusintherightureter CaseA Whatcausesthepainwhenaureteralcalculusispresent Whyisthepainfeltinsuchanextensivearea Wheredoesonelookforthecourseoftheureterinaradiograph Wherealongtheureterisacalculuslikelytobeheldup Question AnexplorerintheAmazonjunglewasfoundaliveafterhavinglostcontactwiththeoutsideworldforsixmonths Onphysicalexamination hewasfoundtobeinanemaciatedcondition Onpalpationoftheabdomen arounded smoothswellingappearedintherightloinattheendofinspiration Onexpiration theswellingmovedupwardandcouldnolongerbefelt Whatanatomicalstructurecouldproducesuchaswelling CaseB Anintravenouspyelogramrevealedthatapatient sleftkidneywasinitsnormalposition buttherightkidneywassituatedinfrontoftherightsacroiliacjoint Canyouexplainthisonembryologicalgrounds CaseC Anexaminationofapatientrevealedthatshehadahorseshoekidney Whatanatomicalstructurepreventsahorseshoekidneyfromascendingtoalevelabovetheumbilicus CaseD Anintravenouspyelogramrevealedthatthecalycesandpelvisofapatient srightkidneyweregrosslydilated aconditionknownashydronephrosis Whatembryologicalanomalymayberesponsibleforthiscondition CaseE Whichcongenitalanomalyoftheureterislikelytopresentasacaseofurinaryincontinence CaseF operationprocedureofkidneytransplant nephrectomy Foranephrectomy thekidneycommonlyisexposedintheloin Afteranobliqueincisionmidwaybetweenthetwelfthribandtheiliaccrest theposteriorfreeborderoftheexternalobliqueisidentified anddividedtorevealtheperitoneum whichispushedforwardtorevealtherenalfascia Thesubcostalnerveandvesselsarepr