肾脏的局部解剖(英)PPT参考幻灯片.ppt

KidneysandAdrenalGlands DepartmentofRegionalAnatomyandOperativeSurgery 1 Position relationStructureBloodsupplyLymphaticdrainageInnervations 2 Position RetroperitonealUpperpolesT12vertebraLowerpolesL3vertebraRightislowerthanleft 3 Cadaverickidneys 4 SurfaceProjectionofkidney 5 RenalAngle Tendernessorpercussingpaincausedbykidneydiseaseislocalizedhere 6 NeighborofKidney 7 8 AnteriorSurfaceofthekidney 9 10 PosteriorSurface 11 Costodiaphragmaticrecessofthepleuralcavity 12 Renalhilum RenalsinusandRenalpedicle Renalhilum Renalsinus Renalpedicle cortex Renalcolumn Renalpyramid calyx papilla 13 14 15 renalveinrenalarteryrenalpelvisFromabovedownwardstherenalarteryrenalveinrenalpelvis Fromanteriortoposterior 16 Hydronephrosis 17 renalartery T11 18 Renalartery 19 Vascularrenalsegment Superior apical Anteriorsuperior upper Anteriorinferior middle Inferior lower posterior 20 variationofrenalartery 21 VariationofRenalArtery 22 Renalveins 23 24 Aorta renalartery segmentalartery lobarartery interlobarartery arcuateartery interlobulorartery afferentarteriole glomerulus capillaries efferentarteriole peritubularcapillariesandvasarecta interlobularvein arcuatevein interlobarvein renalvein interiorvenacava 25 RenalCapsule RenalfasciaAdiposecapsuleFibrouscapsule 26 Renalfascia 27 28 Fibrouscapsule Adiposecapsule Perirenalfat Pararenalfat 29 30 31 FibrousCapsule 32 Ureter 33 Ureterisdividedinto3parts abdominalpart pelvispart intramuralpart 34 28to34cm3narrowingsitesthepelviuretericjunctioncrossingthepelvicbrimtraversingthebladderwall 35 36 37 Horseshoekidney 38 SuprarenalGland 39 EndocrineglandT11levelRightistriangularLeftissemi lunar 40 Relation 41 42 ArteryofAdrenalGland 43 44 45 Veinsofadrenalgland Leftsuprarenalvein intotheleftrenalveinRightsuprarenalvein intotheinferiorvenacava 46 47 48 incision Anteriortransperitonealapproach Posteriorretroperitonealapproach 49 A55 year oldwomanwasfoundrollingonherkitchenfloor cryingoutfromagonizingpaininherabdomen Thepaincameinwavesandextendedfromtherightlointothegroinandtothefrontoftherightthigh Ananteroposteriorradiographoftheabdomenrevealedacalculusintherightureter CaseA 50 Whatcausesthepainwhenaureteralcalculusispresent Whyisthepainfeltinsuchanextensivearea Wheredoesonelookforthecourseoftheureterinaradiograph Wherealongtheureterisacalculuslikelytobeheldup Question 51 AnexplorerintheAmazonjunglewasfoundaliveafterhavinglostcontactwiththeoutsideworldforsixmonths Onphysicalexamination hewasfoundtobeinanemaciatedcondition Onpalpationoftheabdomen arounded smoothswellingappearedintherightloinattheendofinspiration Onexpiration theswellingmovedupwardandcouldnolongerbefelt Whatanatomicalstructurecouldproducesuchaswelling CaseB 52 Anintravenouspyelogramrevealedthatapatient sleftkidneywasinitsnormalposition buttherightkidneywassituatedinfrontoftherightsacroiliacjoint Canyouexplainthisonembryologicalgrounds CaseC 53 Anexaminationofapatientrevealedthatshehadahorseshoekidney Whatanatomicalstructurepreventsahorseshoekidneyfromascendingtoalevelabovetheumbilicus CaseD 54 Anintravenouspyelogramrevealedthatthecalycesandpelvisofapatient srightkidneyweregrosslydilated aconditionknownashydronephrosis Whatembryologicalanomalymayberesponsibleforthiscondition CaseE 55 Whichcongenitalanomalyoftheureterislikelytopresentasacaseofurinaryincontinence CaseF 56 operationprocedureofkidneytransplant 57 nephrectomy Foranephrectomy thekidneycommonlyisexposedintheloin Afteranobliqueincisionmidwaybetweenthetwelfthribandtheiliaccrest theposteriorfreeborderoftheexternalobliqueisidentified anddividedtorevealtheperitoneum whichispushedforwardtorevealtherenalfasc