بسمه تعالى وله الحمد
Urinary systemKidneys:-
(what are functions of kidneys ?
1)excrete the metabolic waste products..in form of urine that pass down to urinary bladder & then uretha where it leaves the body.
2)play arole in acid base balance of blood .
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Location :-lies behind peritoneum ..on post abdominal wall.on either side of vertebral column.
Note :- it lies from last thoracic vertebra to L3.
2)the right kidney lies slower slightly than left kidney.3)the psoas muscle logdes the kidney.
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(what is the effect of contraction of diaphragm on kidneys?
They move downward in avertical direction as much as 2.5cm(hilum :-on the medial concave border of each kidney is a sinus .
(what structures pass through the hilum ?
From front backward :1)renal vein
2)renal artery (2 branches )
3)ureter
4)third branch of renal artery .
5)lymph vessels
6)sympathetic fibers.
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Relations :--of lt kidney :-
Post :-psoas muscle ,quadratus lumborum & transversus abdominis muscles, 12th rib,11th rib ,costodiaphragmatic recess,diaphragm,ilioinguinal n.& iliohypogastric n.subcostal t12 run downward & laterally.Ant :-pancreas ,stomach ,spleen ,left colic flexure , coils of jejunum,suprarenal gland.
SSS((costodiaphragmatic recess :- is the recess in which the lung extends during deep respiration .
Its like costomediastinal recess .
Note :- kidney is retropertoneal organ .no peritoneum post it is immovable.
Relations :-of Rt kidney :-Ant :- suprarenal gland,the liver ,the second part of duodenum ,right colic flexure
Post:-the same above except the T12 rib .
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Coverings of kidney :-
Fibrous capsule
Perirenal fat
Renal fascia
Pararenal fat .
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Renal structure :-
Each kidney has a dark brown cortex brown ..& light brown medulla..the medulla is composed of about dozen pyramids .each having its basedirected toward the cortex& its apex papilla directed mediallythe cortex extends between adjacent pyramids to form renal columnsextensions from base of pyramids toward renal cortex striations called (medullary rays))
Renal sinus :- which is space within hilum contains urterer (renal pelvis )this divides into two or three major calyces ..that divides into three or two minor calycesthat idented by renal papilla.
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Arteries of kidney :-
The renal artery
**at which level ?
2nd lumbar vertebra.
**How renal artery flows ?
It is divided into:
1) five segmental arteries ..that enter the hilum of kidney .four infront & one behind renal pelvis
2)arise from each segmental artery :lobar artery one for each renal pyramid .
3)Interlobar arteries :- 2 or 3 in numbers.before entering renal substance.
4)arcuate arteries :- at the junction of cortex & medulla which arches over bases of pyramids.
5)interlobular arteries :-ascend in cortex .
6)afferent glomerular arteries
Note :- Rt renal artery is longer than the Lt renal artery .
Veins :- renal vein runs infront of renal artery .to drain in inf.vena cava.
Lymph nodes :- lat.aortic lymph nodes .Nerve :- renal afferent plexus travel to enter the sp.cord at 10th ,11th ,12 th thoracic nerves.
((very imp :-
Urinary bladder :-Location :- behind pubis bones within pelvis.
Properties :-
1)has a strong muscular wall
2)its upper shape & relations vary with its contents.
????how ???
Empty bladder :-
a)in adult :- entirely in pelvis as it becomes full ..its upper margin projects in hypogastric region
b)in young child :- it projects above pelvic inlet .
later when pelvis enlarge it sinks in pelvis to take its adult position.
3)its pyramidal in shape .
4)has an apex , base ,superior & two inferiolateral surface5)it has a neck.
((regions of bladder :-
(apex of bladder :-1)points anteriorly .
2)lies just behind the upper margin of symphysis pubis .
3)is connectd to umbilicus by median umbilicus ligament (reminant of urachus).
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(base of bladder:-is triangularFaces post.
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(the sup.surface :- covered by peritoneum
Forms the rectovesical pouch .Is related to coils of ileum or sigmoid colon.
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(the inferolateral surface :-Is related infront to retropubic pad of fats & pubis bones.
Post :- is related to obturator intenus muscle above
& levator ani muscle below.
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(theneck :- rests on prostate gland (upper surface){inferiorly lies}
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**how the neck of bladder is held in position ??
By the 1)puboprostatic ligament in male
2)pubovesical ligament in female.
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Note :- along the lat wall of bladder ,the peritoneum is reflected on lat.pelvic wall.
***location of ureter to bladder :- the superiolateral angle of bladder is connected to ureters.
While inf.angle of bladder is connected to urethra.
Note :- the bladder when becomes full ,,it projects in abdominal cavity.
((((((((((Talk about the mucous membrane of bladder ?
The empty bladder ,its mucous memrane is thrown into folds..that disappear when the bladder is full.
Trigone :-themucous membrane covers the internal surface of base of bladder is known as((trigone)).
The mucous membrane is always smootheven when the vesicus is empty.
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(boundaries of trigone :---
Superior angle :-related to openings of ureters.
Inferior angle :-related to internal urethral orifice .
Upper border is limited by interureteric ridge or crest that is muscular ridge runs from one opening of ureter to another .
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***By what mechanism the reverse flow of urine is prevented ?
The ureters open in the bladder obliquely this forms valve like action the prevents the reverse flow of urine to kidney.*****************************
What is uvula vesicae ?
Is a small elevation
Location :- behind the internal urethral orifice .
Cause of its presence :- the underlying median lobe of prostate .
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What are muscles of bladder ?
The muscular coat of bladder is formed by three layers called:-detrusor muscle.
At the neck ,the circular coat is thickened to form the sphinecter vesicae .
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Arteries of bladder :- sup & inf vesical arteries branches from int.iliac artery.
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Veins :- drains in int.iliac veins.
Note :- there is communication between vesical venous plexus & prostatic veins .
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Nodes of lymph :- drain in int & ex.iliac nodes .
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Nerve supply :- is by :-
1)sympathetic postganglionic nerve plexus :-
Originate in 1st & 2nd lumbar ganglia.Descend to bladder via hypogastric plexus.
2)parasympathetic preganglionic plexus :- originate in 2nd ,3rd ,4th ,sacral nerves called pelvic splanchnic plexusmost afferent fibers from bladder to CNS via the pelvic splanchnic ((coz it is involuntary ))
Some others by :hypogastric plexus .
Role of sympathetic :- 1)inhibit contraction of detrusor muscle
2)stimulate closure of sphinecter vesicae .
Role of parasympathetic :-
1)stimulate the contraction of detrusor muscle .2)inhibit action of spinecter vesicae .
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تمام ان شاء تعالى (
Psoas muscle lodges the kidney
Medial border of kidneyLat border of kidney
Illustration of structures pass through the hilumImp
ImpVery imp .assay
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