1、Kidneys and Adrenal GlandsDepartment of Regional Anatomy and Operative Surgery 1 Kidneys and Adrenal GlandsDepaPosition, relationStructure Blood supply Lymphatic drainageInnervations2 Position, relation2 PositionRetroperitonealUpper poles T12 vertebra Lower poles L3 vertebraRight is lower than left3

2、 PositionRetroperitoneal3 Cadaveric kidneys4 Cadaveric kidneys4 Surface Projection of kidney5 Surface Projection of kidney5 Renal AngleTenderness or percussing pain caused by kidney disease is localized here6 Renal AngleTenderness or percuNeighbor of Kidney7 Neighbor of Kidney7 8 8 Anterior Surface

3、of the kidney9 Anterior Surface of the kidne10 10 Posterior Surface11 Posterior Surface11 Costodiaphragmatic recess of the pleural cavity12 Costodiaphragmatic recess of tRenal hilum, Renal sinus and Renal pedicleRenal hilumRenal sinusRenal pediclecortexRenal columnRenal pyramidcalyxpapilla13 Renal h

4、ilum, Renal sinus and R14 14 15 15 renal vein renal artery renal pelvis From above downwards the renal artery renal vein renal pelvisFrom anterior to posterior16 renal veinFrom anterHydronephrosis17 Hydronephrosis17 renal artery T1118 renal artery T1118 Renal artery19 Renal 19 Vascular renal segment

5、Superior (apical)Anterior superior (upper)Anterior inferior (middle)Inferior (lower)posterior20 Vascular renal segmentSuperiorvariation of renal artery!21 variation of renal artery!21 Variation of Renal Artery22 Variation of Renal Artery22 Renal veins23 Renal veins23 24 24 Aorta-renal artery-segment

6、al 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 cava25 Aorta-renal artery-segmental aRenal Capsule

7、 Renal fascia Adipose capsule Fibrous capsule26 Renal Capsule Renal fascia26 Renal fascia27 Renal fascia27 28 28 Fibrous capsuleAdipose capsulePerirenal fatPararenal fat29 Fibrous capsuleAdipose capsule30 30 31 31 Fibrous Capsule 32 Fibrous Capsule Ureter33 Ureter33 Ureter is divided into 3 parts:ab

8、dominal partpelvis partintramural part 34 Ureter is divided into 3 part28 to 34 cm 3 narrowing sitesthe pelviureteric junctioncrossing the pelvic brimtraversing the bladder wall35 28 to 34 cm 35 36 36 37 37 Horseshoe kidney38 Horseshoe kidney38 Suprarenal Gland39 Suprarenal Gland39 Endocrine glandT1

9、1 levelRight is triangularLeft is semi-lunar40 Endocrine gland40 Leftrightanteriorsuperiorstomachliverinferiortail of pancreas & spleen vesselposteriordiaphragmdiaphragmmedialabdominal aortaInferior vena cavaRelation41 Leftrightanteriorsuperiorstoma42 42 Artery of Adrenal Gland 43 Artery of Adrenal

10、Gland 43 44 44 45 45 Veins of adrenal gland Left suprarenal vein, into the left renal vein Right suprarenal vein, into the inferior vena cava 46 Veins of adrenal gland Left su47 47 48 48 incisionAnterior transperitoneal approachPosterior retroperitoneal approach49 incisionAnterior transperitoneA 55-

11、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 A

12、50 A 55-year-old woman was found 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?Question51 What causes the pain when a u

13、rAn 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 e

14、xpiration, the swelling moved upward and could no longer be felt. What anatomical structure could produce such a swelling?Case B52 An explorer in the Amazon jungAn intravenous pyelogram revealed that a patients left kidney was in its normal position, but the right kidney was situated in front of the

15、 right sacroiliac joint. Can you explain this on embryological grounds?Case C53 An intravenous pyelogram reveaAn 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 D54 An examinat

16、ion of a patient reAn intravenous pyelogram revealed that the calyces and pelvis of a patients right kidney were grossly dilated (a condition known as hydronephrosis). What embryological anomaly may be responsible for this condition?Case E55 An intravenous pyelogram reveaWhich congenital anomaly of

17、the ureter is likely to present as a case of urinary incontinence?Case F56 Which congenital anomaly of thoperation procedure of kidney transplant57 operation procedure 57 nephrectomyFor 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 rev