2 CompositionTwo kidney－form urineTwo ureter－conduct urine from kidneys to bladderBladder－receives and stores urineUrethra－conducts urine from bladder to exterior of body (discharged)
3 Kidney 肾 General features Bean shaped, reddish-brown organs Superior extremity－broad and thinInferior extremity－narrow and thickAnterior surface－convexPosterior surface－flatLateral border－convex
4 Medial border－concave Renal hilum 肾门－a vertical slit on the medial border of kidney, the structures which enter and leave the renal hilum is called renal pedicle肾蒂, including the renal vein, renal artery, renal pelvis, lymphatic vessels and nervesOrder of structures in the renal pedicle from anterior to posterior－V. A. P.; from superior to inferior－A. V. P.
5 Renal sinus 肾窦－which is the renal hilum leads into a space within the kidney, the rental sinus is occupied by the renal vessels, minor renal calices, major renal calices, renal pelvis and some adipose tissue
6 Structure of the kidney Renal cortex 肾皮质renal columns 肾柱Renal medulla 肾髓质Renal pyramids 肾锥体: 15～20Renal papilla 肾乳头Papillary foramina 乳头孔Minor renal calices 肾小盏 (7－8)Major real calices 肾大盏 (2～3)Renal pelvis 肾盂
7 CoveringsFibrous capsule 纤维囊 －a strong fibrous capsule which strips easily from a normal kidney surface but adheres firmly to an organ that has been inflamed
8 PositionLie behind peritoneum one on each side of the vertebral column high up on the post abdominal wall, upper pole nearer to media plan than lower pole
9 Fatty renal capsule 脂肪囊 －a thick adipose connective tissue capsule, surrounds the fibrous capsule. It acts as a shock absorber to protect the kidney from jolting and jarringRenal fascia 肾筋膜－on outside, surrounds both the kidney and suprarenal gland, holding these organs in place
10 Left kidney lies at the level from the lower border of T11 to L2; the 12th rib is behind its middle part of the post surfaceRight kidney lies slightly lower than the left kidney, at the level from the lower border of T12 to L3; the 12th rib is behind its upper part of the post surfaceRenal hilum at the level of L1, is about 5cm from the posterior median lineRenal region－the area between 12th rib and the lateral margin of erector spinae
11 Relationships of kidneys Superiorly－superarenal glandPosteriorlyThree musclesDiaphragm (pleural cavity),Psoas majorQuadratus lumborumThree nervesSubcostalIliohypogastricIlioinguinalMedialLeft kidney－abdominal aortaRight kidney－inferior ceva vana
12 Anteriorly Left kidney Right kidney Stomach (superior), Pancreas (middle),Loops of intestine and left colic flexure (inferiorly)Right kidneyRight lobe of liver (superior)Right colic flexure (inferior)Descending part of duodenum (medially)
13 Renal segmentsThe kidney is divided into five vascular segments and each is supplied by a branch of the renal artery; between the segments there is no anastomosis.The segments areSuperior segmentSuperior anterior segmentInferior anterior segmentInferior segmentPosterior segment
15 Ureters 输尿管 Muscular tube, about 25cm long Three parts Abdominal part－descend on the psoas major behind the peritoneumPelvic part－in females, passes 2cm lateral to the neck of uterus and lies below the uterine arteryIntramural part－passes obliquely through the bladder wall for 2cm long
16 Three constrictions At the pelvoureteric junction Where it crosses the pelvic inlet and iliac vesselsWhere it pierces the bladder wall obliquely (at intramural part)
18 Relation of abdominal part of ureter Anterior to left ureterDescending part of duodenumRight colic vesselesIliocolic vesselesTesticular vesselesTerminal part of ileumRight to left ureterCecumVermiform appendixDuodenojejunal flexureLeft colic vesseles
19 Bladder 膀胱 General features Pyramidal in shape when empty, having Apex,FundusBody of bladderNeck
20 Interior of bladderMucous membrane folded, except for trigone of bladderTrigone of bladder 膀胱三角 －smooth triangular area at inner surface of the funds of bladder, formed by internal urethral orifice anteriorly and two ureteric orifices laerally, in this area absents submucosal layer, where the mucous membrane is firmly adherent to the muscular coat, and is always smoothInterureteric fold 输尿管间襞 －muscular elevation, between ureteric orifices.
21 LocationIn the adult, it lies in the lesser pelvis, behind the pubic symphysis, in front of seminal vesicle, ampulla ductus deferentis and rectum in the male, and in front of uterus and vagina in the female.In the young child the empty bladder projects above the pelvic inlet
22 Urethra 尿道 Female urethra Relatively short (about 5cm long), wide and straightOpens into vaginal vestibule
23 Retroperitoneal space and contents Position－it lies between the parietal peritoneum and transvers fascia of the posterior abdominal wall, from diaphragm to promontory of sacrum, continuation with extraperitoneal fascia.Contents－kidney, suprarenal gland, ureter, abdominal aorta, inferior vena cava, nervers and lymphatics, loose connective tissue
24 Suprarenal gland 肾上腺 Shape and position Right is pyramidal in shape, left one semilunar in shape, consisting of out cortex and inner medullaLocated retroperitoneally, superomedial to superior poles of each kidney, enclose with the kidney by the renal fasciaBlood supplyArteriesSuperior suprarenal a.Middle suprarenal a.Inferior suprarenal a.Venous draingeRight suprarenal v. drains into inferior vena cavaLeft suprarenal v. joins left renal v.
25 Nervers of abdomen Lumbar plexus 腰丛 Formation: formed by anterior rami of L1-L3, a part of anterior rami of T12and L4Position: lies within substance of psoas major
26 Branches Lateral femoral cutaneous 股外侧皮神经 Femoral n. 股神经 Iliohypogastric n. 髂腹下神经Supplies lower part of anterior abdominal wallIlioinguinal n. 髂腹股沟神经Passes through inguinal canal to supply skin of the groin and scrotumLateral femoral cutaneous 股外侧皮神经Femoral n. 股神经Obturator n. 闭孔神经Genitofemoral n. 生殖股神经
27 Lumbar sympathetic trunk 腰交感干 Made up of paired chains with four to five lumbar ganglia anterolateral to vertebral columnEnters abdomen via the diaphragm and as a continuation of he thoracic partPasses inferiorly behind common iliac vessels and terminations by joining to form unpaired ganglion impar, anterior to sacrum
28 Relations of abdominal aorta Anteriorly (from above downward) PancreasAscending part of duodenumRadix of mesenteryPosteriorlyUpper four lumber vertebraeOn its rightInferior vena cavaOn its leftLeft lumbar sympathetic trunk
29 Relations of inferior vena cava Anteriorly (cranially to caudally)LiverHead of pancreasHorizontal part of duodenumRight testicular (or ovarian) a.Radix of mesenteryPosteriorlyRight crus of diaphragmUpper four lumber vertebraeLeft sympathetic trunkParietal branches of abdominal aortaOn its rightPsoas majorRight kidneyRight suprarenal glandOn its leftAbdominal aorta
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