1. The Urinary System
山东大学医学院 解剖教研室
李振华

2. Composition
Two kidney－form urine
Two ureter－conduct urine from kidneys to bladder
Bladder－receives and stores urine
Urethra－conducts urine from bladder to exterior of body (discharged)

3. Kidney 肾 General features Bean shaped, reddish-brown organs
Superior extremity－broad and thin
Inferior extremity－narrow and thick
Anterior surface－convex
Posterior surface－flat
Lateral 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 nerves
Order 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: 15～20
Renal 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. Coverings
Fibrous 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. Position
Lie 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 jarring
Renal 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 surface
Right 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 surface
Renal hilum at the level of L1, is about 5cm from the posterior median line
Renal region－the area between 12th rib and the lateral margin of erector spinae

11. Relationships of kidneys
Superiorly－superarenal gland
Posteriorly
Three muscles
Diaphragm (pleural cavity),
Psoas major
Quadratus lumborum
Three nerves
Subcostal
Iliohypogastric
Ilioinguinal
Medial
Left kidney－abdominal aorta
Right kidney－inferior ceva vana

12. Anteriorly Left kidney Right kidney Stomach (superior),
Pancreas (middle),
Loops of intestine and left colic flexure (inferiorly)
Right kidney
Right lobe of liver (superior)
Right colic flexure (inferior)
Descending part of duodenum (medially)

13. Renal segments
The 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 are
Superior segment
Superior anterior segment
Inferior anterior segment
Inferior segment
Posterior segment

15. Ureters 输尿管 Muscular tube, about 25cm long Three parts
Abdominal part－descend on the psoas major behind the peritoneum
Pelvic part－in females, passes 2cm lateral to the neck of uterus and lies below the uterine artery
Intramural 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 vessels
Where it pierces the bladder wall obliquely (at intramural part)

17. Stone in ureter

18. Relation of abdominal part of ureter
Anterior to left ureter
Descending part of duodenum
Right colic vesseles
Iliocolic vesseles
Testicular vesseles
Terminal part of ileum
Right to left ureter
Cecum
Vermiform appendix
Duodenojejunal flexure
Left colic vesseles

19. Bladder 膀胱 General features Pyramidal in shape when empty, having
Apex,
Fundus
Body of bladder
Neck

20. Interior of bladder
Mucous membrane folded, except for trigone of bladder
Trigone 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 smooth
Interureteric fold 输尿管间襞 －muscular elevation, between ureteric orifices.

21. Location
In 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 straight
Opens 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 medulla
Located retroperitoneally, superomedial to superior poles of each kidney, enclose with the kidney by the renal fascia
Blood supply
Arteries
Superior suprarenal a.
Middle suprarenal a.
Inferior suprarenal a.
Venous drainge
Right suprarenal v. drains into inferior vena cava
Left 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 L4
Position: 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 wall
Ilioinguinal n. 髂腹股沟神经Passes through inguinal canal to supply skin of the groin and scrotum
Lateral 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 column
Enters abdomen via the diaphragm and as a continuation of he thoracic part
Passes 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)
Pancreas
Ascending part of duodenum
Radix of mesentery
Posteriorly
Upper four lumber vertebrae
On its right
Inferior vena cava
On its left
Left lumbar sympathetic trunk

29. Relations of inferior vena cava
Anteriorly (cranially to caudally)
Liver
Head of pancreas
Horizontal part of duodenum
Right testicular (or ovarian) a.
Radix of mesentery
Posteriorly
Right crus of diaphragm
Upper four lumber vertebrae
Left sympathetic trunk
Parietal branches of abdominal aorta
On its right
Psoas major
Right kidney
Right suprarenal gland
On its left
Abdominal aorta