Lecture 2 Kidney PDF

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Die verdere reproduksie daarvan is ontoelaatbaar. 2  Outcomes - kidney Describe the surface anatomy of the kidneys Describe the macroscopic structures of the kidney and its coverings Describe the anterior & posterior relations of both kidneys Describe the blood & nerve supply & lymphatic drainage of kidneys 3 Recommended resources https://www-clinicalkey- com.ez.sun.ac.za/#!/content/bo ok/3-s2.0- B9780323934237000046?scroll To=%23hl0004265 Primal Pictures 4 KIDNEY Overview  Kidney Surface anatomy Coverings (3 layers) Neurovascular Macroscopic Relations: structures and structure Anterior & Posterior lymphatic drainage 7 Urinary system Consists of the following structures: 2 kidneys 2 ureters 1 urinary bladder 1 urethra 8 urethra Surface Anatomy  The Kidney – Surface Anatomy  Retroperitoneal  Vertebral level: T12 – L3 (change during respiration: 2-3cm and with posture)  Superior parts of kidneys: deep to ribs 11 & 12  Hilum of left kidney: near transpyloric plane (L1 level), approx. 5cm from median plane  Transpyloric plane passes through superior pole of right kidney (2.5cm lower than left pole)  Inferior pole of right kidney: superior to iliac crest 10 Moore’s Clinically Oriented Anatomy, Wolters Kluwer Coverings Kidneys - Coverings  Kidneys covered by a renal capsule and 3 layers: ❑Perinephric fat– surrounds kidney & vessels, extends into renal sinuses (see macroscopic anatomy slides) ❑Renal fascia – encloses kidneys, suprarenal glands & perinephric fat (continuous with psoas major, diaphragmatic & transversalis fascia, fascia covering abdominal aorta and inferior vena cava, inferiorly it encloses the ureters) ❑Paranephric fat– posterior to renal fascia 13 Macroscopic Structures  Kidney: External structure Surfaces: anterior & posterior Covered by fibrous renal capsule Poles: superior & inferior Supra-renal (adrenal) glands located on superior pole Margins - lateral & medial: Renal hilum medial: structures enter/exit Continuous with renal sinus (perinephric fat) renal vein anterior, renal artery middle, renal pelvis posterior Lymphatics & nerves  Kidney: Internal structure Renal cortex: outer layer & extends into medulla between pyramids as renal columns Renal medulla: Inner layer Forms renal pyramids: – apex (papilla) terminates into minor calyx Minor calyx receives urine from papillary ducts Minor calyces join to form major calyx Major calyces join to form renal pelvis Renal sinus – contains: Major & minor calyces Renal pelvis (forms ureter) Blood vessels, nerves & fat 16 Relations  Anterior relations of kidneys Right Kidney Superior pole – suprarenal gland Upper anterior surface – liver (separated by peritoneum) Medial – duodenum Inferior pole – lateral side: right colic flexure - medial side: small intestine (separated by peritoneum)  Anterior relations of kidneys Left Kidney Superior pole – suprarenal gland - stomach and spleen (separated by peritoneum) Middle part - pancreas Lower half on lateral side – left colic flexure, beginning of descending colon Lower half on medial side – jejunum (separated by peritoneum)  Posterior relations of kidneys Similar between left and right Superior: diaphragm Inferiorly from medial to lateral: psoas major, quadratus lumborum, transversus abdominis Subcostal vessels & nerves, iliohypogastric and ilioinguinal nerves: posterior to kidney Superior pole in relation to ribs: Right kidney: 12th rib Left kidney: 11th & 12th ribs Pleural sacs and costodiaphragmatic recesses extend posterior to kidneys  Blood supply, innervation, lymphatic drainage  Kidney: Blood supply Renal arteries arise from abdominal aorta (lateral branches) Originate inferior to superior mesenteric artery: between L1 and L2 Left renal artery: higher than the right Right renal artery: longer, passes posterior to inferior vena cava Venous drainage: left and right renal veins Left renal vein is longer, crosses midline anterior to abdominal aorta, posterior to superior mesenteric artery  Kidney: Blood supply Renal arteries divide close to the hilum into five segmental arteries Each segmental artery supplies a specific segment of the kidney Kidney: Lymphatic Drainage Lymphatic drainage of kidney: lateral aortic (lumbar) nodes around origin of renal artery Kidney: Innervation Sympathetic: From T12 level = Least splanchnic nerve, sometimes contribution from L1, synapse in superior mesenteric ganglia Parasympathetic: Vagus nerve 25 RECAP Kidney Surface anatomy Coverings (3 layers) Neurovascular Macroscopic Relations: structures and structure Anterior & Posterior lymphatic drainage 26 THANK YOU FOR LISTENING 27