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1. A PAIR OF EXCRETORY ORGANS SITUATED RETROPERITONEALLY, POSTERIOR TO ABDOMINAL WALL ,one on each side of vertebal column(T12-L3=vertebral relations)
2. Each kidney= 11cm L 6cm B 3cmT
3. anterior to posterior relations= 1.renal vein 2. renal art 3.renal pelvis(10ml)+
4. Suprarenal gland on upper pole , KIDNEY angle= b/w 12 th rib& outer border of sarcospinalis
5. Kidney pain is elicited here
6. mainly in Kidney lesions
KIDNEY-ANATOMY
• Hepatorenal pouch = a deep recess lined in peritoneum,related to upper pole of kidney
• .Fluid collection after liver& CBD surgeries
• Capsule of kidney • Proper capsule = fibrous membrane covering kidney + • Perirenal fat in space of gerota
Fibrous capsulePerirenal/perinephric fatRenal fasciaFascia of GerotaAnterior – fascia of ToldtPosterior – fascia of ZucherkandlPararenal/paranephric fat
STRUCTURE OF KIDNEY
CORTEX
MEDULLA
SINUSES
• ARCHES/LOBULES• RENAL COLUMNS
• RENAL PYRAMIDS
• Branch OF RA• Tributary of RV• RENAL PELVIS
• 1-3 million uriniferous tubulesEach kidney composed of =
• Ducts of bertiniCollecting tubule
• Macula densa• JG cells• Mesangial cells
Juxtaglomerular apparatus
HISTOLOGY
BLOOD SUPPLYBELOW LEVEL OF RENAL ARTERY=(95%ABDOMINAL AORTIC ANEURYSM )
Renal artery=end arteryAccessory renal artery
End arterial supplyRenal portal system
NERVE SUPPLY=T10,11,12 THROUGH=>SPLANCHINIC NERVES• Lymphatics supply=>para aortic nodes+adjacent plexus
• +perinephric fatVenous drainageStarts from peritubular capillary plexusRenal vein drains to IVC
Medullary circulationFastCounter current systems
URETER -ANATOMY• Ureters=20-30cm long ,It begins within
• Renal sinus as a funnel shaped dilatation
• =Called renal pelvis
• It enters bladder wall obliquely to open at
• Angle of trigone
• +lies in retroperitonealspace
• Arterial supply=
• Upper=renal+adrenal arteries
PLAIN X-RAY =KUBPreperation of p/t
• Fasting( to reduce bowel gas in x-ray ) Enema/bowel wash/laxative given ->on previous day->high penetration
• x-ray exposure in supine position,covering pubic symphysis+lower ribs
• Interpreting film -----look for bony abnormalities( pelvis,hip, L vertebra #s,scoliosis,spinabifida etc…….
• ----kidney shadow r visualised in plain x-ray kub• Psoas shadow is obliterated in (1)enlarged kidney• (2) scoliosis due to inflammatory causes• (3) malignancy (4)splenic injury • (5)TB spine+cold abscess(psoas abscess) • (6) retropeitoneal tumours
• Ureteric line=look for (ureteric stone).transverse process
• Of lumbar vertebra,crosses the sarcoiliac jointsto reach a point medial to ischial spine
• Bladder,prostate,urethral areas are visualised for lesions
• Intravenous urogram {IVU}
• PROCEDURE: RFT shud b normal, advice:overnight fasting• Give Laxatives to reduce bowel gas in x-rays( 1st plain x-ray kub)• Sodium diatrizoate(urograffin) i.v is given after applying test
dose• X-ray taken at (1-5m,15m,20-30m,72hrs)=>late films show
BLADDER pathology as resudial urine
• RETROGRADE PYELOGRAPHY(RGP)• Indication(1)IVU failed as late as 72hrs films• (2)Urinary TB(3)urothelial tumours of R.pelvis• PROCEDURE(1) underG/a,cytoscope is passed..ureteric
orifice is visualised(2)uret..catheter is passed+dye(Na diatrizoate)(3)x-ray taken
• Advantage * prior to dye Ing …urine--4m--each ureters collected
• *Brush biopsy –4m—suspected urothelial tumours of UTI
• * better:delination of anatomy (more dye conc)• DISADVANTAGE: * anasthesia required• * labourious
RENAL ANGIOGRAMIndication: RA**{ stenosis,atheroma,aneurysms,RCC,arterial #S}Procedure: retrograde seldinger technique; “through femoral.Art ’’ ” needleselective angiogram is done to view tumour vascularity ,narrowing,anomalies etc…Hypaque dye(6-7ml) is usedTherapeutic embolisim,trans