kidney and Suprarenal gland.ppt


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  • Posterior surgical approach Since the kidneys lie in part above the twelfth rib, a direct posterior approach might pass first into the thorax, perforating the pleural cavity. A posterior approach to the kidney also puts at risk the subcostal and iliohypogastric nerves which pass laterally behind the kidney.
  • kidney and Suprarenal gland.ppt

    1. 1. Kidneys and Adrenal Glands Department of Regional Anatomy and Operative Surgery
    2. 2. <ul><li>Position, relation </li></ul><ul><li>Structure </li></ul><ul><li>Blood supply </li></ul><ul><li>Lymphatic drainage </li></ul><ul><li>Innervations </li></ul>
    3. 3. Position <ul><li>Retroperitoneal </li></ul><ul><li>Upper poles </li></ul><ul><li>T12 vertebra </li></ul><ul><li>Lower poles </li></ul><ul><li>L3 vertebra </li></ul><ul><li>Right is lower than left </li></ul>
    4. 4. Cadaveric kidneys
    5. 5. Surface Projection of kidney
    6. 6. Renal Angle Tenderness or percussing pain caused by kidney disease is localized here
    7. 7. Neighbor of Kidney
    8. 9. Anterior Surface of the kidney
    9. 11. Posterior Surface
    10. 12. Costodiaphragmatic recess of the pleural cavity
    11. 13. Renal hilum, Renal sinus and Renal pedicle Renal hilum Renal sinus Renal pedicle cortex Renal column Renal pyramid calyx papilla
    12. 16. <ul><li>renal vein </li></ul><ul><li>renal artery </li></ul><ul><li>renal pelvis </li></ul><ul><li>From above downwards </li></ul><ul><li>the renal artery </li></ul><ul><li>renal vein </li></ul><ul><li>renal pelvis </li></ul>From anterior to posterior
    13. 17. Hydronephrosis
    14. 18. renal artery T11
    15. 19. Renal artery
    16. 20. Vascular renal segment Superior (apical) Anterior superior (upper) Anterior inferior (middle) Inferior (lower) posterior
    17. 21. variation of renal artery !
    18. 22. Variation of Renal Artery
    19. 23. Renal veins
    20. 25. Aorta-renal artery-segmental 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 cava
    21. 26. Renal Capsule <ul><li>Renal fascia </li></ul><ul><li>Adipose capsule </li></ul><ul><li>Fibrous capsule </li></ul>
    22. 27. Renal fascia
    23. 29. Fibrous capsule Adipose capsule Perirenal fat Pararenal fat
    24. 32. Fibrous Capsule
    25. 33. Ureter
    26. 34. <ul><li>Ureter is divided into 3 parts: </li></ul><ul><li>① abdominal part </li></ul><ul><li>② pelvis part </li></ul><ul><li>③ intramural part </li></ul>
    27. 35. <ul><li>28 to 34 cm </li></ul><ul><li>3 narrowing sites </li></ul><ul><ul><li>the pelviureteric junction </li></ul></ul><ul><ul><li>crossing the pelvic brim </li></ul></ul><ul><ul><li>traversing the bladder wall </li></ul></ul>
    28. 38. Horseshoe kidney
    29. 39. Suprarenal Gland
    30. 40. <ul><li>Endocrine gland </li></ul><ul><li>T11 level </li></ul><ul><li>Right is triangular </li></ul><ul><li>Left is semi-lunar </li></ul>
    31. 41. Relation tail of pancreas & spleen vessel inferior superior liver stomach Inferior vena cava abdominal aorta medial diaphragm diaphragm posterior anterior right Left
    32. 43. Artery of Adrenal Gland
    33. 46. Veins of adrenal gland <ul><li>Left suprarenal vein, into the </li></ul><ul><li>left renal vein </li></ul><ul><li>Right suprarenal vein, into the </li></ul><ul><li>inferior vena cava </li></ul>
    34. 49. incision Anterior transperitoneal approach Posterior retroperitoneal approach
    35. 50. <ul><li>A 55-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. </li></ul>Case A
    36. 51. <ul><li>What causes the pain when a ureteral calculus is present? </li></ul><ul><li>Why is the pain felt in such an extensive area? </li></ul><ul><li>Where does one look for the course of the ureter in a radiograph? </li></ul><ul><li>Where along the ureter is a calculus likely to be held up? </li></ul>Question
    37. 52. <ul><li>An 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 expiration, the swelling moved upward and could no longer be felt. What anatomical structure could produce such a swelling? </li></ul>Case B
    38. 53. <ul><li>An intravenous pyelogram revealed that a patient’s left kidney was in its normal position, but the right kidney was situated in front of the right sacroiliac joint. Can you explain this on embryological grounds? </li></ul>Case C
    39. 54. <ul><li>An 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? </li></ul>Case D
    40. 55. <ul><li>An intravenous pyelogram revealed that the calyces and pelvis of a patient’s right kidney were grossly dilated (a condition known as hydronephrosis). What embryological anomaly may be responsible for this condition? </li></ul>Case E
    41. 56. <ul><li>Which congenital anomaly of the ureter is likely to present as a case of urinary incontinence? </li></ul>Case F
    42. 57. operation procedure of kidney transplant
    43. 58. nephrectomy <ul><li>For 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 reveal the renal fascia. The subcostal nerve and vessels are preserved; the renal fascia is opened; and the kidney exposed. Care must be taken not to damage the pleura, since it is separated from the upper pole of the kidney only by the diaphragm. </li></ul>