Kidney to uretrocele

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