1Anatomy of the Genitourinary TractWord文档下载推荐.docx
《1Anatomy of the Genitourinary TractWord文档下载推荐.docx》由会员分享,可在线阅读,更多相关《1Anatomy of the Genitourinary TractWord文档下载推荐.docx(16页珍藏版)》请在冰豆网上搜索。
![1Anatomy of the Genitourinary TractWord文档下载推荐.docx](https://file1.bdocx.com/fileroot1/2022-10/29/169f9681-ddc7-40a4-9162-e6b7691574c4/169f9681-ddc7-40a4-9162-e6b7691574c41.gif)
INTRODUCTION
Urologydealswithdiseasesanddisordersofthemalegenitourinarytractandthefemaleurinarytract.Surgicaldiseasesoftheadrenalglandarealsoincluded.ThesesystemsareillustratedinFigures1-1and1-2.
ADRENALS
GrossAppearance
A.Anatomy
Eachkidneyiscappedbyanadrenalgland,andbothorgansareenclosedwithinGerota'
s(perirenal)fascia.Eachadrenalweighsabout5g.Therightadrenalistriangularinshape;
theleftismoreroundedandcrescentic.Eachglandiscomposedofacortex,chieflyinfluencedbythepituitarygland,andamedulladerivedfromchromaffintissue.
B.Relations
Figure1-2showstherelationoftheadrenalstootherorgans.Therightadrenalliesbetweentheliverandthevenacava.Theleftadrenalliesclosetotheaortaandiscoveredonitslowersurfacebythepancreas;
superiorlyandlaterally,itisrelatedtothespleen.
Histology
Theadrenalcortexiscomposedof3distinctlayers:
theouterzonaglomerulosa,themiddlezonafasciculata,andtheinnerzonareticularis.Themedullaliescentrallyandismadeupofpolyhedralcellscontainingeosinophilicgranularcytoplasm.Thesechromaffincellsareaccompaniedbyganglionandsmallroundcells.
BloodSupply
A.Arterial
Eachadrenalreceives3arteries:
onefromtheinferiorphrenicartery,onefromtheaorta,andonefromtherenalartery.
B.Venous
Bloodfromtherightadrenalisdrainedbyaveryshortveinthatemptiesintothevenacava;
theleftadrenalveinterminatesintheleftrenalvein.
Lymphatics
Thelymphaticvesselsaccompanythesuprarenalveinanddrainintothelumbarlymphnodes.
KIDNEYS
Thekidneysliealongthebordersofthepsoasmusclesandarethereforeobliquelyplaced.Thepositionofthelivercausestherightkidneytobelowerthantheleft(Figures1-2and1-3).Theadultkidneyweighsabout150g.
Thekidneysaresupportedbytheperirenalfat(whichisenclosedintheperirenalfascia),therenalvascularpedicle,abdominalmuscletone,andthegeneralbulkoftheabdominalviscera.Variationsinthesefactorspermitvariationsinthedegreeofrenalmobility.Theaveragedescentoninspirationoronassumingtheuprightpositionis4-5cm.Lackofmobilitysuggestsabnormalfixation(eg,perinephritis),butextrememobilityisnotnecessarilypathologic.
Onlongitudinalsection(Figure1-4),thekidneyisseentobemadeupofanoutercortex,acentralmedulla,andtheinternalcalicesandpelvis.Thecortexishomogeneousinappearance.PortionsofitprojecttowardthepelvisbetweenthepapillaeandfornicesandarecalledthecolumnsofBertin.Themedullaconsistsofnumerouspyramidsformedbytheconvergingcollectingrenaltubules,whichdrainintotheminorcalicesatthetipofthepapillae.
Figures1-2and1-3showtherelationsofthekidneystoadjacentorgansandstructures.Theirintimacywithintraperitonealorgansandtheautonomicinnervationtheysharewiththeseorgansexplain,inpart,someofthegastrointestinalsymptomsthataccompanygenitourinarydisease.
A.Nephron
Thefunctioningunitofthekidneyisthenephron,whichiscomposedofatubulethathasbothsecretoryandexcretoryfunctions(Figure1-4).Thesecretoryportioniscontainedlargelywithinthecortexandconsistsofarenalcorpuscleandthesecretorypartoftherenaltubule.Theexcretoryportionofthisductliesinthemedulla.Therenalcorpuscleiscomposedofthevascularglomerulus,whichprojectsintoBowman'
scapsule,which,inturn,iscontinuouswiththeepitheliumoftheproximalconvolutedtubule.Thesecretoryportionoftherenaltubuleismadeupoftheproximalconvolutedtubule,theloopofHenle,andthedistalconvolutedtubule.
Theexcretoryportionofthenephronisthecollectingtubule,whichiscontinuouswiththedistalendoftheascendinglimboftheconvolutedtubule.Itemptiesitscontentsthroughthetip(papilla)ofapyramidintoaminorcalyx.
B.SupportingTissue
Therenalstromaiscomposedoflooseconnectivetissueandcontainsbloodvessels,capillaries,nerves,andlymphatics.
BloodSupply(Figures1-2,1-4,and1-5)
Usuallythereisonerenalartery,abranchoftheaorta,thatentersthehilumofthekidneybetweenthepelvis,whichnormallyliesposteriorly,andtherenalvein.Itmaybranchbeforeitreachesthekidney,and2ormoreseparatearteriesmaybenoted.Induplicationofthepelvisandureter,itisusualforeachrenalsegmenttohaveitsownarterialsupply.
Therenalarterydividesintoanteriorandposteriorbranches.Theposteriorbranchsuppliesthemidsegmentoftheposteriorsurface.Theanteriorbranchsuppliesbothupperandlowerpolesaswellastheentireanteriorsur