1Anatomy of the Genitourinary TractWord文档下载推荐.docx

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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