Gross anatomy and Histology of urinary system.
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description of gross anatomy of Kidney, ureter, urinary bladder and urethra long with the microscopic anatomy of all the parts of urinary system.
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Gross anatomy and Histology of urinary system.
- 1. Urinary System Gross Anatomy and Histology Dr Laxman Khanal Assistant Professor Department of Anatomy MBBS 2nd year 01-01-2017
- 2. Components of urinary system •Two Kidneys – Perform all functions except actual excretion. •Two Ureters – Convey urine from Kidneys to Urinary Bladder •Urinary Bladder – Holds Urine until excretion •Urethra – Conveys urine from bladder to outside of body
- 3. Location: • Retroperitoneal area • Side of vertebral column • Below diaphragm • 2 surfaces • 2 end • 2 borders Extension: T12-L3
- 4. • Angle between the lower border of the 12th rib and lateral border of erector spinae. • It overlies the lower part of kidney. • Tenderness can be felt in this area in case of perinephric abscess. Renal angle
- 5. Right Vs Left • Left kidney is nearer to midline than right. • Left is placed higher than the right • Left kidney is longer than that of right. • Transpyloric plane passes through the upper part of right hilum and lower part of left hilum # left is longer and nearer
- 7. Alteration in shape Horseshoe shaped kidney Alteration in position • Pelvic kidney • Thoracic kidney • Crossed ectopic kidney
- 8. Hilum of Kidney • It is the gateway of kidney for different structures. • From anterior to posterior, structures are- 1. Renal vein 2. Renal artery 3. Renal pelvis- continues as ureter 1. Hilum 2. Renal sinus 3. Renal parenchyma
- 9. Muscles 1. Psoas muscle 2. Quadratus lumborum 3. Transversus abdominus 4. Diaphragm Nerves 1. Subcostal N 2. Iliohypogastic N 3. Ilioinguinal N Ribs 11th – left only 12th – Right +left
- 10. Posterior relation View from posterior
- 11. Right • Adrenal gland • Liver • Duodenum • Colic flexure • Small intestine Left • Adrenal gland • Stomach • Pancreas • Colic flexure • Small intestine
- 13. Covering of the kidneys • Fibrous capsule (true capsule) • Perinephric fat • Renal fascia( fascia of Gerota) • Paranephric fat
- 14. Covering of kidney • In Nephroptosis (mobile kidney), fibrous capsule is divided and sutured with the posterior abdominal wall (process is called as Nephropexy).
- 15. Renal Fascia or fascia of Gerota • Consists of two layers 1. Anterior layer or fascia of Toldt 2. Posterior layer of Fascia of Zuckerkandl • Laterally: Both layer fused and continued with the fascia transversalis • Medially: Layers do not fuse.
- 16. Fascia of Toldt Fascia of Zuckerkandl Paranephric fat
- 18. Minor calyx Major calyx Renal pelvis Kidney Kidney proper (parenchyma) 1. Cortex Cortical arch Renal column 2. Medulla = Renal pyramid Renal sinus
- 19. Macroscopic structure Renal parenchyma (Kidney proper) 1. Cortex- Cortical arches Renal column 2. Medulla is made up of renal pyramid. Renal sinus Major and minor calyces Blood vessels Nerves and Lymphatics Perinephric fat
- 21. Renal vasculature Renal arteries arises at the level of L1- L2
- 22. Heterotopic Transplant Orthotopic Transplant • Heart transplant • Liver transplant
- 23. Near the hilum each renal artery divides into 5 segmental arteries.
- 24. • Renal artery • Segmental artery • Lobar artery • Inter lobar artery • Arcuate artery • Interlobular artery • Afferent arteriole • Glomerular capillaries • Efferent arteriole Vascular supply of kidney
- 25. • Renal artery • Segmental artery • Lobar artery • Inter lobar artery • Arcuate artery • Interlobular artery • Afferent arteriole • Glomerular capillaries • Efferent arteriole Peritubular capillaries Vasa recta • Interlobular vein • Arcuate vein • Interlobar vein • Lobar vein segmental vein Renal vein
- 26. • The Vasa recta is a portion of the peritubular capillary system which enters the medulla. • It acts with the loop of Henle to concentrate the urine by a complex mechanism of counter current exchange . • If the vasa recta did not exist, the high concentration of solutes in the medullary interstitium would be washed out.
- 27. Ureter • These are pair of muscular tubes( 25 cm) that are continuous superiorly with the renal pelvis. • Consists of three parts. 1. Abdominal part 2. Pelvic part 3. Intramural part
- 30. Gonadal vessels Vas deference Uterine artery Genitofemoral nerve
- 32. Intramural part Muscle layer of Waldeyer
- 33. Ureteric constrictions sites 1. Ureteropelvis junction 2. Pelvic brim 3. Entrance to bladder
- 34. • Aortic plexus • Sup Hypogastic plexus • Hypogastric nerve • Inf hypogastric plexus • Sympathetic trunk
- 36. Conclusion • Kidneys are retroperitoneal organs extend between T12 to L3 vertebra. • ‘Renal angle’ is the site of tenderness in perinephric abscess. • Let kidney is longer and nearer to the midline and diaphragm. • Relationship of the ureter with the uterine artery is utmost important during hysterectomy procedure.
- 38. Urinary Bladder • The bladder is the most anterior element of the pelvic viscera. • Entirely in the pelvic cavity when empty. • Expands superiorly into the abdomen when full. • An empty bladder is somewhat tetrahedral and oval when full. • Has a base (fundus), neck, apex, a superior and two inferolateral surfaces. • Mean capacity is 220 ml. • 150-250 ml collection lead to desire to micturition. • Volume >500 ml caused pain due to its distension.
- 41. Bladder - Female Superior surface- peritoneal Other- not peritoneal Surfaces: • Superior surface • Posterior surface (Base) • Inferiolateral surfaces Apex- directed anteriorly Neck- directed inferiorly
- 42. Bladder- Male Superior surface- peritoneal Base: upper part peritoneal Other : non peritoneal Neck is encircled by prostate.
- 44. Base of Bladder in male
- 45. Base of urinary bladder of male • Rectovesicle pouch • Seminal vesicle • Ampulla of vas deference • Rectovesicle fascia (Denonvillier’s fascia)
- 46. Base of urinary bladder of female • Anterior vaginal wall • Anterior wall of supravaginal part of cervix
- 47. Space of Retzius Potential space between urinary bladder and pubic symphysis. Content: Retro-pubic fat Veicle plexus of vein
- 48. Neck of Urinary Bladder • The neck of the bladder surrounds the origin of the urethra. • The neck is the most inferior and also the most 'fixed' part of the bladder. • In male it is surrounded by prostate gland. • It is anchored into position by a pair of tough fibromuscular bands • pubovesical ligaments in female • puboprostatic ligaments in male.
- 49. Pubovesicle ligament Puboprostatic ligament
- 50. Interior of bladder Trigone • Bar of Mercier • Bar of Bell’s • Uvula vesicae Internal urethral sphincter (sphincter vesicae)
- 51. • Puboprastatic OR Pubovesicle ligament • Lateral ligament • Posterior ligament • Median umbilical ligament Median umbilical fold Medial umbilical fold Lateral false ligaments Posterior false ligaments False ligaments True
- 52. Anterior division of internal iliac artery 1. Superior vesicle artery 2. Obturator artery 3. Inferior vesicle artery 4. Middle rectal artery 5. Internal pudendal artery 6. Inferior gluteal artery 7. Uterine artery 8. Vaginal artery Vesicle plexus (space of Retzius) Internal iliac vein Posterior ligament of bladder
- 54. Micturation • Automatic bladder • Atonic bladder • Autonomous bladder S2, S3 and S4
- 56. External urethral orifice Apex of trigone (IUS) Male urethra 1. Prostatic urethra (3 cm) 2. Membranous urethra (2 cm) 3. Spongy urethra (15 cm) Urethral lumen
- 57. Base of bladder Base of bladder • Opening of ejaculatory ducts • Opening of prostatic utricle How the ejaculatory ducts runs from base of bladder ?
- 58. • Urethral crest • Seminal colliculus • Prostatic sinus Opening of – Prostatic utricle Ejaculatory duct • urethral sphincters (ext & Int)
- 59. Bulbourethral gland Intra-bulbar fossa Navicular fossa Skene’s gland ≈ prostate gland Urethral gland (Littre’s gland) Greater vestibular gland ≈ bulbourethral gland
- 62. Minor calyx Major calyx Renal pelvis Kidney Kidney proper (parenchyma) 1. Cortex Cortical arch Renal column 2. Medulla = Renal pyramid Renal sinus Lobe of kidney: One pyramid + cortical arch + half of renal column from each side.
- 63. Transitional epithelium lining minor calyx Distal portion of collecting ducts in renal pyramid
- 64. • Renal artery • Segmental artery • Lobar artery • Inter lobar artery • Arcuate artery • Interlobular artery • Afferent arteriole • Glomerular capillaries • Efferent arteriole Vascular supply of kidney
- 65. Renal cortex consists of • Renal corpuscle • PCT • DCT • Collecting tubules • Collecting ducts • Extensive vascular supply Urineferous tubule Vs nephron= + collecting duct
- 67. Renal corpuscle= BC + Glomerulus Vascular pole Urinary pole DCT Urinary space
- 68. Lining of BC Parietal – Simple squamous Visceral- Podocytes
- 69. Filtration membrane 1. Endothelial cells (fenestration) 2. Basement membrane (type IV collagen) 3. Pedicles of podocytes (filtration slits)
- 71. • Nephrotic Syndrome: abnormalities in the structure of glomerular Basement membrane makes filtration membrane functionally leaky. i. Protenuria ii. Hypoalbuminea iii. Oedema iv. Hematuria
- 72. JG cell MD cell Lacis cell Juxtra-Glomerular apparatus BP Na+
- 73. BP Na+ Renin Angiotensinogen by Liver Angiotensin I Angiotensin II ACE (in Lung) Vasoconstriction Aldosterone secretion BP = PR * CO Na+ reabsorption More water in vascular bed
- 74. • Location: cortex • Simple cuboidal epithelium with brush border (formed by microvilli). • Basal striation (by mitochondria) • Irregular lumen • Location: medulla (forms medullary rays) • Simple squamous epithelium (thin part) • Simple cuboidal epithelium (thick part) PCT Loop of Henle
- 75. Medullary rays • Collecting duct • Loop of Henle (thick limb)
- 76. DCT • Location: cortex • Simple cuboidal epithelium with very few microvilli. • Size of cell is smaller than that of PCT • Perfectly round lumen.
- 77. Collecting duct Lined by 1. Principle cells (pale) 2. Intercalated cells (dark)
- 78. Ureter, urinary bladder and urethra. • Except for urethra, general arrangement is – a. Mucosal epithelium (Transitional epithelium) b. Lamina propria c. Muscle layer (inner longitudinal, outer circular) (3rd layer of longitudinal muscle is found in distal ureter and bladder.) d. Adventitia or Serosa layer
- 79. Ureter
- 80. Urinary Bladder Empty Full
- 81. Urethra Prostatic – transitional epithelium Membranous- pseudostratified columnar Spongy-pseudostratified + stratified squamous