泌尿系统

nullThe Urinary System The Reproductive SystemDepartment of Anatomy & Neurobiology, Xiangya School of Medicine, CSUThe Urinary System The Reproductive SystemDeng Xiaohua xiaohuadeng@yahoo.comnullI The Urinary System1. General description of the Urinary System 2. Kidneys General features, Renal sinus, Renal hilum Renal pedicle, Location, Relations Structure of the kidney, Coverings 3. Ureters 4. BladderOutlineII The Reproductive System General description of the Reproductive System Ovary Uterine tube 4. Uterus III CASEnullComposition Kidney Ureter Urinary bladder Urethra Functions Excrete the waste productsEndocrine function: Erythropietoin (红细胞生成素） anaemia贫血, 贫血症 Renin （肾素） 1,25-hydroxycholecalciferol(羟胆钙化醇)(urea,uric acid, excess water, inorganic salt)The Urinary Systemnull -2 borders lateral: convex medial: renal hilum KidneysGeneral features Bean shaped, reddish-brown organs 2-2-2-2 surfaces anterior: convex posterior: plane-2 poles : superior: broad & thin inferior: narrow & thicknullMedial border－concave Renal hilum 肾门－a vertical slit on the medial border of kidney Order of structures in the renal pedicle from A Renal pedicle肾蒂-- the structures which enter and leave the renal hilum are enclosed together by connective tissuefrom SP: V. A. P.I: A. V. P.nullRenal sinus 肾窦 which is the renal hilum leads into a space within the kidney--Contents: the rental sinus is occupied by the renal vessels, minor renal calices, major renal calices, renal pelvis and some adipose tissuenullLocation L: T11i-L2i R:T12s-L3sRenal region • percussion pain • tendernessnullRelations• Medial Left kidney－abdominal aorta Right kidney－inferior cava vana •Superiorly－superarenal glandPosteriorly Three muscles Diaphragm Psoas major Quadratus lumborum Three nerves Subcostal Iliohypogastric Ilioinguinalnull Right kidney Right lobe of liver (superior) Right colic flexure (inferior) Descending part of duodenum (medially)Anteriorly Left kidney Stomach (superior) Pancreas (middle) Loops of intestine and left colic flexure (inferiorly)null• Minor renal calices 肾小盏 (7-8) Major real calices 肾大盏 (2-3) Renal pelvis 肾盂Structure of the kidney• Renal cortex 肾皮质 Renal medulla 肾髓质 renal columns 肾柱Renal pyramids 肾锥体: 15-20 Renal papilla 肾乳头 Papillary foramina 乳头孔nullCoverings There are three layers of coverings surrounding each kidneyFibrous capsulenullnullThe factors maintaining the normal position of kidneycoverings of kidney greater vessels neighbouring organs peritoneum pressure in the abdominal cavityCachexia: nephroptosis floating kidneynullThe segments are Superior segment Superior anterior segment Inferior anterior segment Inferior segment Posterior segmentThe kidney is divided into five vascular segments and each is supplied by a branch of the renal artery; between the segments there is no anastomosis. Renal blood vessels and segmentsnull Superior segment Superior anterior segment Inferior anterior segment Inferior segment Posterior segmentTransplantTransplantCondition Position Anastomose (blood vessel, ureter&urinary bladder) Immunosuppressant UretersUretersIntramural part－passes obliquely through the bladder wall for 2cm longMuscular tube, about 25cm longThree parts Abdominal part－descend on the psoas major behind the peritoneum Pelvic part－in females, passes 2cm lateral to the neck of uterus and lies below the uterine arterynullAbdominal part－descend on the psoas major behind the peritoneum nullPelvic part －in males, the ductus deferens crosses it anteriorly to its medial side－in females, passes 2 cm lateral to the neck of uterus and lies below the uterine arteryIntramural part－passes obliquely through the bladder wall for 2cm longuterotomynullThree constrictions At the pelvoureteric junction Where it crosses the pelvic inlet and iliac vessels Where it pierces the bladder wall obliquely (at intramural part)nullStone in ureterUrinary BladderUrinary BladderGeneral features Pyramidal in shape when it is empty, can be divided into: Apex, Fundus Body of bladder NecknullInterior of bladder Mucous membrane foldedTrigone of bladder －smooth triangular area, formed by internal urethral orifice anteriorly and two ureteric orifices laterally•Interureteric fold －muscular elevation, between ureteric orifices.nullIn the young child the empty bladder projects above the pelvic inletLocation • In the adult, it lies in the lesser pelvis, behind the pubic symphysis, in front of seminal vesicle, ampulla ductus deferentis and rectum in the male, and in front of uterus and vagina in the female.nullRelations of the bladder Urethra Urethra• Opens into vaginal vestibuleFemale urethra Relatively wide , short (about 5cm long) and straightnulloophoritic cyst 卵巢囊肿 ovariectomy 卵巢切除 peridural anesthesia 硬膜外麻醉 urination 排尿 urethral catheterization 导尿（术） urinary catheter 导尿管nullMale urethra 3-3-3-2Prostates part －lies within the prostate and is the widest and most dilatable portion of urethra. Membranous part –lies within the urogenital diaphragm surround by the sphincter of urethra Cavernous part －transverse the length of cavernous body of urethraPosterior urethra－prostatic part and membranous part Anterior urethra –-cavernous partThree partsnullThree constrictions At the internal urethral orifice• At the membranous part At the external orifice of urethraThree enlarged parts• prostatic part• bulb of urethra• navicular fossa of urethranullTwo curvaturesThe Reproductive SystemThe Reproductive SystemComposition Composition Internal genital organ Gonads (sex glands)－manufacture the sex cells and secrete the sex hormones. Genital ducts –transport the sex cells from the site of production into site fertilization Accessory glands－secrete the fluid External genital organFemale internal genital organsFemale internal genital organsGonad: ovary Ducts of conveying ovums: uterine tube uterus vagina Ovary Ovary Position－lies in the ovarian fossa in the angle between the internal and external iliac vessels on the lateral pelvic wall.Shape－an ovoid organ 2-2-2-2 Superior pole Inferior pole Anterior border Mesovarian border 系膜缘 Hilum of ovary 卵巢门 Posterior border－free border Two surfaces－medial and lateral nullSupporting structures of ovary Suspensory ligament of ovary 卵巢悬韧带 Proper ligament of ovary 卵巢固有韧带Functions: Produce ova and secrete estrogensUterine tube Uterine tube General features About 10cm long Located at upper edge of broad ligament of uterus between the two layersnullFour parts •Infundibulum of uterine tube Fimbria of uterine tube ovarian fimbriarteryAmpulla of uterine tube － relatively wide, tortuous, longst part, thin walls; fertilization usually takes place in this region.null• Isthmus of uterine tube －straight and narrow portion, thick walls, it is the place where the tubal ligation is performed usually• Intramural uterine part －narrowest part, pierces uterine wall and opens into the cavity of uterus by uterine orifice of uterine tubeUterusUterusGeneral features－muscular pear-shaped organThree parts Fundus of uterus Body of uterus Neck of uterus --Vaginal parts of cervix 子宫颈阴道部 Supravaginal parts of cervix 子宫颈阴道上部 Isthmus of uterus子宫峡 －short constricted part, transition between the body and the neck of uterus, taken up by body of uterus during pregnancy, thus “lower uterine segment”nullnullInterior cavity Cavity of uterus 子宫腔－the cavity of body of uterus, is triangular in coronal sectionCanal of cervix of uterus 子宫颈管－the cavity of neck, is spindle-shaped， opens into the vagina at the orifice of uterus子宫口 null*null*null*null•Anteflexion :axis of body of uterus is bent forward with that of the cervix forming an angle of about 170o (body of uterus is bent slightly forward at isthmus)Position Lies in the center of the pelvic catity, between bladder, anteriorly, and rectum, posteriorly, usually it is anteversion and anteflexionAnteversion : Long axis of uterus at 90o with that of vagina nullSupports of uterus Pelvic diaphragm Surrounding organs : vagina and bladderLigaments Broad ligament of uterus Round ligament of uterus:maintain anteverted position of fundus Cardinal ligament of uterus － Uterosacral ligament of uterusnullCardinal ligament of uterus 子宫主韧带 －confer lateral stability to cervical region Uterosacral ligament of uterus 骶子宫韧带 －maintain body of uterus in anteverted position.null*null*null Case A 19-year-old female who has borne one healthy child is being seen at 7 weeks’ gestation based on her last menstrual period and her complaints of vaginal spotting and lower abdominal pain. She denies the passage of any tissue through the vagina, trauma, or recent intercourse. Her medical history is significant for a pelvic infection approximately 3 years previously. On examination, her blood pressure is 90/60 mm Hg, heart rate is 110 beats/min, and temperature is within normal limits. The abdomen is normal, and bowel sounds are present and normal. On pelvic examination, the external genitalia and uterus palpate as normal. There is moderate right adnexal tenderness with palpation. Quantitative human β-corticotropin gonadotropin is 2300 mIU/mL, and transvaginal sonogram displays an empty uterus and some free fluid in the cul-de-sac. What is the most likely diagnosis? What is the cause of the hypotension? nullMost likely diagnosis: Ectopic pregnancy （宫怀孕）. Cause of the hypotension: Ruptured ectopic pregnancy in the uterine tube with bleeding into the abdominal cavity.nullThank you!