Kidney to uretrocele

some help

1. A PAIR OF EXCRETORY ORGANS SITUATED RETROPERITONEALLY, POSTERIOR TO ABDOMINAL WALL ,one on each side of vertebal column(T12-L3=vertebral relations) Each kidney= 11cm L 6cm B 3cmT anterior to posterior relations= 1.renal vein 2. renal art 3.renal pelvis(10ml)+ Suprarenal gland on upper pole , KIDNEY angle= b/w 12 th rib& outer border of sarcospinalis Kidney pain is elicited here mainly in Kidney lesions Kidney-anatomy

2. 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 capsule Perirenal/perinephric fat Renal fascia Fascia of Gerota Anterior – fascia of Toldt Posterior – fascia of Zucherkandl Pararenal/paranephric fat

3. Structure of Kidney

4. HISTOLOGy

5. Blood supply below level of renal artery=(95%abdominal aortic aneurysm ) Renal artery=end artery Accessory renal artery End arterial supply Renal portal system

6. Nerve supply=t10,11,12 through=> splanchinic nerves Lymphatics supply=>para aortic nodes+adjacent plexus +perinephric fat Venous drainage Starts from peritubular capillary plexus Renal vein drains to IVC Medullary circulation Fast Counter current systems

7. Ureter -anatomy Ureters=20-30cm long , I t 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

8. Plain x-ray =kub Preperation 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

9. 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

10. Intravenous urogram {IVU} PROCEDURE: RFT shud b normal, advice:overnight fasting Give Laxatives to reduce bowel gas in x-rays( 1 st 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

11. 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 I ng …urine--4m--each ureters collected *Brush biopsy –4m—suspected urothelial tumours of UTI * better:delination of anatomy (more dye conc) DISADVANTAGE : * anasthesia required * labourious

12. RENAL ANGIOGRAM Indication : RA**{ stenosis,atheroma,aneurysms,RCC,arterial #S} Procedure: retrograde seldinger technique; “through femoral.Art  ’’ ” needleselective angiogram is done to view tumour vascularity ,narrowing,anomalies etc… Hypaque dye(6-7ml) is used Therapeutic embolisim,trans