Download - Urinary system Systema urinarium
Urinary systemSystema urinarium
Anatomy + a glimpse of histology and embryology
Upper urinary tract
• Nephron
• Tubuli colligentes
Lower urinary tract
• Calices renales (Renal calices)
• Pelvis renalis (Renal pelvis)
• Ureter
• Vesica urinaria (Urinary bladder )
• Urethra feminina / masculina
Kidney (Ren, Nephros)• margo, hilum, sinus,
facies, extremitas /polus/
• capsula fibrosa, lobi renales
• Cortex: labyrinthus, columnae renales Bertini, radii medullares
• Medulla: pyramides renales → papillae renales (area cribrosa + foramina papillaria)– zona interna + externa
Position and fixation of kidneys
Synthopy and impressions
Kidney
Microcopic structure• Nephron• Interstitium• Vessels
Nephronfunctional unit
• Corpusculum renale Malphigi– glomerulus (vessel skein)
– capsula glomeruli Bowmani
• Proximal tubule• Intermediate tubule• Distal tubule• Juxtaglomerular apparatus
Corpusculum renale(ledvinné tělísko Malpighi)
• Capsula glomeruli (Bowman´s capsule)– parietal lamina (flat monolayer epithelium)
– visceral lamina (podocytes with pedicles)
• Glomerulus – vas afferens vas efferens (= arterioles)
– fenestrated capillars without diaphragm
• Filtration barrierbasal membrane - colagen IV. typ and heparan sulfatenegative charge
• Mesangial cells cleaning function of filter
Proximal tubule
• single layer of cuboidal epithelium rich in microvilli
• resorption of NaCl and water (80-95%)– Na+ passive transport into cells,
active transport out of cells
Intermediate tubulus
• = thin segment of ansa nephroni (Henle´s renal loop)
• descending and ascending limb• flat cells, few organels
– descending segment permeable for water– ascending not!!
• juxtamedullary nephrons with long H. loop– countercurrent together with vasa recta
Distal tubule
• cuboid eptihrelium with few microvilli
• back-resorption Na+ and secretion K-
• macula densa - chemoreceptors (Cl-)
• includes the thick segment of Henle´s loop
Juxtaglomerullar apparatus
• components– macula densa of distal tubulus– granullar cells (transformed smooth muscle
cells) of vas afferens + efferens– mesangial cells
• function– regulation of blood pressure
by hormone renin
Kidney - arterial supply I.
• a. renalis (paired visceral branch of abdominal aorta at level of discus intervertebralis L1/2, left L1)
• accessory renal artery (30%)
• rate flow 1,2-1,3 l blood/min
• arteries are terminated = no arterio-arterial anastomosis
Kidney - arterial supply II.a. renalis r. anterior 4 segmental branches
r. posterior for 1 dorsal segment
aa. segmentales a. lobares (about 12) 2-3 aa. interlobulares aa. arcuatae a. interlobulares arteriolae glomerulares afferentes glomerulus of capillars arteriolae glomerulares efferentes peritubullar capillary plexus or arteriolae rectae along intermediate tubulus of juxtaglomerullary nephrons
Kidney - venous supply
vv. stellatae (from surface) + venulae rectae (along intermediate tubulus of juxtaglomerullary nephrons) + peritubullar capillary plexus vv. interlobulares vv. arcuatae vv. interlobares v. renalis v. cava inferior
Portal system (= rete mirabile) – 2 capillary nets one after the other
migthy veno-venous anastomosis
Kidney Lymph drainage and innervation
• 3 plexus (peritubullar, subcapsullar and from adipose capsule)
• nodi lymphoidei lumbales
• plexus renalis (autonomous, viscerosensitive) from ganglion coeliacum + plexus coeliacus, from ganglion aorticorenale
• from n. splanchnicus minor and plexus aorticus
Kidney examination
• Native X-ray snap
• Sonography
• Excretory urography
• Ascending pyelography
• Clearence
• CT, MR
Kidney diseases• Development defects – agenesis, shape deformities• - cysts• Glomerulonephritis• Pyelonephritis• Hydronephrosis• Nefrohydrosis• Diabetes mellitus – nephropathy• Tumours
• Grawitz´s (solitary metastasis)• Wilms´ (autosomally heridatory - children)
• Renal colic
Development of urinary system
• Development of kidney– Pronephros– Mesonephros– Metanephros
• Development of urinary tract
Pronephros
• From intermediate mesoderm of cranial 12-13 somites
• from 21st day (4 primary segments)• rudimentary, disappears quickly• common presistent ductus mesonephricus Wolffi
Mesonephros
• origin from nephrogenic blastema
• sac elongates to ductus Wolffi
• approximately from 23rd day
• glomerulus and collective tubules
• caudal parts are origin for genital organs
• = urinary system of fish
Metanephros
• definitive stadium of kidney• nephrogenic blastema 3rd to 5th lumbar somites
– development begins at the end of 5th week– relative ascent during development
• ureteral bud sprins upwards from ductus mesonephricus Wolffi and grows in blastema
• induction of maturation of nephronureteral bud ureter, pelvis, calices, collecting
tubulesmetanephrogenic blastema nephron
Development malformations
• Atypical shapes• Cystic, polycystic kidneys• Agenesis of kidney • Ureter duplex, fissus
Kidney transplantation
• since 50s´
• 5 years of graft survival - 70%
• including proximal part of ureter and its blood supply (branches of renal vessels)
• placed to fossa iliaca and renal artery joined to a. iliaca ext. (end-to-side) or to terminal part of a. iliaca int. (end-to-end)
• if present, a. renalis accessoria joined to a. epigastrica inferior
Lower urinary tractgeneral wall structure
• Mucosa (tunica mucosa)– epithelium transitional– lamina propria mucosae (collagen)
• Smooth muscle (tunica muscularis)
• Adventitia (tunica adventitia)
Renal pelvis (Pelvis, pyelon) Renal calices (Calices renales)
• 7-14 calices minores around papilae 2-3 calices majores ureter
• ampullary / branching type (typus dendriticus)
• muscular layer – strong circular
• projection: processus costalis L1
• blood supply: branches of renalartery, tributaries to renal vein
Ureter • 25-30 cm, lumen 4-7 mm• 3 parts: pars abdominalis, pelvina, intramuralis• crossings of important structures• 3 constrictions – risk of stone impact
obstruction hydronephrosis afunction of kidney
• 2 muscular layers– inner longitudinal
– outer circular
• adventitia
Ureter - supply
• Arteries: a. renalis, aorta abdominalis, a. testicularis/ovarica, a. ductus deferentis / uterina, a. vesicalis inf. rr. ureterici
• Veins run along arteries
• Lymph drainage: nll. lumbales (aortici lat.), iliaci int., ext., communes
• Nerves: plexus uretericus plexus renalis, aorticus abd., hypogastricus sup., inf.
Ascending (retrogade)
pyelography
Urinary bladder (Vesica urinaria, Kystos)
• description: fundus, corpus, apex, cervix, uvula
• trigonum vesicae – ostia ureterum, plica interureterica, ostium urethrae internum, Bell´s bands
• muscles: smooth– m. detrusor
(parasympathetic)– m. trigoni vesicae– ♂m. sphincter vesicae
(sympathetic)
• projection: behind symphysis pubica (in child over s.p.)
Cystography
Urinary bladder – wall structure
• folds except trigonum vesicae• smooth muscle fibres create 3 layers:
– inner plexiform– middle circular
m. sphincter vesicae in male only!– outer longitudinal
• upper surface covered with serosa (peritoneum) = partially intraperitoneal organ
Urinary bladder – supply
• a. iliaca int. a. umbilicalis aa. vesicales sup.• a. iliaca int. a. vesicalis inf.• (a. obturatoria, a. glutea inf., a. uterina, a.
vaginalis rr. vesicales) • Veins: plexus venosus vesicalis (connections to
plexus venosus prostaticus/vaginalis) vv. vesicales v. iliaca int.
• Lymph drainage: nodi paravesicales nodi iliaci int. et ext. nodi iliaci comunes
• Nerves: plexus vesicalis plexus hypogastricus inf.
Urinary bladder - fixation• Ligaments: pubovesicale,
puboprostaticum, rectovesicale, vesicouterinum
• Smooth muscle: pubovescalis, rectovesicalis
• Ligamentum umbilicale medianum (= chorda urachi)
• Fascia vesicoumbilicalis Delbeti
• Septum rectovesicale Denonvilliersi
• Septum vesicovaginale• Spatium retropubicum
Reztii
Urinary bladder - peritoneum• Fossae paravesicales• ♂ excavatio
rectovesicalis= most caudal space of peritoneal
cavity in male (in contact with top of glandula vesiculosa)
♀ exc. vesicouterina♀ exc. rectouterina (=
Douglas´space)= most caudal space of
peritoneal cavity in female (in contact with top of posterior vaginal vault)
– palpation and puncture in inflammation via vagina !
Urethrae
• Male urethra is divided in 4 parts:– transitional epithelium in firts 2 parts– pseudostratified or stratifoed columnar
epithelium in the rest
• Female urethra – transitional epithelium in intramural part– squamous stratified
Urethra feminina (Female urethra)• 3 parts: pars intramuralis, pelvina, perinealis• ostium urethrae internum (trigonum vesicae)
– accipiens, evacuans• ostium urethrae externum (vestibulum vaginae)• crista urethralis, lacunae, glandulae urethrales
(Skenei s. Guérini), ductus paraurethrales (Schülleri)
• smooth muscles, around urethra striated m. sphincter urethrae, m. compressor urethrae a m. sphincter urethrovaginalis
• adventitia
Urethra feminina - supply
• Arteries: paired branches of a. vesicalis inf. et a. vaginalis
• Veins: plexus venosus vesicalis plexus venosus vaginalis vv. pudendae int. • Lymph drainage: nl.l. iliaci int., ext.• Nerves: plexus hypogastricus inf. plexus
vesicalis, plexus uterovaginalis nn. vaginales
Development of lower urinary tract
• Urinary bladder– developed from cranial part of urogenital sinus– urachus– separation of excretory urinary trct and genital
ducts
• Urethra♀ developed from medial part of urogenital sinus
♂ developed from medial and caudal part of urogenital sinus and glandular plate
Urine continence in female• no smooth muscle sphincter in urinary
bladder• elastic fibres + venous plexuses in urethra • striated muscle m. sphincter urethrae
(externus) /S2-S4/• so-called „periurethral muscles“ (in
increased intra-abdominal pressure)– m. levator ani (S3-S4)– m. compressor urethrae, m. sphincter
urethrovaginalis, m. bulbospongiosus (n. pudendus)
Urethra masculina (Male urethra)
• 4 parts
• see male genital system