KIDNEY URETER Anatomy

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KIDNEY AND URETERS

1. ANATOMY

The  two kidneys are situated on either side of the midline,  the

hilium  being  at the level of the lower border of  first  lumbar

vertebra. 

They  weigh about 160 gms each and are surrounded by  perinephric

fat. The right kidney is 1-2 cm. lower than the left.

The kidneys are protected posteriorly by the 11 + 12th ribs,  the

quadratus lumborum and the psoas major muscle.

The anterior relations are colon, duodenum and suprarenals at the

upper poles. The pancreas is one additional anterior relation  of

the left kidney 

The  kidney  is a solid organ made up of an outer cortex  and  an

inner placed medulla.

The cortex contains the glomeruli (Shown below) and a port of the tubucles. The

medulla  contains  the rest of the tubule and  collecting  ducts.

The collecting ducts open into the minor calices and these  minor

calyx open into the major calyx which open into the renal pelvis.

1.1 Ureters

The  calyceal system of the kidney opens into the  funnel  shaped

renal pelvis that narrows into a muscular tube 28-30 cm long  and

5 mm in diameter.

This tube courses through the retroperitoneum just lateral to the

transverse  processes  of the lumbar vertebra, crosses  into  the

bony pelvis at the bifurcation of the iliac vessels and then ends

at the trigone of the bladder.

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Strangulated and other hernias

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STRANGULATED HERNIA

An   emergency  operation  is  undertaken  for  a   hernia   with

strangulated  content  when  gangrene  may  have  developed,  all

gangrenous tissue must be resected.  When strangulated intestinal

is  present;  this requires an anastomosis between  normal  bowel

sections proximal and distal to the necrotic area.

Other Hernia

The so called lumber hernias develop through the lateral abdominal

wall  and  occur in the scar of the incision used to  expose  the

kidney.

A Petit's triangle hernia is another lumbar hernia bounded by the

external  obliquue anteriorly iliac crest inferiorly,  latissimis

dorsi  posteriorily. 

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Para Umbilical Hernia Mayo repair

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. PARAUMBILICUL HERNIAS

Paraumbilicul  hernias  occur later in adult life  especially  in

females  at  or  around  the  umbilicus  usually  after  multiple

pregnancies.   It  may  be  due to a minor  defect  left  at  the

umbilicus in the  process of repair in infancy.

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MAYO'S OPERATION

The  incision is transverse, the sac neck is identified, the  sac

opened near this site.   The content reduced.   The lower flap of

the  rectus sheath is brought under the upper flap of the  rectus

sheath  and  is  sutured with matress sutured.   The  upper  flap

overlaps the lower flap and sutured in place.

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