SISTEMUL URINAR

destinate secreiei i excreiei

de urin

Rinichi organe secretoare

Uretere ductele excretoare

interne

Vezica urinar rezervorul

Uretra conduct excretor

extern
 retroperitoneali RINICHII
T11 L2 fosa lombo-diaf
R dr L3
Ax:oblic-jos-lat180
110-160g, 12cm/6cm
fascia renal(2 lame) loja
renal
capsula adipoas
(perirenal) rezerv
perinefrita
grsimea pararenal
(Gerota) chirurgie
diafragm pelvis (
patologie)
septul reno suprarenal /
nefrectomii
inf se continu cu .c. fosei
iliace
MIJLOACELE DE FIXARE
Fascia renal,
Capsula adipoas,
Peritoneul,
Fascia retrocolic Toldt,
Pediculul renal

Mobilitate normal micrile

respiratorii
Deplasri anormale (!R.dr):
Ectopia
R. flotant
 ANOMALII
Anomalii de numr
Agenezia renal
uni/bilateral, izolat/asociat
cauza absena mug. ureteral
unilateral 1/1000, , Rstg(buton),
asimptomatic, R dr hipertrofiat
compensator
bilateral 1/10000; oligoamnios,
neviabil

Rinichii supranumerari
f.rar
vascularizaie, ci excretoare
proprii
cauza duplicaie prematur a
mug. ureteral
Anomalii de structur
Rinichiul polichistic
lipsa de racordare a tubilor
colectori (div.ureteral) cu cei
secretori(masametanefric)
acumularea urinei n tubii uriniferi-
dilataie chistic distrugerea
complet a parenchimului
Dysplasie polykystique autosomique rcessive

Anomalii vasculare
comprimare a ureterului cu
hidronefroz

Aspect de kystes juxtaposs en grappe de raison

Anomalii de rotaie
relativ frecvent
anat+histo = N Ectopie vraie

Uni/bilat, asociat cu ectopie/ fuziune

Anomalii de migrare ectopia

nalt f.rar,Rstg,dg.dif cu ascensiunea
toracic prin agenezie diafragmatic
R.toracic (AR din aorta toracic;
VRVCS),urografie
Joas-pelvian (lombaire ou iliaque) Ectopie basse

n cruce R+U sunt contralateral

R n potcoav 1/600 Ectopie croise

fuzionarea - n bazin S5
migrarea compromis obsacol AMI
asimptomatic/ infecii urinare, litiaz (S
Turner)

Rein en fer cheval

Anomalies congnitales de l'uretre
de trajet
de calibre
de nombre

Uretre rtrocave / rtroiliaque

Mga-uretre primitif obstructif

Duplications partielles Duplications compltes

RAPORTURI:
1. FAA POSTERIOAR - CXII lig.
arcuat lateral al diafragmei :

Segm.toracic A

CXI,XII
diafragma, recesul pleural
costodiafragmatic, hiatul
lombocostal

! lig.lombocostal-reper
proiecia reces pleural
patologie toracic
 Segm lombar B
lombar Petit (latissim-o.e),
tetragonul Grynfelt (m.c - d.p.i.-
o.i) hernii lombare

corpul adipos pararenal

CXII reper, CXII /masa
musc= punctul costolombar
durere colica
 m. al lombelor,
n. subcostal,
iliohipogastric, ilioinghinal
iradierea durerilor
m.transvers abdom
m.psoas
accesul chirurgical
2. FAA ANTERIOAR X MZcolonul
transvers
R.dr. ficat, D2, gl. suprarenal,
fl.colic dr, (fascia Toldt, +/-J-I)

R.stg. stomac, splina,

pancreas, colon transvers,
fl.colic stg, ansele intestinale
gl. Suprarenal
3.MARGINE:
medial:
R.dr D2,VCI(! nefrectomie) gl.Sr
R.stg. flexura d-j, aorta, gl.Sr
lateral
R.dr ficat, colon asc.
R.stg. splina, colon desc.

4. EXTREMITATE
sup CXII,, gl. Sr, splina
Inf creasta iliac 3-5cm
STRUCTURA

1. Capsula fibroas
(.f.cinextensibil,aderent)
2. Parenchim
a. Cortical
Glomerulii
Coloane Bertin
Subst cort.periferic:
P..radiat (Ferrein,
radiaiile medulare
Ludwig)
P.convulat labirintul
renal (corpusculii, tubii
contori, vase)
b. Medulara
Piramidele renale Malpighi
7-14/R (tubii colectori)

Lobi (pM+radiaiile.med
aferente) lobuli corticali
(1rad.med+s.c. adiacent)
le labyrinthe (LAB) comprend des tubes contourns et de nombreux corpuscules de Malpighi (flches);
au centre de la diapositive, on observe une artre rnale interlobulaire (A) coupe longitudinalement.

1 cortex
2 colonne de Bertin
3 mdulla
4 artres
5 radiations mdullaires
6 papille rnale
7 petit calice
8 sinus rnal
Sistemul tubular:

A. Nefroni 2,5 mil

situai n cortical
orig- esut metanefrogen
f-ie: ultrafitrare glomerular,
reabsorie + secreie tubular

B. Tubi colectori -
orig-mugurele ureteral
situai n medular
f-ie colectoare i excretoare
tubii papilari Belinii calicele
mici
Nefronul: 30- 50mm

1. Corpusculul renal (situai n

cortical)
Glomerul (ghem anse
capilare)
aparatul
juxtaglomerular(reglare
a fluxului sg)
ultrafiltrarea plasmei sg
urina primar
Capsula Bowman
1,2mp, 4-8km(L capilare)
2. Tubul renal
ncepe n corticala
convulat TCP n
radiaia medular
piramida renal
ansa Henle(spre
corpuscul) TCD
tub colector Bellini
Formarea urinei 3
procese:
ultrafiltrarea
glomerular
reabsorbia tubular,
secreia tubular
VASCULARIZAIA:
a. Arterial - tip terminal
a.renale:
r. ant:
seg. sup
ant sup
ant inf
inf
r. post
seg. post

Spaiul Hyrtl-
paucivascular !nefrectomii
 A. segm interlobare(coloane)
arcuate interlobulare vasele
aferente se capilarizeaz
glomerulul renal vas eferent
plex capilar peritubular

Din arteriolele eferente arteriole

drepte n ploaie irig medulara
arteriole drepte i din: a.
arcuat,interlobulare,

!! 2 teritorii arteriale (ant+ post)

segmente (nefrectomii pariale)

10 . papille rnale
14 . artre interlobaire
15. veine interlobaire
16. artre arque
17. veine arque
18. vaisseaux interlobulaires
 Circulaie de tip terminal
(anastomoze) infarct alb

capsula adipoas
vascularizaie proprie anast: a.
renal + a. frenic inf.+ a. genital,
+ AMS + a. lombare + a.
suprarenale + a. interlobulare.
! Circulaie colateral

Acute renal arterial obstruction in this case led to massive renal infarction
in which the entire cortex is pale yellow, with medullary hemorrhage. neoplasm.
 Categories of Renal Injuries
Michael Federle placed renal injuries into four categories
1.Minor injury:
renal contusion.
intrarenal and subcapsular
hematoma.
minor laceration with limited perinephric
hematoma without extension to the collecting
system or medulla.
small subsegmental infarct.
2. Major injury:
major laceration into medulla or collecting
system.
segmental infarct.
3.Catastrophical injury:
Maceration of the kidney
Total devascularization due tot arterial
occlusion.
4.Rupture collecting system.
b. Venoas
vena renal VCI
c. Limfaticele nod.
Lombare

Inervaia:
gg. celiac
gg. mezenteric superior
gg. aorticorenal
n. splanhnici
lanul simpatic
n. X
 URETERELE
Retroperitoneal 25-30cm
P abdominal: 12cm
A1 lombar
A2 iliac
P. pelvian B 13cm
B1 vezical 1cm
Proiecie:
Post:
vrful pr.transv L2L5
spina iliac post-sup

Ant: linie pc. pelvi-renal

tuber.pubian
pc. pelvi-renal - la 5cm de
linia median,prin pl
transpiloric A
pc ureteral sup la 4cm sub
ombilic
pc ureteral mijlociu- 1/3 ext a
liniei interspinoase B
pc ureteral inf,pelvin- acesibil
prin tueu vaginal/rectal
1. P. ABDOMINAL

Segm. Lombar -10cm

D2, X de vasele genitale,
vasele colice
m. psoas, n. genitofemural, n.
cutanat femural lateral
(iradierea durerilor)
abord chirurgical posterior
Aorta, VCI, lan simpatic
R, colon ascendent, descendent

Segm. Iliac -4cm

X vasele iliace(2,5mm lateral de
promontoriu)
dr. X de mezenter, apendice
stg. X de mezosigma+ vasele
sigmoidiene
Vasele testiculare/ovariene
2. P pelvian (13-14cm)

Segm. parietal vertical pe

peretele lateral
X vasele iliace interne
(a.ombilical,obturatoare,v
ezical inferioar)
+ ovar, a uterin
Segm.visceral transversal
X de ductul deferent,
anterior de vez.seminal
8 cm deasupra
anusului (! explorat prin
tueu rectal)
X de artera uterin
(n baza ligm. largi)

Segm.intravezical 15mm