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Sectional Anatomy. Renal. Ultrasound Techniques. Supine or decubitus LLD - Rt kidney RLD - Lt kidney Kidney is scanned in sagittal, transverse, & coronal Sagittal & coronal - renal capsule is smooth bean shaped. Ultrasound Techniques. Transverse - shape varies at different levels

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sectional anatomy

Sectional Anatomy

Renal

CS-Renal-L.Zanin

ultrasound techniques
Ultrasound Techniques
  • Supine or decubitus
  • LLD - Rt kidney
  • RLD - Lt kidney
  • Kidney is scanned in sagittal, transverse, & coronal
  • Sagittal & coronal - renal capsule is smooth bean shaped

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ultrasound techniques3
Ultrasound Techniques
  • Transverse - shape varies at different levels
  • Upper & lower poles are round or oral shaped
  • Midportion slightly indented in the hilium region
  • Kidney develops from lobes that fuse together
  • They develop in the pelvis embryonicly and ascends to abdomen by birth

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renal upper pole
Renal Upper Pole

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renal mid portion
Renal Mid-portion

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renal lower pole
Renal Lower Pole

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kidney anatomy
Kidney Anatomy
  • Retroperitoneal organ
  • Kidney surrounded by fibrous capsule
  • Surrounding the encapsulated kidney is perinephric fat
  • Enclosing kidney’s, perinephric fat and adrenals is a fibrous sheath, called Gerotas Fascia

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renal long
Renal Long

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renal long9
Renal Long

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renal long10
Renal Long

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renals
Renals

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kidney anatomy12
Kidney Anatomy
  • Retroperitoneal organ

Renal Parenchyma can be divided into:

Renal Cortex (outer portion)

  • Consists of glomerula complex
  • Occupies outer 1/3 of parenchyma
  • Moderately hypoechoic outer zone
  • Slightly less echogenic than liver

Medulla (inner portion)

  • Pyramids – contain collecting tubles and loops of Hnle
  • Column of bertin is cortical tissue that extends inward toward the renal sinus between the pyramids
  • Appears echogenic, when it is enlarged they appear as pseudotumers

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column of bertin
Column of Bertin

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kidney anatomy14
Kidney Anatomy

Renal Sinus (Center of the kidney)

  • Sinus is centrally located, oblong, and highly echogenic
  • Contains vessels, fat, normally collapsed calyces, arteries and veins, lymphatics, peripelvic fat, fibrous tissues and part of the renal pelvis

Vaculature of the Kidney

  • Vessels that can be identified include the main renal artery and vein, interlobar artery & vein, and arcuate artery & vein

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renal sinus
Renal Sinus

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renal sinus16
Renal Sinus

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renal sinus17
Renal Sinus

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renal anatomy
Renal Anatomy

Collecting System

  • Minor caylces - 7-13 per kidney, they are found adjacent tot the renal pyramids and connect to the major calyces
  • Major caylces - 2-3 per kidney, they connect to the renal pelvis

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renal anatomy19
Renal Anatomy

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renal
Renal

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left kidney
Left Kidney

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renal sinus cortex
Renal Sinus & Cortex

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renal sinus cortex23
Renal Sinus & Cortex

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sonographic appearance
Sonographic Appearance

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renal25
Renal

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renal26
Renal

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kidney anatomy27
Kidney Anatomy

Renal Medulla (pyramids)

  • Occupies inner 2/3 of parenchyma
  • Triangular inner portion of kidneys that surrounds the renal sinus
  • Represents loops of Henley and the collecting tubules
  • Pyramids are separated from each other by bands of cortical tissue called columns of Bertin

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renal anatomy28
Renal Anatomy
  • Apex of the pyramid is directed toward the sinus and base forms a junction with cortex - called corticomedullary junction.
  • Arcuate arteries seen at the corticomedullary junction & the interlobar arteries seen between each pyramid
  • Infants pyramids appear larger and are hypoechoic

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renal anatomy29
Renal Anatomy

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renals30
Renals

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renals31
Renals

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normal renal anatomy
Normal Renal Anatomy

Normal adult kidney measures 8-13 cm in length and has smooth contour

  • Adult: 11.5 X 6 X 3.5 (ap)
  • Renal Blood Supply
  • Renal artery enters the hilium, it branches into 4-5 segmental arteries
  • Interlobar arteries found between pyramids, they go up and over the pyramids to form arcuate arteries
  • Arcuate arteries branch to form interlobular arteries

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normal renal anatomy33
Normal Renal Anatomy
  • Interlobular arteries enter the glomeruli and empty into the capillaries
  • From the capillaries the blood travels through the interlobular, arcuate, interlobar, to the renal vein

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renal hilus
Renal hilus

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power doppler
Power Doppler

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power doppler36
Power Doppler

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power doppler37
Power Doppler

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renal system
Renal system

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color doppler
Color Doppler

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renal functions
Renal Functions

Renal Function

1. Water regulation

  • Under influence of (ADH) anti-diuretic hormone, water absorption is controlled by blood osmosis

2. Salt Balance

  • Essential to maintain fluid and maintain blood pressure

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renal functions41
Renal Functions

3. PH maintenance

  • Controlled by excretion of hydrogen

4. Excretion of urea, creatinine, and other end products of metabolism

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lab values
Lab Values

Serum Creatine

  • Measures renal function
  • Elevation means a disturbance in renal function which is due to a large number of nephrons being destroyed
  • More sensitive than BUN in determining renal dysfunction

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lab values43
Lab Values

BUN - (blood urea nitrogen)

  • Urea is an end product of protein metabolism and it is excreted by kidney's so blood urea concentrations is normally low
  • Rises when kidney's ability to excrete urea is impaired
  • Elevated levels may lead to mental confusion, disorientation & coma
  • Other diseases that may cause BUN to elevate: GI bleeding - Congestive heart failure - Shock

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normal anatomic variants
Normal Anatomic Variants

Dromedary Hump

  • Bulging of the lateral aspect of the left kidney probably due to developmental relationship between the kidney & spleen

Ultrasound Findings:

  • Coronal -lateral contour bulge of the kidney without evidence of parenchymal disruption

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normal anatomic variants45
Normal Anatomic Variants

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normal anatomic variants46
Normal Anatomic Variants

Hypertrophied Column of Bertin

  • Isoechoic & contiguous with the renal cortex
  • Located between renal pyramids
  • Triangular or blunted shape

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normal anatomic variants47
Normal Anatomic Variants

Renal Sinus Lipomatosis

  • Isoechoic and continuous with the perirenal & sinus fat
  • An increase in the renal sinus fat
  • No clinical significance

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congenital anomalies
Congenital Anomalies

Solitary kidney

  • One normal functioning kidney with the other undeveloped and not seen, it is atrophied

Unilateral renal agenesis

  • Absence of one side of the collecting system
  • No kidney or ureter developed
  • Associated with uterine or testicular variants

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congenital anomalies49
Congenital Anomalies

Bilateral Renal Agenesis

  • Fatal - not compatible with life
  • Infant dies shortly after birth
  • Associated with Potter's syndrome

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congenital anomalies50
Congenital Anomalies

Supranumerary Kidney

  • Duplication of the ureters and pelvis with a single kidney
  • Double collecting system
  • Sonographicly demonstrates two separate central sinus echoes separated by cortical tissue

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supranumerary kidney
Supranumerary Kidney

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congenital anomalies52
Congenital Anomalies

Megacalyces/Megaureter

  • Congenital condition consists of nonobstructive enlargement of the calyces
  • There are usually less calyces with this condition
  • The appearance on ultrasound is identical to obstructive hydronephrosis or dilatation secondary to vesicoureteral reflux

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megacalyces megaureter
Megacalyces/Megaureter

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congenital anomalies54
Congenital Anomalies

Pelvic Kidney

  • In the embryo the kidneys develop in the pelvis and migrate upward, they ascend and rotate to the adult position
  • Right kidney lower than left kidney
  • Ascend by 5-6 years
  • Incomplete ascension leads to ectopic kidneys

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pelvic kidney
Pelvic Kidney

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congenital anomalies56
Congenital Anomalies

Horseshoe Kidney

  • Form of renal fusion
  • Fused at the lower pole with the connecting bridge located just anterior to the aorta
  • Isthmus (connection) is seen at about the level of the aortic bifurcation

Cross-fused Renal Ectopia

  • Kidneys are positional in the same quadrant and are fused together

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horseshoe kidney
Horseshoe Kidney

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mri of the kidneys
MRI of the Kidneys

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mri of the kidneys59
MRI of the Kidneys

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