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Sectional Anatomy

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  1. Sectional Anatomy Renal CS-Renal-L.Zanin

  2. 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 CS-Renal-L.Zanin

  3. 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 CS-Renal-L.Zanin

  4. Renal Upper Pole CS-Renal-L.Zanin

  5. Renal Mid-portion CS-Renal-L.Zanin

  6. Renal Lower Pole CS-Renal-L.Zanin

  7. 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 CS-Renal-L.Zanin

  8. Renal Long CS-Renal-L.Zanin

  9. Renal Long CS-Renal-L.Zanin

  10. Renal Long CS-Renal-L.Zanin

  11. Renals CS-Renal-L.Zanin

  12. 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 CS-Renal-L.Zanin

  13. Column of Bertin CS-Renal-L.Zanin

  14. 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 CS-Renal-L.Zanin

  15. Renal Sinus CS-Renal-L.Zanin

  16. Renal Sinus CS-Renal-L.Zanin

  17. Renal Sinus CS-Renal-L.Zanin

  18. 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 CS-Renal-L.Zanin

  19. Renal Anatomy CS-Renal-L.Zanin

  20. Renal CS-Renal-L.Zanin

  21. Left Kidney CS-Renal-L.Zanin

  22. Renal Sinus & Cortex CS-Renal-L.Zanin

  23. Renal Sinus & Cortex CS-Renal-L.Zanin

  24. Sonographic Appearance CS-Renal-L.Zanin

  25. Renal CS-Renal-L.Zanin

  26. Renal CS-Renal-L.Zanin

  27. 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 CS-Renal-L.Zanin

  28. 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 CS-Renal-L.Zanin

  29. Renal Anatomy CS-Renal-L.Zanin

  30. Renals CS-Renal-L.Zanin

  31. Renals CS-Renal-L.Zanin

  32. 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 CS-Renal-L.Zanin

  33. 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 CS-Renal-L.Zanin

  34. Renal hilus CS-Renal-L.Zanin

  35. Power Doppler CS-Renal-L.Zanin

  36. Power Doppler CS-Renal-L.Zanin

  37. Power Doppler CS-Renal-L.Zanin

  38. Renal system CS-Renal-L.Zanin

  39. Color Doppler CS-Renal-L.Zanin

  40. 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 CS-Renal-L.Zanin

  41. Renal Functions 3. PH maintenance • Controlled by excretion of hydrogen 4. Excretion of urea, creatinine, and other end products of metabolism CS-Renal-L.Zanin

  42. 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 CS-Renal-L.Zanin

  43. 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 CS-Renal-L.Zanin

  44. 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 CS-Renal-L.Zanin

  45. Normal Anatomic Variants CS-Renal-L.Zanin

  46. Normal Anatomic Variants Hypertrophied Column of Bertin • Isoechoic & contiguous with the renal cortex • Located between renal pyramids • Triangular or blunted shape CS-Renal-L.Zanin

  47. Normal Anatomic Variants Renal Sinus Lipomatosis • Isoechoic and continuous with the perirenal & sinus fat • An increase in the renal sinus fat • No clinical significance CS-Renal-L.Zanin

  48. 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 CS-Renal-L.Zanin

  49. Congenital Anomalies Bilateral Renal Agenesis • Fatal - not compatible with life • Infant dies shortly after birth • Associated with Potter's syndrome CS-Renal-L.Zanin

  50. 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 CS-Renal-L.Zanin