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Urinary system

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Urinary System Anatomy www.training.seer.cancer.gov The urinary system is one of the excretory systems of the body and consists of four main parts: * 2 kidneys - excretory organs * 2 ureters - ducts draining the kidneys * The bladder - reservoir of urine * The urethra - channel from bladder to exterior (Ross, J. et al. 1990) The kidneys The kidneys are bean shaped organs approximately 10-12cm long, 5-7cm wide, and 3cm thick. They lie behind the peritoneum and the posterior wall of the abdomen between last thoracic (T12) and third lumbar vertebrae (L3). The right kidney is slightly lower that the left one because of the presence of the liver superiorly (Tortora, J.G et al. 2003). The medial concave border contains a notch called the renal hilus (see diagram below), the area where structures enter and leave kidney. These structures include the renal artery and vein, lymphatic vessels and nerves (Mace, J.D. et al. 1998). Tortora, J.G. et al. (2003), p.952 A fibrous layer of connective tissue, called the renal fascia, connects the kidney to the abdominal wall and to the surrounding structures (See Appendix A). Beneath the renal fascia is a fatty layer known as the adipose capsule, which surrounds the renal capsule and aids in protection of the kidney. The renal capsule is a thin transparent membrane that serves to hold kidney together and helps to maintain its shape (Tortora, J.G et al. 2003). Tortora, J.G et al. (2003), p.951 A frontal section through kidney reveals two distinct regions: the renal cortex and the renal medulla, which consists of 8 to 18 renal pyramids. The base of each pyramid faces the renal cortex and its apex, called renal papilla, points toward the renal hilus. The renal papilla project into minor calyces, which lead into the major calyces and into the renal pelvis. Each kidney has between 8 to 18 minor calyces and 2 to 3 major calyces. ...read more.


* Aldosterone - controls potassium content of the blood, which will affect muscle and nerve function. * Rennin - plays a key role in filtration rate of the kidneys and the production of angiotensin II, which is the body's most potent vasoconstrictor. (Tortora, J.G. et al. 2003) Urinary system pathology A common pathology of the urinary system is renal calculi, known as kidney stones (Figure 1). Renal calculi Figure 1 www.xray2000.co.uk There are five distinct varieties of calculi that vary in size, shape, contour, colour and consistency (See Appendix B). Renal calculi usually originate in collecting tubules or in renal papillae and then pass into the renal pelvis where they may increase in size (Ross, J. et al. 1990). Some calculi become too large to pass through the ureter and may obstruct the flow of urine. Others pass to the bladder and are either excreted or increase in size and obstruct urethra. Occasionally stones may originate in bladder. These stones are either single or multiple (Figure 2) and vary in size. Bladder stones have a tendency to form from stagnant urine that is unable to be passed, due to urethral outlet obstruction (Linn-Watson, T. 1996). Renal bladder calculi Figure 2 www.xray2000.co.uk Calculi are usually asymptomatic until they begin to descend through the ureters or until they cause an obstruction (Linn-Watson, T. 1996). The exact cause of the formation of calculi is not known, but several conditions are implicated: * Dehydration - this leads to increased reabsorption of water from the tubules, but does not change solute reabsorption, which results in a reduced volume of highly concentrated filtrate in the collecting tubules. * pH of urine - when the normally acid filtrate becomes alkaline some substances, such as phosphate, may be precipitated. This may occur when the kidney system is defective and in some infections. * Renal infection - necrotic material and pus provide foci upon that solutes in the filtrate may be deposited and the products of infection may alter the pH of the urine. ...read more.


1986) Appendix D Some applications of Computed Tomography in the urinary tract Renal mass Differentiate cyst from tumour when ultrasound equivocal Upper tract obstruction Retroperitoneal fibrosis Filling defects in renal pelvis Differentiate uric acid calculi from the urothelial tumour Renal trauma If IVU is abnormal, to show extent of injury Tumours Staging renal, bladder, prostatic and testicular tumours. Follow up after surgery, radiotherapy or chemotherapy (Grainger, R.G., et al. 1986) Appendix E Route of contrast agent from the median cubital vein to the kidneys Median cubital vein v Basilic and cephalic veins (superficial veins of the arm - medial and lateral respectively) v Axillary vein v Subclavian veins v Branchiocephalic vein v Superior vena cava v Right atrium v Right ventricle v Pulmonary artery v Pulmonary veins v Left atrium v Left ventricle v Aorta - ascending, arch and descending thoracic, then abdominal v Renal artery (Tortora, J.G., et al. 2003) Appendix F If the patient is on Metformin the following are the Royal College of Radiologists recommendations for patients with Diabetes Mellitus, who are receiving Metformin and who are referred for a radiological investigation using intravascular contrast media: * The referring clinician should take responsibility for assessing the patients' renal function either by checking the serum creatinine or accepting a normal level within the past year. * In patients with normal renal function, although there are as yet no reports of Metformin-induced lactic acidosis in the United Kingdom after intravenous contrast agents, there is a remote theoretical risk of interaction. Metformin should therefore be discontinued at the time of the investigation and withheld for the subsequent 48 hours * For those patients with abnormal renal function, Metformin should similarly be discontinued at the time of the investigation and the subsequent 48 hours, and only reinstated when renal function has been re-evaluated and found to be normal * As the British Association states that Metformin is contra-indicated in the presence of abnormal renal function, it is suggested that such patients, who require intravascular contrast examinations should have their drug history reviewed by the appropriate physician to ensure suitability of the drug regime. (www.e-radiography. ...read more.

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