MUSCULI THORACIS EXTRINSIC MUSCLES M. pectoralis major M. pectoralis minor M. subclavius M. serratus ant. Auxiliary respiratory muscles constant tension of m.pectoralis major -kyphotic chest-round back-shoulder outposts M. sternalis INTRINSIC MUSCLES M. intercostales externi M. intercostales interni M. intercostales intimi M. subcostales Scan0012 Scan0011 mm. intercostales externi mm. intercostales interni M. transversus thoracis DIAPHRAGM Centrum tendineum - foramen VCI Pars sternalis Pars costalis Pars lumbalis - crus dextrum - crus sinistrum - lig. arcuatum medianum - lig. arcuatum mediale - lig. arcuatum lat. Hiatus esophageus Hiatus aorticus URINARY SYSTEM Function •Water management (antidiuretic hormone) •removing nitrogen residues •control of blood pressure (renin) •controlling the formation of erythrocytes (hematopoietic hormone) Kidney (ren) Efferent urinary tract (hollow system): calyces, renal pelvis, ureter, urinary bladder, urethra Parts Skeletotopy ren topo 1 Costae – XI – XII Crista iliaca ren topo 2 Position against other retroperitoneal organs REN, NEPHROS - facies anterior et posterior - margo lateralis et medialis - hilum renale - sinus renalis - extremitas superior et inferior R L Capsula fibrosa Sinus renalis Cortex renalis Medulla renalis – 6-20 pyramides renales Columnae renales Pars radiata corticis Papilla renalis Ductus papillares Foramina papillaria Area cribrosa Lobus renalis (Renculus) Renculi-marking (renculization) NEPHRON - Corpusculum renale (Malpighi) - Glomerulum - Capsula glomeruli (Bowman) - Tubulus proximalis - Henle’s loop - Tubulus distalis Tubulus colligens Ductus papillaris Foramen papillare 200 µm A.renalis - r. anterior – 4 rr. praepelvici - r. posterior – r. retropelvicus - aa. lobares – aa. interlobares Segmenta renalia – s. superius - s. anterius superius - s. anterius inferius - s. inferius - s. posterius Aa. interlobares: 1. A. arcuata 2. A. interlobularis 3. Vas afferens 4. Vas efferens 5. Peritubular capillary plexus 6. Arteriola recta 7. Capillary plexus in the medulla 8. Capillary plexus around papillary duct 9. Venulae stellatae 10.V. interlobularis 11.V. arcuata 12.Vein from the peritubular plexus 13.Venulae rectae Aa. renales accessoriae 1.Diaphragma 4. M. transversus abdominis 2.11th rib 5. M. quadratus lumborum 3.12th rib 6. M. psoas major N. subcostalis N. iliohypogastricus N. ilioinguinalis 1.Gl. suprarenalis dx. 2.Liver 3.Duodenum 4.Flexura coli dx. 5.Jejunum 1.Gl. suprarenalis sin. 2.Stomach 3.Spleen 4.Pancreas 5.Flexura coli sin. 6.Jejunum SIN. 1.Fascia renalis 5. Corpus adiposum pararenale 2.Lamina praerenalis 6. Peritoneum 3.Lamina retrorenalis 7. Fascia transversalis 4.Capsula adiposa REN MIGRANS ANd9GcS6wUK1Sx2zfJNzZrxAyp3sZI5n1LSrxoNBtyH2T50QDxOB0EB_ Ectopic kidney x ren migrans anatomy_Horseshoe_Kidney Horseshoe kidney •ren sigmoideus • ren fungiformis • ren duplex • agenesia renis Nephrolithiasis Calcium oxalate crystals – 80% Uric acid – 5 - 10% Transverse section through the intervertebral disc between T12 and L1 Cross-sectional image through the L1 obtained with CT GLANDULA SUPRARENALIS – facies anterior – hilum - facies posterior - facies renalis Cortex (aldosterone, cortisol) Medulla (epinephrine, norepinephrine) Five-month old fetus CALICES RENALES – minores (7-14) et majores (2-4) PELVIS RENALIS (2-5 , 5-8) Various types of pelvis renalis URETER 1.pars abdominalis 2.pars pelvina 3.pars intramuralis ostium ureteris 25-30cm, 0,5cm image1134 Plicae longitudinales Adventitia 39 kidney-stones LANZ 3 physiological constrictions Pelvis duplex Ureter fissus Ureter duplex Megaloureter Ectopia ostii ureteris Retrocaval passage of ureter VARIATIONS OF URETER Dorsal view at urinary bladder Male Ductus deferens Female a. uterina and ureter 2 cm from uterus 2,5 cm from fornix vaginae VESICA URINARIA -fundus vesicae -corpus vesicae -apex vesicae - lig. umbilicale medianum -cervix vesicae Ureter Vesica urinaria Symphysis Uterus, vagina Rectum Urethra Fundus, Apex, basis Ostium urethrae ext. Trigonum vesicae – ostia ureterum - ostium urethrae internum - plica interureterica - fossa retrotrigonalis - bundles of Bell - uvula vesicae - m. detrusor - m. sphincter vesicae - m. sphincter urethrae Median section through the male pelvis 1. Excavatio rectovesicalis Median section through the female pelvis 1.Excavatio rectouterina 2.Excavatio vesicouterina Paracystium – lig. pubo prostaticum (pubovesicale), lig. sacroprostaticum (sacrovesicale) URETHRA FEMININA Ostium urethrae internum - pars intramuralis (m. sphincter vesicae) - pars pelvina -pars membranacea (diaphragmatica) -(m. sphincter urethrae ext.) - pars perinealis Ostium urethrae externum Papilla urethralis Vestibulum vaginae URETHRA FEMININA Crista urethralis Lacunae urethrales Glandulae urethrales Ductus paraurethrales URETHRA MASCULINA Pars praepubica Pars subpubica Ostium urethrae int. Ostium urethrae ext. Pars intramuralis (m. sphincter vesicae) Pars prostatica Pars membranacea (diaphragmatica) (m. sphincter urethrae) Pars spongiosa PARS PROSTATICA URETHRAE Crista urethralis Colliculus seminalis Utriculus prostaticus Ductus ejaculatorii Sinus prostaticus Ductuli prostatici PARS SPONGIOSA URETHRAE Bulbus penis – ostium urethrae externum Fossa navicularis Valvula fossae navicularis Glandulae bulbourethrales Lacunae urethrales Glandulae urethrales URETHRA MASCULINA - LUMEN Prostata - semilunar Diaphragma urog. – star shape Pars spongiosa – T Ostium urethrae ext. – fissure Curvatures Curvatura subpubica Curvatura praepubica narrowings: Ostium urethrae externum Fossa navicularis – bulbus penis Pars membranacea Pars inramuralis X- ray´s of urinary system IVU urography Retrograde pyelography Vesicoureteral reflux (VUR) – voiding cystourethrogram (VCU) Retrocaval ureter Ureter duplex Horseshoe kidney PELVIC FLOOR DIAPHRAGMA PELVIS M. levator ani – pars iliaca (M. iliococcygeus) - pars pubica (M. pubococcygeus) (- M. puborectalis) M. coccygeus/ischiococcygeus Hiatus urogenitalis MALE DIAPHRAGMA UROGENITALE M. transversus perinei profundus – Centrum perineale M. sphincter urethrae Lig. transversum perinei Glandulae bulbourethrales FEMALE DIAPHRAGMA UROGENITALE M. transversus perinei profundus – centrum perineale M. sphincter urethrae M. sphincter urethrovaginalis M. compressor urethrae M. transversus perinei superficialis Lig. transversum perinei M. ischiocavernosus M. bulbospongiosus (M. constrictor cunni) M. sphincter ani externus Lig. anococcygeum Fossa ischiorectalis FOSSA ISCHIORECTALIS Mediocranially: diaphragma pelvis Laterally: m. obturatorius int. fascia obturatoria (canalis pudendalis) Ventrally: recessus pubicus Dorsally: m. glutaeus maximus FOSSA ISCHIORECTALIS – recessus pubicus a. et v. pudenda interna, n. pudendus – canalis pudendalis - aa., vv. et nn. rectales inf. A.dorsalis penis (clitoridis) N. dorsalis penis (clitoridis) V. dorsalis penis (clitoridis) profunda A.,v. et n. perinealis Gl. bulbourethralis Fascia obturatoria Canalis pudendalis (Alcock) Fascia diaphragmatis pelvis sup. Fascia diaphragmatis pelvis inf. Fossa ischiorectalis Illustrations were copied from: Atlas der Anatomie des Menschen/Sobotta. Putz,R., und Pabst,R. 20. Auflage. München: Urban & Schwarzenberg, 1993) Netter: Interactive Atlas of Human Anatomy. Windows Version 2.0 Čihák R: Anatomie 2 (Splanchnologia). Avicenum, zdravotnické nakladatelství, Praha, 1988.