Excretory System
Excretory System
SYSTEM
PREPARED BY,
MS.MUSKAN TIWARI
M.SC.NURSING(OBG)
K.N.P.I.,LUCKNOW
INTRODUCTION
TWO POLES :
UPPER : BROAD
LOWER : POINTED
TWO BORDERS :
LATERAL : CONVEX
MEDIAL : CONCAVE
TWO SURFACES :
ANTERIOR : CONVEX
POSTERIOR : FLAT
HILUM : EACH KIDNEY HAS THICK LIPS OF RENAL MATERIAL TERMED THE HILUM, WHICH
SURROUNDS ITS MEDIAL CONCAVE BORDER. THE RIGHT KIDNEY HILUM IS LOCATED 5 CM
FROM THE MIDLINE, BENEATH THE LEFT KIDNEY IN THE TRANSPYLORIC PLANE. THE RENAL
SINUS IS A WIDE CAVITY INTO WHICH HILUM EXPANDS. THE RENAL VEIN, RENAL ARTERY,
THE URETER, LYMPHATIC VESSELS, AND SYMPATHETIC FIBERS ARE ALL SENT FROM THE
FRONT TO THE BACK BY THE HILUM.
COVERINGS OF KIDNEYS
THE KIDNEYS HAVE THE FOLLOWING COVERINGS:
FIBROUS CAPSULE: THIS CLOSELY ENCIRCLES THE KIDNEY, IS APPLIED TO ITS OUTSIDE, AND IS
EASILY DETACHED FROM THE KIDNEY'S SURFACE.
PERIRENAL FAT: THIS IS ADIPOSE TISSUE THAT COVERS THE FIBROUS CAPSULE.
RENAL FASCIA: THIS CONNECTIVE TISSUE SURROUNDS THE KIDNEYS AND SUPRARENAL GLANDS
AND IS LOCATED OUTSIDE THE PERIRENAL FAT. IT IS SITUATED BETWEEN THE POSTERIOR
ABDOMINAL WALL AND PARIETAL PERITONEUM.
PARARENAL FAT: THIS IS LOCATED OUTSIDE OF THE RENAL FASCIA AND IS FREQUENTLY PRESENT
IN CONSIDERABLE AMOUNTS. IT IS A COMPONENT OF THE RETROPERITONEAL FAT.
• THE KIDNEYS ARE HELD IN PLACE ON THE POSTERIOR ABDOMINAL WALL BY THE PERIRENAL FAT, RENAL
FASCIA, AND PARARENAL FAT.
• RENAL STRUCTURE
• CORTEX: THE OUTER REGION IS DARK BROWN IN COLOR. THE CORTEX PENETRATES
INTO THE MEDULLA BETWEEN TWO PYRAMIDS. MEDULLARY RAYS ARE STRIATIONS THAT
EXTEND INTO THE CORTEX FROM THE BASE OF THE RENAL PYRAMIDS.
• MEDULLA: THE INNER REGION IS LIGHT BROWN AREA, DEEP TO THE CORTEX. THE
MEDULLA IS MADE UP OF AROUND A DOZEN RENAL PYRAMIDS, EACH OF WHICH HAS
THE RENAL PAPILLA PROTRUDING MEDIALLY AT ITS PEAK AND ITS BASE
FACING THE CORTEX.
• THE UPPER ENLARGED ENDS OF THE URETER AND THE RENAL A PELVIS ARE LOCATED IN
THE RENAL SINUS REGION, WHICH IS A REGION R WITHIN THE HILUM. THE RENAL PELVIS
HAS A 5 ML CAPACITY. THIS SPLITS INTO TWO OR THREE BIG CALYCES, AND THEN EACH
OF THOSE BREAKS DOWN INTO THE SAME NUMBER OF MINOR CALYCES. EACH MINOR
• ANTERIOR AND POSTERIOR RELATIONS OF KIDNEYS :
• THE ANTERIOR RELATIONS:
• RIGHT KIDNEY
• ANTERIORLY: THE SUPRARENAL GLAND, THE LIVER, SECOND PART OF DUODENUM, AND RIGHT COLIC
FLEXURE.
• LEFT KIDNEY
• ANTERIORLY: THE SUPRA RENAL GLAND, THE SPLEEN, STOMACH, PANCREAS, THE COLIC FLEXURE, AND
COILS OF JEJUNUM.
• THE POSTERIOR RELATIONS
• LEFT KIDNEY
• POSTERIORLY: DIAPHRAGM, 12TH RIB, PSOAS MAJOR, QUADRATUS LUMBORUM, AND TRANSVERSE
ABDOMINAL MUSCLE.
• RIGHT KIDNEY
• POSTERIOR: DIAPHRAGM, 11TH AND 12TH RIBS, PSOAS MAJOR, QUADRATUS LUMBORUM, AND
TRANSVERSE ABDOMINAL MUSCLE.
• BLOOD SUPPLY TO KIDNEY:
• BLOOD IS SUPPLIED BY RENAL ARTERIES ARISING FROM THE AORTA AT
THE LEVEL OF THE 2ND LUMBER VERTEBRA. RENAL ARTERY DIVIDES INTO
POSTERIOR AND ANTERIOR SEGMENTAL ARTERY, LOBAR ARTERY,
INTERLOBAR ARTERY, AND ARCUATE ARTERY.
• LYMPH DRAINAGE
• LYMPH DRAINS TO THE LATERAL AORTIC LYMPH NODES AROUND THE
ORIGIN OF THE RENAL ARTERY.
• NERVE SUPPLY
• NERVE SUPPLIES THROUGH RENAL SYMPATHETIC PLEXUS. THE AFFERENT
FIBERS THAT TRAVEL THROUGH THE RENAL PLEXUS ENTER THE SPINAL
CORD IN THE 10TH, 11TH, AND 12TH THORACIC NERVE.
FUNCTIONS OF KIDNEY
• MAINTAINING HOMEOSTASIS
• THE KIDNEYS PLAY SEVERAL IMPORTANT FUNCTIONS IN HOMEOSTASIS. THEY
COLLABORATE WITH NUMEROUS OTHER ORGAN SYSTEMS TO DO THIS. THEY, FOR
EXAMPLE, COLLABORATE WITH THE CIRCULATORY SYSTEM TO FILTER BLOOD AND THE
URINE SYSTEM TO ELIMINATE WASTES. EVERY DAY, THE KIDNEYS FILTER ALL OF THE
BLOOD IN THE BODY AND CREATE AROUND 1.5 LITRES OF URINE. THE KIDNEYS
REGULATE BLOOD VOLUME BY EXCRETING MORE OR LESS WATER, IONS, AND OTHER
CHEMICALS IN URINE. THE KIDNEYS ALSO RELEASE HORMONES THAT AID IN THE
MAINTENANCE OF HOMEOSTASIS. ERYTHROPOIETIN IS A KIDNEY HORMONE THAT
INDUCES BONE MARROW TO CREATE MORE RED BLOOD CELLS WHEN NEEDED. THEY
ALSO RELEASE RENIN, WHICH CONTROLS BLOOD PRESSURE, AS WELL AS THE ACTIVE
FORM CALCITRIOL. THE KIDNEYS PERFORM THE FOLLOWING PRIMARY FUNCTIONS.
• REGULATION OF PLASMA IONIC COMPOSITION
• BY INCREASING OR DECREASING THE EXCRETION OF SPECIFIC IONS IN THE URINE, THE KIDNEYS REGULATE
THE CONCENTRATION OF:
• SODIUM (NA+), POTASSIUM (K+), AND CALCIUM (CA2+)
• MAGNESIUM (MG2+), CHLORIDE (CL-), AND BICARBONATE(HCO3)
• HYDROGEN (H+), PHOSPHATES (HPO4 2- AND H2PO4-).
• REGULATION OF PLASMA VOLUME AND BLOOD PRESSURE
• RENAL TUBULES CAN ABSORB WATER BACK INTO THE BLOOD AND BY THIS PROCESS THE RENAL TUBULES
CAN CONTROL THE RATE AT WHICH WATER IS EXCRETED IN THE URINE. IN THIS WAY, THE KIDNEYS
REGULATE PLASMA VOLUME, WHICH HAS A DIRECT EFFECT ON TOTAL BLOOD VOLUME AND, THEREFORE,
ON BLOOD PRESSURE.
• REGULATION OF PLASMA OSMOLARITY :
• BECAUSE THE KIDNEYS VARY THE RATE AT WHICH THEY EXCRETE WATER RELATIVE TO SOLUTES, THEY HAVE
THE ABILITY TO REGULATE THE OSMOLARITY (SOLUTE CONCENTRATION) OF THE PLASMA.
• REGULATION OF THE PH OF PLASMA
• BY REGULATING THE CONCENTRATION OF BICARBONATE AND HYDROGEN IONS
IN THE PLASMA, THE KIDNEYS PARTNER WITH THE LUNGS TO
REGULATE BLOOD PH.
• REMOVAL OF METABOLIC WASTE PRODUCTS PLASMA CONTAINS METABOLIC
WASTES AND OTHER UNDESIRABLE SUBSTANCES. THE NEPHRONS CLEAR THE
PLASMA OF WASTE PRODUCTS AND ELIMINATE THEM FROM THE BODY IN THE
URINE. THESE MATERIALS INCLUDE METABOLIC BY-PRODUCTS SUCH AS UREA
AND URIC ACID THAT ARE GENERATED DURING PROTEIN AND NUCLEIC ACID
CATABOLISM, RESPECTIVELY, AS WELL AS FOREIGN SUBSTANCES SUCH AS FOOD
ADDITIVES, DRUGS, OR PESTICIDES THAT ENTER THE BODY FROM THE EXTERNAL
ENVIRONMENT.
• ENDOCRINE FUNCTIONS
• THE KIDNEYS ARE CONSIDERED ENDOCRINE ORGANS.
• SPECIAL CELLS PRESENT IN THE INTERSTITIAL TISSUE OF KIDNEY CAN SENSE HYPOXIC
CONDITION WHICH STIMULATES THE SECRETION OF ERYTHROPOIETIN. THE HORMONE
STIMULATES ERYTHROCYTE PRODUCTION BY THE BONE MARROW.
• THE JUXTAGLOMERULAR CELLS OF NEPHRON SECRETE RENIN IN RESPONSE TO DECREASE
SODIUM CONCENTRATION IN THE RENAL TUBULAR FLUID. THE RENIN IS NECESSARY FOR
THE PRODUCTION OF ANGIOTENSIN II, A HORMONE THAT CORRECTS PLASMA SALT AND
WATER BALANCE AS WELL AS BLOOD PRESSURE. REGULATION OF BLOOD PRESSURE BY
THE RENIN ANGIOTENSIN SYSTEM IS CALLED LONG- TERM CONTROL OF BLOOD
PRESSURE.
• THE KIDNEYS ARE ALSO NECESSARY FOR THE ACTIVATION OF VITAMIN D3 ULTIMATELY
TO 1,25(OH)2 VITAMIN D3, WHICH IS AN IMPORTANT FACTOR IN REGULATING BLOOD
CALCIUM AND PHOSPHATE LEVELS.
URETER
• THE URETER ARE TWO MUSCULAR TUBES THAT RUN FROM THE KIDNEY TO THE URINARY
BLADDER (POSTERIOR) SURFACE. EACH URETER IS 6 MM IN DIAMETER AND AROUND 25 CM
(10 INCHES ) LONG.
• SIMILAR IN LENGTH (10 INCHES) AND POSSESSING THREE CONSTRICTIONS THROUGHOUT ITS
PATH, THE URETER RESEMBLES THE ESOPHAGUS. THESE CONSTRICTIONS ARE :
• WHERE THE RENAL PELVIS JOINS THE URETER (PELVIURETERIC JUNCTION).
• WHERE IT IS CURVED AS IT CROSSES THE PELVIC BRIM (PELVIC BRIM).
• WHERE IT PIERCES THE BLADDER WALL (URETEROVESICAL JUNCTION).
COURSE OF URETER
• ABDOMINAL PART:
• THE EXTENDED UPPER END OF THE URETER THAT HAS A FUNNEL-LIKE STRUCTURE CALLED THE RENAL PELVIS.
• IT LIES WITHIN THE HILUM OF THE KIDNEY AND RECEIVES THE MAJOR CALYCES.
• THE URETER EMERGES FROM THE HILUM OF THE KIDNEY AND TRAVELS OVER THE PSOAS MAJOR MUSCLE, RUNNING VERTICALLY
DOWNWARD BENEATH THE PARIETAL PERITONEUM.
• RIGHT URETER:
• POSTERIORLY : THE RIGHT PSOAS MAJOR MUSCLE, THE BIFURCATION OF RIGHT COMMON ILIAC ARTERY.
• LEFT URETER :
• POSTERIORLY : LEFT PSOAS MAJOR MUSCLE, THE BIFURCATION OF LEFT COMM0ON ILIAC ARTERY.
• PELVIC PART :
• IT ENTERS THE PELVIS BY CROSSING THE BIFURCATION OF THE
COMMON ILIAC ARTERY IN FRONT OF SACROILIAC JOINT.
• THE URETER THEN RUNS DOWN THE LATERAL WALL OF THE PELVIS
TO THE REGION OF THE ISCHIAL SPINE AND TURNS FORWARD TO
ENTER THE LATERAL ANGLE OF THE BLADDER.
• RELATIONS :
• ANTERIORLY : DUCTUS DEFERENS, SEMINAL VESICLE, AND VESICAL
VEINS.
• POSTERIORLY : COMMON ILIAC ARTERY, INTERNAL ILIAC ARTERY
AND VEIN, AND SUPERIOR VESICLE ARTERY.
• BLOOD SUPPLY :
• UPPER END : THE RENAL ARTERY
• MIDDLE PART : TESTICULAR OR OVARIAN ARTERY
• PELVIC PART : SUPERIOR VESICLE ARTERY, UTERINE, AND MIDDLE
RECTAL ARTERIES.
• VEINS : VENOUS BLOOD DRAIN INTO VEIN THAT CORRESPONDS
TO THE ARTERIES.
• NERVE SUPPLY : RENAL, TESTICULAR (OR OVARIAN), AND
HYPOGASTRIC PLEXUES.
FUNCTION OF URETER
• THE WALL OF THE URETER INCLUDES A LINING OF EPITHELIAL CELLS, A
RELATIVELY THICK LAYER OF INVOLUNTARY MUSCLE, AND FINALLY, AN
OUTER COAT OF FIBROUS CONNECTIVE TISSUES.
• THE EPITHELIUM IS THE TRANSITIONAL TYPE . WHEN URINE ENTERS THE
URETER, THE TUBE STRETCHES BY FLATTENING OF ITS CUBOIDAL
EPITHELIUM.