Yeison Alexander Arias Valencia
1094890782
Summary Anatomy, ureter and bladder.
The ureters are muscular from 25 to 30 centimeters in length, with a thickness of 8 to 10mm, can be considered the left a little longer in vivo can see white or gray, are attached to the parietal peritoneum later, being retroperitoneal. Continue after the renal pelvis, and ends at the bottom of the bladder, referred to two major parts of 12.5cm approx., Length each, and correspond to the abdominal and pelvic portion, other authors use three servings a lumbar and pelvic sacroilica (Testut, Latarjet)
The ureter has three normal constraints on their journey, the first is at the ureteropelvic junction, where the renal pelvis and ureter is continuous, the second is on the brim of the pelvis, the common iliac vessels pass on your fork, where they take an anterior, medial and convex, and the last is in contact with the bladder to join. The clinical significance of these constraints is that there may aground kidney stones, causing obstruction called urolithiasis.
The primary function of the ureter is driving the urine from the kidney to the bladder.
Relations (see fig.1)
relations are presented by portion of the ureter: lumbar
:
Post: it is in relation with celuloadiposo pararenal tissue, the phasic iliac psoas inserts, and the apex of the transverse processes of lumbar vertebrae. Laterally
: superolateral to the kidney, then the psoas muscle and femoral cutaneous nerve and the femoral genito. Medially
: they differ according to the ureter on each side:
the right side, the inferior vena cava, with the lymph nodes, and a little more distant with the right sympathetic chain.
On the left: the aorta at a distance.
Previous: also differ according on each side.
Right: from top to bottom, is in conjunction with the second portion of the duodenum, the gonadal vessels cross it obliquely, the ascending mesocolon, with the right colic vessels, and the root of the mesentery.
Left: relates to the descending mesocolon, the left colic vessels, with an oblique segment of the root of the mesentery, also with the gonadal vessels, and the sigmoid mesocolon. Pelvic Portion
: begins when the ureters cross the common iliac vessels at its bifurcation.
later: it is in relation to the common iliac vessels, the right ureter is in relation to the external iliac artery and the left common iliac. When you reach the ureters into the bladder, the man is posteromedially seminal gland, and the woman just before making contact with the bladder, is in relation to the front of the vagina. Laterally
: is present, the psoas major, and gonadal vessels some distance in parallel relationship to the ureter.
Medially, these distance more or less than two inches of the sacral promontory. And near the junction with the bladder in man is related to the vas deferens at its termination, the woman is on its way to the main uterine artery at the level of the uterine isthmus.
Previously: depending on their peritoneal relations is different on each side.
law: for the lower end of the mesentery, in conjunction with the appendix and the vessels that supply. Arriving near the bladder, it was found earlier on both sides.
Left: corresponds to the root of mesosigmoid with sigmoid vessels, and on their way, Breast intersigmoid. (See fig. 3.)
When you get in contact with the bladder, ureters have an oblique, opening the ureteral orifices found in the bladder trigone, a distance of 5 cm when the bladder is full and a 2 or 3 centimeters when that empty.
Irrigation:
arteries is given by that are related to its journey, including ureteral arteries, from the kidney, also have contribution of gonadal, and either common iliac or internal. In the final portion of women also contribute to the uterine artery, and the man of the lower bladder. The branches from anastomoses are frequent, where there are mainly two branches an ascending and descending.
venous drainage: drain mainly to the gonads, and the common iliac. Branched counterparts.
Nodes: lumbar lymph nodes, aortic, and both common and internal iliac, are responsible for lymphatic drainage.
Innervation: The plexus renal, aortic and superior hypogastric below, are responsible for providing innervation to the ureteral peristaltic function to send the urine in an inferior direction. Afferent fibers are by the nice going to the spinal segments T11 to L2.
Histological structure (see fig.4.)
The ureter is composed of three layers, from outside to inside, adventitial, muscular with its different layers and the mucosa. The adventitia is the connective tissue that connects the posterior peritoneal lamina, and provides some mobility.
The muscular coat has different layers, are composed of smooth muscle, and is a longitudinal internal and external circular, the bottom layer is a third outer longitudinal and circular begins to disappear, to come into contact with the bladder.
The tunica mucosa is characteristic, as it is called transitional epithelium, which is one of these pathways, which are different cell layers with the ability to adapt to changes in mucosal surface of liquid volume in glorious ureter.
embryological development of the ureter.
The ureter is produced mainly in the fifth week of the ureteric bud of the mesonephric duct derivative,
The most common developmental anomalies of the ureters there occurs double ureter by duplication of the ureteric bud, and may give rise to two ureters pelvis. As for the bifurcation of the ureter may be complete or partial, with the difficulty that if full, one of the ureters can lead to a different place to the bladder, such as urethra, vagina, vestibule, or elsewhere, This is often called ectopic ureter.
Bladder:
The urinary bladder is the collector time between the urinary tract is a hollow organ with muscular characteristics important to be described later.
Status and Form:
to describe the bladder is necessary to know the names of their dimensions are when empty, by cadaver study. In addition to its location and shape is very variant depending on age, as infants in the bladder is abdominal, and will desentiendo until age 6 has a nearly pelvic position, which actually reaches the lower pelvis puberty. Also change, with sex as there are anatomical differences of the pelvis, its shape is modified by physiological conditions such as emptiness or fullness, although it should be noted that the bladder always has a normal and small volume of urine, in addition to other physiological condition that adjust is pregnancy.
Finally it is clear that when empty it is Semicon, is located mostly in the pelvis less, being the most anterior viscera, relating to the pubis.
of the bladder base or bottom recognize a post, a body with two faces a lower and an upper, an apex, its lateral edges, and the bladder neck. The apex is directed upward to the symphysis pubis, the body is the part between the top and bottom, and slightly convex posterior wall is the base or bottom. When the base and sides are united inferiorly, the neck is formed.
Regarding the situation of the pubic bone and levator ani muscle up the bladder bed being behind either the woman's vagina or rectum in man. The bladder is wrapped in a layer of connective tissue that is called fascia bladder. It should be noted peritoneal fornices, the vesicouterine in women between bladder and uterus, and rectovesical in man between bladder and rectum. (See Figs 5 and 6)
Relations:
Institutions: relates to the sigmoid colon in man and the woman's uterus. And through the peritoneum with thin handles.
Bottom: through the bladder fascia anterior to posterior communicating with the symphysis pubis, and the front of the levator ani and internal obturator muscle, covered by pelvic fascia, retropubic space there is filled with tissue loose cell, which allows expansion to her bladder.
Laterally: The man is with the vas deferens, with the arrival of the ureter, and seminal glands.
Previously, the vertex can be described in relation to the symphysis pubis. Later
: describes the relationship with the straight man, or the vagina in women.
As the bladder neck, the man that is attached to the prostate, and the woman is with pubococcygeal muscles. Fixing
bladder (see Fig 7)
The bladder is secured by the collateral ligaments, which are pods neurovascular vessels and nerves accompany bladder, both are set in front of the tendinous arch of the pelvis. Puboprostatic ligament in man and ensure women pubovesical in fixing the bladder neck to the upper face of the symphysis pubis.
Histological structure (see Fig 9)
is formed by layers, serosa, a thick muscle, the submucosa, and mucosa.
The serosa is formed by the peritoneum at the top, which gives its name to the bladder subperitoneal viscera, and around the bladder is the bladder fascia composed of loose connective tissue.
The muscle, which emphasizes the detrusor muscle, you have three layers, a circular half thickness that is between the two longitudinal than in the cervix form an arch above, which is lost with the opening of the urethra. Subsequently, it is called muscle trigonal to portions of longitudinal muscle from the ureters to make contact with the bladder.
The submucosa is strongly attached to the muscle, but there in the bladder trigone.
mucosa epithelium corresponds to the already known transitions, being smooth and trabeculated child in the adult, the only portion that remains smooth and uniform the trigone, which highlights the interureteral fold.
Irrigation:
is given by the internal iliac arteries, including the bladder over the lower bladder in men and vaginal uterine and women, besides the contribution of the middle rectal, bladder and from the pudenda previous internal.
The venous drainage through the bladder plexus anastomosing with prostate cancer in men and women, besides bladder vein that will drain into the internal iliac vein.
Nodes: Lymph nodes are responsible for the iliac, common, internal, external, and sacred.
Innervation: is given through the vesical plexus, which is composed as follows: (see Figure 8)
Friendly, through the contribution of the hypogastric plexus, with its spinal cord segments T11 to L2, this is action trigonal muscle. Parasympathetic
: by the sacral segments II, III, IV and pelvic splanchnic nerves, which have activity motor on the detrusor muscle.
afferent pathways follow the pelvic splanchnic, and nice to get the T11 to L2 segments.
The somatic innervation is given by the pudendal nerves from S2, S3, S4, supplying mainly the urethral sphincter.
eventually concluded that sacral segments are of great importance in the control of urination.
physiology: Urination, depending on the amount of urine in the bladder, you buy a muscle tone that causes a neural response. When the bladder volume is between 200 to 400 milliliters of urine, feels the desire to evacuate, then there, the abdominal muscles contract, and the pelvic floor as it descends down the neck of the bladder, detrusor contraction straightens the vesicourethral angle opens the internal opening urine comes after emptiness, generates a nervous hand control. If you do not want to urination, to sphincter education is achieved to suppress the desire to urinate by relaxing the muscle
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