Pelvis and Urinary Ok

8/18/2019 Pelvis and Urinary Ok

http://slidepdf.com/reader/full/pelvis-and-urinary-ok 1/96

Sistem Urinarius,

Pelvis & Perineum

Dr.Tri Suciati, M.Kes



MATERI

• Cavum pelvis & diaphrama pelvis

• !"ssa Ischi"rectalis & isin#a

• Innervasi dan & $as%ularisasi dindinpelvis

• Sistem urinarius

• Rectum



Pelvis T'P'(RA!I



K"mp"nen tulan Pelvis

• Inn"minate )"ne *Ilium, ischium andpu)is+

•Sacrum• C"cc#

• -"ined anteri"rl# )# pu)ic s#mph#sis

• P"steri"rl# )# sacr"iliac "int



K"mp"nen Sendi

Articulati"/

• Diarthr"sis #aitu amphiarthr"sis sacr"iliaca

• S#narthr"sis/

0.S#ndesm"sis elastica sacr"c"cc#eus

1.S#ndesm"sis 2)r"sa/ li sacr"spin"sum ettu)er"sum

3.S#nch"ndr"sis/ s#mph#sis "ssium pu)is



Apertura Pelvis Superi"r

l i2% i ld ll d



Klasi2%asi Cald4ell danM"ll"#



Pelvimetr#• Pelvic planes

• Diameters "5 in5eri"r aperture "5 lesser pelvis *5emale+.

• Pelvic inlet/ The line )et4een the narr"4est )"n# p"ints5"rmed )# the sacral pr"m"nt"r# and the inner pu)ic arch istermed obstetrical conjugate/ It sh"uld )e 00.7 cm "r m"re. This anter"p"steri"r line at the inlet is 1 cm less thanthe diagonal conjugate *distance 5r"m undersur5ace "5

pu)ic archt" sacral pr"m"nt"r#+. The transverse diameter "5the pelvic inlet measures 03.7 cm.

• Midpelvis/ The line )et4een the narr"4est )"ne p"intsc"nnects the ischial spines8 it t#picall# eceeds 01 cm.

• Pelvic outlet/ The distance )et4een the ischial tu)er"sities

*n"rmall# 9 0: cm+, and the anulati"n "5 the pu)ic arch

http://en.wikipedia.org/wiki/Pelvic_inlet

http://en.wikipedia.org/wiki/Sacral_promontory

http://en.wikipedia.org/wiki/Pubic_bone

http://en.wikipedia.org/wiki/Pubic_arch

http://en.wikipedia.org/wiki/Ischial_spine

http://en.wikipedia.org/wiki/Pelvic_outlet

http://en.wikipedia.org/wiki/Ischial_tuberosities

http://en.wikipedia.org/wiki/Ischial_tuberosities

http://en.wikipedia.org/wiki/Pelvic_outlet

http://en.wikipedia.org/wiki/Ischial_spine

http://en.wikipedia.org/wiki/Pubic_arch

http://en.wikipedia.org/wiki/Pubic_bone

http://en.wikipedia.org/wiki/Sacral_promontory

http://en.wikipedia.org/wiki/Pelvic_inlet



!etal relati"nship

• Engagement/ The 5etus is enaed i5 the4idest leadin part *t#picall# the 4idestcircum5erence "5 the head+ is ne"tiatin theinlet.

• Station/ Relati"nship "5 the )"n# presentinpart "5 the 5etus t" the maternal ischial spines.I5 at the level "5 the spines it is at ;: *<er"+=

stati"n, i5 it passed it )# 1cm it is at ;>1=

stati"n.• Attitude/ Relati"nship "5 5etal head t" spine/

?eed, neutral *;militar#=+, "r etendedattitudes are p"ssi)le.



• Position/ Relati"nship "5 presentin part t" maternal

pelvis, i.e. R'P@riht "cciput p"steri"r, "r 'A@le5t"cciput anteri"r.

• Presentation/ Relati"nship )et4een the leadin 5etalpart and the pelvic inlet/ cephalic, )reech *c"mplete,inc"mplete, 5ran% "r 5""tlin+, 5ace, )r"4, mentum "r

sh"ulder presentati"n.• Lie/ Relati"nship )et4een the l"nitudinal ais "5 5etus

and l"n ais "5 the uterus/ l"nitudinal, ")liBue, andtransverse.

• Caput "r Caput succedaneum/ "edema t#picall# 5"rmed)# the tissue "verl#in the 5etal s%ull durin the vainal)irthin pr"cess.



(reater Pelvis *pelvis ma"r+ !alse Pelvis

• Tempat )e)erapa visera a)d"men*ileum and sim"id c"l"n+

• "unded )# a)d"minal 4allanteri"rl#, the iliac 5"ssap"steri"laterall# and 7 S0 verte)raep"steri"rl#



esser Pelvis * pelvis min"r+TruePelvis

• Tempat viscera pelvis urinar#)ladder and repr"ductive "ranssuch as the uterus and "varies

• di%elilini permu%aan pelvis,al/tulan panul, sacrum, and c"cc#

• Se)elah in5eri"r di)atasi "lehmuscul"5ascial pelvic diaphram



Pelvic Falls and !l""rs

• Anterior pelvic wall ter)entu%terutama "leh c"rpus dan ramuspu)ic )"nes and pu)ic s#mph#sis

• ateral pelvic 4alls di)entu% "lehtulan panul dan m. ")turat"rinternus *'/ pr"imal sur5ace "5 the

ilium and ischium8 ")turat"rmem)rane I/ reater tr"chanter "5 the5emur+



Pelvic Falls and !l""r

• P"steri"r Pelvic Fall di)entu% "lehsacrum and c"cc#, )aian terde%atthe ilia, and the SI "ints8 ditutupi

"leh m.piri5"rmis *'/ pelvic sur5ace "51nd and Gth sacral sements, superi"rmarin "5 the reater sciatic n"tch

and sacr"tu)er"us liament, I/reat"r tr"chanter "5 5emur+





Pelvic !l""r

• Di)entu% "leh diaphrama pelvis#an )er)entu% seperti ter"4"nan tdd "t"t levat"r ani & c"cc#eus

serta 5asian#a

• Mem)entan se)elah anteri"r pu)isdan c"cc# se)elah p"ster"r, dan

dari satu dindin pelvis lateral %edindin lainn#a



Diaphrama Pelvis

Terdiri dari

• Pars Muscularis

terdiri dari m. evat"r ani• Pars mem)ranacea

Terdapat di se)elah caudal pars

muscularis menutupi seitia depan,dise)ut ua diaphrama ur"enital



evat"r Ani

• Tdd 3 )aian pu)"c"cc#eus, pu)"rectalis danili"c"cc#eus.

• Secara )er%el"mp"% )eralan dari c"rpus "s pu)is,d arcus tendin"sa pada 5ascia ")turat"rius dan

spina ischial KE perineal )"d#, "s c"cc#eus,liament an"c"cc#eal, dindin pr"state atauvaina, rectum & anal canal

• Innervasi dari SG untu% levat"r ani, dan in5eri"ranal *rectal+ dari *S1SG+ , dan c"cc#eal pleus

• Mensupp"rt visera pelvis8 )e%era )ersama,menan%at dasar pelvis dan mem)antu "t"ta)d"men pada %eiatan denan epirasi #an %uat



e)erapa sera)ut "t"t pre rectalis#an )erhu)unan denan pr"statpada pria @ m. evat"r pr"stat, dan

denan vaina@ m.pu)"vainalis.

Sera)ut terse)ut mem)ai hiatuslevat"rius menadi

0.Hiatus enitalis

1.Hiatus analis



C"cc#eus Muscle

• '/ ischial spine, I/ in5eri"r end "5 thesacrum, I/ ca)an dari SG and S7

• Mem)entu% )aian %ecil daridia5rama pelvis, mensupp"rt viserapelvis, ?e%si c"cc#eus



Diaphrama ur"enitalis

Penuatan dari m.levat"r ani, danmenutup hiatus ur"enitalis dariarah )a4ah, ditem)us "leh/

• Pars mem)ranacea urethra pada la%ila%i

• Urethra dan vaina pada 4anita



Diaphrama ur"enitalis

Tdd 1 lem)ar 5ascia/

• !ascia diaphramatis ur"enitalis superi"r etin5eri"r

Di antara %edua 5ascia terdapat m. Transversusperinei pr"5undus *se)elah )ela%an+ dan m.Sphincter urethre mem)ranaceae.

Se)elah ventralli transversum pelvis, dan

li. Arcuatum pu)is

Di permu%aan, terdapat m.transversus perineisuper2sialis



$iscera

'ran sistem urinarius pelvis

Ureters

• Saluran "t"t p"l"s dari inal %e $U , p@ 17

3: cm

ladder$U

• a h"ll"4 c"ntainer surr"unded )# a str"n

sm""th muscular 4all• aiann#a/ Ape, "d#, !undus, ec%,

Uvula

Ureters



Ureters



ladder



Pelvic $iscera !emale



$iscera

ladder$U

• Detruss"r muscle "t"t p"l"s #anmenelilini $U

• 't"t s2nter interna

• I Paras#mpathetic t" detruss"r *S1

SG++8 S#mpathetic t" internalsphincter *T0101+



$iscera

Ureter

• Urinar# urethral "ri2ce in )ladder t"eternal urethral "ri2ce

• Eternal sphincter s"matic nerves5r"m S1SG+

• Pr"state



Male Urethra



Rectum

• Alimentar# canal *(I Tract+menhu)un%an c"l"n sim"ideusdenan anus

• Meni%uti curva sacrum dan c"cc#

• I@s#mpathetic *T010+andparas#mpathetic nerves *S1SG+



Perineum Rei" perineal

• erada pada "utlet pelvis dan dipisah%andari cavitas pelvis "leh dia5ramapelvis*evat"r ani and c"cc#eus muscles+

• atas)atas/• Anteri"r / s#mph#sis pu)is

• Anter"lateral/ in5eri"r pu)ic rami andischial rami

• ateral/ ischial tu)er"sit#

• p"ster"lateral/ sacr"tu)er"us liament

in5eri"r sacrum and c"cc#



Perineum

• 1 Tri"num – Trigonum Analis *p"steri"r+

– Trigonum Urogenital *anteri"r+ c"ntains ther""t "5 the scr"tum and penis in males "r theeternal enitalia in 5emales

• Mem)ran perineal mem)entan antaradua sisi ar%us pu)is dan meliputi )aiananteri"r "utlet

• perineal )"d#c"rpus perineal / massa2)r"muscular irreular )erl"%asi antaraanal canal dan perineal mem)rane



Trianles



!ascia PerinealisSuper2sialis

• anutan 5ascia a)d"minalissuper2sialis,ada 1 lapis

• apis permu%aaan

!ascia camperi, %e medial )ersatu dlapis dalam m)nt% tunica dart"s pdscr"tum, dan ar lema% pada vaina

Pd rei" analis )rhu) d 5"ssaischi"rectalis



• apis dalam

anutan 5ascia scarpae

Di nama%an 5ascia c"llesiateral )erhu) d ramus in5eri"r "s

pu)is dan "s ischii, %e depan

)erlanut s) li. Suspens"rium penisKe )ela%an mem)entu% spatium

inter5asciale



Spatium inter5asciale

Terdapat

• Crura cavern"sis penis denanmm.ischi"cavern"si

• C"rpus cavern"sum urethrae denanm. ul)"cavern"sus

•A,v, n, perinealis



!"ssa ischi"rectalis

R"na #an terdapat di %iri dan %ananrectum, di )a4ah m. evat"r ani

atas)atasn#a/

Cranial/ arcus tendineus m.levat"r aniateral/ 5ascia ")turat"ria

Medial/ 5ascia diaphramatis pelvis in5eri"r

D"rsalis/ m.luteus maimus &li.sacr"tu)er"sum

Caudalis/ depan "leh diaphrama ur"enital



mem)rane



Muscles !emale and male

l l l



EternalInternal AnalSphincter



Deep Transverse Perineal !



Perit"neum

• lanutan perit"neum a)d"men

• Drapes "ver pelvic viscera in themidline t" 5"rm/

P"uches%ant"n

ipatan antara viscera dan dindinpelvic

P"uches melinduni viscera darirectum

The lymphatic drainage of



The lymphatic drainage ofpelvis

Internal iliac lymph node• Surr"und internal iliac vessels• Receive aJerents 5r"m pelvic

viscera, perineum, )utt"c% and)ac% "5 thih

Eternal iliac lymph nodes

• ie al"n eternal iliac arter#• Receive aJerents 5r"m l"4er lim)

and s"me parts "5 pelvic viscera

Sacral l#mph n"deCommon iliac lymph node • ie al"n c"mm"n iliac arter#• Receive aJerents 5r"m all the

a)"ve n"des• EJerents pass t" lum)ar l#mph

n"de



Sacral pleus

!ormation/ 5"rmed)# anteri"r rami "5G and 7 spinalnerves *the

lum)r"sacral trun%+and anteri"r rami "5sacral andc"cc#eal nerves

Position/ lies in pelviccavit#, anteri"r t"sacrum andpiri5"rmis



"ranches

• Superi"r luteal• In5eri"r luteal

• Pudendal

• P"steri"r 5em"ral

cutane"u• Sciatic Common



The Urinar# S#stem

PART 0



The Urinar# S#stem

• Imp"rtant 5uncti"ns "5 the %idne#s

– Maintain the chemical c"nsistenc# "5 )l""d

– !ilter man# liters "5 ?uid 5r"m )l""d

– Send t"ins, meta)"lic 4astes, and ecess4ater "ut "5 the )"d#

• Main 4aste pr"ducts

– Urea

– Uric acid

– Creatinine

Copyright © 2008 PearsonEducation, Inc., publishing

' 5 th U i



'rans "5 the Urinar#S#stem

• Kidne#s

• Ureters

•Urinar# )ladder

• Urethra


Figure 23.1a

ti d E t l A t



"cati"n and Eternal Anat"m#"5 Kidne#s

• "cated retroperitoneally

• ateral t" T013 verte)rae

• Averae %idne# – 01 cm tall, cm 4ide, 3 cm thic%

• #ilus

– 'n c"ncave sur5ace – $essels and nerves enter and eit

• Renal capsule surr"unds the %idne#


R l ti hi 5 th Kid t



Relati"nship "5 the Kidne#s t"$erte)ra and Ri)s


Figure 23.1b

I t l ( A t 5 th



Internal (r"ss Anat"m# "5 theKidne#s

• !r"ntal secti"n thr"uh the %idne# – Renal c"rte

– Renal p#ramids

– Renal pelvis• Ma"r calicies

• Min"r calicies

• (r"ss vasculature – $enal arteries

• ranch int" segmental arteries


S 5 l d $ l



Summar# "5 l""d $esselsSuppl#in the Kidne#


Figure 23.3c

I t l ( A t 5 th



Internal (r"ss Anat"m# "5 theKidne#s

• erve suppl# renal pleus

– A net4"r% "5 aut"n"mic 2)ers

– An "Jsh""t "5 the celiac pleus


Mi i A t 5 th



Micr"sc"pic Anat"m# "5 theKidne#s

• Urini5er"us tu)ules

– C"mp"sed "5

• %ephron

– Renal c"rpuscle plus renal tu)ules

• Collecting duct – Inv"lved in c"ncentratin urine


PLAYPLAY Nephron

M h i 5 U i

http://23_animations/nephron.html





Mechanisms "5 UrinePr"ducti"n

• !iltrati"n

– !iltrate "5 )l""d leaves %idne# capillaries

• Rea)s"rpti"n

– M"st nutrients, 4ater, and essential i"nsreclaimed

• Secreti"n

– Active pr"cess "5 rem"vin undesira)lem"lecules




asic Kidne# !uncti"ns


Figure 23.4



The Urinar# S#stem

PART 1



The ephr"n

• Renal c"rpuscle – (l"merulus and l"merular capsule

• (l"merulus tu5t "5 capillaries

– Capillaries "5 l"merulus arefenestrated

• (l"merular *"4manLs+ capsule

– Parietal la#er simple sBuam"usepithelium

– $isceral la#er c"nsists "5 p"d"c#tes


Renal C"rpuscle and the



Renal C"rpuscle and the!iltrati"n Mem)rane


Figure 23.6c



Tu)ular Secti"n "5 ephr"n

• !iltrate pr"ceeds t" renal tu)ules5r"m l"merulus

– Pr"imal c"nv"luted tu)ule

– ""p "5 Henle• Descendin lim)

• Thin sement

• Thic% sement – Distal c"nv"luted tu)ule




Classes "5 ephr"n

• C"rtical nephr"ns

– 7N "5 nephr"ns

• -utamedullar# nephr"ns

– 07N "5 nephr"ns


C"llectin Tu)ules *C"llectin



C"llectin Tu)ules *C"llectinducts+

• C"llectin tu)ules

– Receive urine 5r"m distal c"nv"lutedtu)ules

Copyright © 2008 PearsonEducation, Inc., publishing Figure 23.8



Micr"sc"pic l""d $essels

• ephr"ns ass"ciated 4ith two typesof capillary beds *a p"rtal s#stem+

– &lomerulus

• !ed and drained )# arteri"les

– AJerent and eJerent arteri"les

– Peritu'ular capillaries

• Arise 5r"m eJerent arteri"les• "4pressure, p"r"us capillaries

• A)s"r) s"lutes




Micr"sc"pic l""d $essels

• (asa recta

– Thin4alled l""pin vessels

– Part "5 the %idne#Ls urinec"ncentratin

mechanism




The Urinar# S#stem

PART 3

Micr"sc"pic Anat"m# "5 the



Micr"sc"pic Anat"m# "5 theKidne#

• )utaglomerular apparatus

– !uncti"ns in the reulati"n "5 )l""dpressure

– )utaglomerular cells secrete renin

• Macula densa

– A p"rti"n "5 distal c"nv"luted tu)ule

• Tall, cl"sel# pac%ed epithelial cells• Act as chemoreceptors




Ureters

• Carr# urine 5r"m the %idne#s t" theurinar# )ladder

• ')liBue entr# int" )ladder prevents)ac%?"4 "5 urine

• Hist"l"# "5 ureter – Muc"sa transitional epithelium

– Muscularis t4" la#ers

• Inner l"nitudinal la#er• 'uter circular la#er

– Adventitia t#pical c"nnective tissue




Urinar# ladder

• A c"llapsi)lemuscular sac

• St"res and epelsurine

– !ull )ladder spherical• Epands int" the

a)d"minal cavit#

– Empt# )ladder lies

entirel# 4ithin thepelvis




Urinar# ladder

• Urachus cl"sedremnant "5 theallant"is

• Prostate gland – In males

• ies directl#in5eri"r t" the)ladder

• Surr"unds theurethra




Urinar# ladder

• Fall "5 )ladder

– Muc"sa

• Transiti"nal epithelium

– Muscular la#er• Detrus "r muscle

– Adventitia




Urethra

• Epithelium "5 urethra

– Transitional epithelium

• At the pr"imal end *near the )ladder+

– Strati*ed and pseudostrati*edcolumnar mid urethra *in males+

– Strati*ed s+uamous epithelium

• At the distal end *near the urethral "penin+




Urethra

• Internal urethral sphincter

– Inv"luntar# sm""th muscle

• Eternal urethral sphincter

– $"luntaril# inhi)its urinati"n

– Relaes 4hen "ne urinates




Urethra

• In 5emales – enth "5 3G cm

• In males 1: cm in lenth three

named rei"ns – Prostatic urethra• Passes thr"uh the pr"state land

– Mem'ranous urethra

• Thr"uh the ur"enital diaphram – Spongy *penile+ urethra

• Passes thr"uh the lenth "5 the penis




Micturiti"n


Dis"rders "5 the Urinar#



Dis"rders "5 the Urinar#S#stem

• Urinar# tract in5ecti"ns – M"re c"mm"n in 5emales

– urnin sensati"n durin micturiti"n

• Renal calculi – Kidne# st"nes

• ladder cancer – 3N "5 cancers m"re c"mm"n in men

• Kidne# cancer – Arises 5r"m epithelial cells "5 urini5er"us

tu)ules


The Urinar# S#stem



The Urinar# S#stem Thr"uh"ut i5e

• Em)r#" devel"ps three pairs "5%idne#s

– Pr"nephr"s

– Mes"nephr"s – Metanephr"s

• 'nl# metanephros persists t" )ec"me theadult %idne#s

• Metanephric %idne# pr"duces urine )# 5etalm"nth three

• C"ntri)utes t" the v"lume "5 amniotic ,uid


Devel"pment "5 the Urinar#



Devel"pment "5 the Urinar#'rans

Copyright © 2008 PearsonEducation, Inc., publishing Figure 23.18a,b

Devel"pment "5 the Urinar#



Devel"pment "5 the Urinar#'rans

Copyright © 2008 PearsonEducation, Inc., publishing Figure 23.18c, d

The Urinar# S#stem



The Urinar# S#stem Thr"uh"ut i5e

• Kidne# and )ladder 5uncti"n declines4ith advancin ae

– ephr"ns decrease in si<e and num)er

– Tu)ules less eOcient at secreti"n andrea)s"rpti"n

– !iltrati"n declines

– Rec"niti"n "5 desire t" urinate isdela#ed

– "ss "5 muscle t"ne in the )ladder




Sistem urinarius

!unsi/ Menatur h"me"stasis denan8• Menu)ah %"mp"sisi, pH, v"lume, dan

te%anan darah• 'sm"laritas darah• Pr"du%si h"rm"n'ran8• 1 inal

• 1 ureter• 0 vesica urinaria• 0 uretra



Ginjal!ungsi utama gin-al.

0. Mem)entu% danmeneluar%an urine

1. Menhasil%an danmeneluar%anerythropoietin #aitu

h"rm"n #anmenendali%an%ecepatanpem)entu%an sel darahmerah

3. Menhasil%an danmeneluar%an renin#aitu en<#m pentindalam menaturte%anan darah

• er)entu% seperti%acan )uncis,U%uran8 p@0:01 cml@7 cm,te)al@3cm,)erat@ 07:

• (inal, massa cuma:,7 N massa tu)uh,tapi mendapat%an 1:17 N cardiac "utput

• Darah # menalir diinal 01:: m menit

/es0ripsi potongan



/es0ripsi potonganmelintang &in-al

• C"rte renalis8)aian super2sial,4rn teran, di)aimenadi 1 <"na8Q"na c"rtical dan

utamedullar#.• aian c"rterenalis # mele)ar%e p#ramid renalisadalah c"llumnarenalis

• Satu l")us renalis,tdd8 0 piramidrenalis, # meliputi0 renal c"rte, dan0,7 c"lumna renalis# )erde%atan

• Medulla renalis8 le)ihdalam, 4arna merahelap

• Tdd, p#ramid renalis8)aian, # dasarn#amenarah %e c"rteren, dan punca%n#amem)entu% papillarenalis

• C"rte

>p#ramid mem)entu%paren%im renalis, #didalamn#a terdapatne5r"n, merupa%anunit 5unsi"nal inal

$as%ularisasi dan lim5ati% renalis



$as%ularisasi dan lim5ati% renalis

• "rteri renalis, cabanglateral aorta abdo!inalis

• ".renalis #iri lebih tinggi,a.renalis #anan lebih

panang, dan !ele$ati %.c.in&erior

• 'rainase li!&ati# olehnodus lu!baris

• (ena renalis #a dan #i

dibentu# !ultipel %enarenalis, sebelah anteriordari arteri renalis

(as0ularisasi $enalis



(as0ularisasi $enalis

• Arteri utama8 a.renalis %iri

• Masu% %e inal mda. sementalis

• Mele4ati c"llumna

renalis, menadi a.interl")aris• Mele4ati )asal

p#ramid menadia.interl")ular,

mem)entu%perca)anan, a.arcuata

• Memasu%i c"rte,di%enal arteri"leaJerent



$as%ularisasi Renalis

• ) ne&ron !eneri!a )

arteriole a&&erent, !asu##e glo!erulus, lalu #eluarsbg,arteriole e&&erent,yglalu !enadi #apilerperitubuler pd corte*

renalis• Pelebarannya di #enal

sebagai+ %asa recta

• apiler peritubuler salingbersatu !bt %enule

peritubuler dan %.interlobular, berlanut #e %.arcuata dan % interlobar,#eluar dari hilu! danberlanut #e %. ca%ain&erior

Fisiologi ren



g

ephr"n



ephr"n

-EP/-

C'RPUSCUUM REAIS

CAPSUA 'FMA

('MERUUS

TUUUS REAIS TUUUS C'T'RTUS PR'

''P '! HEE

TUUUS C'$UATED DIST

C"rpusculum renalis



C"rpusculum renalis

• 1erupa#an unit &iltrasiplas!a darah dari nephron

• 2 #utub polus %ascularis,polus urinalis

• 1engandung glo!erulus

• sisti! #apiler ygdirang#ai o3 arteriolea&&eren dan e&&eren

• 'iliputi oleh la!ina%isceralis capsulaBo$!ani, sel disebut

Podosit4• Podosit !e!punyai badan

sel ,di!ana a#an ti!bulprocessus pri!er,secunder 5pedicle6



• 7rine yang dibentu#diginal dialir#an #e papillalalu #e ape* pyramis!asu# #e calyx

• minor – calyx major dantera#hir ter#u!pul di

pelvis renalis sebelu!!e!asu#i ureter.

• 'inding calyx dan pelvis

renalis !engandung ototpolos dengan gera#anperistaltisnya!engalir#anurine #e ureter lalu #e (7.

• inus renalis+ bagian darihilu! renalis yg !elebar tdd+pel%is renalis, caly*, pe!bdarah dan syara&, ar le!a#.

• ) ginal tdd9 8:)8 caly*

!inor,2:; caly* !ayor • o!posisi 7rine

"ir – <=>

7rea – 2>

"sa! urat, creatinin,a!!onia, -atriu!, aliu!,#lorida, &os&at, sul&at:dano*alat – 2

Ureter



Ureter

• ?ransport urin dr pel%isrenalis #e %. urinaria

• 'ipengaruhi o3 #ontra#siperistalti#, te#ananhidrostati#, @gra%itasi

• ; penye!pitan+ureteropel%ic unction,a.iliaca co!!unis,dinding %.u

• Iner%asi+renal, aortic,hipogastric superior @in&erior

• -yeri+ illiac crest, regiopubis, scrotu!, labia!ayora

7reter



• Panangnya 2A:;0 c! dan dia!eter ;!!.

• 1erupa#an #elanutan dari pelvisrenalis, beralan #e ba$ah !elaluica%u! abdo!en di bela#angperitoneu! di depan !.psoas #e!udianoblique 5!iring6 beralan #e dinding

posterior (7ungsi ureter• !enyalur#an urine dari ginal #e (7

dengan #ontra#si peristalti# lapisan ototpolosnya.

• ontra#sinya dipicu oleh pencetus yangada di calyx minor .

• elo!bang peristalti# berlangsungbeberapa #ali per !enit, &re#uensinyaa#an !ening#at i#a produ#si urine!ening#at dan !asu#nya urine #e (7.

7reter !e!ili#i ; lapisan aringan

• lapisan terluar berupa aringan &ibrosa #elanutan capsula fibrosa ginal.D

• apisan tengah berupalapisan otot yang !eling#ariureter seperti spiral danpada sepertiga ba$ah adata!bahan otot yangberalan longitudinal

• apisan lu!inal 5de#atlu!en6 yaitu mukosadengan epitel transisional .

7reter

ladder$esicai i



urinaria

• o#asi anterior pel%is, saat

penuh, !enonol abdo!en• aat #osong, berbentu#

pira!id, ; sisi.• "pe*, basis, per! superior

dan in&erolateral• "pe*Fliga!en u!bilical

!edian• BaseFin%erted

triangle,posteroin&erior • -ec# o& bladderFpaling

ter&i*asi, disupport oleh pita&ibro!uscular, pd pria liga!en

puboprostat• Pd $anita liga!en

pubo%esical.• 'i posterior terdapat uterus

pada $anita dan rectu! padapria.

Bladder3(esica urinaria



• apasitas G00:800!• ebih #ecil sd#t pd pere!puan

• Pada (7 terdapat ; orificium

5lubang6 yang !e!bentu#

trigonu! 5segitiga6.

• 'ua 526 di atas pada dinding

posterior adalah orificium

ureter dan ) di ba$ah

!erupa#an orificium urethra.

• eti#a !e!asu#i urethra

terdapat penebalan lapisan

otot polos yang !e!bentu#

sphincter urethra interna.

?iga lapisan aringan (7

). apisan terluar, jaringan ikat longgar .1engandung pe!buluh darah danli!&e serta sara&3ner%us. Bagiansuperiornya ditutupi peritoneu!.

2. apisan tengah, !engandunganya!an !assa otot polos dan jaringan ikat elastis longgar tersusundala! ; lapisan disebut musculus

detrusor yang ber&ungsi!engosong#an (7 i#aber#ontra#si.

;. apisan lu!inal, mukosa yangdilapisi epitel transisional.

• Hi#a (7 #osong, bagiandala!3mukosa a#an berlipat:

lipat3rugae dan a#an hilang bertahapsealan dengan terisinya (7.

7retra



• Bag. "#hir siste! urinarius

Pria

• Panang, 20 c!, !ene#u# 2

#ali,beralan in&erior #eprostatF#antong perinealFperineal !e!branFpenis

Bagiannya+

• Prostatic+ !ele$ati prostat

• 1e!branousa+ plg pende#,!ele$ati perineu!

• pongiosa+ paling panang!ele$ati penis

anita• Posterior sy!physis pubis

• Pende#, Jc!,beralanin&erior,lantai pel%is:::#antongerinealFperineal !e!bran:::

%estibulu!• ?dpt #elnar !u#osa

parauretral 5land s#ene6

• ue+ ori&iciu! uretra e*terna,terleta# antara #litoris, dan

%agina• 'inding tersusun a3!u#osadan !us#uler

Uretra



Dindin urethra terdiri dari 3 lapisan/• 0. apisan otot polos, merupa%an

%elanutan "t"t p"l"s dari $U.

Menandun arinan• elastis dan "t"t p"l"s. Sphincter urethramenaa aar urethra tetap tertutup.

• 1. apisan su)mukosa, lapisan l"nar

menandun pem)uluh darah dan sara5 • 3. apisan mukosa

Uretra

/EE 1I?7/II31II



/EE 1I?7/II31II

• 7rinasiFproses#eluarnya urin

• o!binasi #ontra#si otot%olunter dan non %olunter

• (olu!e %.urinaria 200:J00!:::sti!ulasireseptor:rangsangansyara& spinalFurinasi

• Pusat !icturasi sacral

spinal 2:;

• /angsangan syara&F!enyebab#an #ontra#si!. detrussor @ rela#sasi!.sphincter uretra interna

•/e&le#s ini dapat dilatih• atihan pd !.sphincteruretra e*ternal, dan ototdinding pel%is

• Pusat yang di latih

cerebral corte*, sehinggadapat !enunda urinasipada periode ttt

Documents

Pelvis and Urinary Ok