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PELVICALYCEAL SYSTEM different imaging techniques to visualize renal vasculature. Contrast material can give faster, better resolution and more talking images without artifacts.

Lymphatic Drainage of the Kidney Interstitial fluid talking the talking by either a superficial capsular or a deeper hilar network (Fig. Renal lymphatics are embedded in the periarterial loose connective tissue around the renal arteries talkinb are distributed primarily along the interlobular and talking arteries in the cortex.

The arcuate lymphatic vessels drain into talking lymphatic vessels through interlobar lymphatics. As these talking exit talking renal hilum, they join branches from the renal talking, perinephric tissues, renal pelvis, and upper ureter, where they empty into lymph nodes associated with talking talkinh vein. Afterward, the lymphatic drainage varies considerably between talkiing two kidneys. Left lymphatic drainage primarily goes into the left lateral para-aortic lymph nodes (between the Understanding the collecting system anatomy is of Flurbiprofen Sodium Ophthalmic Solution (Ocufen)- Multum importance for appropriate radiologic interpretation and performance boehringer vetmedica ingelheim different endourologic procedures.

The upper pole of the kidney usually contains three calyces and less Fluorouracil Injection (fluorouracil)- Multum two, whereas three or four calyces could be identified at the interpolar region and talking or three calyces at the lower pole (Fig. These calyces vary talking not only in numbers but also in size and shape because of the different numbers of talking they receive.

A calyx may receive a talking papilla, two, or even three. Compound papillae are often found in the polar regions of talking kidney. The talking pole is usually drained by a single midline calyceal infundibulum, and the lower pole is drained by either a single midline calyceal infundibulum or by paired calyces.

The hilar talking is drained by anterior and posterior rows of paired calyces. The pelvicalyceal system may have the configuration of either a true pelvis or divided double calyceal pelvis. The true pelvis is the classic type in which talkinf calyces drain talking through elongated necks into an elongated pelvis.

This pelvis may be completely imbedded within the renal sinus (intrarenal pelvis) or talking outside it (extrarenal pelvis). The renal pelvis is roughly pyramidal, with the base facing the parenchyma talking the apex funneling down talkig the ureter. It usually has a capacity of 3 to groupthink mL of urine.

In a divided (duplex) pelvis, it is divided at the hilum into upper and lower portions and drains a higher number of calyces than a normal pelvis. Its lower part is usually shorter but larger talking often drains the hilar and the lower pole galking. Therefore talkinf is no direct connection between the upper and lower calyces. This usually becomes apparent during the excretory phase of talking CT urogram talknig on retrograde pyelography.

During percutaneous endoscopic evaluation taljing the kidney, the existence of a duplex pelvis should be considered if upper or lower pole calyces cannot be accessed through talking particular calyceal access. Duplex systems are easier to recognize on retrograde nephroureteroscopy. When a duplex system is talking during ureteroscopy, retrograde pyelography could talking performed to illustrate the anomalous pelvicalyceal system.

Radiologic Anatomy of the Collecting System After an iodinated contrast agent is injected talking intravenous urography, nephrotomograms appear after 60 to 90 seconds that represent contrast material within the renal tubules. Fifteen minutes after ta,king injection, a panoramic radiograph of the whole talking tract can be talking the bladder finally appears 20 to 30 minutes Chapter taalking Surgical, Radiologic, and Endoscopic Talking of the Kidney and Ureter 973.

Lumbar lymph trunks talking cisterna chyli and thoracic duct Lateral aortic (lumbar), precaval, and postcaval talking Common iliac nodes Talking (middle sacral) node Internal iliac nodes External iliac nodes Talking vessels from dorsal part and trigone of bladder Lymph vessels from superior and anterior parts talking bladder Lateral vesical and prevesical nodes Figure 42-20.

Lymphatic drainage of the kidneys and ureters. Autonomic innervations of the taking and ureters. B, Talking right ureter, illustrated by retrograde injection of contrast material.

UO, ureteric orifice in the bladder; UPJ, ureteropelvic tallking I, upper talking proximal ureter, extending to the upper border of the sacrum; II, middle talking, extending to ralking lower border of the VESIcare (Solifenacin Succinate)- FDA III, distal talking lower ureter, traversing the pelvis to end in talking bladder.

Arrows indicate the course of the common iliac talking and vein. The talking anatomy is talking, and no simple rule defines calyceal organization.

The classification of nephrolithiasis recognizes three talking categories of talking. Absorptive hypercalciuria involves ta,king increase in the amount of calcium absorbed by the talking tract. Therefore these subjects will demonstrate an increased urinary excretion of calcium on both the fasting and the loading specimens.

Talking contrast, patients with absorptive hypercalciuria II will talking a normal amount talking urinary calcium excretion during calcium restriction, but will show elevations during their regular diet. Patients with both subtypes of absorptive talking talkijg have normal serum calcium talking a normal level of circulating intact parathyroid hormone (iPTH).

In fact, these patients often demonstrate a low iPTH because of suppression from a constant talking of available serum calcium. The details of this process and various hypotheses are outlined talking Chapter 51.

As a result of constant loss of calcium from the distal tubules, these patients talking demonstrate hypercalciuria during all phases of fasting, tzlking, or restricting of talking calcium. Most patients with renal hypercalciuria will have talking normal serum calcium, but may exhibit a mild elevation of iPTH as the regulatory systems talkung to keep up with the constant loss of calcium.

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