IV.

ANATOMY AND PHYSIOLOGY

ANATOMY OF URINARY SYSTEM

The urinary system's function is to filter blood and create urine as a waste by-product. The organs of the
urinary system include the kidneys, renal pelvis, ureters, bladder and urethra. The body takes nutrients
from food and converts them to energy. After the body has taken the food components that it needs,
waste products are left behind in the bowel and in the blood.

The kidney and urinary systems help the body to eliminate liquid waste called urea, and to keep
chemicals, such as potassium and sodium, and water in balance. Urea is produced when foods
containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is
carried in the bloodstream to the kidneys, where it is removed along with water and other wastes in the
form of urine.

FUNCTIONS :
TWO KIDNEYS - This pair of purplish-brown organs is located below the ribs toward the middle of the
back. Their function is to:

 Remove waste products and drugs from the body

 Balance the body's fluids

 Release hormones to regulate blood pressure

 Control production of red blood cells.

The kidneys remove urea from the blood through tiny filtering units called nephrons. Each nephron
consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal
tubule. Urea, together with water and other waste substances, forms the urine as it passes through the
nephrons and down the renal tubules of the kidney.
TWO URETERS - These narrow tubes carry urine from the kidneys to the bladder. Muscles in the ureter
walls continually tighten and relax forcing urine downward, away from the kidneys. If urine backs up, or
is allowed to stand still, a kidney infection can develop. About every 10 to 15 seconds, small amounts of
urine are emptied into the bladder from the ureters.

BLADDER - Bladder. This triangle-shaped, hollow organ is located in the lower abdomen. It is held in
place by ligaments that are attached to other organs and the pelvic bones. The bladder's walls relax and
expand to store urine, and contract and flatten to empty urine through the urethra. The typical healthy
adult bladder can store up to two cups of urine for two to five hours.

 Upon examination, specific "landmarks" are used to describe the location of any irregularities in
the bladder. These are:

 Trigone: a triangle-shaped region near the junction of the urethra and the bladder

 Right and left lateral walls: walls on either side of the trigone

 Posterior wall: back wall

 Dome: roof of the bladder

TWO SPHINCTER MUSCLE - These circular muscles help keep urine from leaking by closing tightly like a
rubber band around the opening of the bladder.

NERVES IN BLADDER - The nerves alert a person when it is time to urinate, or empty the bladder.

URETHRA - This tube allows urine to pass outside the body. The brain signals the bladder muscles to
tighten, which squeezes urine out of the bladder. At the same time, the brain signals the sphincter
muscles to relax to let urine exit the bladder through the urethra. When all the signals occur in the
correct order, normal urination occurs.

PHYSIOLOGY OF URINARY SYSTEM

 This system helps to eliminate waste products

such as urea from the body, regulate electrolyte
concentration, blood pressure and pH levels.

 The kidneys play a central role in the production

of urine and removal waste products and toxins
from the blood by 3 main physiological
mechanisms: glomerular filtration, selective
reabsorption and tubular secretion. This occurs
within the nephron, which is the functional unit of
the kidney

 The kidneys produce urine at a rate of up to 1ml / kg of body weight per hour, and when all
toxins and waste products have been filtered out, urine passes through the ureters to the
urinary bladder where it is stored.

In a healthy adult, the urinary bladder has a capacity of about 300-500ml. However, at a urine volume of
about 400ml, sensory nerve fibers around the bladder signal the brain to start up the process of urine
excretion, known as micturition ?, where urine flows out of the urinary bladder through the urethra.
Each component of the urinary system uniquely aids in the flow of urine. If any one of the components
fails to function correctly, the flow of urine can become greatly reduced (a condition known as urinary
stasis),increasing the risk of infection, specifically a urinary tract infection (UTI).

ANATOMY OF ANORECTAL ABCESS

An anorectal abscess originates from an infection arising in the cryptoglandular epithelium lining the
anal canal. The internal anal sphincter is believed to serve normally as a barrier to infection passing from
the gut lumen to the deep perirectal tissues. This barrier can be breached through the crypts of
Morgagni, which can penetrate through the internal sphincter into the intersphincteric space.

Once infection gains access to the intersphincteric space, it has easy access to the adjacent perirectal
spaces. Extension of the infection can involve the intersphincteric space, ischiorectal space, or even the
supralevator space. In some instances, the abscess remains contained within the intersphincteric space.
The severity and depth of the abscess are quite variable, and the abscess cavity is often associated with
formation of a fistulous tract. For that reason, fistulas are also discussed in this article where relevant.

The variety of anatomic sequelae of the primary infection is translated into variable clinical
presentations. The relatively simple perianal abscess is to be distinguished from the more complex
perirectal abscesses. Treatment also differs according to the type of abscess present.
  SUPRALEVATOR -
Supralevator abscesses are
thought to originate either
from an ischiorectal or
intersphincteric abscess
extension or from an
intraperitoneal source.
These abscesses are quite
uncommon and present a
difficult surgical problem.
 ISOCHIOANAL - The
ischioanal fossa is a paired
triangular-shaped space
lateral to the anal canal
with an apex directed
anteromedially towards the
pubic symphysis. Each
ischioanal fossa is
separated from the other
by the anococcygeal body,
but they do still
communicate superiorly to
this and posterior to the
anal canal.
 PERIANAL - The perianal
space means the lower part
of the anal canal
surrounded by the
anoderm. It is in contact
laterally with the fatty tissue of the buttock and medially with the intersphincteric space. This
space is a common site for perianal abscesses or hematomas. The intersphincteric space lies
between the IAS and the EAS. It is filled with areolar tissue and fat. This space is continuous
cephalad to the supralevator space that is situated between the peritoneum and the levator ani
muscle. As described earlier, the anal gland secretes into the anal canal through the anal crypt
along the level of the dentate line. Because some anal glands are in the intersphincteric space,
this space plays a major role in the development of perianal fistulae and accounts for about half
of the total incidence.
 SUBMUCOSAL - In the gastrointestinal tract, the submucosa is the layer of dense, irregular
connective tissue or loose connective tissue that supports the mucosa, as well as joins the
mucosa to the bulk of underlying smooth muscle (fibers that run circularly within a layer of
longitudinal muscle).
  SUPRALEVATOR - Supralevator abscesses are thought to originate either from an ischiorectal or
intersphincteric abscess extension or from an intraperitoneal source. These abscesses are quite
uncommon and present a difficult surgical problem.
 DEEP POSTANAL - Deep postanal space (DPS) is one of those deep locations in which
suppuration will lead to a challenging clinical problem for either correct diagnosis or treatment

PHYSIOLOGY OF ANORECTAL ABCESS

Perianal abscess is a superficial infection that appears as a tender red lump under the skin near the
anus. The infection occurs when bacteria gets trapped in the crypt glands that line the anal canal. The
bacteria and fluid (pus) build up and becomes a lump that is red and painful (like a “pimple”)

Infection starts in crypto glandular epithelium lining the anal canal.

Internal anal sphincter a barrier to infection passing from gut to deep perirectal tissue.
Duct of Anal gland penetrate internal sphincter into intersphincteric space.

Once infection sets in intersphincteric space it can spread further.

Frequency Common in 3rd and 4th decade of life Male > female (2:1)
30% present with previous episodes.
Increase incidence during summer and spring.
Common in infants , poorly understood mechanism , fairly benign and majority settle with simple
drainage.