1 Urinary System Anatomy

Question 1

Which landmarks in the body can be used to locate the kidney? (vertically)

Answer 1

Left kidney:

Upper pole: T11-T12

Lower pole: L2-L3

higher due to liver on the right

Right kidney:

Upper pole: T12

Lower pole: L3-L4

Question 2

What is are the typical dimensions (length and height) of the kidneys in cm?

Answer 2

Question 3

What is normal range for the weight of a kidney?

Answer 3

170-220g

Question 4

In terms of kidney size, when would we need to carry out further investigations?

Answer 4

• If >2cm difference in dimensions between L and R kidney
• If <8cm in length- may be CKD

Question 5

Fill in the missing labels in the following image:

Answer 5

Question 6

At what vertebral level can the hilum of each kidney usually be found?

Answer 6

L1

Question 7

What is the renal angle?

Answer 7

Angle between 12th rib and erector spinae muscle

Area where tenderness can be reported

Question 8

Why are kidneys surrounded by fascia and so much fat?

Answer 8

Only thing holding them in position

(kidneys move up and down during breathing)

Question 9

Label the 3 layers on the following diagram surrounding the kidneys:

Answer 9

Perirenal fat= continuous with fat found in renal sinus of kidney

Renal fascia= aka Garota’s fascia

Pararenal fat= extra peritoneal, associated with lumbar region

Question 10

How do the ureters propel urine to the urinary bladder?

Answer 10

Smooth muscle fibres

Peristaltic waves

Question 11

What are the usual dimensions of the ureters (length and diameter)?

Answer 11

Length: 25-30 cm

Diameter: about 1.5mm

Question 12

Where do the ureters run with relation to the lumbar vertebrae?

Answer 12

Lateral to tips of transverse processes

Question 13

Name the 3 sections that the ureter is divided into.

Answer 13

Question 14

Where do the ureters run with relation to the gonadal vessels?

Answer 14

Underneath (water under the bridge)

Important to remember in surgery

(Ureters tilt in anteriorly at the point of the ischial spine)

Question 15

Where is the ureter most prone to damage?

Answer 15

Near pelvic brim

Question 16

How is urine reflux from the bladder to the ureters prevented?

Answer 16

Ureters (in intramural (distal) segment) run obliquely through bladder wall musculature–> forms flap

Ureter in intramural part= 1.2-2.5cm

Question 17

Where can urothelium be found?

Answer 17

Lining bladder, ureter and pelvis of kidney

Question 18

Fill in labels 1-6 in the following diagram.

Answer 18

Question 19

If the bladder is full, where can it be palpated? (bony landmark)

Answer 19

Above pubic symphysis

Question 20

Fill in the missing labels on the following prosection:

Answer 20

Question 21

Fill in the missing labels in the following diagram:

Answer 21

Question 22

What is the function of the Internal urinary sphincter?

Answer 22

Prevent retrograde ejaculation

(not much function in women)

Question 23

What is the external urinary sphinter responsible for?

(sits in Urogenital diaphragm in men and women)

Answer 23

Continence

Question 24

Label the names of the divisions of the urethra:

Answer 24

Question 25

Fill in the missing labels on the following diagram:

Answer 25

Question 26

Fill in the missing labels:

Answer 26

Question 27

Where is the glomerulus found in the kidney?

Answer 27

Within the cortex

Question 28

What occurs at the papilla in the kidney?

Answer 28

Location where the renal pyramids in the medulla empty urine into the minor calyx in the kidney

Question 29

Fill in the missing labels:

Answer 29

Question 30

What are the 2 broad classes of nephron and what are the main differences between them?

Answer 30

* Cortical (90%) * Short loops of Henle * Juxtamedullary (10%) * Long loop of Henle

Question 31

Which artery can be used as a landmark to locate the renal vessels?

Answer 31

Superior mesenteric artery- hooks over renal vessels

Question 32

Why are the kidneys so ulnerable to ischaemic damage? (Eg if blood pressure drops)

Answer 32

Require large blood flow (22% of cardiac output) BP drop likely to damage kidneys first

Question 33

Why are left kidneys preferential for transplants?

Answer 33

Long vessels

Question 34

Fill in the missing labels:

Answer 34

Question 35

Identify the following arteries on the diagram: Renal Segmental Interlobar Arcuate

Answer 35

Question 36

Fill in the missing gaps in the following diagram:

Answer 36

Question 37

What is the glomerulus?

Answer 37

Tuft of capillaries between afferent and efferent arteriole

Question 38

Within the ureter, at what 3 points is a kidney stone likely to get stuck?

Answer 38

* Pelvoureteric junction * Pelvic brim * Entering bladder

Question 39

If the hilum of each kidney can be seen on a CT scan, what vertebral level is that CT scan at?

Answer 39

L1

Question 40

The vasa recta can be found in the medulla of the kidney. What vessel does it branch off?

Answer 40

Branches of efferent arteriole

Question 41

A patient with a known abdominal aortic aneurysm presents with nausea and unilateral flank pain. What is the most likely cause for their symptoms?

Answer 41

Ureter entrapment Unilateral hydronephrosis

Question 42

What is likely to be present in the urine due to renal vein entrapment syndrome?

Answer 42

* Haematuria * Proteinuria

Question 43

Useful to see where is peri and where is pararenal:

Answer 43