Anatomy Kidney and Urinary System

Question 1

The gut tube grows into the (blank)

Answer 1

abdominal coelomic cavity

Question 2

Certain structures stay outside of the mesentery of the coelomic cavity and these are said to be (blank)

Answer 2

retroperitoneal

Question 3

Kidneys start and end (blank)

Answer 3

retroperitoneal

Question 4

What becomes the peritoneal layer that lines the gut tube?

Answer 4

splachnic mesoderm

Question 5

Kidneys develop behind the (blank) from the (blank)

Answer 5

peritoneal sac

urogenital ridge

Question 6

Is there anything in the periotoneal sac?

Answer 6

NO!

Question 7

The urinary system (kidneys, ureters) the aorta, the adrenal glands, posterior abdominal walls and the IVC are all where?

Answer 7

in the retroperitoneal space

Question 8

Where are the liver, stomach, and spleen located?

Answer 8

the intraperitoneal space

Question 9

What is a good way to access the kidneys?

Answer 9

posterior abdominal wall

Question 10

What attaches organs to posterior abdominal wall?

Answer 10

peritoneal ligaments

Question 11

(blank) is a sheet of pearly-white fibrous tissue that takes the place of a tendon in sheetlike muscles having a wide area of attachment.

Answer 11

aponeurosis

Question 12

What is the pearly white diamond of connective tissue that is located at the thoracic lumbar region of the back?

Answer 12

the thoracolumbar aponeurosis

Question 13

What gives rise to muscle anteriorly and superiorly around to the front such as the latisimus doris?

Answer 13

the thoracolumbar aponeurosis

Question 14

What is an upper limb muscle that we need to be aware of because of its size and position obscuring the posterior approach to the kidneys?

Answer 14

latissimus dorsi

Question 15

If you reflect the latissimus dorsi what will be underneath?

Answer 15

External and internal obliques.

Question 16

Why are the external and internal obliques orthogonal to each other?

Answer 16

to provide strength

Question 17

The muscles that are important for getting to the kidney are what and what is there direction?

Answer 17

• Latissimus Dorsi
• External abdominal oblique muscles are extending medially and anteriorly, downward,
• Internal abdominal oblique muscles are extending medially, anteriorly and upwards.
• transversus abdominis wraps around posteriorly and takes origin from the thoracolumbar aponeurosis
• Quadratus Lumborum
• psoas muscle

Question 18

What muscles does the thoracolumbar aponeurosis give rise to?

Answer 18

internal oblique, external obliques, latissimus dorsi, transversus abdominis

Question 19

Do you ever encounter some anterior abdominal wall muscles that have posterior origins or insertions?

Answer 19

yes, like the external and internal abdominal obliques and transversus abdominis

Question 20

A final abdominal wall muscle, the (blank) is seen as the deepest of the three (latissimus dorsi, external and internal obliques), also having an extensive origin from the posterior side of the thoracolumbar aponeurosis

Answer 20

transversus abdominis

Question 21

What are the three anterior wall muscles you need to cut through to get to the kidney?

Answer 21

internal oblique
external oblique
transversus abdominis

Question 22

What are the 2 posterior wall muscles you need to cut through to get to the kidney?

Answer 22

Latissimus dorsi, quadratus lumborum

Question 23

What has the kidney line partly on this muscle. This is a very deep muscle underneath the anterior abdominal wall muscles and runs from illiac crest to 12th rib.

Answer 23

Quadratus lumborum

Question 24

What is a large muscle forming a good deal of the posterior abdominal wall?

Answer 24

quadratus lumborum

Question 25

Where does the quadratus lumborum extend form and to?

Answer 25

from iliac crest to the 12th rib

Question 26

What is the top of your pelvis bone called?

Answer 26

illiac crest

Question 27

What is right above the illiac crest?

Answer 27

quadratus lumborum

Question 28

Which kidney is lower, the right or left?

Answer 28

the right

Question 29

The kidney is laying right over the (blank) and a little bit of the (blank)

Answer 29

quadratus lumborum | psoas muscle

Question 30

The lower pole of the kidney sits right above the (blank).

Answer 30

illiac crest

Question 31

The kidneys are surrounded by both (blank) and (blank).

Answer 31

peri and para renal fat.

Question 32

The kidneys are enclosed in a (blank), which is basically an extension of the outer covering of the renal vessels and situated posterior to the peritoneum.

Answer 32

the renal fascia

Question 33

Where is the renal fascia situated?

Answer 33

posterior to peritoneum

Question 34

Is perirenal or pararenal fat next to the kidney and in between the renal fascia?

Answer 34

perirenal fat

Question 35

IS the right kidney covered by the 11th rib? | Is the left kidney?

Answer 35

no, only 12th | Yes the 11th and 12th.

Question 36

The adrenal glands sit on top of the kidney and the (blank) slips between them.

Answer 36

renal fascia and perirenal fat

Question 37

Are the adrenal gland and the kidney developed together?

Answer 37

no! they are not related at all!!

Question 38

Where is fat most extensive on a kidney?

Answer 38

posteriorly

Question 39

Where do kidneys develop and how?

Answer 39

in the pelvis and they ASCEND to their adult positions

Question 40

As kidneys ascend what do they establish?

Answer 40

new blood supplies (old blood supplies deteriorate) to eventually become renal artery

Question 41

Do kidneys move with inspiration?

Answer 41

yes (2-3cm)

Question 42

What are extra arteries due to miscommunication upon ascent of the kidney?

Answer 42

polar and accessory arteries

Question 43

The renal arteries come off the (blank) near the superior mesenteric artery.

Answer 43

aorta

Question 44

What does the renal artery divide into?

Answer 44

anterior and posterior segmental branches as they reach the hilum

Question 45

How many branching arteries come off of the posterior and anterior segmental branches of the kidney?

Answer 45

3-5

Question 46

Segmental branches supply a (blank) area

Answer 46

resectable

Question 47

There may be polar branches on either pole due to (blank)

Answer 47

developmental differences

Question 48

Which kidney has a longer renal artery? Which kidney has a longer renal vein? WHY?

Answer 48

the right side the left side Due to the arrangement of the aorta and the IVC (IVC is on right side so it has to travel farther to the left etc.)

Question 49

Inside of the renal hilum there is a fat filled cavity called a (blank)

Answer 49

renal sinus

Question 50

All vessels entering and leaving a kidney do so via the (blank)

Answer 50

hilum

Question 51

Where will the ureter continue to branch out into major and minor calyces? Where will blood vessels continue to branch out?

Answer 51

Renal sinus | Renal sinus

Question 52

Renal arteries also give a branch off to what?

Answer 52

the adrenal gland and ureter

Question 53

What has an extensive blood supply, getting blood from the renal artery, directly from the aorta, and from the inferior phrenic artery?

Answer 53

the adrenal gland

Question 54

Why does the adrenal gland need so much blood?

Answer 54

its an endocrine gland

Question 55

Why do ureters have blood supplies from numerous areas?

Answer 55

cuz they are so long

Question 56

The renal vein drains to the (blank)

Answer 56

IVC

Question 57

The left renal vein is longer and is located where?

Answer 57

posterior to the superior mesentaric artery (cuz it has to cross aorta to reach the IVC)

Question 58

Why is it relevant to know that the left renal vein is located posteriorly to the superior mesentaric artery?

Answer 58

Obstruction of this artery could compress this left renal vein

Question 59

The left renal vein has numerous branches to what structures?

Answer 59

diaphragm, pelvis, left gonadal vein and ascending lumbar vein which connects with azygos system (important for preventing blood backup in left testicle)

Question 60

What has a connecting with the azygos system?

Answer 60

Left renal vein! (so if you compress left renal vein you arent really in trouble because blood can still be drained to heart via azygos system)

Question 61

The right gonadal vein drains where?

Answer 61

directly to the IVC (unlike the left which goes to left renal vein)

Question 62

Where do all the collecting ducts come together?

Answer 62

At the papilla of the renal pyramid

Question 63

the renal pelvis is surrounded by lots of (blank)

Answer 63

fat (renal sinus)

Question 64

Where does the ureter get its blood supply?

Answer 64

renal, gonadel, vesicular arteries (long course into pelvis into bladder)

Question 65

What are the three sites of potential narrowing of the ureter?

Answer 65

1: transition from pelvis to ureter 2: pelvic brim 3: entrance into the bladder

Question 66

The entrance into the bladder is (blank) to prevent backflow of urine as the bladder pressure rises.

Answer 66

diagonal (oblique)

Question 67

DOes the ureter have a sphinctor?

Answer 67

no

Question 68

Ureters are very strong and muscular, why? | Do they have a significant nerve supply?

Answer 68

so they can overcome any pressure in the bladder | Yes (lots of afferents)

Question 69

sympathetics to the kidneys come from where?

Answer 69

Sympathetics to the kidneys come from the lesser (T10-11) and least (T12) thoracic splanchnics. And contributions from the first lumbar splachnics (L1)

Question 70

Where do the least and lesser splachnics synpase?

Answer 70

the aorticorenal ganglion and on ganglia near the renal artery.

Question 71

What is the major function of nerve supply to the kidneys?

Answer 71

changing blood flow

Question 72

The nerves supply to the kidney comes down through the (blank) nerves (greater less and least thoracic splachnics) which are presynaptic until they get to the (blank) where they synapse and distrubute along the plexus to the kidney.

Answer 72

splachnic | preaortic/preverterbal ganglia (aortic/ mesentaric/ renal)

Question 73

In addtion to supplying the kidney, some postsynaptic fibers will send fibers on the the (blank). What lumbar nerves will be on the ureter? .

Answer 73

ureter | L1 and L2

Question 74

Are there afferents coming back on the Ans fibers that go to the ureter? A:

Answer 74

YES! (parasympathetics and sympathetics) The difference on afferents will be quality of pain (sympathetics will be local and pain and parasympathetics will be responsible for reflexes).

Question 75

Because ANS sympathetic fibers come from many different places the quality of pain that will come back from these fibers can synapse on levels of T10-L2. So the ureter the affarant fibers coming back on these sympathetic fibers can come from as has high as T10 and low as L2 but the lower part of the ureter has even different localization. What is the bottom line of these statements?

Answer 75

Pain that is coming back from the ureter can synapse at many different levels. resulting in referred pain at many different places

Question 76

Fibers to the kidney all come as (blank) and then synapse on ganglias

Answer 76

presynaptic

Question 77

Where are the lesser and least splachnic nerves coming from on the spinal cord?

Answer 77

T10-L1

Question 78

Where is the lesser thoracic splachnic nerve synpasing?

Answer 78

aorticorenal ganglion

Question 79

Where is the least thoracic splachnic nerve synapsing?

Answer 79

renal artery plexus/ganglion

Question 80

What parasympathetic fibers innervate the ureter and the kidney?

Answer 80

Vagus (preganglionics) and form pelvic splachnics S2,3,4 that travel up hypogastric plexus

Question 81

Pain referring from the kidneys and upper ureters can refer to dermatomes from (blank) . The location of referred pain from a kidney stone can descend as the stone passes lower in the system.

Answer 81

T10-L2

Question 82

Because the urinary system (kidney and ureter) referes from T10-L2 so you will have wide distribution of (BLANK)

Answer 82

where you will feel pain.

Question 83

What kind of gland is the adrenal gland?

Answer 83

endocrine (cortex) and neuroendocrine (medullary)

Question 84

What are the three major blood supplies to the adrenal gland?

Answer 84

superior suprarenal off inferior phrenic middle suprarenal off aorta inferior suprarenal off the renal

Question 85

What are the veins on the adrenal gland?

Answer 85

you have a single vein to the IVC on the right adrenal gland | you have a single vein to the renal vein on the left adrenal gland

Question 86

If you see a CT scan where you can see the right kidney before you see the left, what does this tell you?

Answer 86

that the left kidney is longer so PROBLEM!

Question 87

What is the only autonomic pathway with just one neuron?

Answer 87

the adrenal gland

Question 88

(blank) fibers innervated secretory cells of the adrenal medulla

Answer 88

preganglionic sympathetic fibers

Question 89

Fibers come off the (blank) either before (goes directly to adrenal medulla) or after the ciliac plexus (through plexus and then into adrenal medulla, no synapse) and distribute to the adrenal medulla . However some fibers do synapse in the ganglion (become post-ganglionic) if they are going where?

Answer 89

greater thoracic splachnic nerves | the cortex and blood vessels

Question 90

When the sympathetic fibers to the adrenal medulla synapse in them what do they synapse on?

Answer 90

endocromial cells that secrete epinephrine and norepinephrine->released into blood stream to the rest of body.

Question 91

So when you think adrenal medulla what do you think? | When you think adrenal cortex or adrenal blood vessels what do you think?

Answer 91

preganglionic | postganglionic

Question 92

Neuroendocrine cells get a (blank) neuron all the way down into them.

Answer 92

single (i.e they dont have post-ganglionics cuz the endocromial cells pass the message on instead)