Anatomy of Kidneys and Ureters Flashcards
(89 cards)
1
Q
what do the ureters do?
A
allow passage of urine from kidneys to bladder
2
Q
where is the bladder located?
A
pelvis
3
Q
what are the functions of the urinary system?
A
regulation of fluid/ blood volume regulation of osmolarity regulation of ion concentrations regulation of pH production of hormones for BP regulation and production of RBCs vitamin D metabolism pathway
4
Q
what is normal GFR?
A
125ml/min of blood
180L/day
5
Q
what is normal urine volume?
A
1L/day
6
Q
what does the kidney receive?
A
25% of cardiac output
consumes 7% of oxygen
7
Q
length of kidney
A
10-13cm
8
Q
Where are the kidneys located?
A
retroperitoneal
upper posterior abdomen
in extraperitoneal connective tissue
lateral to vertebral column
9
Q
what does retroperitoneal mean?
A
lie behind the peritoneum
10
Q
what is the peritoneum?
A
lining of the abdo cavity
11
Q
supine location of kidney
A
T12-L3
right kidney is lower than left due to liver
12
Q
difference between the 2 kidneys
A
left is longer and slimer than right
13
Q
what causes alterations in the location of the kidneys?
A
respiration and body position
14
Q
what happens to the kidney position in respiration?
A
kidneys closely associated with diaphragm so when it contracts
on inspiration they move inferiorly - 2.5cm
15
Q
renal hilum location
A
located at L1 - 5cm from midline
16
Q
rib levels of kidneys
A
left reaches rib 11 but right only 12
17
Q
L1
A
transpyloric plane
18
Q
where are the lower poles of the kidneys
A
L3-4
on right few cm superior to iliac crest
19
Q
clinical examination of kidneys
A
not dull to percussion due to overlying colon
bimanually between 2 palpating hands - balloting
normally impalpable
when kidney can be felt (especially left) may indicate pathology
20
Q
what are the surfaces of the kidney?
A
anterior and posterior surfaces
inferior and superior poles
21
Q
what is the hilum of the kidney?
A
structures run from and to the kidney through here
on anteromedial side
vertical cleft entrance
22
Q
kidney sinus
A
space within kidney, runs past hilum
23
Q
what is in the sinus of the kidney?
A
pelvis calices vessels nerves fat
24
Q
what enters and leaves through the renal hilum?
A
renal vessels
lymphatics
nerves
ureter
25
what covers the kidney
smooth surface covered by fibrous capsule - easily removable
26
what makes up the internal structure of the kidney?
cortex and medulla
27
what is the renal cortex?
continuous band of pale tissue that surrounds the medulla
| has extensions that project into the medulla, dividing it into segments - renal pyramids
28
renal pyramids
bases face the medulla and tips project inwards
29
what surrounds the renal pyramids?
minor calyx
30
minor calyx
fuse to form major calyx
31
major calyx
unite to form renal pelvis
32
what is the renal pelvis?
funnel shaped superior end of ureter
33
where is the renal sinus located in relation to renal hilum
deep to it
34
which structures are retroperitoneal
```
suprarenal - adrenal glands
aorta/ inferior vena cava
dueodenum
pancreas - except tail
ureters
colon
kidneys
oesophagus
rectum
```
Mnemonic = sadpucker
35
what is found anterior to the right kidney
```
adrenal gland - superior
liver
2nd part of dudenum
right colic flexure
ascending colon
```
36
what is found anterior to the left kidney?
```
adrenal gland - superior
stomach
spleen
pancreas
jejunum
left colic flexure
descending colon
```
37
what separates structures from the kidney
some are separated by layer of peritoneum
| some are directly against the kidney
38
hepatorenal recess
on the right
| place where intra-abdo fluid can collect
39
lienorenal ligament
on left
mesenteric fold
contains splenic vessels
40
where do the kidneys lie?
on top of the posterior abdominal wall muscles
41
what is found posterior to the kidneys?
```
diaphragm
costodiaphragmatic recesses
posterior abdo wall muscles
transversus abdominis
nerves
```
42
what are the posterior abdo wall muscles?
psoas and quadratus
43
what nerves pass posterior to the kidney?
subcostal vessels and nerves of 12th ribs
iliohypogastric
ilioinguinal
44
how many layers surround the kidney?
4
45
what are the layers that surround the kidney?
renal capsule
perinephric fat
renal fascia
paranephric fat
46
renal capsule
attached to kidney itself
47
perinephric fat
extends into renal sinus
surrounding renal capsule
protects
48
renal fascia
encloses kidneys and adrenal glands
separates perinephric and paranephric fat
another fascia layer within this separates the adrenal gland and kidneys
49
what is the blood supply to the kidneys?
renal arteries which branch from the abdominal aorta
50
what level do the kidney arteries branch from the aorta?
L1
left slightly higher than right
just below origin of superior mesenteric artery
51
accessory arteries
30% population
come into kidneys outside of hilum - extrahilar insertions
from more inferior along aorta or along iliac artery
52
branches of the renal artery
splits into 5 when enters the kidney
53
what are the vascular segments of the kidney?
```
apical/ superior
caudal/ inferior
upper anterior
middle anterior
posterior
no collateral circulation between them
```
54
benefit of vascular segments
surgically resectable
55
right and left renal arteries
right renal artery longer and passes posterior to inferior vena cava
left renal vein longer than right
56
renal veins
multiple renal veins fuse together to form the left and right renal veins
communicate across segments
57
location of renal arteries and veins
arteries are posterior to veins
58
left renal vein
longer
crosses midline anterior to abdominal aorta and posterior to superior mesenteric artery
risk of compression
59
what does the left renal vein drain
left gonadal vein
left suprarenal vein
but on the right they drain directly into IVC
60
compression of left renal vein
caused by lymphodenopathy
aortic aneurysm
etc.
causes varicocele
61
what is the lymphatic drainage to the kidney?
lateral aortic lumbar nodes
para caval
para aortic nodes
follows venous drainage
62
what is the innervation of the kidneys?
parasympathetic and sympathetic
celiac and intermesenteric plexuses
splanchnic nerves
pain fibres from ureteric pelvis
63
structure of renal hilum
front to back:
vein
artery
pelvis of ureter
64
what does the renal pelvis receive?
each one receives 2 or 3 major calyces
each major calyces receives 2 or 3 minor calyces
usually all collapsed
65
what happens when there is abnormal distension of calyces
hydronephrosis
minor calyces losse concave shape
renal pelvis distended
66
transpyloric plane
imaginary line
halfway between suprasternal notch and pubic symphysis
L1
67
what does the transplyoric plane pass through
```
9th costal cartilage
end of spinal cord
2nd part of duodenum
neck of pancreas
fundus of gall bladder
sphincter of oddi
lower border of spleen
superior mesenteric artery
origin of portal vein
```
68
what are the ureters?
muscular tubes that transport urine from kidneys to bladder
69
what lines the ureters
transitional epithelium
70
what lines the bladder?
transitional epithelium
71
course of ureters
25cm long from renal pelvis to entrance of bladder at ischial spine
retroperitoneal course in line with transverse porcesses
medial to psoas muscle
72
where do the ureters enter the pelvis?
bifurcation of common iliacs
in front of sacroiliac joint
runs on lateral wall of pelvis in front of internal iliac artery
73
ureter from renal pelvis
ureteropelvic junction
74
ureters in females
ureters pierce the cardinal and broad ligaments of uterus
75
what structures are anterior to the ureters?
ovarian/ testicular vessels
right colic vessels and ileocolic vessels
left colic vessels
uterine vessels
76
what structures are posterior the the ureters?
psoas major
| common iliac artery bifurcation - internal iliac
77
where are the constrictions of the ureters?
where the ureters leave the kidney - ureteropelvic junction
where ureters cross common iliac vessels at the pelvic brim
where the ureters enter the bladder
78
what is the clinical relevance of constrictions of the ureters
where calcifications/ calculus or blood clots can get stuck
79
blood supply to ureters
multiple arteries as it descends:
1. aorta
2. renal arteries
3. gonadal (ovarian/ testicular) arteries
4. common and internal iliacs
5. inferior vesicle artery - branch of internal iliac, supplies part of bladder as well
form a longitudinal anastomosis
80
venous drainage of ureters
renal and gonadal veins
81
water under the bridge
ureter passes under uterine artery which can be potentially injured at ligation of the artery for hysterectomy
82
where can the ureter be damaged?
pelvic brim
hysterctomy - uterine artery
vesical uretero junction during C section
83
lymphatic drainage of ureters
follows arterial supply
lateral aortic lumbar nodes
common iliac vessel nodes
external and internal iliac vessel nodes
84
loin to groin pain
classic ureteroteric pain
| comes and goes
85
motor innervation of ureters
visceral efferent fibres from sympathetic and parasympathetic sources
86
sensory innervation of ureters
visceral afferent fibres of ureter return to T11 and L2 spinal cord level
87
where is ureteric pain felt?
```
loin to groin regions
cutaneous areas supplied by T11-L2
posterior and lateral abdo wall
pubic region
scrotum or labia majora
proximal anterior aspect of thigh
```
88
what causes ureteric pain?
obstruction and or distension of ureter
| from renal colic
89
nephrostomy
drains urine from kidney if ureters are blocked
