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Anatomy of the renal tract Flashcards

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1
Q

Describe the urinary tract (simply)?

A

Kidney: produces urine
Ureter: drains urine
Bladder: stores/voids urine
Urethra: excretion of urine

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2
Q

What is the upper urinary tract?

A

Kidneys

Ureters

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3
Q

What is the lower urinary tract?

A

Bladder

Urethra

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4
Q

What aspects of the urinary tract are contained within the abdomen?

A

RETROPERITONEUM:
Kidneys
Proximal 1/2 of ureters

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5
Q

What aspects of the urinary tract are contained within the pelvis?

A

Distal 1/2 of ureters
Bladder
Proximal urethra

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6
Q

What aspects of the urinary tract are contained within the perineum?

A

Dital urethra

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7
Q

What muscle makes up the pelvic floor?

A

Levator ani

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8
Q

What lies lateral to the kidneys?

A

Anterolateral abdominal muslces: external oblique, internal oblique, transversus abdominus

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9
Q

What lies medial to the kidneys?

A

Psoas major muscle

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10
Q

What lies posterior to the kidneys?

A

Quadratus lumborum muscle

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11
Q

What lies anterior to the kidneys (going from anterior to posterior)?

A 
Most anteriorly:
Visceral peritoneum
Paranephric fat
Renal deep fascia
Perinephric fat
Most posteriorly: renal capsule
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12
Q

On CT scan, where will the aorta and IVC be found?

A

Aorta = left side - commonly see the left renal vein coming off
IVC right and more anterior - commonly see right renal vein draining into it

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13
Q

What vertebral bodies does the right kidney correspond with?

A

L1-L3

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14
Q

What vertebral bodies doe the left kidney correspond with?

A

T12-L2

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15
Q

What ribs are associated with the kidneys?

A

Floating ribs 11 and 12

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16
Q

What regions and quadrants of the abdomen do the kidneys sit in?

A

RUQ and LUQ

Right and left lumbar (flank) region

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17
Q

Describe a normal kidney

A 
12 cm long
6 cm wide
Smooth
Regular
Firm
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18
Q

What are the anatomical relationships to the right kidney?

A 
Liver 
Hepatorenal recess
2nd part of the duodenum
Ascending colon
Right colic flexure
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19
Q

What are the anatomical relationships to the left kidney?

A

Stomach
Tail of pancreas
Hilum of spleen
Splenic vessels

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20
Q

What is the importance of the hepatorenal recess?

A

Deepest part of the greater sac of the peritoneal cavity in the supine position

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21
Q

Describe the renal hilum?

A

Renal veins most anterior
Then renal arteries
Then ureter

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22
Q

What is the kidneys lymph drainage?

A

Lumbar nodes - located around the abdominal aorta and the inferior vena cava

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23
Q

Where does the abdominal aorta bifurcate into the common iliacs?

A

Umbilicus - L4

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24
Q

What is the lymph drainage of the ureters?

A

Lumbar and iliac nodes

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25
What is the ureteric blood supply?
``` Branches from: Renal artery Abdominal aorta Common iliac Internal iliac Vesical artery ```
26
Why does renal stenosis occur with an infra-renal AAA?
Atherosclerosis
27
Why does renal stenosis occur with a suprarenal AAA?
Occlusion of the proximal renal artery by the aneurysm
28
Why can you get a solitary kidney?
Agenesis | Nephrectomy - pathologically or donation
29
What makes up the kidney?
Outer cortex | Inner medulla which contains the renal pyramids
30
What is in the renal pyramids of the medulla?
Nephrons - this is why the medulla looks striped
31
Describe the drainage of urine from the kidney?
``` Nephrons collecting duct Minor calyx Major calyx Renal pelvis Ureter ```
32
What are the 3 anatomical sites of ureteric obstruction in the urethral tract?
Pelviureteric junction Ureter crossing the anterior aspect of the common iliac artery as is transitions from abdomen to pelvis across the iliac crest Ureteric orifice - where the ureter opens into the trigone
33
How can a ureteric obstruction occur?
Internal obstruction - calculus or clot | External compression - tumour
34
What type of muscle are the ureter?
Smooth
35
Describe the type of pain associated with an obstructed ureter?
There will be increased peristalsis proximal to the site of the obstruction at an attempt to remove it As peristalsis comes in waves, a patient with ureteric obstruction will have colicky pain
36
What are consequences of urinary tract obstruction?
Renal failure due to a back up of urine
37
What is renal failure?
Failure of filtration at the glomerulus of the nephron in the renal pyramid
38
What is hydronephrosis?
Enlarged kidney due to back pressure of urine on the medullary pyramids
39
Why is acute hydronephrosis painful?
Stretching of the deep fascia renal capsule
40
What are the landmarks of the false pelvis?
Iliac crests to the pelvic inselt (part of abdominal cavity)
41
What are the landmarks of the true pelvis?
Pelvic inlet to the -pelvic floor (levator ani)
42
Describe the route of the ureters?
Pass anteriorly to the common iliac vessels to enter the pelvis Run anteriorly (along lateral walls of pelvis) At ischial spine they will turn medially to enter the posterior aspect of the bladder
43
Why do the ureters enter the posterior bladder wall in an inferomedial direction?
Prevent reflux of urine back into the ureters when the bladder contracts
44
What is the most inferior part of the male peritoneal cavity?
Rectovesical pouch
45
What is the most inferior part of the female peritoneal cavity?
Rectouterine pouch (of douglas)
46
What is the function of the round ligament of the uterus?
Attaches the uterus to the perineum via the inguinal canal
47
Describe the anatomical relations of the pelvic ureters in females and males
Females: ureter runs inferiorly to the uterine tubes and the uterine artery Males: ureter runs inferiorly to the vas defrens
48
What are the key arteries that enter the pelvis?
``` Internal iliac Middle rectal Vesical arteries In females: uterine and vaginal In males: prostatic (branches of vesical) ```
49
What makes up the trigone?
2 ureteric orifices and the internal urethral orifice
50
What muscle makes up the bladder?
Detrusor muscle
51
Why do the detrusor muscle fibres encircle the ureteric orifices?
Tighten with the bladder contracts to prevent reflux
52
What is the 3rd sphincter present ONLY in males?
Internal urethral sphincter muscle which contracts during ejaculation to prevent retrograde ejaculation of semen into the bladder
53
Where does the uterus lie in relation to the bladder?
Superior in an anteflexed position
54
Where does the prostate lie in relation to the bladder?
Inferiorly
55
Describe the differences in the anatomical positions of an empty and full bladder?
Empty bladder lies within the pelvis with a peritoneal covering over its superior surface Full bladder can extend out of the pelvis into the abdominal cavity
56
How can you be catheterized?
``` Urethral Suprapubic (through anterior abdominal wall) ```
57
At what level is the external urethral sphincter located?
Level of levator ani
58
What does the spongy urethra lie within?
The corpus spongiosum of the penis
59
Describe the movement of sperm
Produced in the seminiferous tubules Passes through epididymis into the vas deferens Vas deferens passes though the deep inguinal ring to enter the abdominal cavity where it passes posterior to the bladder to pass through the seminal gland to form the ejaculatory duct Here is passes through the prostate gland where it joins with the prostatic urethra to leave the penis via the spongy urethra
60
Where do the testes descend from in babies?
Form on the posterior abdominal wall where they will descend through the inguinal canal into the scrotum
61
What is contained within the spermatic cord?
``` Testicular artery Testicular vein Vas deferens Lymphatic vessels Autonomic and somatic nerves ```
62
What do the tests sit within inside the scrotum?
The tunica vaginalis
63
What can torsion of the spermatic cord result in?
Severe pain | Danger of testicular necrosis
64
Where will the right testicular vein drain to?
IVC
65
Where will the left testicular vein drain to?
Left renal vein
66
What can you feel of the prostate upon PR examination?
Peripheral zone
67
Where does the root of the penis attach?
To the ischium of the pelvis
68
What are the 3 cylinders of erectile tissue within the penis?
``` Right and left corpus cavernosum (posterior, transmit the deep arteries of the penis) Corpus spongiosum (anterior, transmits the spongy urethra and expands distally to form the glans) ```
69
What is the blood supply to the penis?
Deep arteries of the penis which are branches of the internal pudendal artery from the internal iliac artery
70
What is the blood supply to the scrotum?
Internal pudendal and branches of the external iliac artery
71
What is the lymph drainage of the scrotum and most of the penis (not the testis)
Superficial inguinal nodes in the superficial fascia of the groin
72
What is the lymph drainage of the testes?
Lumbar nodes around the abdominal aorta

Renal (22 decks)

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