Anatomy of the Upper Urinary Tract

Question 1

What is the route of urine flow?

Answer 1

Kidney produces urine - ureter drains from kidney to bladder - bladder stores and voids urine - urethra excretes urine

Question 2

What structures make up the upper urinary tract?

Answer 2

Kidneys and ureters = infection of this area may spread to the kidneys

Question 3

What structures make up the lower urinary tract?

Answer 3

Bladder and urethra = infection of this area will involve these structures

Question 4

What parts of the urinary tract are found in the abdomen?

Answer 4

In the retroperitoneum = kidneys, proximal ureters

Question 5

What parts of the urinary system are present in the pelvis?

Answer 5

Distal ureters, bladder, proximal urethra

Question 6

What part of the urinary tract is found in the perineum?

Answer 6

Distal urethra

Question 7

What are the contents of the hilum of the kidneys?

Answer 7

Renal artery, renal vein, ureter

Question 8

What part of the abdomen are the kidneys found in?

Answer 8

In the abdominal cavity behind the peritoneum

Question 9

What are the layers of tissue that surround the kidneys (from superficial to deep)?

Answer 9

Visceral peritoneum, paranephric fat, renal (deep) fascia, perinephric fat, renal capsule

Question 10

What muscles are the kidneys related to?

Answer 10

Anterior to quadratus lumborum and lateral to psoas major

Question 11

What is the relationship of the kidneys to the lower thoracic/upper lumbar vertebral bodies?

Answer 11

Lateral to the vertebral bodies

Question 12

What vertebral level are the kidneys found at?

Answer 12

Right kidney = L1-L3

Left kidney = T12-L2

Question 13

Why is the right kidney slightly inferior to the left kidney?

Answer 13

Due to the liver

Question 14

What ribs are posteriorly related to the kidneys?

Answer 14

Ribs 11 and 12 = offer protection against penetrating injury but can bruise/lacerate the kidneys if they fracture

Question 15

What sections of the abdomen are the kidneys found in?

Answer 15

Left and right upper quadrants

Left and right hyperchondria

Question 16

What are the anatomical relationships of the liver and spleen?

Answer 16

In contact with the diaphragm superiorly and the superior poles of the kidneys inferiorly

Question 17

How do the kidneys move during breathing?

Answer 17

Move inferiorly on inspiration and superiorly on expiration

Question 18

How would you ballot the right kidney?

Answer 18

Palpate posteriorly within the right flank just below rib 12

Palpate anteriorly within the RUQ

Question 19

How does breathing aid balloting the kidneys?

Answer 19

As the patient breathes in the kidneys descend and may be trapped for examination between the palpating hands

Question 20

What structures is the right kidney posterior to?

Answer 20

Liver, hepatorenal recess, second part of the duodenum, right colic flexure, ascending colon

Question 21

What structures is the left kidney posterior to?

Answer 21

Stomach, tail of the pancreas, hilum of the spleen, splenic vessels

Question 22

What is significant about the hepatorenal recess?

Answer 22

One of the lowest dependent parts of the greater sac of the peritoneal cavity in the supine patient

Question 23

What are the renal veins anterior to?

Answer 23

The renal arteries

Question 24

What are the common iliac arteries anterior to?

Answer 24

Common iliac veins

Question 25

Where does lymph from the kidneys drain to?

Answer 25

The lumbar nodes = located around the abdominal aorta and the IVC

Question 26

Where does the abdominal aorta bifurcate?

Answer 26

At the level of the umbilicus

Question 27

What vessels give branches to supply the ureter?

Answer 27

Renal artery, abdominal aorta, common iliac artery, internal iliac artery, vesical artery

Question 28

Where does lymph from the ureters drain to?

Answer 28

Lumbar nodes | Iliac nodes = located around the common, internal and external arteries

Question 29

What are the characteristics of renal stenosis when it is associated with AAA?

Answer 29

Combined with infra-renal AAA = both caused by atherosclerosis Due to supra-renal occlusion = occlusion of proximal renal artery by the aneurysm

Question 30

What are some anatomical variations that exists in the upper urinary tract?

Answer 30

Bifid renal pelvis, bifid ureter and unilateral duplicated ureter, horseshoe kidney, retrocaval ureter, ectopic pelvic kidney

Question 31

What are some causes of a solitary kidney?

Answer 31

Agenesis, nephrectomy (pathology-driven or donation)

Question 32

What does each kidney consist of?

Answer 32

An outer cortex and inner medulla

Question 33

What does the medulla of the kidney contain?

Answer 33

Renal pyramids = each pyramid contains around 50,000 nephrons

Question 34

What gives the renal pyramids their striped appearance?

Answer 34

Nephrons run axially towards the apex of each pyramid

Question 35

What route does urine drain through the kidney via?

Answer 35

Nephron collecting duct - minor calyx - major calyx - renal pelvis - ureter

Question 36

What happens to the diameter of the urine drainage tubes at the pelviureteric junction?

Answer 36

The diameter increases = the wider renal pelvis becomes the narrower ureter

Question 37

Where are the sites of ureteric constriction?

Answer 37

Pelviureteric junction Ureter crossing anterior aspect of common iliac artery (often crosses bifurcation) Ureteric orifice

Question 38

What is the ureteric orifice?

Answer 38

Opening into one corner of the trigone on the floor of the bladder

Question 39

What are renal calculi?

Answer 39

Kidney stones = usually visible on x-ray

Question 40

What are filling defects in the kidney suggestive of?

Answer 40

Renal calculi

Question 41

What are renal calculi formed from?

Answer 41

Urine calcium salts = may obstruct the urinary tract

Question 42

What can cause obstruction of the ureter?

Answer 42

Internal obstruction = impacted renal stone, blood clot | External compression = expanding mass (tumour)

Question 43

What is in the walls of the ureter?

Answer 43

Smooth muscle

Question 44

How does the urinary tract respond to obstruction?

Answer 44

Increased peristalsis proximal to the site of the obstruction in an attempt to flush the obstruction into the bladder

Question 45

What kind of pain to patients with urinary tract obstruction present with?

Answer 45

Colicky pain = due to the fact that peristalsis comes in waves

Question 46

What do obstructions cause?

Answer 46

Back up of urine in the tract towards the kidneys

Question 47

What do obstructions in the calyces or ureter cause?

Answer 47

Unilateral back pressure of urine

Question 48

What do obstructions within the bladder cause?

Answer 48

Unilateral or bilateral kidney problems

Question 49

What do obstructions in the urethra cause?

Answer 49

Bilateral kidney problems

Question 50

How does obstruction of the urinary tract affect urine production?

Answer 50

Urine production continues until the pressure within the urinary tract exceeds the pressures favouring filtration at the glomerulus

Question 51

What is renal failure?

Answer 51

Failure to adequately filter blood to produce urine

Question 52

What is hydronephrosis?

Answer 52

Water inside the kidneys

Question 53

What can hydronephrosis lead to?

Answer 53

Renal failure = due to urine back pressure into the calyces compresses the nephrons within the medullary pyramids

Question 54

What does acute hydronephrosis cause?

Answer 54

Painful stretching of the renal capsule