Anatomy Topic 4 Case 6

Question 1

Are the kidneys intra- or retroperitoneal?

Answer 1

• Retroperitoneal

Question 2

Between which vertebral levels do the kidneys extent between?

Answer 2

• T12 to L3

Question 3

Which kidney is slightly lower and why?

Answer 3

• Right kidney

- Because of its relationship to the liver

Question 4

Which kidney is longer and more slender?

Answer 4

• Left kidney

Question 5

Which kidney is closer to the midline?

Answer 5

• Left kidney

Question 6

For each part of the right kidney, identify the structure that it is related to:

[A] Superior pole

[B] Upper part

[C] Medially

[D] Inferior pole

Answer 6

• [B] Liver
• [C] Descending part of duodenum
• [D] Right colic flexure

Question 7

For each part of the left kidney, identify the structure that it is related to:

[A] Superior pole

[B] Upper part

[C] Inferiorly

[D] Laterally

[E] Medially

Answer 7

• [A] Left suprarenal gland
• [B] Stomach and spleen
• [C] Pancreas
• [D] Left colic flexure
• [E] Jejunum

Question 8

Identify the structures that the posterior surfaces of the right and left kidney relate to

Answer 8

• Diaphragm superiorly

- Psoas major, quadratus lumborum and transversus abdominis

Question 9

The superior pole of the right kidney is anterior to rib [A] while the same region of the left kidney is anterior to rib [B]

Answer 9

• [A] 12

- [B] 11

Question 10

Describe the arrangement of renal fat and fascia

Answer 10

• Kidney is encircled by perinephric fat
• Which is enclosed within the renal fascia
• Outside of which is paranephric fat, mainly posterolateral to each kidney

Question 11

What is the hilum of the kidney?

Answer 11

• Located medially

- Point at which renal vessels, lymphatics and nerves enter and leave the kidney

Question 12

Identify the two main parts of the kidney

Answer 12

• Outer renal cortex

- Inner renal medulla

Question 13

What are the renal columns?

Answer 13

• Extensions of the renal cortex that project into the inner aspect of the kidney
• And divide the medulla into triangular shaped renal pyramids

Question 14

What is the renal papilla? What surrounds it?

Answer 14

• Apical projections of renal pyramids

- Which are surrounded by minor calices

Question 15

What is a renal sinus?

Answer 15

• Cavity within the kidney
• Where minor calices unite
• To form a major calyx

Question 16

What is the renal pelvis formed od?

Answer 16

• Two or three major calices that unite

Question 17

Where do the renal arteries branch from the abdominal aorta?

Answer 17

• Laterally
• Just inferior to the origin of the superior mesenteric artery
• Between L1 and L2

Question 18

Describe the branches of each renal artery

Answer 18

• Renal artery divides into segmental arteries that enter the hilum
• Which give off lobar arteries, one for each pyramid
• Which give off interlobar arteries on each side of pyramid
• Which give off arcuate arteries over the base of each pyramid
• Which give off interlobular artery that ascend in cortex
• Which give off afferent glomerular arterioles

Question 19

What is the clinical significnace of the left renal vein

Answer 19

• Crosses the midline anterior to abdominal aorta
• And posterior to superior mesenteric artery
• Can be compressed by either of these two vessels

Question 20

Identify the lymphatic drainage of the kidneys

Answer 20

• Lateral aortic (lumbar) nodes

- Around the origin of the renal artery

Question 21

Outline the innervation of the kidneys

Answer 21

• Aorticorenal ganglia

- Abdominal prevertebral ganglia

Question 22

Where is kidney pain referred to?

Answer 22

• Transmitted via least splanchnic nerve (T12)

- To flanks (lateral regions)

Question 23

What are ureters?

Answer 23

• Muscular tubes

- That transport urine from kidneys to bladder

Question 24

What are the ureters continuous with superiorly?

Answer 24

• Renal pelvis in the renal sinus

- At the ureteropelvic junction

Question 25

How is a renal pelvis formed?

Answer 25

- From condensation of two to three major calices

Question 26

The ureters descend retroperitoneally on the medial aspect of which muscle?

Answer 26

- Psoas major

Question 27

Which arteries do the ureters cross?

Answer 27

- Common iliac artery

Question 28

In the pelvis, the ureters cross the [A] in men and the [B] in women

Answer 28

- [A] Ductus deferens | - [B] Uterine artery

Question 29

Identify the three positions where the ureters become constricted. What is the clinical significance of these?

Answer 29

- Ureteropelvic junction - Where they cross the common iliac vessels - Where they enter the wall of the bladder - Kidney stones become lodged at these constrictions

Question 30

Outline the arterial supply of the ureters

Answer 30

- Upper end: Renal arteries - Middle part: Branches from abdominal aorta, testicular and ovarian arteries, common iliac arteries - Lower end: Internal iliac arteries - All of which divide into ascending and descending branches forming longitudinal anastomoses

Question 31

Outline the innervation of the ureters

Answer 31

- Renal, aortic, superior hypogastric and inferior hypogastric plexuses - Visceral afferents from sympathetic and parasympathetic fibres return to T11-L2

Question 32

What causes ureteric pain and where is it referred?

Answer 32

- Distension of ureter - T11 to L2 - Posterolateral abdominal wall - Pubic region - Scrotum in males - Labia majora in females - Anterior aspect of thigh

Question 33

How do the left and right suprarenal glands differ from one another?

Answer 33

- Right: Pyramidal and smaller | - Left: Semilunar and larger

Question 34

What is located anterior to the right suprarenal gland?

Answer 34

- Right lobe of the liver | - Inferior vena cava

Question 35

What is located anterior to the left suprarenal gland?

Answer 35

- Stomach - Pancreas - Spleen (on occasion)

Question 36

What layer of fat surrounds the suprarenal glands

Answer 36

- Perinephric fat | - Enclosed in renal fascia

Question 37

Outline the arterial supply of the suprarenal glands

Answer 37

- Superior suprarenal arteries from inferior phrenic arteries - Middle suprarenal arteries from abdominal aorta - Inferior suprarenal arteries from renal arteries