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Flashcards in Kidneys Deck (337)
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Name some anatomical relations of the kidneys

Suprarenal glands
Liver
Transverse mesocolon
Jejunum
Stomach
Spleen
Pancreas
2nd part duodenum
Costodiaphragmatic recess
Quadratus lumborum
Psoas major
12th rib

1

Describe the surface anatomy of the kidneys

Between vertebral levels T11-L2/3, the right is lower and the hila sit around L1
Sit under 12th rib with the left under 11th & 12th rib

2

What is the renal angle?

Between 12th rib and lateral border of vertebral column extensor muscles

3

Describe the surface anatomy of the ureters

Run vertically inferior to pelvic cavity; follow tips of lumbar vertebrae
transverse processes

4

What protective layers cover the kidneys?

Perinephric fat
Renal fascia
Paranephric fat
Psoas fascia

5

Renal fascia is loose & kidneys can move with body position. What occurs if they move too much? And what can be a sign of this?

Nephroptosis
Blood in urine when running

6

What tissue type do kidneys derive from?

Metanephros - mesoderm
Ureteric bud

7

What can happen if the ureteric bud develops abnormally?

Bifid Ureter
Duplicated ureter
Absent

8

During what time frame do the kidneys ascend to their adult position?

Week 6-9
Start in pelvic cavity
Migrate superiorly
Receive new blood supply as they move upwards and take the ureters with them

9

What is a pelvic kidney?

One kidney never migrates and so remains in the pelvic cavity
If there is no impingement then it doesn't matter

10

What is a horseshoe kidney?

Two kidneys fused and not ascended. Gets stuck on IMA, can block it so ischemic bowel

11

What is a polar renal artery?

Artery not running into hilum. Squash ureter so renal pelvis enlarges

12

What is the allantois?

Passes from cloaca to umbilicus

13

What is the adult remnant of the allantois?

Urachus

14

Name 3 remnants of the allantois that can cause clinical problems

Urachal fistula/patent - urine can leak out
Urachal cyst - can get infected
Urachal sinus - blind ended tract from umbilicus, cheesy discharge

15

Describe the blood supply to the kidneys

Renal arteries at L1/2 (listen for bruits)
Run posterior to renal vein & IVC
Segmental supply (4/5 end arteries)

16

Describe venous drainage of the kidneys

Right renal vein directly join IVC
Left veins receive gonadal & suprarenal veins
Left renal vein runs under SMA to join IVC

17

Describe nerve supply to the supra renal glands

Preganglionic sympathetic fibres (T10-L1)
Synapse directly with chromaffin cells in medulla

18

What arteries do the ureters receive blood supply from?

Renal
Gonadal
Aortic
Internal iliac
Vesical/prostatic

19

Which direction should the ureters be displaced in order to prevent disrupting their blood supply?

Displace ureter medially in abdo cavity
Displace ureter laterally in pelvic cavity

20

What pain pattern occurs with renal calculi?

Shifting loin to groin pain T12-L1/2

21

What is the main differential concern for an elderly patient presenting with presumed left sided renal colic?

Dissecting aortic aneurysm

22

What are potential sites for stones?

Renal tract (urolithiasis)
Gallbladder/biliary tree (cholelithiasis)
Salivary glands (sialolithiasis)
Appendix (faecolith)
Prostate
Veins (phleboliths)

23

How do stones form?

Increased concentration of solutes causing supersaturated solution
Stasis
Infection

24

What effects can stones have?

Block ducts: colic, jaundice, renal failure
Chronic inflammation: Cholecystits, cystitis, sialadenitis
Infection

25

Describe salivary stones

Occur more in females
Usually Wharton’s duct
Pain and swelling of gland
Idiopathic, infection, drugs
Remove stone – open/endoscopic

26

Describe gallstones

Common (10%), more in females
GB stores & concentrates bile
Most stones cholesterol based due to high fat diets/hypercholesterolaemia
Pigment stones found in haemolytic disorders (high serum bilirubin)
Ratio of cholesterol:bile salts & lecithin

27

How do gallstones present?

Asymptomatic
Abdominal pain
Jaundice
Fever

28

How do you investigate gallstones?

Bloods – LFT, amylase
USS
ERCP (endoscopic retrograde cholangio pancreatography)/MRCP

29

Describe what factors can affect the likelihood of developing renal stones

Common (10%) Males > females
Varies with geography/climate
Age, Peak onset 20-30
Fluid intake, Family history, Affluence/diet/BMI