Flashcards in Kidneys, Ureters and Suprarenal Glands Deck (41):
What is the location of the kidneys
Against post. abd. wall - in paravertebral gutter
Sup. pole of right kidney and inf. part of hilum of left kidney are at the transpyloric plane (L1)
Left kidney is narrower and longer and closer to midline
What is the size of the kidney
Antero-posterior length: 3cm
150g in males. 135g in females
What are the surfaces and borders of the kidney
Superior and Inferior poles
Lateral and medial border (medial has hilum)
Anterior and POsterior Surfaces (Anterior against ant. abd. wall)
What is the organisation of structures coming out of the hilum of the kidney
VAP in an anterio-posterior direction
AVP in superior-inferior direction
How does the kidney lie in relation to the peritoneum
What are the anterior relations of the left and right kidney from superior to inferior for each
Right Kidney: (sup to inf)
-Rt. colic flexure
Left Kidney: (sup to inf)
-Colon and Left Colic Flexure
What are the posterior relations of both the left and right kidney
(med to lat)
-Psoas major m.
-Quadratus Lumborum m.
-Transversus Abdominus m.
Right: Same except that not the XI'th rib
Where does the Renal Fascia originate?
From the Subserous Extraperitoneal Fascia
What does the Renal Fascia split into and what does each part cover?
-Continues over renal vessels and aorta to join opposite layer
-Anterior to Transversalis Fascia which is on Quadratus Lumborum and Psoas Major
-Continues to join opposite layer
Where does the Peri-renal (perinephric) fat lie?
Between surface of kidney capsule and renal fascia. This is the Space of Gerota.
Where does the Para-renal (paranephric) fat lie?
Posterior to Renal Fascia.
More extensive and fibrous in new-borns than adults.
How many medullary pyramids does the cortex of the kidney have?
Explain urine drainage in kidney
Major Calyces (2-3 Minor Calyces)
What is the function of the renal columns
To support the renal vessels and tubules
What is the blood supply to the kidneys? Where does it originate
Originate at the Abdominal Aorta at L1 and/or L2
What are the relations of the Left and Right Renal arteries
-Post. to renal vein
-post. to pancreatic body
-post. to splenic vein
-IVC crosses the left RA anteriorly
-Longer than left RA
-Post to IVC
-Post to renal vein
-Post to head of pancreas
-Post to descending duodenum
Where do the renal veins drain into?
What are the relations of the left renal vein? What is this significance?
Crosses anterior to Aorta and posterior to SMA
Opens into IVC above the right vein
What are the tributaries of the Left and Right Renal Veins?
-Left Inferior Phrenic v
-Left Testicular (or ovarian) v
-left Suprarenal V
-No extra-renal tributaries
What are the 5 segmental arteries branching off from each Renal Artery
What is the lymphatic drainage of the kidneys
Lateral aortic lymph nodes
What is the innervation of the kidneys
Renal plexus (arising from the celiac plexus
What is the significance of the SMA with the rising of the kidneys during embryological development?
If kidneys dont separate properly, the kidneys can be prevented from rising due to the SMA origin stopping it
How long are the suprarenal glands?
How do the left and right suprarenal glands vary in position?
Right one is close to IVC, left is away from aorta
What are the relations of the suprarenal glands
Related to superior pole of kidneys
Lower part of left gland is covered by pancreas, upper is related to stomach
Greater part of right gland is related to caudate lobe of liver and the superior recess of omental bursa
What is the arterial supply to the suprarenal glands
Superior suprarenal artery (from Inferior Phrenic Artery)
Middle suprarenal artery (from Aorta @L1)
Inferior suprarenal artery (from Renal Artery)
What is the venous drainage of the suprarenal glands
-Directly into IVC
-Left Renal Vein and then into IVC
What is the size of the ureters
3mm in diameter
What is the origin of the ureters
Renal pelvis (at level of L1)
What is the relationship of the ureters to the peritoneum
Retroperitoneal in its enitre course
What are the relations (crossings) of the ureters
Crossed by vas deferns in males.
Crossed by uterine artery in females
What are the clinical implications of the ureters during surgery
Can be damaged as they are closely adhered to the posterior abdominal wall.
Uterine Artery runs close so many surgeons clamp the ureter by mistake instead
What are the relations of the ureter in the pelvic cavity in males
Ant to interal iliac artery
Medial to Obturator, Inferior vesical and Middle rectal arteries
At lower part of sciatic notch, turns to reach the lateral angle of the urinary bladder
Anterior to seminal vesicles but crossed above and anteriorly from lateral to medial by the vas deferens
What are the relations of the ureter in the pelvic cavity in females
Anterior to internal iliac artery
Posterior boundary of ovarian fossa
Related to uterine artery at medial part of broad ligament. The uterine artery lies superior and crosses the ureter anteriorly on the medial side
Ureter runs medially and anteriorly on lateral aspect of cervix of uterus and upper vagina
Where are the three ureteric constrictions
At the Ureteropelvic junction. Here, the renal pelvis narrows to form ureter.
At the pelvic brim as it crosses the common iliac vessels
At the Ureterovesical Junction. Here is enters the bladder
What is the arterial supply of the ureters
Ureteric Branches From
-Renal Artery (proximal end)
-Gonadal Artery (at intermediate part)
-Int. Iliac A (sup. and Inf. Vesical branches --- at the distal part)
What is the venous drainage of the ureters
Same as arterial supply
What is the Lymphatic drainage of the ureters
Lumbar LN (superior)
Iliac LN (middle)
Internal Iliac LN (inferior)
What is the nerve supply of the ureters
-Lesser and Lower splanchnic nerves
-Superior and |nferior Mesenteric plexuses