L16 – Anatomy of the Kidneys, Ureters and Urinary Bladder

Question 1

Where are the kidneys located?

Answer 1

Retroperitoneum= posterior to parietal peritoneum

Upper border= T12
Lower border = L3

Question 2

What 2 types of nodes are for draining the posterior abdominal wall?

Answer 2

Pre-aortic nodes

Lateral aortic nodes

Question 3

Which nodes drain lymph from kidneys, supraadrenal glands, testes, ovaries? What does the efferent lymph of these nodes form?

Answer 3

Lateral aortic nodes: common iliac nodes

Efferent lymph forms right and left lumbar trunk

Question 4

What does the lateral lumbar trunk drain into until BCV?

Answer 4

lumbar/ para-aortic nodes+ lateral Aortic nodes > cisterna chyli > thoracic duct > BCV

Question 5

Where does the blood supply of kidney comes from?

Answer 5

Renal A/V arise from abdominal aorta

Question 6

What is the consequence of the location of the inferior vena cava on the length of renal veins?

Answer 6

Left renal vein is longer than right renal vein because inferior VC is located off to the right

Question 7

What is the nerve supply of the kidney?

Answer 7

Renal plexus, autonomic nerves

Consists of T12 (sympathetic) and Vagus (parasympathetic)

Question 8

Why is the right kidney at a slightly different level to the Left?

Answer 8

Due to right lobe of liver being lower

Right kidney is lower than left

Question 9

What is the order of the coverings of the kidney?

Answer 9

(From most outer)

Pararenal fat
Renal fascia
Perirenal fat
Fibrous capsule

Question 10

What is the role of kidney coverings?

Answer 10

Hold in position, structure

Question 11

Where are renal tubules located (Loop of Henle and Collecting duct)? (not including juxtamedullary nephrons)

Answer 11

In the pyramids in renal medulla

Question 12

What are the two layers of the kidney responsible for filtration?

Answer 12

Cortex and Medulla

Question 13

How do the pyramids connect to major calyxes?

Answer 13

Pyramid > Renal papilla > minor calyx > major calyx

Question 14

What structures are found in the hilum of kidney?

Answer 14

Renal A
Renal V
Renal Pelvis

Question 15

How does the minor calyx connect with the bladder?

Answer 15

Minor calyx > Major calyx > Renal pelvis > Uroteropelvic junction > ureter

Question 16

What are the two parts of the gland over the kidneys?

Answer 16

Supraadrenal glands

Adrenal cortex (outer) and Adrenal medulla (inner)

Question 17

What are the functional role differences between renal medulla and renal cortex?

Answer 17

Cortex = filtration role

Medulla = urine concentration role

Question 18

What structures are found in the renal cortex?

Answer 18

parts of juxtamedullary nephron and cortical nephron

Question 19

Where do renal veins drain?

Answer 19

At level of L2, drain into Inferior VC

Question 20

What is located anterior to right kidney?

Answer 20

2nd descending part of duodenum

Question 21

What is antero-lateral to right kidney?

Answer 21

Right Colic Fissure

Question 22

What is inferior to right kidney?

Answer 22

Small intestines

Question 23

Inferior to L. kidney?

Answer 23

Jejunum

Question 24

What is anterolateral to left kidney?

Answer 24

Descending colon

Question 25

What is anterior to left kidney? (4)

Answer 25

Stomach Spleen Pancreas Left colic fissure

Question 26

What muscle is posterior to kidney?

Answer 26

Quadratus Lumborum muscle

Question 27

Suprarenal glands. Artery supplies?

Answer 27

3 artery supplies: Superior: Branch of Inferior phrenic artery (from abdominal aorta) Middle: Branch of abdominal aorta Inferior: Branch of Renal artery

Question 28

Veins of suprarenal glands?

Answer 28

Right= inferior VC Left = Left renal vein

Question 29

Nerves of suprarenal glands?

Answer 29

Sympathetic only T5-T9

Question 30

Lymphatic drainage of suprarenal glands?

Answer 30

Lateral aortic/ lumbar nodes

Question 31

Ureter has three physiological narrowings. Name each in sequence.

Answer 31

Uretopelvic junction (where renal pelvis joins ureter) When ureters cross pelvic inlet Uretovesical junction/ entrance to bladder

Question 32

Why condition is common at the physiological narrowings of the ureter?

Answer 32

obstruction due to uretero stones Severe nonspecific pain when ureter smooth muscle contracts

Question 33

Ureter blood supply divided into three parts. Name each?

Answer 33

Upper = renal A/V Middle= Gonadal A/V Pelvic= Vesical A/V

Question 34

What are the nerve supplies of ureter?

Answer 34

Renal, testicular and hypogastric plexuses

Question 35

What is the lymphatic drainage of ureters?

Answer 35

Lateral Aortic/ lumbar nodes

Question 36

What is the difference in the gonadal A/V supplying middle ureter between two genders?

Answer 36

Male = testicular A/V Female= ovarian A/V

Question 37

Where does vescial A/V supplying pelvic (lower) ureter come from?

Answer 37

From internal iliac artery branching from aorta

Question 38

What structure lies adjacent to ureter in male and female?

Answer 38

Male = Ductus deferens anterior to ureter Female = uterine arteries is anterior

Question 39

During a surgical removal of uterus, what may be accidentally ligated?

Answer 39

The ureter instead of the uterine artery Cause no renal output and enlargement of abdomen

Question 40

What are the three components to the pelvic inlet?

Answer 40

Margin of Ala -formed by S1 bone, up to sarco-iliac joint Promontory (body) -formed by protrusion of S1 bone Linea terminalis

Question 41

What forms Linea terminalis ? (3) (PPA)

Answer 41

From medial to lateral: Pubic crest Pecten pubis Arcuate line

Question 42

What is the clinical significance of the Pelvic inlet?

Answer 42

Important for determining the first stage of labour Fetal distress if inlet is too small and fetus forces into pelvis

Question 43

What are the three bones that form the Pelvis?

Answer 43

Ilium Ischium Pubis

Question 44

Where do the three pelvic bones join?

Answer 44

Acetabulum, head of femur is located there

Question 45

Diagonal conjugate vs Obstetrical conjugate How are they measured?

Answer 45

Obstetrical conjugate / true conjugate only measured by X-ray = 11.5cm Diagonal conjugate > 11.5cm, indirect measurement, ultrasound

Question 46

Which two muscles are attached to the lateral rotator of hip joint?

Answer 46

Piriformis muscle on lateral wall Obturtator intermus muscle

Question 47

What VAN supplies the adductor muscles of the thigh?

Answer 47

Obturator VAN that passes through obturator canal at the medial side of thigh

Question 48

What two ligaments attached to the lateral rotator of hip joint?

Answer 48

Sacrospinous and Sacrotuberous ligaments

Question 49

What are the components of the Pelvic outlet?

Answer 49

Ischial tuberosity Pubic symphysis Ischiopubic ramus Sacrotuberous ligament Coccyx

Question 50

How is diagonal conjugate measured?

Answer 50

Mesaure tip of S1 to lower border of pubic bone

Question 51

How is Obstetrical/ True conjugate measured?

Answer 51

Only by X-ray | Actural Anterior-Posterior diameter

Question 52

How does common iliac artery branch?

Answer 52

Into internal and external iliac arteries

Question 53

How does Internal iliac artery further subdivide? posterior ll ls sg

Answer 53

Anterior and Posterior divisions Posterior is closer to spine, further divides into: Iliolumbar, Lateral sacral and superior gluteal arteries

Question 54

How does sacral arteries differ in origin?

Answer 54

Lateral sacral artery is from: Posterior division on internal iliac artery from common iliac artery Medial sacral artery is from: Abdominal aorta

Question 55

What are the three divisions of one of the branches of posterior division of internal iliac artery?

Answer 55

Iliolumbar artery branches into iliac, lumbar and spinal branch

Question 56

The ANTERIOR division of internal iliac artery branches into which arteries? Umb Ob Ves IG MR IP V Uter MR IP V V U U IG Ob MR. IP's VERY, VERY OBSESSED with Ur 2 IGs

Answer 56

Umbilical artery Obturator artery Superior and Inferior vesical artery Inferior gluteal (vs superior gluteal in POSTERIOR) Middle Rectal artery Internal Pudendal artery Vaginal artery Uterine Artery

Question 57

What does the umbilical artery supply?

Answer 57

Bladder

Question 58

What artery supplies the external genitalia?

Answer 58

Internal pudendal artery Male= dorsal artery of penis Female = clitoris

Question 59

What does the inferior vesical artery supply?

Answer 59

Ureter and bladder same as supeior vesical artery

Question 60

What is anterior to the bladder?

Answer 60

pubic symphysis

Question 61

What procedure is done to drain the bladder?

Answer 61

Suprapubic aspiration Puncture needle above symphysis pubis to drain the bladder

Question 62

What things are posterior to the bladder?

Answer 62

Sacrum Sacral nerves Male= rectum Female= rectum and uterus

Question 63

What is in the wall of the bladder?

Answer 63

Detrussor muscle

Question 64

What is the difference in epithelium in the bladder wall?

Answer 64

Internal = transitional epithelium External, superior outer portion = serous (parietal) peritoneal layer

Question 65

What part of he bladder is covered by peritoneum?

Answer 65

Only superior portion

Question 66

The peritoneum can reflect/fold in two ways in male and female. How?

Answer 66

Female= Vesico-uterine pouch, space between bladder and uterus Male= Recto-vesical pouch, space between bladder and rectum

Question 67

What is the sphincter on bladder and what nerve supplies this sphincter?

Answer 67

Sphincter vesicae Supplied by autonomic NS

Question 68

How is the sphincter fixed in male and female?

Answer 68

Male= Pubo-prostatic ligament Female= Pubo-vesical ligament

Question 69

What supports the bladder? ***

Answer 69

Urogenital diaphragm (perineal muscle) Pelvic fascia (inferior) Medial umbilical ligament (posterior) Median umblilical ligament (from Urachus, anterior)

Question 70

Trigone is where in bladder?

Answer 70

Triangular area at base of bladder Lies between urethral orifice and 2 ureteric orifices

Question 71

How is the lining of the Trigone different?

Answer 71

Smooth lining

Question 72

Where is the ureteral fold?

Answer 72

on the superior border of trigone

Question 73

What is the blood supply off the bladder?

Answer 73

Superior and inferior vesical A/V

Question 74

What is the nerve supply of the bladder?

Answer 74

hypogastric plexus Sympathetic L1-L2 Parasympathetic S2-S4

Question 75

What procedure is done to extract urethral stone?

Answer 75

Transurethral cytoscopy

Question 76

Bladder lymphatic drainage?

Answer 76

Internal and external iliac nodes

Question 77

What structure is found anterior to bladder in male and female?

Answer 77

Male = ductus deferens, seminal vesicle Female= uterine artery

Question 78

What is the urogenital diaphragm formed by?

Answer 78

Deep transverse perineal body Supports bladder and prostate

Question 79

How can the male urethra be divided anatomically? (not like in embryology)

Answer 79

Preprostatic part Prostatic part Membranous part Spongy part

Question 80

Which of the two umbilical ligaments attached to the bladder is more anterior?

Answer 80

MEDIAN

Question 81

What is the structure at the tip of the male urethra?

Answer 81

Navicular Fossa