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Metabolism 2 > Renal anatomy > Flashcards

Renal anatomy Flashcards

1
Q

What makes up the kidneys and the urinary system

A
  • Kidneys & adrenal glands
  • Ureters
  • Urinary Bladder
  • Urethra
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2
Q

what is the main job of the kidney

A

maintain overall fluid balance

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3
Q

what do the kidneys do

A
  • Osomoregulation
  • Filter waste material
  • Produce urine
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4
Q

Where are the kidneys located

A

• Paravertebral gutters - this is the rounded expanse of the ribs as they go towards the spinal column

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5
Q

when can you palpate the kidneys

A

• Kidneys only palpable if enlarged or very low body fat

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6
Q

where and when can you palate the kidneys

A

• You can palpate them at the Renal Angle: Junction of 12th rib and lat border of erector spinae muscles
◦ In order to palate as them to inspirited this lowers the diaphragm and moves them down this allows you to palpate them

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7
Q

what is basically kidneys related to anteriorly

A
  • Anteriorly the kidneys are covered by extraperitoneal fat and peritoneum or other retroperitoneal structures such as the pancreas or duodenum
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8
Q

what are the right and left anterior relations of the kidney

A

• Right
– Liver
– Duodenum/sml intestine
– R. colic (hepatic) flexure

•	Left
–	Spleen
–	Stomach
–	Pancreas (body or tail)
–	L. colic (splenic) flexure
–	Sml intestine
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9
Q

what is harder to palpate the right or left kidney and why

A

◦ The left kidney is higher than the right so it is difficult to fill it unless it is really enlarged

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10
Q

what is between the liver and the kidney

A
  • between the liver and the kidney there is a gap

- this is called the hepatorenal recess (or Morrisons pouch)

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11
Q

what is morriosns pouch (hepatorenal recess)usually filled with

A

not usually filled with the fluid, usually empty

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12
Q

why would Morrisons pouch (hepatorenal recess) be filled with fluid

A
  • heamoperitoneum,
  • ascites,
  • pancreatitis
  • when the fluid builds up the lines of the organs become sharp
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13
Q

what are the posterior relations of the kidneys

A 
•	Diaphragm
–	11th & 12th rib
–	Costodiaphragmatic recess
•	Psoas m.
•	Quadratus lumborum m.
•	Transversus abdominis m.
•	T12 
     – subcostal n.
•	L1 
–	iliohypogastric n.
-       ilioinguinal n
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14
Q

what do the iliohypogastric and ilioinguinal nerve provide sensation to

A
  • they are anterior to the quadrates lumborum

- they give sensation to the front of the stomach and upper thigh region

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15
Q

what does the genitofemorla nerve give sensation to

A
  • the upper thigh
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16
Q

are the kidneys retorperiotenal or intraperitoneal

A

retroperitoneal

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17
Q

what are the layers of the kidney that protect it

A

1, has a capsule
2, perinephric/perineal fat
3, renal fascia
4, paranephric/pararenal fat

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18
Q

describe the layers of the kidney that protect it

A
  • Kidney has a capsule that surrounds it,
  • The kidney and the adrenal glands are covered within a layer of perinephric/perineal fat,
  • This is then protected by a fascial layer this is called the renal fascia
  • It also has paraneprhic fat/pararenal fat– another fatty layer,
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19
Q

where does the renal fascia go

A
  • – this is continuous with the transversalis fascia, and is continues towards the midline, and continuous inferior with the uterus as we go down towards the bladder and superior continuous up towards the diaphragm
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20
Q

where is the paranephric fat found

A

this is mostly found posterior and posterior laterally,

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21
Q

what are the gross external features of the kidney

A
  • Posterior – ureter is most posterior in the hilum

- Have a superior pole and inferior pole

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22
Q

what does the hilum of the kidney have in it

A
  • Renal artery
  • Renal vein
  • Ureter
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23
Q

what is the renal pelvis

A

– funnel shaped part of the ureter is called the renal pelvis, the renal pelvis leads into the ureter

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24
Q

what are the two layers of the kidney

A

cortex

medulla

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25
Q

describe the internal structure of the kidney and how drainage into the ureters happen

A
  • Some of the fibres extend down into the medulla region from the cortex, these are called the renal columns and this separates the medulla into the pryamida and triangular shaped areas called the renal pyramids
  • Renal medulla – at the apex of the pyramid there is the renal papilla
  • The renal papilla is where the urine is going to come into the renal pelvis into the ureter
  • This enters into the area called the minor calx
  • The minor calx drains into the major calx
  • A few major will drain into the renal pelvis and into the ureters
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26
Q

what does insufficient blood pressure result in

A
  • Insufficient blood pressure will result in less filtrate being produced (e.g. atherosclerosis of renal arteries/ heart failure, shock, dehydration
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27
Q

describe how blood goes through the glomuerli

A
  • Blood from arteries enters through the afferent arteriole
  • Goes into the glomeruli
  • Blood enters the efferent arteriole
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28
Q

what is the nephron

A

Functional unit of the kidney is the nephron

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29
Q

describe the renal artereis

A
  • These split form segmental arteries
  • Interlobar arteries
  • Arcuate arteries
  • Interlobular arteries in the cortex
  • Will then go into the nephron area – afferent arteriole, glomuerlus, efferent arteriole, peritiubular capillaeis/vasa recta,
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30
Q

describe the renal veins

A
  • Drain into the interlobular veins
  • Arcuate veins
  • Interlobar veins
  • Segmental veins
  • Renal vein
31
Q

where are the renal arteries and vein

A

L1 L2

- left is higher than that on the right

32
Q

what venous drainage is longer

A
  • left renal venous drainage
    • Left kidney eis longer in regards to venous drainage as the IVC is on the right of the abdominal aortal
  • Left renal vein travels under the superior mesenteric artery and anterior to the abdominal aorta before draining into the inferior vena cava
33
Q

name the nerve supply that make up the renal plexus

A
  • Sympathetic T10-L2
  • thoracic and lumbar splanchics
  • parasympathetic vagus
  • visceral afferent fibres T10-L2
34
Q

describe the the sympathetic nerve supply to the renal plexus

A
    • regulate the vascular tone and secretion of renin, they do not synapse in the symapethic chain and they bypass the ganglia in the sympathetic chain,
  • they will enter the superior mesenteric and colic ganglion and synapse here
35
Q

describe the visceral afferent supply to the renal plexus

A

• Visceral afferent fibres travel through the renal plexus enter T10-L2
– these will trace back into the spinal segments T10-T12 – receive input from the baroreceptors and chemoreceptors,
- it is these that can have referred pain

36
Q

describe the type of pain experienced in the kidneys

A

• Direct pain in region of kidneys.
- Referred pain can be in the flank/groin – referred pain in the groin think of the ureters and not so much the kidneys

37
Q

where does the lymphatic drainage of the kidneys drain into versus the ureter

A
  • Lymphatic drainage drain into the aortic node and lumbar nodes,
  • As the ureter is travelling towards the bladder they drain into the common iliac lymph nodes
38
Q

describe how the lymph nodes drain the kidney and end up in the thoracic duct

A
  • left lumbar lymph nodes
  • left lumbar trunk
  • cistern chyli
  • thoracic duct
39
Q

are the ureters retroperitoneal or intraperionteal

A

retroperitoneal

40
Q

what are the ureters made up of

A

smooth muscle - they are muscular tubes

41
Q

where do the ureters run

A
  • Run on lateral walls of pelvis

* Opposite ischial spine, curve anteromedially

42
Q

how do the ureters enter into the bladder and where do they enter into the bladder

A
  • Posterosuperior angles of the bladder

* Oblique entrance into bladder – one way flap valve, stop urine going back up

43
Q

what structures do the ureters pass over

A

1, pass over the pelvic brum, and where the common iliac splits into the external and internal iliac,
2, run over the pelvic walls in close proximity to the ischial spine,

44
Q

what is the tri-layered wall of the ureters

A

– Transitional epithelial mucosa
– Smooth muscle muscularis
– Fibrous connective tissue adventitia

45
Q

what is the function of the ureters

A
  • Ureters actively propel urine to the bladder via response to smooth muscle stretch
46
Q

what are the three constriction points of the ureters

A
  1. Renal pelvis
  2. Pelvic brim where the common iliac bifurcates
  3. Or where it enters the bladder
47
Q

A elderly man with a history of gout has a sudden onset of severe left flank pain. The pain comes in waves all night long. The pain begins to radiate into his groin and he then attends A&E. Urinalysis shows heamauturia. Imaging shows a large calculi at the level of the left common iliac .
explain the following:
1. Pain occurring in ‘waves’ 2. locationn of stone
3. Radiation of pain to groin

A
  1. Pain occurring in ‘waves’ – peristalsis – ureter is trying to pass urine and cant pass the urine
    1. Location of stone – pelvic brim where the common iliac bifurcates
    2. Radiation of pain to groin – kidney stones in the ureter – genitofemoral nerve causes the referred pain
48
Q

what is the ureters nerve supply

A

• Visceral afferents enter at spinal levels T11-L1/2

49
Q

why does pain change as kidney stones move down the ureters

A
  • The loin pain is referred along the ilioinguinal and the iliohypogastric nerves (L1). As the stone descends the patient may start to feel pain descend over the groin and scrotum/labium majora (“from loin to groin”)
  • This is because of the changing nerve segments and the pain is now referred through the genitofemoral nerve (L1,2)
50
Q

is the urinary bladder retroperiotenal or intraperiotneal

A

retroperitoneal

51
Q

what is the anatomical position of the bladder

A

on the pelvic floor posterior to the pubic symphysis

52
Q

what is the position of the bladder in children

A

lies higher up in children, the size of hips to bladder changes the position of the bladder and moves it higher up slightly

53
Q

what happens when the bladder is distended

A

when the bladder is in distension it expands up into the abdominal cavity

54
Q

what ligament holds the bladder in place

A
  • Medial umbilical ligament – this holds the bladder in place
55
Q

what is the trigone area of the bladder

A
  • On the posterior side of the bladder can see the ureters coming into the trigone area of the bladder
    = this is a triangular area that is outlined by openings for the ureters and urethra
56
Q

what is the origin of the urethra

A

neck of the bladder

57
Q

where does the urea end and start

A
  • This begins at the base of the bladder and ends with the external opening in the perinume – path differs siginifcantly between males and females
58
Q

what are the three layers of the bladder

A
  • Transitional epithelial mucosa
  • A thick muscular layer – called detrusor muscle
  • A fibrous adventitia
59
Q

why is the trigone important

A

• Trigone is Clinically important (infection) – paritucllar in females if the infection comes back up from the urethra

60
Q

why are females more likely to get urinary infections

A
  • because the urethra is shorter than in males
61
Q

what is the uthreea

A

• Muscular tube that:
– Drains urine from the bladder
– Conveys it out of the body

62
Q

what do sphincters do

A

• Sphincters keep the urethra closed when urine is not being passed

63
Q

is the internal or external sphincter voluntary

A
  • internal urethral sphincter in males is involuntary

- external urethra sphincter is voluntary

64
Q

describe the sphincters and where they are

A

– Internal urethral sphincter (males) – involuntary sphincter at the bladder-urethra junction
– External urethral sphincter – voluntary sphincter surrounding the urethra as it passes through the urogenital diaphragm
– Levator ani muscle – voluntary urethral sphincter

65
Q

what is a feature of the internal urethral sphincter in males

A

preventing retrograde ejaculation into the bladder

66
Q

what is the difference in internal sphincter in males and females

A
  • In males they have an anatomical internal urethra spincter – can see the sphincter and helps control the passage of urine,
  • in females there is a physiological internal sphincter
67
Q

what is the female urethra bound tightly to

A

• The female urethra is tightly bound to the anterior vaginal wall

68
Q

where does the female urethra lie

A

• Its external opening lies anterior to the vaginal opening and posterior to the clitoris

69
Q

name the 4 sections of the urethra in males

A
  • intramural
  • prostatic
  • intermediate (membranous)
  • spongy
70
Q

describe the 4 sections of the urethra in males

A

◦ Intramural (pre-prostatic)
 Length varies on bladder filling

◦ Prostatic
 Contains ejaculatory ducts

◦ Intermediate (membranous)
 Penetrates perineal membrane and becomes the membranous part – surrounded by the external ureathra sphincter
 Surrounded by external urethral sphincter

◦ Spongy
 Final part in corpus spongiosum of penis

71
Q

what is micturition

A

• The act of emptying the bladder

72
Q

describe the nerve control of micturition

A

• Sympathetic (hypogastric n; T12-L2)
– Stimulate contraction (closure) of the internal urethral sphincter
– Inhibit the detrusor muscle (prevents contraction and bladder emptying)

• Parasympathetic (S2-S4)
– Stimulate the detrusor muscle to contract
– Inhibits (opens) the internal urethral sphincters
• Somatic - external urethral sphincter (Pudendal n.S2-S4)

73
Q

what does the disunion of the bladder walls initiate

A

• Distension of bladder walls initiates spinal (visceral afferents)

74
Q

name the sympathetic nerve that supplies the bladder

A

hypogastric

Metabolism 2 (40 decks)

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