Flashcards in Renal and Urinary Anatomy Deck (48):
What is the renal angle?
Between the junction of the 12th rib and the lateral border of the erector spinae muscle
Where is the hepatorenal recess?
Just in front of the kidney in a space just behind the liver
To which ribs does the diaphragm attach?
11 and 12
To which abdominal muscles do the kidneys lie anterior?
Psoas major, quadratic lumborum and transversus abdominis
Which nerves do the kidneys lie anterior to?
Subcostal (T12), iliohypogastric and ilioinguinal nerves (L1)
What is another name for the renal fascia?
Are the kidneys intra or retro-peritoneal?
Intraperitoneal and therefore can move
Describe the fat and fascia that encompasses the kidneys
The kidney is surrounded by a renal capsule; this renal capsule contains peritoneal fat anteriorly and the renal (Gerota's) fascia posteriorly. There is also pararenal fat that is present anteriorly and lateral to the kidney
What is the renal capsule?
The layer that surrounds the kidney surface, which contains peritoneal fat and renal fascia
Where does the renal artery pass in relation to the inferior vena cava (IVC)?
The renal artery passes behind the inferior vena cava
At what level does the renal artery arise?
At what level do the renal veins arise?
L2, anterior to the aorta
Which structures have venous drainage into the left renal vein?
Left suprarenal veins and the left gonadal veins
How does the length of the left renal vein differ from the right?
The left renal vein is much longer as the right renal vein drains directly into the IVC.
Where does the lymphatic fluid from the kidneys drain?
Into the lateral aortic lymph nodes
What provides the nerve supply to the kidney?
The renal plexus
Describe the renal plexus of nerves
The renal plexus contains sympathetic visceral afferents from the thoracic and lumbar splanchnic nerves from T10-T12
Why may an individual have a sensation of pain over the small of the back or the flanks due to AKI?
The renal plexus supplies sympathetic afferents from the level of T10-T12 and therefore if damage occurs, this will be relayed to the dermatomes of T10-T12 which is usually the small of the back or flanks
Are the ureters retro or intra-peritoneal?
The ureters are retroperitoneal
At what point do the ureters begin to curve inwards towards the bladder?
When they reach the level of the ischial spine
What are the three layers of the ureteric wall?
1) transitional epithelia (mucosa)
2) smooth muscle (muscular)
3) fibrous connective tissue (adventitia)
What is the nerve supply to the ureters?
Sensory innervation from the visceral afferents enter from T11-L2:
If pain is acknowledged in the upper part of the ureter then this causes 'loin pain' which is referred by the ilioinguinal and iliohypogastric nerves (L1)
If the pain is acknowledged lower down in the ureter then the patient will feel 'groin pain' as the pain is now referred via the genitofemoral nerve (L1,L2) instead and therefore goes to groin dermatomes
What is meant by 'loin and groin' pain in ureteric stones?
If there is a ureteric stone in the superior portion of the ureter this will stimulate iliohypogastric and ilioinguinal nerves which will refer this pain to the L1 dermatome which signifies groin pain
If the stone moves down and irritates the inferior portion of the ureter, this will stimulate the genitofemoral nerve instead which stimulates the L1,L2 dermatome which causes referred pain to the groin dermatomes
Is the urinary bladder intra- or retro-peritoneal?
It is retroperitoneal
Describe the location of the urinary bladder
It is located on the pelvic floor, posterior to the pubic symphysis
How is the urinary bladder connected to the umbilicus?
Via the median umbilical ligament (urachus)
What are the three layers of the bladder wall?
1) Mucosa - transitional epithelia
2) Muscular - thick muscular layer
3) Adventitia - fibrous tissue
What is the trigone? What is it's clinical importance?
This is the triangular area outlined by the openings for ureters (two of them) and the urethra (one of these) and it is clinically important because infections tend to persist in this region of the bladder.
Describe the location and anatomical relations of the female urethra
The urethra is tightly bound to the anterior vaginal wall (posterior to the clitoris, anterior to the vaginal wall)
Name the four different sections of the male urethra
Intramural (pre-prostatic), prostatic, membranous and spongy urethra
What is the pre-prostatic/intramural urethra?
The aspect of the urethra before the prostate, and the length of this section depends upon the extent of bladder filling
What is the prostatic urethra?
This part of the urethra contains the ejaculatory ducts stemming from the seminal vesicle
What is the membranous (intermediate) urethra?
This part of the urethra penetrates the perineal membrane and is surrounded by the external urethral sphincter
What is the spongy urethra?
This is the final part of the urethra and it is found in the corpus spongiosum of the penis
What is the role of the internal urethral sphincter in males?
An involuntary sphincter at the bladder-urethra junction which prevents retrograde ejaculation
What is the main voluntary urethral sphincter in females?
Levator ani muscle (pelvic floor)
Why, in kidney trauma, does blood remain contained to one side?
The renal fascia blends with the fascia of the great vessels which means that the left and right kidneys are entirely discrete from each other.
What is a common site of secondary metastasis of testicular cancer?
The kidneys, due to embryological connections
What is a varicocele?
The distention of the pampniform plexus of veins that drain the testes into the gonadal veins
Why is a varicocele more likely to occur on the left side than the right?
The left pampniform plexus of veins has to drain into the left testicular vein, then up to the left renal artery before entering the IVC whereas the right pampniform plexus drains into the right gonadal vein and directly into the IVC
Why may kidney stone/renal calculi pain occur in waves?
Due to the peristaltic contraction of the ureters causing the movement of the stone
What are the three most common locations for ureteric stone lodgement?
- Between the renal pelvis and the ureter
- Crossing of the ureter over the iliac blood vessels
- At the entrance of the ureter into the bladder
Where does the ureter lie in relation to the uterine artery in women?
The ureter lies just behind (posterior) to the uterine artery
How may hydronephrosis occur as a result of a complication of a hysterectomy?
As the ureter passes just posterior to the uterine artery, in these forms of intimate surgery, accidental damage to the ureter may occur; a lesion to the ureter will mean that there will be an inability for the renal fluid to drain away, leading to build-up and hydronephrosis
Where is bladder pain often referred? What may this suggest?
To the back, and this may suggest bladder cancer
How may a large urinary bladder calculi lead to penile pain in males?
As the stone settles at the ureteric orifice, the stone will lead to the stimulation of visceral afferents which travel in the parasympathetic nerves to the sacral region of the spinal cord and subsequently to the S3 dermatome which is located on the posterior aspect of the penis.
How may faecal compaction lead to oliguria?
Due to extreme constipation (drug-induced) the compacted faeces put pressure on the urethra or the ureter and prevent the passage of urine in the patient.