1 Flashcards
Describe the position of kidneys
- Left kidney has superior lobe right at 12th rib
- Right kidney has superior lobe just below 12th rib because of liver
- lower poles of kidneys are around L3-L4 vertebrae
- hylum is at around L1 where the ureter comes out
Describe the size of kidneys
- length: 9-14cm
- width: 6-7cm
- males have bigger kidneys than females
- if the difference in the size of kidneys is >2cm then it’s concerning
- if length of kidney is <8cm then also concerning
- each kidney weighs about 200g
What are the bony landmarks and anatomical position of the kidneys?
- Retroperitoneal
- Upper pole: T11-12 (L) and T12 (R)
- Lower pole: L2-L3 (L) and L3-L4 (R)
- Hilum: L1
What is the renal angle?
- area just between 12th rib and erector spinae muscle
- where you can palpate the kidney
- if pt. Has inflammation in and around the kidneys, then the renal angle would be tender
What does it mean to balate a kidney?
-to palpate the kidney
Why do the kidneys move up and down upon respiration?
- because they’re not attached to anything
- only fat and fascia anchor them down
What are the fascial layers of the kidney from out to in and describe them
- paranephric fat: external to the posterior layer of the renal fascia, extra peritoneal, associated with the lumbar region
- renal fascia (Garota’s fascia)
- perinephric fat: surrounds the kidney within renal fascial layers, continuous with the fat found in the renal sinus of the kidney
Describe the appearance of the ureter
- smooth muscle fibres that propel urine (peristaltic waves) to the urinary bladder
- ureter is 25-30cm long
- retroperitoneal
- located lateral to the tips of the transverse processes of the L-spine
- crossed by gonadal vessels
What are the 3 sections that the ureter is divided into at the pelviureteric junction (PUJ)?
- proximal (abdominal) segment
- middle (pelvic) segment
- distal (intramural) segment
What are the most common areas of ureteric injury?
- near the pelvic brim
- at the level of gonadal vessels
Describe the intramural segment of the ureter
- runs obliquely through the bladder wall (prevents urine reflux)
- near the bladder the ureter coalesces with bundles of destructor muscle in bladder wall
- no sphincter at the VUJ (vesicular uretile junction)
What substance is only found in the urinary system? Describe it
- urothelium
- continuous lining of the bladder, ureter and pelvis of kidney
- lines of smooth muscle around wall of ureter
- peristaltic tube
What are some positional changes of the ureter? Describe them
- retrocaval: when right ureter goes around IVC
- duplexed ureter (one not entering bladder): cause of urinary infection, if enters urethra then pt. Will constantly dribble urine
- duplexed ureter (both entering bladder): usually goes unnoticed
Describe the trigone.
- region in bladder which is connected by
- internal urethra entrance
- internal urethral meatus (exit point)
What is the muscle surrounding the bladder?
-detrusor muscle
What is the cavity superior to the bladder in males and females respectively?
- Males: recto-vesicle pouch
- Females: uterine-vesicle pouch
Why can’t you palpate an empty bladder?
- Because of the pubic symphysis in the way, empty bladder wont poke up above the symphysis
- if the bladder is full, then you can palpate