Anatomy Flashcards
What is the function of the kidneys?
filter blood, produce urine; hormone secretion (erythropoeitin, renin); calcitrol production
Where are the kidneys located?
- located on each side of vertebral column, between parietal peritoneum and musculature of posterior abdomina wall and diaphragm (“paravertebral gutter”)
- right kidney is slightly lower due to liver pushing it down - and can be more easily palpated than left kidney
RIGHT: TV12-LV3
LEFT: TV11-LV2
What lies posterior to kidneys and anterior? What is Psoas sign?
Posterior: diaphragm, psoas major, quadratus lumborum, transversus abdomnis
- subcostal n. iliohypogastric n. ilioinguinal n: all lie posterior to kidney, must be avoided when operating on kidney
Anterior:
- Right: liver, duodenum ascending colon, hepatorenal recess
- Left: stomach, spleen, pancreas, jejunum, descending colon
Iliopsoas Test:
- Pain upon extension of the thig against resistance can indicate abdominal infection.
- This is due to the relationship of the psoas major to many viscera (kidneys, ureters, pancreas, appendix, cecum, sigmoid colon)
- infection can spread from these organs to the psoas, producing pain upon stretch
What is purpose and layering of renal fascia/renal fat? What clinical correlation is associated with deficiency here?
- each kidney is surrounded by fat/fascia that serves a protective function and helps kidney anchored in place.
Pararenal fat: (external) found external to renal fascia
Renal fascia: (in middle)
- anterior and posterior layers surrounding kidney and suprarenal gland
- layers blend medially with adventitia of renal vessels
Perirenal (periphrenic) fat: (internal) fat found betwen the kidney and the renal fascia
**Nephrotosis: “dropped kidney” **
- caused by deficiency in fats and fascia surrounding the kidney
- often seen in late stages of starvation or anaeorexic
- can be associated with acute pain in flank region which radiates to groin
spread of perinephric abscesses?
- The renal fasciae tightly attaches to the renal vessels at the renal hilum; thus a perinephric avscess typically can’t spread to contralateral kidney
- the anterior and posterior layers of fasciae fuse delicately around the border of the kidney; thus perinephric avscesses **can spread inferiorly into the pelvis. **
What are external features of kidney? what is the relationship of vessels passing through the hilum?
1. Renal Capsule: outermost layer
2. Hilum: Entrance to the renal sinus
- allows for passage of renal pelvis, renal vessels, lymphatics and nerves
- Renal v. is most anterior, then Renal a., Renal pelvis is most posterior
3. Renal sinus: open space in the kidney containing renal calyces, renal pelvis (proximal portion of ureter), vessels, nerves and lymphatics
What is internal organization of kidney? Cortex? Medulla? Minor/Major Calyx?
- Cortex: outer portion of kidney
- contains nephrons
- also contains medullary rays (projections of medullary tissues)
- Medulla:
- contains collecting tubules organized into renal pyramids
- also contains cortical columns (projections of cortical tissue)
- renal papillae - apex of renal pyramid - directed towards renal sinus
- Minor Calyx: surround and drain the renal papillae/renal pyramids
- Major Calyx: confluence of 2-3 minor calyces
What is the vascular supply to the kidneys? what syndrome can result from problems?
**1. Renal aa. **
- lateral, paired visceral branches of aorta (LV1/LV2)
- Right renal aa. is longer than left, and passes posterior to IVC.
- Renal aa. divide into 5 segmental aa (“end aa”) at the renal hilum
**2. Renal vv. **
- course anterior to the renal aa.
- drain directly to the IVC
- left renal v. is longer than right, and must pass between the superior mesenteric aa. and the abdominal aorta
Renal Vein Entrapment Syndrome “Nutcracker syndrome”
- can be compressed between superior mesenteric aa. and abdominal aorta
- may cause hematuria (blood in urine), left renal v. hypertension, abdominal pain, and left testicular pain (due to varicosities around gonadal v.)
Where is pain from kidney referred to? What can pain in this area indicate?
- lower back and abdomen and pain in groin “from loin to groin”
Can be indicative of Kidney Stones (calculi)
- concretions of salts and inorganic material
- accumulate in the kidney and pass into the ureter
What is the innervation to kidney? Sympathetic? Parasympathetic?
- the autonomic fibers distribute via the renal plexus
1. Sympathetic: - preganglionic fibers found in lateral horn of T10-L1, via lesser, least, and lumbar splanchnic
- postganglionic fibers found near kidney via renal plexus at aorticorenal and renal ganglia
- Efferent Vasomotor: vasoconstriction and control amount of blood going to kidney
- Affarent Acute Pain: to T10-L1
- Parasympathetic:
- preganglonic fibers come from vagus nerve
- Postganglionic fibers found within wall of kidneys
- Efferent, vasomotor? smooth muscle contraction of calyces
- Affarent Sensory: register stretch of calyx –> results in movment of urine through calyces and into the ureters
What is the function of the ureter? Where is its anatomical position? aterial supply?
Function: muscular tube which transports urine from kidney to urinary bladder
General features:
- primary retriperitoneal
- courses inferomedially along posterior abdominal body wall, descends over pelvic brim to enter pelvis, then along lateral pelvic wall to enter posterior bladder wall.
Anatomical relationships:
- posterior: psoas major, common iliac vessels
- anterior: gonadal vessels; colic vessels
Arterial supply:
- upper 1/3: renal a/v
- middle 1/3: gonadal, aorta, common iliac aa/vv.
- lower 1/3: internal iliac a/v
Three main constriction sites of the ureter?
Constrictions:
- ureter passes over inferior renal pole (abdominal part): at renal/pelvis ureteric junction
- ureter crosses over external iliac vessels (pelvic part): passage over pelvic brim
- ureter traverses the bladder wall (intramural part) at entry into urinary bladder
What is the innervation of the ureter?
- autonomic fibers distribute via renal (upper ureter) and inferior hypogastric plexuses (lower ureters)
1. Sympathetic: - preganglionic fibers T10-L1/2 via lesser least and lumbar splanchnic nerves
- postganglionic cell bodies located in various ganglia
- Efferent: vasomotor
- Affarent: acute pain to T10-L1/2“loin to groin”
- Parasympathetic:
- preganglionic fibers travel with vagus (upper ureter) and pelvic splanchnic nerves (lower ureters)
- postganglionic cells within wall of organ
- Efferent: vasomotor; motor to smooth muscle - moves urine down ureter
- **Afferent stretch **
Clinical correlation:
- kidney stones pass from kidney into ureter. pain from kidney and ureter is felt from “loin to groin” due to sensory afferents entering the spinal cord at T10-L2
Structure and function of urinary bladder? detrusor muscle? Trigone?
function: stores urine
Features:
- apex: posterior to pubic symphysis; attachment of median umbilical ligament
- neck - inferior portion; surounds internal urethral orifice
- posterior base surface = point at which ureter enters bladder
Structure:
- distendable muscular sac lined by transitional epithelium
- detrusor muscle: 3 layers of smooth muscle; not well-organized; innervated by PS; primarily muscle responsible for emptying urinary bladder
- only superior surface is covered with a serosa; remainder has adventitia for outer layer
- Trigone: triangular area between the ureteral orifices and internal urethral orifice. Inner trigonal is extension of ureteric muscle; outer trigonal is typical detrusor muscle. Trigonal muscle innervated sympathetically and acts as a sphincter for ureter preventing urine from going back up ureter
Supporting ligaments of urinary bladder? clinical correlation?
- Lateral ligament of bladder
- puboprostatic or pubovesicle ligament
these ligaments function in keeping the urinary bladder in place.
**Cystocele: “fallen bladder” **
- can result from weakening of the pelvic diaphragm and ligaments which support the bladder. Most common cause is weakening of ligaments as a result of childbirth.
- can also be due to obesity, chronic constipation, or heavy lifting
- can cause urinary incontinence as well as incomplete emptying of the bladder
