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SUGER > Anatomy 25 > Flashcards

Anatomy 25 Flashcards

1
Q

Where do the adrenal glands lie?

A

Close to the upper pole of each kidney

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2
Q

Where does the right adrenal gland lie?

A

Behind the liver and inferior vena cava

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3
Q

Where does the left adrenal gland lie?

A

Behind the stomach and pancreas

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4
Q

Which 3 arteries supply the adrenal glands?

A

Superior adrenal artery
Middle adrenal artery
Inferior adrenal artery

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5
Q

What is the superior adrenal artery a branch of?

A

Inferior phrenic artery

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6
Q

What is the middle adrenal artery a branch of?

A

Abdominal aorta

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7
Q

What is the posterior adrenal artery a branch of?

A

Renal artery

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8
Q

What does the right adrenal vein drain directly into?

A

Inferior vena cava

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9
Q

What does the left adrenal vein drain first into?

A

Left renal vein

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10
Q

What does the left adrenal vein join?

A

Inferior vena cava

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11
Q

What is the adrenal gland composed of?

A

Cortex (outer part) and Medulla (inner part)

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12
Q

What does the cortex produce?

A

Steroid hormones including cortisol, aldosterone and testosterone

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13
Q

What does the medulla produce?

A

Adrenaline

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14
Q

What is Phaeochromocytoma?

A

Rare hormone-producing tumour of the adrenal medulla

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15
Q

What does secretion of excess adrenaline cause?

A

Symptoms and signs related to hyperactivity of the sympathetic nervous system, typically hypertension, tachycardia and excessive sweating

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16
Q

Where do the kidneys lie?

A

Outside the peritoneum so are called ‘extra-peritoneal’ structures, one on either side of the upper lumbar vertebrae

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17
Q

What is each kidney embedded in and what is it covered by?

A

Perinephric fat and this fatty layer is covered by renal fascia

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18
Q

What is on the medial border of the kidney?

A

Renal hilum, where the renal vessels, nerves, lymphatics and ureter enter or leave the kidney

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19
Q

What are the left and right arteries branches of?

A

Abdominal aorta

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20
Q

What do the left and right renal veins drain directly into?

A

Inferior vena cava

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21
Q

What is the internal aspect of the kidney composed of?

A

Cortex - outer part
Medulla - inner part arranged in pyramids
Calyces

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22
Q

What are the functional units of the kidneys (nephrons) responsible for?

A

Filtering blood
Reabsorbing water and solutes
Secreting and excreting waste products as urine

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23
Q

What structures are found in the cortex of the kidney?

A

Glomeruli
Glomerular capsules (Bowman’s capsule)
Proximal and distal tubules
Part of the collecting ducts

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24
Q

What structures are found in the renal pyramids?

A

Nephron loop (of henle)
Rest of the collecting ducts

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25
Q

What forms a major calyx?

A

Minor calyces merging with other minor calyces

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26
Q

What happens to urine from the collecting ducts?

A

Urine travels down the pyramid towards the renal papilla (the apex of the pyramid) where it enters a minor calyx

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27
Q

What do major calyces merge to form?

A

Renal pelvis

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28
Q

What is the renal pelvis continuous with?

A

Ureter

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29
Q

What is the function of the ureter?

A

Carry urine to the urinary bladder

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30
Q

What is the ureter?

A

Narrow tubes with muscular walls which transport urine by peristalsis

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31
Q

What do the ureter run anterior to?

A

Psoas major on the posterior abdominal wall and cross the pelvic brim to enter the pelvis

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32
Q

Where do the ureter enter the bladder?

A

On its inferomedial aspect

33
Q

What are kidney stones often made from?

A

Calcium oxalate

34
Q

What are some risk factors to developing kidney stones?

A

High urine calcium levels
Dehydration
Obesity
Certain medications

35
Q

What can happen to smaller kidney stones?

A

Can pass into the ureter and out of the body via the bladder and urethra without causing any problems

36
Q

What is the typical presentation of an obstructing kidney stone in the ureter?

A

Excruciating, pulsatile pain felt from ‘loin to groin

37
Q

Why do kidney stones cause pain from ‘loin to groin’?

A

Pain fibres supplying the ureters originate from the T12 to L2 nerves, so pain is referred and felt in the T12-L2 dermatomes

38
Q

what happens if the flow of urine from the kidney is obstructed?

A

The kidney will fill with urine and swell (hydronephrosis)

39
Q

What can hydronephrosis lead to?

A

Infection

40
Q

What are the 3 places where the ureter narrows?

A
  1. Pelvi-ureteric junction (PUJ) – between the renal pelvis and ureter.
  2. Pelvic brim - where the ureter runs over the pelvic brim, anterior to the iliac artery.
  3. Vesico-ureteric junction (VUJ) - where the ureter joins the bladder.
41
Q

Where are kidney stones most likely to get stuck?

A

In the 3 places/regions where the ureter narrows

42
Q

What are UTIs almost always caused by?

A

Bacteria (most commonly E. Coli) entering the urinary bladder via the urethra

43
Q

Are UTIs more common in males or females and why?

A

Females as the female urethra is much shorter

44
Q

What is infection of the urinary bladder called?

A

Cystitis

45
Q

What are symptoms of cystitis?

A

Burning pain on passing urine and the sensation of having to pass urine much more frequently

46
Q

What is the spread of infection from UTIs to the kidney called?

A

Pyelonephritis

47
Q

What does Pyelonephritis require for treatment?

A

Intravenous antibiotics

48
Q

What are symptoms of Pyelonephritis?

A

Fever
flank pain
Nausea and vomiting in addition to the symptoms of cystitis

49
Q

What can caner of the kidneys be divided into?

A

3 main types, based on their histological origin

50
Q

Where do Renal cell carcinomas (RCC) originate from?

A

Lining of the nephron

51
Q

Where do Transitional cell carcinomas (TCC) originate from?

A

Epithelial lining inside the kidney

52
Q

Where do Wilms’ tumours originate from?

A

Renal stem cells

53
Q

What are the triad of symptoms of renal cancer?

A

Pain in the flank, a palpable mass in the abdomen and haematuria (blood in the urine)

54
Q

What are kidneys encased in and what are their clinical importance?

A

Renal capsule, perinephric fat, renal fascia and paranephric fat, a renal cancer must grow very large and penetrate these layers before it is able to invade adjacent organs and structures

55
Q

Why does a left-sided varicocele warrant investigation?

A

Left testicular vein drains into the left renal vein, which may be
compressed or obstructed by a renal tumour

56
Q

What is the posterior abdominal wall?

A

Region behind the abdominal cavity and extends from the attachments of the diaphragm above to the pelvic brim below

57
Q

What does the posterior abdominal wall consist of?

A

Lumbar spine together with the psoas and quadratus lumborum muscles

58
Q

What structures run along the posterior abdominal wall?

A

Inferior vena cava
The aorta with its associated autonomic plexuses and lymph nodes
The sympathetic trunks on either side of the lumbar spine

59
Q

What do the gonadal vessels supply?

A

The gonads (testes or ovaries)

60
Q

Which spinal nerves form the lumbar plexus?

A

Lumbar spinal nerves L1-L4 (with a contribution from the T12
nerve) on the posterior abdominal wall

61
Q

What does the lumbar plexus give rise to?

A

Several branches that innervate the skin and muscles of the abdominal wall and thigh

62
Q

What do the Iliohypogastric and ilioinguinal nerves supply?

A

The anterior abdominal wall muscles and skin of the external genitalia

63
Q

What does the Genitofemoral nerve supply?

A

The skin of the external genitalia

64
Q

What does the Lateral femoral cutaneous nerve supply?

A

The skin over the lateral thigh

65
Q

What does the Femoral nerve supply?

A

Supplies the muscles and skin of the anterior thigh and is often a target for nerve blocks to provide pain relief for lower limb fractures or surgery

66
Q

What does the Obturator nerve supply?

A

Supplies the muscles and skin of the medial thigh

67
Q

At which level does the thoracic aorta pierce the diaphragm?

A

Level of the T12 vertebra and descends through the abdomen as the abdominal aorta

68
Q

Where does the thoracic aorta terminate?

A

Terminates by bifurcating into the left and right common iliac arteries at approximately the level of L4

69
Q

What does the abdominal aorta give rise to?

A

Several unpaired and paired branches

70
Q

Give examples of unpaired branches

A

Coeliac trunk
Superior mesenteric artery
Inferior mesenteric artery

71
Q

Give examples of paired branches

A

Renal, adrenal, gonadal and lumbar arteries
(the latter supply the posterior abdominal wall)

72
Q

What is the inferior vena cava formed by?

A

Union of the left and right common iliac veins at approximately the level of L5

73
Q

Where do the veins which correspond to the paired arterial branches from the abdominal aorta drain into?

A

The inferior vena cava, although the left gonadal vein typically drains into the left renal vein

74
Q

Which veins does the inferior vena cava receive?

A

Hepatic veins

75
Q

What is an aneurysm?

A

The bulging of a blood vessel caused by a weak point in the blood vessel wall

76
Q

What are some risk factors for the development of an abdominal aortic aneurysm (AAA)?

A

Smoking
Alcohol
Hypertension
Atherosclerosis

77
Q

When are AAAs diagnosed?

A

If the diameter of the aorta is wider than 3cm

78
Q

What happens if a AAA ruptures?

A

Significant intra-abdominal bleeding rapidly occurs, and mortality is high

79
Q

What happens if a small AAA is found incidentally?

A

They are monitored to see if they increase in size, and treatment, including surgery or stenting, may be offered if they become too large

SUGER (5 decks)

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