Anatomy

Question 1

kidneys

Answer 1

retroperitoneal 
T12-L3
right kidney: 12th rib
left kidney: 11th and 12th rib
*right kidney lower: only one that is palpable normally

Question 2

ureters

Answer 2

1. descend on surface of psoas major
2. cross pelvic brim at bifurcation of iliac arteries
3. enter posterior wall of bladder at superior angles of trigone

Question 3

bladder

Answer 3

rests on pelvic diaphragm just posterior to pubic symphysis

Question 4

urethra

Answer 4

neck of bladder

passes through perineum to urethral orifice

Question 5

arrangement of vessels/ureter

Answer 5

anterior: vein
middle: artery
posterior: ureter

Question 6

renal columns

Answer 6

extension of renal cortex into the medulla

Question 7

renal papilla

Answer 7

apex of medullary pyramid surrounded by minor calyx

Question 8

renal corpuscle

Answer 8

glomerular (Bowman’s) capsule and glomerulus

Question 9

nephron

Answer 9

renal corpuscle and tubular system (PCT, LOH, DCT, NOT including CD)

Question 10

collecting ducts

Answer 10

empty renal papilla into minor calyx

Question 11

hilum of kidney

Answer 11

medial

transpyloric plane

Question 12

paravertebral gutter

Answer 12

junction between posts major and quadratus lomborum muscles

kidneys lie here

Question 13

perirenal (perinephric) fat

Answer 13

deep to renal fascia

Question 14

pararenal (paranephric) fat

Answer 14

superficial to renal fascia

Question 15

renal fascia

Answer 15

fused superiorly and across hilum
open inferiorly for movement during inspiration
*infection spreads inferiorly in pelvic cavity rather than up or to contralateral kidney

Question 16

nephroptosis

Answer 16

dropped kidney: fascia does not provide support inferiorly

differentiate from ectopic: normal length of ureter (coils and kinks)

Question 17

superior to superior pole of kidney

Answer 17

suprarenal glands/ adrenal glands

Question 18

anterior surface of right kidney

Answer 18

hilum: 2nd part of duodenum
most of anterior surface (superior pole to middle): liver
inferior: right colic flexure

Question 19

anterior surface of left kidney

Answer 19

hilum, middle of kidney: pancreas
superior: gastric
upper lateral: spleen
lower lateral: descending colon

Question 20

posterior surface of kidney

Answer 20

muscles: diaphragm, psoas major, quadratus lumborum, transversus abdominis muscles
ribs 11-12
nerves of lumbar plexus: subcostal, iliohypogastric and ilioinguinal nerves

Question 21

nutcracker

Answer 21

aorta and superior mesenteric artery

superior: left renal vein
lower: 3rd part of duodenum

Question 22

renal arteries

Answer 22

branch slightly below superior mesenteric branch
LV1/LV2
right: longer, passes behind IVC
branch into anterior and posterior branch before entering hilum
give off inferior suprarenal artery

Question 23

renal veins

Answer 23

left: longer, receives left gonadal vein (right gonadal vein empties into IVC)

Question 24

nutcracker syndrome

Answer 24

compression of left renal vein between SMA and aorta
Sx: hematuria, proteinuria, left flank pain, left testicular pain, varicocele (bag of worms)
N/V if duodenum is compressed
differentiate from hydrocele: pain reduces while lying down, does NOT transmit light

Question 25

SMA sundrome

Answer 25

compression of duodenum between SMA and aorta

Question 26

sympathetic innervation of kidney

Answer 26

T12 preganglionic: least splanchnic nerve renal/aorticorenal ganglion vasoconstriction, decreased urine production

Question 27

parasympathetic innervation of kidney

Answer 27

dorsal motor nucleus vagus vasodilation, increased urine production

Question 28

sensory innervation of kidney

Answer 28

GVA fibers traveling with sympathetic or parasympathetic feed

Question 29

lymphatic drainage of kidney

Answer 29

``` lateral aortic (lumbar) or lateral caval nodes around origin of renal vessels lateral lumbar lymph to lumbar trunk to cisterna chyli to thoracic duct to junction of subclavian and jugular vein ```

Question 30

renal transplant

Answer 30

site: iliac fossa of greater pelvis, attach artery and vein to external iliac, ureter to bladder fascia between adrenal gland and kidney prevents adrenal gland damage

Question 31

What embryonic tissue is the kidney derived from?

Answer 31

intermediate mesoderm of urogenital ridge

Question 32

ureteric bud

Answer 32

ureter, renal pelvis, calyces, CD | absent: renal agenesis

Question 33

mesonephric duct

Answer 33

contributes to male genital tract

Question 34

metanephric mass (blastema)

Answer 34

cap over ureteric bud forms nephron absent: renal agenesis

Question 35

supernumerary kidney

Answer 35

more than 2 kidneys | splitting of metanephric blastema

Question 36

kidney lobe

Answer 36

medullary pyramid and overlying cortex + half of renal columns on each side of pyramid

Question 37

cortical interstitial cells

Answer 37

fibroblasts and macrophages

Question 38

medullary interstitial cells

Answer 38

myofibroblasts

Question 39

mesangial cells

Answer 39

phagocytose debris, provide structural support | secrete: IL-I, PDGF

Question 40

cortical labyrinths

Answer 40

renal corpuscles, PCT, DCT

Question 41

medullary ray

Answer 41

straight, ascending tubules, collecting ducts

Question 42

kidney lobule

Answer 42

medullary ray and adjacent one half of labyrinths

Question 43

blood flow in kidney

Answer 43

renal to lobar to interlobar to arcuate to interlobular into afferent arteriole to glomerulus to efferent to pertibular capillaries to vasa recta and veins

Question 44

epithelium of ureter

Answer 44

transitional mucosa submucosa muscularis: inner longitudinal, middle circular, outer longitudinal (outer only in distal ureter) adventitia/serosa lower: stratified or pseudo stratified columnar epithelium

Question 45

epithelium of bladder

Answer 45

``` transitional same as ureter muscular thicker suprerior surface: serosa rest: adventitia ```