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Renal > Anatomy > Flashcards

Anatomy Flashcards

1
Q

List the components of the urinary tract

A

The kidney - produces urine
The ureter - drains urine from kidney to bladder
The bladder - stores and voids urine
The urethra - excretes the urine

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2
Q

What structures are found in the upper urinary tract

A

Right and left kidneys

Right and left ureters

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3
Q

What structures are found in the lower urinary tract

A

The bladder
The urethra

Both unpaired midline structures

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4
Q

Where might an upper urinary tract infection spread to

A

The kidneys

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5
Q

Which structures are affected by a lower urinary tract infection

A

Bladder and urethra

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6
Q

Which parts of the urinary tract are found in the abdomen

A

Kidneys and proximal ureters

In retroperitoneum

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7
Q

Which parts of the urinary tract are found in the pelvis

A

Distal ureters
Bladder
Proximal urethra

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8
Q

Which parts of the urinary tract are found out in the perineum

A

Distal urethra

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9
Q

Which part of the kidney is in contact with the peritoneum

A

The anterior surface touches the visceral peritoneum

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10
Q

What is contained in the hilum of the kidney

A 
Renal vein (anterior) 
Renal artery (middle) 
Ureter (posterior)
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11
Q

What surrounded the lateral part of the kidney

A

Abdominal wall muscles

External and internal obliques and the transversus abdominus

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12
Q

How can the abdominal muscles protect the kidney

A

Guarding can help protect them from trauma

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13
Q

List the layers that surround the front of the kidney (from outside in)

A 
Visceral peroneum 
Paranephric fat 
Renal (deep) fascia 
Perinephric fat - liquid 
Renal capsule - more fascia
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14
Q

How can the renal capsule cause problems in pathology

A

Does not stretch so any swelling of the kidney causes pain

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15
Q

Describe the position of the following vessels on a CT - abdominal aorta, IVC, renal vein and artery

A

Aorta is on the patients left
IVC is anterior to this and over to the right
Renal artery comes off aorta
Vein goes to IVC

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16
Q

The kidneys lie anterior and lateral to which muscles

A

In front of quadratics lumborum

Lateral to psoas major

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17
Q

Which vertebral levels are the kidneys at

A

Left - T12-L2
Right - L1-3

Right is lower due to the liver

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18
Q

Which ribs protect the kidney

A

Floating ribs 11 and 12

They cover the posterior and lateral parts of the kidney

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19
Q

Rib fracture can do what to the kidneys

A

Cause laceration or bruising

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20
Q

In which quadrants are the kidneys found

A

Left upper and right upper

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21
Q

In which abdominal regions are the kidneys found

A

Left and right lumbar (flank)

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22
Q

How do you palpated the kidneys

A

Place hand on the back just below rib 12

Get patient to breathe in and palpate in upper quadrant

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23
Q

Describe the location of the right kidney in relation to other organs

A

Posterior to the liver, part of the duodenum, ascending colon and hepatic flexure

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24
Q

Describe the location of the left kidney in relation to other organs

A

It’s sits posterior to the stomach, tail of the pancreas, hilum of the spleen and the splenic vessels

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25
Q

What is the significance of the hepatorenal recess

A

When someone lies on their back, it becomes the deepest part of the peritoneal cavity
Any excess fluid will collect here

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26
Q

Where does lymph from the kidneys drain to

A

The lumbar nodes

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27
Q

At what level does the abdominal aorta bifurcate

A

Level of the umbilicus

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28
Q

Where does lymph from the ureters drain to

A

Lumbar nodes and the iliac nodes

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29
Q

Where do the renal veins sit in relation to the arteries

A

They sit in front of the arteries

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30
Q

What sits anteriorly - common iliac arteries or veins

A

The arteries, when the aorta bifurcated it becomes anterior to the veins

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31
Q

Describe the blood supply to the ureters

A

Supplied by branches of the renal artery, abdominal aorta, common iliac, internal iliac and vesical artery

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32
Q

Renal stenosis related to an infra-renal AAA is likely caused by what

A

Atherosclerosis

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33
Q

Renal stenosis related to a supra-renal AAA is likely caused by what

A

Occlusion of the renal artery by the AAA itself

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34
Q

What are the two different placements of AAA

A

Supra renal - occurs at the level of the renal arteries

Infra-renal - occurs below the renal arteries, just above the bifurcation of the abdominal aorta

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35
Q

List some common variations in the renal system

A

Bifid ureter
Retrocaval ureter - sits posterior to IVC
Ectopic kidney - in a weird place, may be due to transplant
Solitary kidney - may have not formed or been removed

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36
Q

Describe the composition of the kidney

A

Made up of cortex and medulla
The medulla contains renal pyramids
The medulla has a striated appearance due to collections of nephrons which make up the pyramids

37
Q

Describe how urine drains from the kidney

A

Comes from the collecting duct of the nephrons into the minor calyx
Then into major calyx
Then into renal pelvis
Then into ureter

38
Q

What is the pelviureteric junction

A

Anatomical site of constriction between the renal pelvis and ureter
The ureter is narrower than the pelvis

39
Q

List the anatomical sites of uretic constriction

A

pelviureteric junction
Where the ureter crosses the common iliac artery
Ureteric orifice - when it opens into the floor of the bladder

40
Q

what are renal calculi

A

Kidney stones

41
Q

how do renal calculi form

A

From urine calcium salts

they then cause obstruction

42
Q

What can cause a ureteric obstruction

A

Internal problem - stone or blood clot

External compression - tumour

43
Q

What happens to the ureter when it becomes obstructed

A

The smooth muscles in the walls start contracting to try and clear the problem
This leads to colicky pain

44
Q

what is the consequence of urinary tract obstruction

A

The urine backs up to the kidneys

This leads to lots of back pressure and eventually renal failure

45
Q

What is hydronephrosis

A

Excess urine backing up in the kidney - swells

Very painful

46
Q

Where is the false pelvis

A

Goes from iliac crests to pelvic inlet

Part of the abdominal cavity

47
Q

Where is the true pelvis

A

Pelvic inlet to pelvic floor

Makes up the pelvic cavity

48
Q

Describe the path of the ureter through the pelvis

A

Pass through the retroperitoneum - anterior to common iliac vessels
Through the false pelvis and into the true pelvis
- along lateral walls
At level of ischial spine it turns medially to enter the posterior aspect of the bladder

49
Q

What is the main muscle that makes up the pelvic floor

A

Levator ani

50
Q

What are the deepest parts of the pelvic cavity in men and women

A

In men - rectovesicle pouch (between bladder and rectum)
In women its the pouch of douglas (between uterus and rectum)

Any excess fluid will collect here when standing

51
Q

Where does the ureter runs in relation to the uterine artery

A

Ureter runs inferiorly to the uterine artery

‘water under the bridge’

52
Q

Where does the ureter runs in relation to the vas deferens

A

Runs inferiorly to the vas deferens

‘water under the bridge’

53
Q

List arteries that branch off the internal iliac artery in women

A

vesicle arteries - to bladder
uterine artery
middle rectal artery
vaginal artey

54
Q

List arteries that branch off the internal iliac artery in men

A

vesical arteries- to bladder
prostatic arteries - come from vesicle
middle rectal artery

55
Q

What is the trigone of the bladder

A

Triangle shaped area found in the internal aspect of the bladder formed by the 3 orifices of the bladder
2 ureter entrances and the internal urethral orifice
Smooth part of the wall

56
Q

What muscle is responsible for bladder contraction

A

the detrusor

57
Q

What happens to the orifices when the detrusor contracts

A

The muscles surrounding them also contract to prevent reflux of urine

58
Q

What is the function of the internal urethral sphincter muscle

A

Found in men only

Contracts during ejaculation to prevent semen entering the bladder

59
Q

List the anatomical relations of the bladder in women

A

Uterus lies superior to it - separated by the uterovesical pouch
Cervix/vagina is posterior
It sits posterior to the pubic bone

60
Q

List the anatomical relations of the bladder in men

A

It sits posterior to the pubic bone
Rectum is posterior to it
Prostate is inferior to it

61
Q

What are the 2 routes of catherization

A

Urethral - more common

Suprapubic - through abdominal wall, must be done on full bladder

62
Q

Describe the difference in position between the empty and full bladder

A

An empty bladder lies within the pelvis

A full bladder can extend out of the pelvis: its superior part lies superior to the pubic bone

63
Q

Which surface of the bladder is covered by peritoneum

A

The superior surface only

64
Q

What are the different named parts of the male urethra

A

Prostatic urethra - passes through prostate

Spongy urethra - passes through the corpus spongiosum of the penis

65
Q

Is the external urethral sphincter voluntary or involuntary

A

Voluntary (hopefully)

66
Q

Describe the path of sperm through the male reproductive tract

A

Produced in seminiferous tubules
Passes to epididymis - storage
Then up vas deferens
Joins with seminal glands to form the ejaculatory duct
Then connects to urethra, passes through prostate and out

67
Q

What is found in the spermatic cord

A

Testicular artery, vein
Vas deferens
Lymphatic vessels
Nerves - autonomic and somatic

68
Q

The testes should be in the scrotum by birth - true or false

A

True

69
Q

What covers the testis within the scrotum

A

A sac called the tunica vaginalis
The testes push into it like the lungs do the pleura
Has a visceral and parietal section

70
Q

What is hydrocele

A

Abnormal fluid in the tunica vaginalis

71
Q

What is testicular torsion

A

Twisting of the spermatic cord
Can disrupt blood supply to the testes and leads to severe pain
Risk of necrosis

72
Q

What drains blood from the testes

A

Pampinform venous plexus
Drains into the testicular vein
The right testicular vein drains into IVC whilst the left goes to the renal vein

73
Q

What are the different zones of the prostate

A

Has a central zone with peripheral zones either side

Peripheral zones are what is felt on PR (cancer is most common here anyway)

74
Q

List the different sections of erectile tissue in the penis

A

Right and left corpus cavernosum
Corpus spongiosum
All 3 engorge with blood to cause erection

75
Q

Where does the root of the penis attach

A

The ischium

76
Q

What is the blood supply to the penis

A

Deep arteries of the penis which are branches of the internal pudendal artery
This comes from the internal iliac

77
Q

What is the blood supply to the scrotum

A

Internal pudendal artery (from internal iliac)

Branches from the external iliac artery

78
Q

Where does lymph from the scrotum and penis (except glans) drain to

A

Superficial inguinal lymph nodes found in the superficial fascia in the groin

79
Q

Where does lymph from the testis drain to

A

Lumbar nodes around the abdominal aorta

80
Q

At what level does the left renal hilum lie

A

L1

81
Q

At what level does the right renal hilum lie

A

L1/2

82
Q

What aspects of the kidney is US good for looking at

A 
Size 
Scarring 
Distension of the calyx 
Calculi 
Any abnormalities in structure
83
Q

What is a pre-contrast CT used for

A

Good at showing calculi - stone search

84
Q

What is a corticomedullary CT used for

A

Cortical enhancement

Inject iondine contrast and take image after 25-70 secs

85
Q

What is a nephrographic CT

A

Take image 80-180 secs after contrast injected

Medulla and cortex are enhanced equally

86
Q

What is an excretory CT

A

Take image 5-15 mins after contrast injection

Gives opacification of the renal collecting system and ureters

87
Q

How can MRI be used to assess the kidney

A

shows lesions, allows for vascular assessment

Shows up most pathology

88
Q

What is the most common type of imaging used for the bladder

A

US

89
Q

Who has the longer urethra - men or women

A

Men

Renal (18 decks)

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