Anatomy

Question 1

location of the kidneys

Answer 1

R lower than L
superior pole R - level with 11th ICS
L at 11th rib
hilum at L1 for both - because vertebrae so big

Question 2

position of kidney raltive to thorax

Answer 2

diaphragm is between the kidney and the rib

lung between the diaphragm and the rib

Question 3

position of kidney relative to abdominal wall

Answer 3

ab wall lined by transversalis fascia
fascia goes round kidney and becomes renal fascia
encorportating perinephric fat
fascia continues and covers the great vessels

Question 4

position of kidney relative to spleen

Answer 4

spleen at ribs 9 and 10

more latera; than L kidney

Question 5

posterior relations of the kidneys

Answer 5

top relates to the diaphragm
medial - psoas major muscle
middle - quadratus lumborum muscle
lateral - transversalis abdominal muscle

Question 6

nerves

Answer 6

last IC nerve
subcostal nerve
iliohypogastric nerve
ilioinguinal nerve

Question 7

anterior relations of the kidney

Answer 7

R - liver, hepatic flexure; hilus lies behind 2nd part of duodenum
L - stomach, pancreas, spleen and splenic flexure

Question 8

hepatic flexure

Answer 8

of colon

ascending colon turn to transverse colon

Question 9

splenic flexure

Answer 9

transverse colon -> descending

Question 10

why do the flexures exist

Answer 10

the top corners of the colon attach to the posterior abdominal wall

Question 11

relation of pancreas and kidney

Answer 11

only related to the L kidney

Question 12

position of the ureters

Answer 12

vertically down posterior abdominal wall
along tips of transverse process of lumbar vertebrae
cross pelvic brim anterior to sacro-iliac joint and bifurcation of the common iliac arteries
descend anteromedially to enter bladder at level of ischial spine

Question 13

blood supply

Answer 13

from every major vessel they cross
renal 
gonadal
common iliac
internal iliac - (they go between internal and external iliac)

Question 14

how do they move urine

Answer 14

very muscular - sm

peristalsis

Question 15

connection of ureters with bladder

Answer 15

obliquely

Question 16

places of ureteric constriction

Answer 16

pelviureteric junction - top of ureter
where ureter crosses pelvic brim
where it crosses bladder wall

Question 17

significance of ureteric constriction

Answer 17

where kidney stones likely to get stuck

Question 18

structure of ureters

Answer 18

endothelium - transitional, when empty layers on top of each other, can be pulled into single layer so not stratified
circular muscle coat - peristalsis

Question 19

male urethra

Answer 19

through prostrate - may be constrictions

2 right angles

Question 20

female urethra

Answer 20

short and straight

Question 21

structural anatomy of the bladder

Answer 21

triangular pyramid
apex point anteriorly, base posteriorly
urothelium - transitional epithelium
3 layered epi - slow turn over
large luminal cells - low permeability luminal membrane
prevent dissipation of urine plasma gradients

Question 22

ureter and the bladder

Answer 22

enter at superior posterior junction

close as urine enters - prevent backflow

Question 23

trigone

Answer 23

triangle formed by the entry of the ureters and exit via urethra 
smooth 
epi stretched 
attached to material below 
bladder cancer likely to occur here

Question 24

position of the bladder

Answer 24

held in place by pubovesical ligament or puboprostic ligament

Question 25

perineal pouch

Answer 25

where the external sphincter is

Question 26

urethra in males

Answer 26

have to go through prostate which sits on perineal membrane

Question 27

sphincter vesicae

Answer 27

``` internal sphincter sm at neck of bladder reflex opening - response to bladder wall tension relaxed by PNS contracts by SNS ```

Question 28

sphincter urethrae

Answer 28

external sphincter in perineum tone maintained by somatic nerves in pudenal nerve - S2, 3, 4 opened by vol inhibition of nerves

Question 29

position of male internal sphincter

Answer 29

between bladder and prostate

Question 30

control of sphincter vesicae

Answer 30

``` bladder fills stretch receptors PNS bladder contracts internal sphincter opens ```

Question 31

control of sphincter urethrae

Answer 31

cerebral cortex motor neuron inhibits opening have to actively inhibit pudenal nerve

Question 32

where are the kidneys in the abdomen

Answer 32

retroperitoneal

Question 33

external features of the kidneys

Answer 33

surrounded by dense fibrous capsule outside capsule is fascial pouch containing peri-renal adipose tissue overlapped postero-superiorly by diaphragm and pleural cavity

Question 34

function of the fascial pouch

Answer 34

separate renal fascia from kidney

Question 35

how does the development of the kidney affect the structure

Answer 35

develop as discrete lobules and fuse | accessory arteries, veins, ureters common - failure of developmental process

Question 36

kidney structure

Answer 36

cortex granular - irregular features eg glomerulus medulla striated - radial arrangement of tubules multilobular each lobule drain through own papilla and calyx renal column - cortex between the medulla

Question 37

renal pyramids

Answer 37

base faces the cortex apex inwards towards the renal sinus apec is the renal papilla renal papilla is surrounded by the minor calyx minor calyx receive urine - eventually become ureter in renal sinus minor calices unite and form major calyx 2 or 3 major calices join to make renal pelvis - funnel shaped renal end of ureters

Question 38

functional significance of the blood supply

Answer 38

abundant | blood pressure drives ultrafiltration

Question 39

relative positions of aorta and IVC

Answer 39

aorta L of midline | IVC - R

Question 40

renal arteries

Answer 40

R renal artery longer than L | got to pass behind the IVC

Question 41

Renal veins

Answer 41

L renal vein longer got to pass in front of aorta goes under the superior mesenteric artery

Question 42

pathophysiological effect of renal artery location

Answer 42

if aneurysm in aorta | block flow through renal vein

Question 43

abdominal arteries

Answer 43

celiac trunk - midline - supply the foregut superior mesenteric artery - midline - supply panc and lower intestine L and R gonadal arteries - in same place for either sex

Question 44

kidney hilum

Answer 44

anteriorly - vein -> artery | posteriorly - renal pelvis

Question 45

location of vessels when in kidney

Answer 45

closely related

Question 46

blood supply to the kidney

Answer 46

renal artery branch to each lobe arcuate arteries form at the top of the medulla and anastomose with adjacent arteries afferent vessel form glomerulus

Question 47

lymphatic drainage

Answer 47

mirror the arteries from bladder - internal iliac and common iliac nodes from ureters - root of gonadal arteries, inferior and superior mesentry, renal - - paraaortic nodes pulsation of artery drive lymph upwards