ANATOMY (+ a lil bit of embryo and histo shiz) Flashcards
how much urine does the kidney produce each day
1.5 litres
size of kidneys
10x5x3cm
size of clenched fist
are the kidneys retroperitoneal or intraperitoneal
retroperitoneal
which part of the kidneys is in contact with the peritoneum
anterior aspect
what are the layers between the anterior kidney and the peritoneum (starting from the kidney) (5)
renal capsule Perinephric fat renal/deep fascia PARAnephric fat visceral peritoneum
what back muscle is directly posterior to the kidneys
quadratus lumborum
what back muscle is behind the kidneys but is slightly medial (beside the vertebrae)
psoas major
is the abdominal aorta to the left or the right of the IVC
left (patients left)
which vein is shorter, the R or L renal vein
R renal vein
which artery is shorter, the R or L renal artery
L renal artery
the L renal vein is longer, what drains into it that doesnt happen on the R
L gonadal vein drains into the L renal vein then IVC
R gonadal vein drains into IVC
vertebral level of R kidney
vertebral level of R kidney hilum
is it higher or lower than the L kidney
L1-L3
L2
lower than the L kidney bc the R has the liver on top of it = pushes it down
vertebral level of L kidney
vertebral level of L kidney hilum
is it higher or lower than the R kidney
T12-L2
L1 (bc its the left one (L1!!!!))
higher than the R kidney bc the R kidney has the liver on top of it = pushes it down
what is the recess between the right kidney and the liver called
hepatorenal recess
which ribs protect (and have potential to bruise) the kidneys
ribs 11 and 12
in the renal hilum, are veins or arteries in front
veins!!!
must know this
which cant you see from an anterior view; renal arteries or renal veins
renal arteries (they are behind the renal veins)
does a supra renal AAA include the renal arteries
yes
does a infra renal AAA include the renal arteries
no
how many branches of the renal artery are there
5
where does lymph from the R kidney drain
lumbar lymph nodes on the IVC (bc its closer)
where does lymph from the L kidney drain
lumbar lymph nodes on the abdominal aorta (bc its closer)
anatomical variation
what is it called when the renal pelvis splits in 2
bifid renal pelvis
where is the ureter in relation to the renal artery and renal vein
behind the renal artery (which is behind the renal vein)
what is the renal capsule made of
dense collagen fibres
what is the ‘peak’ of the pyramids in the renal medulla called
papillae
how many nephrons do we have in total
1 million
what are the 2 types of nephron called
% of both
cortical nephron (80%) juxtameduallry nephron (20%)
what length is the loop of henle in cortical nephrons compared to juxtameduallry nephrons
what is the blood supply to the loop of henle
shorter
peritubular capillaries
what length is the loop of henle in juxtameduallry nephrons compared to cortical nephrons
what is the blood supply to the loop of henle
longer = go further into medulla = produce more conc urine
vasa rectae
what is the blood supply into the glomerulus
afferent arteriole
travels Away from artery
what is the blood supply leaving the glomerulus (gives rise to vasa rectae OR peritubular capillaries)
efferent arteriole
what is the capsule around the glomerulus called
bowmans capsule
what are the 2 poles of the renal corpuscle (glomerulus and bowmans capsule)
vascular pole
urinary pole
what is the region between the distal convoluted tubule and the glomerulus it came from called
juxtaglomerular apparatus
what are the ‘salt sensor’ cells in the juxtaglomerular apparatus called
where are they
macula densa cells
distal convoluted tubule
in the juxtaglomerular apparatus, what do the juxtamedullary/granular cells do
where are they
secrete renin for RAAS
afferent arteriole
where are the mesangial (lacis) cells in the juxtaglomerular apparatus
between the macula densa cells (distal convoluted tubule) and juxtaglomerular cells (afferent arteriole)
route of urine after nephron (11)
renal papillae (apex of medullary pyramid) minor calyx major calyx renal pelvis ureter ureteric orifices in trigone of bladder internal urethral orifice internal urethral sphincter (in males) urethra external urethral sphincter external urethral orifice
on xray, what are the ureters in line with
transverse processes of spine
points of constriction of ureters (3)
pelviureteric junction (between renal pelvis and ureter) crossing of common iliac artery bifurcation (into internal and external) ureteric orifice (opening into bladder trigone)
where are the ureters in relation to uterine tubes and uterine artery in women
inferior (deep?)
‘water under the bridge’
what is it called when you have 2 ureters on 1 side, but they join to become one before the bladder
bifid ureter
what is it called when you have 2 separate ureters (dont join) on 1 side
duplicated ureter
when the bladder fills with urine, which direction does it expand
superiorly
is the bladder in the peritoneum
no
which surface of the bladder is covered in peritoneum
superior
pouch between the rectum and the uterus in women
rectouterine pouch (of douglas)
pouch between the bladder and the uterus in females
uterovesical pouch
pouch between the bladder and the rectum in males
rectovesical pouch
what is the muscle in the bladder
what is its nerve supply
detrusor muscle S2-S4
3 points that make the triangle of trigone in the bladder
2 ureteric orifices superiorly
1 internal urethral orifice inferiorly
where is the base of the bladder
what is in it
posterior
2 ureteric orifices
where does lymph from the bladder drain to (1)
sacral nodes
where does lymph from the ureters drain to (2)
lumbar or iliac nodes
blood supply to bladder
vesical arteries
what type of epithelium is in the proximal urethra
transitional epithelium
what type of epithelium is in the distal urethra
stratified squamous epithelium
name of urethra after its passed through the prostate
prostatic urethra
name of urethra when its passing through the corpus spongiosum (penis)
spongy urethra
purpose of internal urethral sphincter (in males only)
prevent semen entering bladder during ejaculation
internal sphincter (in males) nerve supply
parasympathetics and sympathetics (for contraction eg ejaculation)
external sphincter (in females and males) nerve supply
S2-4 somatic motor
which levels do the sympathetic nerves to the renal system come from
T10-L2
which splanchnic nerve group do they sympathetics form T10-L2 to the renal system leave in
where do they synapse
abdominopelvic splanchnic nerves
abdominal sympathetic ganglia
parasympathetic supply to the kidneys and ureters
CN X
parasympathetic supply to detrusor muscle (+ hence internal urethral sphincter in males)
what does it cause
S2-S4
relaxation of internal urethral sphincter (in males) = can pee
what is the general rule for the somatic sensory innervation of the renal system above the bladder (and including the top of the bladder that is touching the perineum)
what do they travel alongside
T11-L2
(kidneys are T11-L1)
travel alongside sympathetics
what is the general rule for the somatic sensory innervation of the things below the bladder (including the parts of the bladder that dont touch the perineum)
what do they travel alongside
S2-S4
(testes are T10-T11 and travel alongside sympathetics)
travel alongside parasympathetics
where does somatic sensory pain from testes go to
T10-T11
from embryological origin
presentation of kidney pain
loin
presentation of ureter pain
loin to groin
presentation of bladder pain
dully achy suprapubic
presentation of proximal urethra pain
suprapubic
presentation of distal urethra pain
sharp pain in perineum
presentation of scrotal pain (2)
suprapubic (dermatome bc its T10-T11)
and probs scrotum too bc of close proximity
which nerve from the lumbosacral plexus emerges through the psoas major then travels through it
genitofemoral nerve L1-L2
which BIG nerve (there are others) from the lumbosacral plexus travels lateral to the psoas major
femoral nerve L2-L4
which nerve from the lumbosacral plexus travels medial to the psoas major (the rest travel through it/lateral to it)
obturator nerve L2-L4
what does the femoral nerve L2-L4 supply
anterior thigh
what does the obturator nerve L2-L4 supply
medial thigh
what does the sciatic nerve L4-S3 supply via its 2 branches (4)
posterior thigh
sole of foot
anterior leg
lateral leg
which spinal cord region is required in micturition (urination)
via which 3 nerves
S2-S4
visceral afferents S2-S4
pelvic splanchnic nerves for parasympathetics (relaxation of sphincter in males)
pudendal nerve
what happens to the brain during potty training
central inhibition of micturition reflex
what happens when the kidney grows without a ureteric bud
agenesis (no kidney growth)
where do the kidneys originate embryologically
pelvis then ascend up
in a horseshoe kidney (only 1 kidney), the inferior poles meet and fuse before ascent and get stuck under the …
inferior mesenteric artery
why might kidneys be in the pelvis
failure to ascend (embyrologically are in the pelvis)
what is the name for the hindgut endoderm that supplies the primitive urogenital sinus (bladder, pelvic urethra, definitive urogenital sinus)
cloaca
what type of cells are in between the arterioles in the glomerulus
mesangial cells
which cells are external to basement glomerular membrane and internal to the bowmans space
podocytes
histology
what is in the proximal convoluted tubule that isnt in the distal convoluted tubule
how does the luminal margin look bc of this
microvilli
fuzzy/less defined brush border
what does the distal convoluted tubule look like on histology compared to proximal one
straight border (proximal is fuzzy/less defined brush border)
what are the 2 main types of epithelium in the nephron (dont bother learning specifics)
simple cuboidal and simple columnar epithelium
what type of epithelium is in the things after the nephron eg minor calyx, major calyx, ureter etc etc
transitional epithelium
which cell is associated with transitional epithelium
umbrella cells (look like umbrellas)
what type of epithelium is in the bladder
transitional epithelium
what type of epithelium is in the urethras (proximal and distal)
proximal - transitional
distal - stratified squamous, stratified columnar (up the top in men)
