anatomy lecture 1; the upper urinary tract Flashcards
what is the urinary tract
the anatomical structures through which urine passes through from its production to its excretion
the kidney
produces urine
the ureter
drains the urine (from kidney to bladder)
the bladder
stores and voids the urine
the urethra
excretes urine (and semen in males)
clinical definition of the upper urinary tract
- the kidneys (right and left)
- the ureters (right and left)
an upper urinary tract infection can spread to
the kidneys
clinical definition of the lower urinary tract
- the bladder (unpaired midline structure)
- the urethra (unpaired midline structure)
A lower urinary tract infection can spread to the
urethra and the bladder
where is the urinary tract
- the abdomen= retroperitoneum contains the kidneys and the proximal ureters
- the pelvis= contains the distal ureters, the bladder and the proximal urethra
- the perineum= contains the distal urethra
the kidney are what type of organs
retroperitoneal and located in the abdominal cavity behind the peritoneum
kidney structure
- superior pole
- anterior surface
- inferior pole
- renal hilum
Structures of the renal hilum
- renal artery
- renal vein
- ureters
the kidneys are located
- posterior to there own visceral peritoneum
- enclosed within the renal fat, fascia and capsule
- surrounded by skeletal muscles
the visceral peritoneum
is most anterior
behind the visceral peritoneum is the paranephric fat, renal fascia, perinephric fat, renal capsule
the kidneys are surrounded by skeletal muscles
- muscles of the posterior abdominal wall= quadrates lumborum
- muscles of the anteroom-lateral abdominal wall= external oblique, internal oblique, transversus abdominus
- muscles of the back
muscle guarding
can protect the kidneys from trauma
kidneys are located lateral to 4 specific structures what are they
- right kidney is lateral to the inferior vena cava
- left kidney is located lateral to the abdominal aorta
- psoas major
- T12-L3 vertebral bodies
axis CT scan of kidneys structures which you should annotate
- vertebral body
- muscles of the back
- abdominal aorta
- inferior vena cava
- renal artery
- renal vein
- posts major muscles
where exactly are the kidneys?
the kidneys lie anterior to the quadratus lumborum muscle and lateral to the posts major muscle
the kidneys lie lateral to the
lower thoracic and upper lumber vertebral bodies (T12-L3) but due to the size of then liver the right kidney lies slightly inferior to the left kidney
exact location of right kidney
L1- L3
exact location of the left kidney
T12-L2
what are the posterior locations of the kidneys
floating ribs and 11 and 12
floating ribs 11 and 12 offer
some protection to the kidneys from trauma however, if these ribs fracture the sharp end can cause contusion (bruising) or laceration of the kidneys
surface anatomy of the kidneys
each kidney can be palpated in the upper quadarant/ flank region respectively
clinical examination
balloting the kidney
a normal kidney is
6cm wide, 12cm long, smooth, regular and firm
if palpating the right kidney
- palpate posteriorly within the right flank and palpate anterior within the right upper quadrant
the liver and spleen
lie in contact with the diaphragm superiorly and the superior poles of the kidneys inferiorly, so the kidneys move inferiorly on inspirations and superiorly on expiration
as the patient breathes in
the kidney descends and can be trapped for palpation
right kidney is posterior to
the liver (and the hepato-renal recess), the 2nd part of the duodenum, ascending colon and colic flexure
left kidney is posterior to
the stomach, tail of the pancreas, hilum of the spleen, splenic vessels
the hepato-renal recess
is one of the deepest part of the greater sac of the peritoneal cavity in the supine patient
renal veins are
anterior to the renal arteries
common iliac arteries are
anterior to the common iliac veins
most lymph from the kidneys
drains into the lumbar nodes located around the abdominal aorta and the inferior vena cava
the abdominal aorta bifurcates at the level of the
umbilicus
arterial supply to the ureter
branches from the renal artery, abdominal aorta, common iliac artery, internal iliac artery, the vestal artery (bladder artery)
lymph from the ureters drains into the
lumbar nodes and the iliac nodes
the iliac nodes are located around the
common iliac, external iliac and internal iliac vessels
when associated with AAA
renal artery stenosis may be:
- combined with an infra-renal AAA both caused by atherosclerosis
- due to a supra-renal AAA, occlusion of the superior renal artery caused by the aneurysm
anatomical variations in the renal system
- bifid renal pelvis
- bifid ureter and unilateral, duplicated ureters
- rectocaval urters (ureter cross behind the inferior vena cava)
- horseshoe kidney (during foetal development the kidneys suffer together)
- ectopic pelvic kidney (kidney does not ascend during normal foetal development and remains in the pelvis)
causes of a solitary kidney
agenesis, nephrectomy for a pathology or from donation
each kidney consists of an
outer corte and inner medulla
the inner medulla is made up of
renal pyramids
each renal pyramids contains
50,000 nephrons
the regularly arranged nephrons
which runs axially towards the apex of each pyramid give the renal pyramids there striped appearance
structure of a nephron
glomerulus–> proximal convoluted tubule–> loop of henle–> distal convoluted tubule–> collecting duct
what happens at the glomerulus
ultra-filtration of blood arriving via brashness of the renal artery
the collecting duct passes thorough
the renal pyramid to drain the modified filtrate into the minor calyx as urine
how does urine drain from the kidney
collecting ducts of nephrons–> minor calyx–> major calyx–> renal pelvis–> ureter
diameter of the drainage tubes
continuously increased from collecting ducts to the renal pelvis until it reaches the pelvico-ureteric junction where the wider renal pelvis becomes the narrower ureter
anatomical sites of constrictions
- pelvics-ureteric junctions
- ureter crossing the common iliac artery
- ureteric orifice= opening of the ureter into one corned of the trigone of the bladder
renal calculi (stones)
can form from urine calcium slats and obstruct the urinary tract from within, renal calculi tend to be visible on X-ray
obstruction of the ureter can be caused by
- internal obstruction caused by renal calculi or a blood clot
- external compression (from an expanding mass or tumour)
the ureter has what in its walls?
smooth muscle, therefore if there is an obstruction, peristalsis increase proximal to the site of the obstruction to try and unblock it, as peristalsis comes in waves, this is why people with renal obstruction experiences colicky pain which comes in waves
consequences of a urinary obstruction
- obstruction can cause urine to back up in the tract towards the kidneys
- obstruction within calyxes of ureters causes unilateral back pressure
- obstruction within the bladder causes unilateral or bilateral kidney problems
- obstructions to the urethra causes bilateral kidney problems
urine production will continue
until the pressure within the urinary tract exceeds the pressing favouring filtration in the glomerulus and causes renal failure
renal failure mean
failure to adequately filter blood to produce urine
hydronephrosis means
water inside of the kidney
hydronephrosis
urine back pressure into the calyxes compresses the nephrons within the medullary pyramids and causes renal failure
acute hydronephrosis causes
painful stretching of the renal capsule
