anatomy of the renal system

Question 1

what layers surround the kidneys

Answer 1

perirenal fat (around)
renal fascia (extraperitoneal fascia)
pararenal fat (along side)

Question 2

at what vertebral levels are the kidneys

Answer 2

t12 - L3

Question 3

which kidney is lower

Answer 3

right

Question 4

which kidney is longer

Answer 4

left

Question 5

what are the anterior relations of the right kidney

Answer 5

IVC, duodenum, liver, colic flexure, suprarenal gland

Question 6

what are the anterior relations of the left kidney

Answer 6

pancreas, spleen, stomach, colic flexure, small intestine

Question 7

what ribs does the kidney overlie

Answer 7

10, 11, 12

Question 8

why do the kidneys move with respiration

Answer 8

they lie on the diaphragm

Question 9

what abdominal muscles do they kidneys lie on

Answer 9

QL, TA, psoas major

Question 10

what is the renal column

Answer 10

the extension of cortex between the pyramids

Question 11

what are the renal papillae

Answer 11

the part of the medulla that projects into the minor calyx

Question 12

where in the kidney are the nephrons

Answer 12

renal pyramids

Question 13

what vertebral level are the renal arteries

Answer 13

L1- left
L2- right
behind the renal veins
there may be extrahilar arteries branching from the aorta

Question 14

where does lymph from the kidney go to

Answer 14

lumbar nodes

Question 15

what structures are in the renal hilum, from anterior to posterior

Answer 15

vein
artery
pelvis

Question 16

why is the right renal vein short

Answer 16

the IVC is to the right of the midline

this makes surgery difficult

Question 17

what does the renal artery divide into

Answer 17

five segmental arteries that enter at the hilum

Question 18

what arteries arise from each segmental artery

Answer 18

lobar arteries, one for each pyramid

Question 19

what arteries arise from the lobar arteries

Answer 19

interlobar arteries

Question 20

what are the arcuate arteries

Answer 20

branches of the interlobular arteries which arch over the base of the pyramids
these give off interlobular arteries

Question 21

what do the afferent glomerular arterioles supply

Answer 21

renal corpuscle

arise from the branches of the interlobular arteries

Question 22

what is the kidney nerve supply

Answer 22

T12 and L1

Question 23

where is kidney pain referred to

Answer 23

back and lumbar regions, loin and groin

nausea and emesis may be associated due to vagal afferents

Question 24

where is the ureter

Answer 24

posterior abdo wall

23-30 cm long

Question 25

where are the narrowings of the ureter

Answer 25

pelvic ureteric junction crossing the pelvic brim passing into the bladder

Question 26

what do the ureters cross

Answer 26

``` ant to psoas major anterior to lumbar plexus bifurcation of the common iliac artery overlies the lumbar transverse process runs medial to the sacral iliac joints passes medial to the branches of the internal iliac on the lateral pelvic wall and floor ```

Question 27

what does the pelvic ureter cross in the male

Answer 27

between the vas and seminal vesicle

Question 28

where does the pelvic ureter pass in the female

Answer 28

posterior to ovary inf to uterine artery passes cervix and lateral fornix of vagina

Question 29

where does lymph from the ureter pass

Answer 29

para aortic and iliac nodes

Question 30

what is the blood supply of the ureter

Answer 30

``` Aorta Renal Gonadal Common and internal iliac Uterine, vaginal Vesical ```

Question 31

how is urine prevented from refluxing into the ureters

Answer 31

oblique entry flap valve pressure of urine forces the ureters to close

Question 32

how far apart are the orifices of the ureters in the bladder wall

Answer 32

2.5 cm when empty | 5cm when full

Question 33

what muscle relaxes in order to fill the bladder

Answer 33

detrusor

Question 34

what epithelium is found in the bladder

Answer 34

transitional

Question 35

what part of the ANS controls the bladder wall

Answer 35

mostly PNS

Question 36

what is the nerve supply of the ureters

Answer 36

nerves not required for peristalsis due to pacemakers T10 -S4 from aortic, renal and pelvic plexuses

Question 37

where is ureteric pelvic pain referred to

Answer 37

t11- L2 | loin to groin and scrotum or labia

Question 38

what is the nerve supply of detrusor

Answer 38

S2-4 parasympathetic

Question 39

what is the function of the preprostatic sphincter

Answer 39

prevents backflow of semen into the bladder sympathetic control

Question 40

what contributes to urinary continence in females

Answer 40

bladder neck is above the pelvic floor so the pressure of pelvic organs and levator ani contribute to continence

Question 41

how long is the female urethra

Answer 41

4 cm

Question 42

where is the external urinary sphincter

Answer 42

inferior to the bladder neck | striated muscle

Question 43

what are the four parts of the male urethra

Answer 43

preprostatic- int sphincter prostatic membranous -ex sphincter spongey/penile urethra

Question 44

what is the blood supply of the bladder and urethra

Answer 44

branches of the internal iliac sup and inf vesical internal pudendal branches from adjacent structures

Question 45

what is the venous drainage of the bladder and urethra

Answer 45

vesical and prostatic plexuses converging on internal pudendal and internal iliac arteries

Question 46

what is the lymph drainage of the bladder

Answer 46

internal and external iliac nodes

Question 47

how does prostate cancer spread

Answer 47

communications with the valveless veins of the vertebral plexuses

Question 48

what is the nerve supply of the bladder

Answer 48

S2-4 pudendal nerve pelvic plexus for ANS

Question 49

how does micturition happen

Answer 49

Parasympathetic to detrusor “switched off” in spinal cord to allow bladder to relax and fill Usual volume (male) about 400 ml, if reach 500 ml – pain in lower abdomen and perineum 2. “Full”, causes desire to micturate Afferents (sensory) to spinal cord, then “M” Centre in pons – stimulates preganglionic, parasympathetic neurones at S 2, 3, 4 3. Void 1y neurones stimulate 2y neurones in bladder wall ganglia, causing detrusor contraction Simultaneous relaxation of external urethral sphincter (striated muscle) – pudendal nerve (S 2, 3, 4) and contraction of abdo. wall; sensation of urine in urethra maintains the reflex

Question 50

where does the left renal artery arise

Answer 50

L1, behind the renal vein

Question 51

where does the right renal artery arise

Answer 51

L2, behind the renal vein

Question 52

what vein does the SMA overlie

Answer 52

left renal vein

Question 53

what part of the duodenum overlies the hilum of the right kidney

Answer 53

2nd, descending

Question 54

where is the pelvis in relation to the renal vessels

Answer 54

behind

Question 55

what is nutcracker syndrome

Answer 55

compression of the left renal vein between the aorta and the SMA renal venous hypertension and haematuria

Question 56

where does the left suprarenal vein and gonadal vein drain

Answer 56

left renal vein

Question 57

what arterial bifurcation do the ureters pass

Answer 57

common iliac artery

Question 58

what do the ureters lie posterior to

Answer 58

everything except lumbar plexus, common iliac artery bifurcation posterior to the gonadal vessels and colic vessels

Question 59

what muscle contributes to continence in females

Answer 59

levator ani

Question 60

where is the urethra embedded in females

Answer 60

anterior vaginal wall

Question 61

what part of the male urethra is enclosed by the internal sphincter

Answer 61

preprostatic

Question 62

what part of the male urethra is enclosed by the external sphincter

Answer 62

the membranous urethra

Question 63

where is the micturition centre in the brain

Answer 63

pons