anatomy of the renal system Flashcards
what layers surround the kidneys
perirenal fat (around) renal fascia (extraperitoneal fascia) pararenal fat (along side)
at what vertebral levels are the kidneys
t12 - L3
which kidney is lower
right
which kidney is longer
left
what are the anterior relations of the right kidney
IVC, duodenum, liver, colic flexure, suprarenal gland
what are the anterior relations of the left kidney
pancreas, spleen, stomach, colic flexure, small intestine
what ribs does the kidney overlie
10, 11, 12
why do the kidneys move with respiration
they lie on the diaphragm
what abdominal muscles do they kidneys lie on
QL, TA, psoas major
what is the renal column
the extension of cortex between the pyramids
what are the renal papillae
the part of the medulla that projects into the minor calyx
where in the kidney are the nephrons
renal pyramids
what vertebral level are the renal arteries
L1- left
L2- right
behind the renal veins
there may be extrahilar arteries branching from the aorta
where does lymph from the kidney go to
lumbar nodes
what structures are in the renal hilum, from anterior to posterior
vein
artery
pelvis
why is the right renal vein short
the IVC is to the right of the midline
this makes surgery difficult
what does the renal artery divide into
five segmental arteries that enter at the hilum
what arteries arise from each segmental artery
lobar arteries, one for each pyramid
what arteries arise from the lobar arteries
interlobar arteries
what are the arcuate arteries
branches of the interlobular arteries which arch over the base of the pyramids
these give off interlobular arteries
what do the afferent glomerular arterioles supply
renal corpuscle
arise from the branches of the interlobular arteries
what is the kidney nerve supply
T12 and L1
where is kidney pain referred to
back and lumbar regions, loin and groin
nausea and emesis may be associated due to vagal afferents
where is the ureter
posterior abdo wall
23-30 cm long
where are the narrowings of the ureter
pelvic ureteric junction
crossing the pelvic brim
passing into the bladder
what do the ureters cross
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
what does the pelvic ureter cross in the male
between the vas and seminal vesicle
where does the pelvic ureter pass in the female
posterior to ovary
inf to uterine artery
passes cervix and lateral fornix of vagina
where does lymph from the ureter pass
para aortic and iliac nodes
what is the blood supply of the ureter
Aorta Renal Gonadal Common and internal iliac Uterine, vaginal Vesical
how is urine prevented from refluxing into the ureters
oblique entry
flap valve
pressure of urine forces the ureters to close
how far apart are the orifices of the ureters in the bladder wall
2.5 cm when empty
5cm when full
what muscle relaxes in order to fill the bladder
detrusor
what epithelium is found in the bladder
transitional
what part of the ANS controls the bladder wall
mostly PNS
what is the nerve supply of the ureters
nerves not required for peristalsis due to pacemakers
T10 -S4 from aortic, renal and pelvic plexuses
where is ureteric pelvic pain referred to
t11- L2
loin to groin and scrotum or labia
what is the nerve supply of detrusor
S2-4 parasympathetic
what is the function of the preprostatic sphincter
prevents backflow of semen into the bladder
sympathetic control
what contributes to urinary continence in females
bladder neck is above the pelvic floor so the pressure of pelvic organs and levator ani contribute to continence
how long is the female urethra
4 cm
where is the external urinary sphincter
inferior to the bladder neck
striated muscle
what are the four parts of the male urethra
preprostatic- int sphincter
prostatic
membranous -ex sphincter
spongey/penile urethra
what is the blood supply of the bladder and urethra
branches of the internal iliac
sup and inf vesical
internal pudendal
branches from adjacent structures
what is the venous drainage of the bladder and urethra
vesical and prostatic plexuses converging on internal pudendal and internal iliac arteries
what is the lymph drainage of the bladder
internal and external iliac nodes
how does prostate cancer spread
communications with the valveless veins of the vertebral plexuses
what is the nerve supply of the bladder
S2-4
pudendal nerve
pelvic plexus for ANS
how does micturition happen
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
where does the left renal artery arise
L1, behind the renal vein
where does the right renal artery arise
L2, behind the renal vein
what vein does the SMA overlie
left renal vein
what part of the duodenum overlies the hilum of the right kidney
2nd, descending
where is the pelvis in relation to the renal vessels
behind
what is nutcracker syndrome
compression of the left renal vein between the aorta and the SMA
renal venous hypertension and haematuria
where does the left suprarenal vein and gonadal vein drain
left renal vein
what arterial bifurcation do the ureters pass
common iliac artery
what do the ureters lie posterior to
everything except lumbar plexus, common iliac artery bifurcation
posterior to the gonadal vessels and colic vessels
what muscle contributes to continence in females
levator ani
where is the urethra embedded in females
anterior vaginal wall
what part of the male urethra is enclosed by the internal sphincter
preprostatic
what part of the male urethra is enclosed by the external sphincter
the membranous urethra
where is the micturition centre in the brain
pons
