Anatomy of the upper renal tract: Flashcards
what does the urinary tract consist of?
The urinary tract consists of the anatomical structures through which urine passes from its production to its excretion (removal from the body)
what is the order through which urine is excreted?
the kidney (bilateral) - produces urine
the ureter - drains urine (from kidney to bladder)
the bladder (large muscle, detrusor muscle - contracts in order to empty the bladder) - stores/voids urine
the urethra - excretion of urine and semen in males
the urinary tract is divided into the?
upper and lower urinary tracts
the upper urinary tracts consists of?
the kidneys (right &left) the ureters (right & left) one to drain each kidney
the lower urinary tracts consists of?
the bladder (unpaired midline structure) the urethra (unpaired midline structure)
where can an upper UTI spread to?
kidneys or ureter
what does a lower UTI involve?
urethra and/or bladder
where is the urinary tract?
in the abdomen:
in the retroperitoneum (behind the peritoneum cavity):
Kidneys and proximal ureters
in the pelvis:
the distal ureters
the bladder
the proximal urethra
the perineum (floor of pelvis down to skin of the external genetalia): the distal urethra
what is in direct contact with the visceral peritoneum?
the anterior part of the kidney
the root of the kidney is
the renal hilum, where you find the arteries, veins and urinary structures
what is anterior to the artery?
Veins
Vein, Artery, ureter - most posteriorly
what are the anterolateral abdominal wall muscles?
external oblique
internal oblique
transversus abdominus
what is the order of tissues around the kidney?
visceral peritoneum
paranephric fat - looks like superficial fascia
renal (deep) fascia (thick)
perinephric fat - immediately surrounds the kidneys - liquid fat in the living
renal capsule
kidneys are cushioned by the layer of fat
renal capsule - a layer of deep fascia - needed for pathology
what is special about the renal capsule?
even if the kidney expands due to pathology, the renal capsule doesn’t allow it to expand
what is found on the patient’s left hand side?
the aorta, renal artery comes off the aorta
what is found on the patient’s right hand side?
the IVC , renal vein comes off the IVC, more anterior than the aorta
what lies posterior to the kidneys?
quadrates lumborum and lateral to posts major
what displaces the right kidney inferiorly?
the liver
what are the two ribs associated with the posterior and lateral aspects of the kidney?
ribs 11 and 12
the ribs offer some protection to the kidneys against penetrating trauma
but…should the ribs fracture the sharp displaced ends may contuse (bruise) or lacerate the kidney
the kidneys lie within which regions or quadrants?
in the left flank/LUQ and in the right flank (RUQ)
where duo you palpate for kidneys?
palpate posteriorly within the right flank just inferior to the 12th rib
palpate anterior within the RUQ
the liver and spleen lie in contact with the diaphragm superiorly and the superior poles of the kidneys move inferiorly on inspiration then superiorly on expiration. As the patient breathes in the kidneys descend and may be “trapped” for examination between the palpating hands
a normal kidney is?
a normal kidney is ~ 12 long ~ 6 cm wide smooth regular firm
the right kidney’s anatomical relations?
the liver and the hepatorenal recess
the 2nd part of the duodenum
ascending colon
right colic flexure
the left kidney is posterior to?
the stomach
the tail of the pancreas
the hilum of the spleen
the splenic vessels
where does abnormal liquid collect in the abdomen?
in the hepatorenal recess:
one of the most dependent parts of the greater sac of the peritoneal cavity in the supine patient
venous drainage to the kidneys?
r and l renal vein drains back to the IVC
and the arterial supply to the ureter?
branches from: the renal artery the abdominal aorta the common iliac artery the internal iliac artery (deeper) the vesical (bladder) artery
the renal veins are —— to the renal arteries?
anterior
the common iliac arteries are —— to the common iliac veins?
anterior
the kidney arterial supply?
the renal artery
where does lymph of the kidneys drain?
the lymph from the kidneys drains to the lumbar nodes (located around the abdominal aorta and inferior vena cava)
where does the lymph from the ureter drain?
the lymph from the ureters drains to the lumbar nodes & the iliac nodes (the latter located around the common, internal & external iliac vessels)
where does the abdominal aorta bifurcate?
at the level of the umbilicus
AAA and the renal arteries?
infra-renal AAA - bifurcation of the abdominal aorta is below the AAA
supra-renal AAA
when associated with AAA, renal artery stenosis may be:
combined with an infra-renal AAA (both caused by atherosclerosis)
due to suprarenal AAA (occlusion of the proximal renal artery by the aneurysm)
always note that there is
anatomical variation in the renal system
variations can be?
bifid renal pelvis - two pelvis coming from a single kidney
bifid ureter and unilateral duplicated ureter - very common
retrocaval ureter
horseshoe kidney - no embryological separation between the right and left kidney
ectopic pelvic kidney
what are causes of the solitary kidney?
agenesis (doesn’t form)
nephrectomy (pathology)
nephrectomy (Donation)
darker - sptriped areas:
medulla
striped appearance of the medulla is due to the collecting ducts from the nephrons
regularly arranged nephrons (running axially towards the apex of each pyramid) give the pyramids their striped appearance
the human. medulla contains?
renal pyramids
each pyramid contains?
around 50 000 nephrons
what is the largest urine collecting area in the kidney?
the renal pelvis
what happens to the diameter of the tubes from the nephrons collecting ducts to the renal pelvis?
diameter of urine drainage “tubes” is increasing
where does a constriction occur?
at the pelviureteric junction - the wider renal pelvis becomes the narrower ureter
kidney stones?
what are the anatomical sites of ureteric constriction?
pelviureteric junction
ureter crossing anterior aspect of the common iliac artery (often crosses the bifurcation)
ureteric orifice (opening into one corner of the trigone on the floor of the bladder)
what is the significance of ureteric constrictions?
kidney stones can get stuck there
ureteric constriction - calculi
renal calculi (stones) can form from urine calcium salts and obstruct the urinary tract from within
cause filling defect - suggest a calculus is causing a ureteric narrow at that point
what causes ureteric obstructions?
internal obstruction
external compression
internal obstruction of the ureter are caused by?
an impacted renal calculat or a blood clot
external compressions?
an expanding mass (e.g. tumour)
what is the UT’s response to obstructions?
ureter has smooth muscle in its walls
increased peristalsis proximal to the site of the obstruction in an attempt to remove it (flush it into the bladder)
as peristalsis comes in waves, a patient with a ureteric obstruction tends to experience pain that “comes and goes” (“colicky”)
what are the consequences of UT obstruction?
obstructions cause urine to “back up” in the tract towards the kidneys
obstructions within the calyces or ureter cause unilateral back pressure of urine
obstructions within the bladder may cause unilateral or bilateral kidney problems
obstructions to the urethra cause bilateral kidney problems
urine production will continue until the pressure within the urinary tract exceeds the pressures favouring filtration at the glomerulus
renal failure means failure to adequately filter the blood to produce urine
hydronephrosis?
urine back pressure into the calyces compresses the nephrons within the medullary pyramids leading to renal failure
right kidney enlargement due to unilateral hydronephrosis is palpable during clinical examination
acute hydronephrosis causes painful stretching of the renal capsule
