Anatomy of the Upper Renal Tract

Question 1

what is the urinary tract?

Answer 1

anatomical structures through which urine passes from its production to its excretion
Kidney > Ureter > Bladder > Urethra

Question 2

what is excreted via the urethra?

Answer 2

urine and semen in males

Question 3

what are the components of the upper urinary tract?

Answer 3

kidneys (right and left)
ureters (right and left)
- one to drain each kidney

Question 4

what are the components of the lower urinary tract?

Answer 4

bladder

urethra (unpaired)

Question 5

where will an upper urinary tract infection spread?

Answer 5

kidneys

Question 6

where will a lower urinary tract infection spread?

Answer 6

urethra and bladder

Question 7

what urinary tract components are found in the abdomen?

Answer 7

kidneys
proximal ureters
(both are retroperitoneal)

Question 8

what urinary tract components are found in the pelvis?

Answer 8

distal ureters
bladder
proximal urethra

Question 9

what urinary tract components are found in the perineum?

Answer 9

distal urethra

Question 10

where are the kidneys found?

Answer 10

retroperitoneal organs inside the abdominal cavity
anterior surface of kidneys are in contact with visceral peritoneum
right = level of L2
left = level of L1

Question 11

what is the renal hilum?

Answer 11

root of the kidney

main arteries, veins and urinary structures enter/exit the kidney here

Question 12

what enters/exits via the renal hilum?

Answer 12

renal vein
renal artery
ureter
(from anterior to posterior)

Question 13

what are the 3 layers of the anterolateral abdominal wall msucles?

Answer 13

external oblique
internal oblique
transversus abdominus

Question 14

what layers are found on top of the kidneys (anteriorly)?

Answer 14

visceral peritoneum
paranephric fat
renal (deep) fascia
perinephric fat
renal capsule (basically another layer of deep fascia)
(from outside to inside)

Question 15

describe perinephric fat

Answer 15

almost like liquid fat

kidney is therefore almost floating in the liquid fat

Question 16

what causes pain when kidney is inflamed etc?

Answer 16

affects the renal capsule which is very tightly wrapped around the kidney

Question 17

aorta vs vena cava on CT?

Answer 17

aorta always on patient’s left side
IVC always on patients right side, site more anteriorly than aorta
can look similar as renal artery extends from aorta and renal vein from the IVC

Question 18

vertebral position of each kidney?

Answer 18

left = T12 - L2
right = L1 - L3
- due to presence of liver which pushes it down

Question 19

which ribs are associated with the kidneys?

Answer 19

ribs 11 and 12 (floating ribs)

Question 20

muscle relations of kidneys?

Answer 20

kidneys lie anterior to quadratus lumborum and lateral to psoas major

Question 21

in what quadrants are the kidneys found?

Answer 21

LUQ

RUQ

Question 22

balloting the right kidney?

Answer 22

palpate posteriorly within the right flank, just inferior to the 12th rib
palpate anteriorly within the RUQ
as the patient breathes in, the kidneys descend and may be trapped for examination between the palpating hands
kidneys then move superiorly on expiration

Question 23

normal examination of kidney?

Answer 23

12cm long
6cm wide
smooth 
regular
firm

Question 24

anatomical relations of the right kidney?

Answer 24

posterior to the liver and hepatorenal recess

posterior to 2nd part of duodenum, ascending colon and right colic flexure

Question 25

deepest part of the peritoneal cavity when lying supine?

Answer 25

hepatorenal recess | - means abnormal fluid will collect here

Question 26

anatomical relationships of the left kidney?

Answer 26

posterior to the stomach, tail of the pancreas, hilum of spleen and splenic vessels

Question 27

arterial supply to the kidneys?

Answer 27

renal arteries

Question 28

venous drainage of the kidneys?

Answer 28

renal veins | most anterior

Question 29

lymphatic drainage of the kidneys?

Answer 29

drains to lumbar nodes (around midline around abdominal aorta and vena cava)

Question 30

arterial supply tot he ureter?

Answer 30

branches from renal artery, abdominal aorta, common iliac, internal iliac and vesical (bladder) artery

Question 31

lymphatic drainage of the ureter?

Answer 31

drains to the lumbar nodes and iliac nodes

Question 32

where does the abdominal aorta bifurvate?

Answer 32

umbilicus | vertebral level L4

Question 33

supra vs infra renal AAA?

Answer 33

suprarenal originates above the branching of the renal arteries infrarenal = below

Question 34

management of AAA?

Answer 34

EVAR | open repair

Question 35

what might a infrarenal AAA be associated with when combined with renal artery stenosis?

Answer 35

atherosclerosis

Question 36

what might a suprarenal AAA be associated with when combined with renal artery stenosis?

Answer 36

occlusion of the proximal renal artery by the aneurysm | the aneurysm is causing the stenosis

Question 37

anatomical variations?

Answer 37

``` bifid renal pelvis bifid/duplicated ureter retro-caval ureter (goes behind IVC) horse shoe kidney ectopic pelvic kidney ```

Question 38

what gives the striped appearance of the pyramids of the medulla?

Answer 38

regularly arranged nephrons

Question 39

what are the components of the kidney?

Answer 39

``` renal capsule renal cortex renal medulla - contains renal pyramids - each pyramid contains 50,000 nephrons ```

Question 40

how does urine drain from the kidney?

Answer 40

nephrons collecting duct > minor calyx > major calyx (combination of minor calyxes) > renal pelvis > ureter

Question 41

describe how the diameter of urine drainage tubes changes as urine drains from the kidneys

Answer 41

diameter increases until a constriction at the pelviuteric junction (the wider renal pelvis becomes the narrower ureter)

Question 42

significance of sites of constriction?

Answer 42

means things can get stuck (renal stones)

Question 43

what are the 3 anatomical sites of ureteric constriction?

Answer 43

pelviuteric 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

Question 44

what are renal calculi?

Answer 44

renal stones | form from urine calcium salts and can obstruct the urinary tract from within

Question 45

what can cause uteric obstruction?

Answer 45

internal obstruction - impacted calculus or blood clot | external compression - expanding mass (e.g tumour)

Question 46

how does the ureter respond to obstruction?

Answer 46

has smooth muscle so responds similarly to GI tract - increased peristalsis proximal to site of obstruction - as peristalsis comes in waves, a patient with a ureteric obstruction tends to have colicky pain

Question 47

consequences of urinary tract obstruction?

Answer 47

can cause urine to back up into kidneys obstrucitons within calyces or ureter cause unilateral back pressure of urine obstruction within the bladder may cause unilateral or bilateral kidney problems obstructions in 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

Question 48

what is hydronephrosis?

Answer 48

water inside the kidney urine back pressure into the calyces compresses the nephrons within the medullary pyramids leading to renal failure causes painful stretching of the renal capsule