Anatomy of the Upper Renal Tract Flashcards
what is the urinary tract?
anatomical structures through which urine passes from its production to its excretion
Kidney > Ureter > Bladder > Urethra
what is excreted via the urethra?
urine and semen in males
what are the components of the upper urinary tract?
kidneys (right and left)
ureters (right and left)
- one to drain each kidney
what are the components of the lower urinary tract?
bladder
urethra (unpaired)
where will an upper urinary tract infection spread?
kidneys
where will a lower urinary tract infection spread?
urethra and bladder
what urinary tract components are found in the abdomen?
kidneys
proximal ureters
(both are retroperitoneal)
what urinary tract components are found in the pelvis?
distal ureters
bladder
proximal urethra
what urinary tract components are found in the perineum?
distal urethra
where are the kidneys found?
retroperitoneal organs inside the abdominal cavity
anterior surface of kidneys are in contact with visceral peritoneum
right = level of L2
left = level of L1
what is the renal hilum?
root of the kidney
main arteries, veins and urinary structures enter/exit the kidney here
what enters/exits via the renal hilum?
renal vein
renal artery
ureter
(from anterior to posterior)
what are the 3 layers of the anterolateral abdominal wall msucles?
external oblique
internal oblique
transversus abdominus
what layers are found on top of the kidneys (anteriorly)?
visceral peritoneum paranephric fat renal (deep) fascia perinephric fat renal capsule (basically another layer of deep fascia) (from outside to inside)
describe perinephric fat
almost like liquid fat
kidney is therefore almost floating in the liquid fat
what causes pain when kidney is inflamed etc?
affects the renal capsule which is very tightly wrapped around the kidney
aorta vs vena cava on CT?
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
vertebral position of each kidney?
left = T12 - L2
right = L1 - L3
- due to presence of liver which pushes it down
which ribs are associated with the kidneys?
ribs 11 and 12 (floating ribs)
muscle relations of kidneys?
kidneys lie anterior to quadratus lumborum and lateral to psoas major
in what quadrants are the kidneys found?
LUQ
RUQ
balloting the right kidney?
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
normal examination of kidney?
12cm long 6cm wide smooth regular firm
anatomical relations of the right kidney?
posterior to the liver and hepatorenal recess
posterior to 2nd part of duodenum, ascending colon and right colic flexure
deepest part of the peritoneal cavity when lying supine?
hepatorenal recess
- means abnormal fluid will collect here
anatomical relationships of the left kidney?
posterior to the stomach, tail of the pancreas, hilum of spleen and splenic vessels
arterial supply to the kidneys?
renal arteries
venous drainage of the kidneys?
renal veins
most anterior
lymphatic drainage of the kidneys?
drains to lumbar nodes (around midline around abdominal aorta and vena cava)
arterial supply tot he ureter?
branches from renal artery, abdominal aorta, common iliac, internal iliac and vesical (bladder) artery
lymphatic drainage of the ureter?
drains to the lumbar nodes and iliac nodes
where does the abdominal aorta bifurvate?
umbilicus
vertebral level L4
supra vs infra renal AAA?
suprarenal originates above the branching of the renal arteries
infrarenal = below
management of AAA?
EVAR
open repair
what might a infrarenal AAA be associated with when combined with renal artery stenosis?
atherosclerosis
what might a suprarenal AAA be associated with when combined with renal artery stenosis?
occlusion of the proximal renal artery by the aneurysm
the aneurysm is causing the stenosis
anatomical variations?
bifid renal pelvis bifid/duplicated ureter retro-caval ureter (goes behind IVC) horse shoe kidney ectopic pelvic kidney
what gives the striped appearance of the pyramids of the medulla?
regularly arranged nephrons
what are the components of the kidney?
renal capsule renal cortex renal medulla - contains renal pyramids - each pyramid contains 50,000 nephrons
how does urine drain from the kidney?
nephrons collecting duct > minor calyx > major calyx (combination of minor calyxes) > renal pelvis > ureter
describe how the diameter of urine drainage tubes changes as urine drains from the kidneys
diameter increases until a constriction at the pelviuteric junction (the wider renal pelvis becomes the narrower ureter)
significance of sites of constriction?
means things can get stuck (renal stones)
what are the 3 anatomical sites of ureteric constriction?
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
what are renal calculi?
renal stones
form from urine calcium salts and can obstruct the urinary tract from within
what can cause uteric obstruction?
internal obstruction - impacted calculus or blood clot
external compression - expanding mass (e.g tumour)
how does the ureter respond to obstruction?
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
consequences of urinary tract obstruction?
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
what is hydronephrosis?
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
