Anatomy of the Upper Urinary Tract Flashcards
Describe how urine passes from the kidney to outside the body
Produced in kidney
Drained in the ureter to the bladder
Stored in the bladder
Excreted via the urethra
What makes up the upper urinary tract
Kidneys and the ureters
What makes up the lower urinary tract
Bladder and urethra
What parts of the urinary tract are located within the abdomen
The kidneys
The proximal ureters
Where is the division of the abdomen and the pelvis
In line with the iliac crests
What parts of the urinary tract are located within the pelvis
Distal ureters
Bladder
Proximal urethra
What parts of the urinary tract are located within the perineum
Distal urethra
What is the spinous process that lies at the division of the abdomen and pelvis
L4
What does L4 represent
The bifurcation of the abdominal aorta
Where do the kidneys sit in the body
retroperitoneal
in abdominal cavity but behind the peritoneum
What does the anterior surface of the kidneys contact
The peritoneum
What is the right kidney lateral to
the IVC
What is the left kidney lateral to
The Abdominal Aorta
What encloses the kidneys
The renal fat/ fascia/ capsule
What muscles surround the kidneys
Muscles of the posterior abdominal wall, muscles of the anterolateral abdominal wall and muscles of the back
What structures make up the renal hilum
Renal artery
renal vein
ureter
What are the posterior abdominal wall muscles that make up the posterior boundary
Quadratus lumborum
psoas major muscle (more anteriorly)
What is the name of the fat that lies between the visceral peritoneum and the deep renal fascia
Paranephric fat
What is the name of the fat that is deep to the paranephric fat and completely surrounds the kidney
Perinephric fat
What is the muscle of the side of the posterior abdominal wall
quadratus lumborum
What are the 3 muscles that lie posteriolaterally to the kidney
External oblique
Internal oblique
Transversus abdominis
What do the kidneys lie anterior to
Quadratus lumborum
What do the kidneys lie lateral to
psoas major
lower thoracic/ upper lumbar vertebral bodies
Why does the right kidney lie at a slightly inferior vertebral level
Due to the size of the liver
At what vertebral level does the left kidney sit
T12-L2
At what vertebral level does the right kidney sit
L1-L3
What ribs can protect the kidneys
11 and 12 - the floating ones
What can a fractures floating rib do to a kidney
Lacerate the kidney at the fracture site
What quadrant do the kidneys lie in
Left is in the left flank / LUQ
Right is in the right flank / RUQ
Describe the structure of a normal kidney
12cm long 6cm wide smooth regular firm
What direction do the kidneys move on inspiration and expiration and why
Inferior on inspiration
Superiorly on expiration
The liver and spleen lie in contact with the diaphragm superiorly and the superior poles of the kidneys inferiorly
Describe the anatomical location of the right kidney
Posterior to: Liver duodenum ascending colon right colic flexure
Describe the anatomical location of the left kidney
Posterior to: stomach tail of the pancreas hilum of the spleen splenic vessels
What is the hepatorenal recess
one of the most dependent parts of the greater sac of the peritoneal cavity in the supine patient
The renal arteries are anterior to the renal veins. True or False
False the veins are anterior to the renal arteries
The common iliac arteries are anterior to the common iliac veins. True or False
True
Where does the lymph from the kidneys drain to
The lumbar nodes (located around the abdominal aorta and the IVC)
Where does lymph from the ureters drain to
The lumbar nodes and the iliac nodes
Where are the iliac nodes located
around the common, internal and external iliac vessels
Describe the ureteric arterial blood supply
branches from: renal artery abdominal aorta Common iliac artery internal iliac artery vesical (bladder) artery
If an AAA is infra-renal, what causes renal artery stenosis
Atherosclerosis
If an AAA is suprarenal, what causes renal artery stenosis
The AAA itself, causing occlusion of the proximal renal artery by the aneurysm
What is the treatment for renal artery stenosis
Stent into the femoral artery and push up towards the AA to reduce the pressure on the walls of the aorta
Name some anatomical variations in the renal system
Horseshoe shaped kidney (R&L fuse during embryological development)
Ectopic pelvic kidney
Retrocaval ureter
Bifid renal pelvis
Bifid ureter and unilateral duplicated ureter
Why might a patient have a solitary kidney
Agenesis (failure of one side to form)
Nephrectomy (pathology)
Nephrectomy (donation)
How many pyramids does the human medulla contain
27
What does each kidney consist of
Outer cortex and inner medulla
How many nephrons does each pyramid contain
50,000
Describe how the nephrons are arranged within the pyramid
Regularly arranged. running axially towards the apex of each pyramid giving the pyramids their striped appearance
What structure connects the proximal convoluted tubule to the distal convoluted tubule
Loop of Henle
Describe the course of the collecting duct
it passes through the pyramid to drain the modified filtrate into the minor calyx as urine
What happens in the glomerulus
ultrafiltration of the blood arriving via the branches of the renal artery
How does urine drain from the kidney
Nephrons collecting duct minor calyx major calyx renal pelvis ureter
Describe the change in size of the tubes in the kidney
The diameter increases until a constriction point (pelvireteric junction)
What are the 3 anatomical sites of ureteric constriction
Pelviureteric junction
ureter x common iliac artery
Ureteric orifice
What is the bony landmark at the point at which the ureter crosses the common iliac artery
Pelvic brim
What is the main problem that arises at the ureteric constriction sites
Kidney stones (renal calculi)
What do renal calculi form from
urine calcium salts
Where do kidney stones usually develop
within the major and minor calyx
What are stag horn calculus
a collection of kidney stones
What would cause an internal ureteric obstruction
Impacted renal calculus or a blood clot
What would cause an external ureteric compression
an expanding mass e.g. a tumour
Why do kidney stones often present with colicky pain
The ureter has smooth muscle within its walls so peristaltic waves come to try and dislodge something that is stuck resulting in colicky pain
What happens to urine when there is an obstruction
Urine is backed up towards the kidney
If the obstruction is within the calyces or ureter, what happens to the pressure of urine
Unilateral back pressure of urine
What can obstructions in the bladder cause
unilateral or bilateral kidney problems
What might obstruction tot the urethra cause
Bilateral kidney probelsm
What does renal failure mean
failure to adequately filter the blood to produce urine. This can be caused by urine being backed up into the kidney
What is hydronephrosis
water inside the kidney
What does acute hydronephrosis cause
painful stretching of the renal capsule. This can be palpated during clinical examination
