Anatomy of the Upper Urinary Tract Flashcards
What is the route of urine flow?
Kidney produces urine - ureter drains from kidney to bladder - bladder stores and voids urine - urethra excretes urine
What structures make up the upper urinary tract?
Kidneys and ureters = infection of this area may spread to the kidneys
What structures make up the lower urinary tract?
Bladder and urethra = infection of this area will involve these structures
What parts of the urinary tract are found in the abdomen?
In the retroperitoneum = kidneys, proximal ureters
What parts of the urinary system are present in the pelvis?
Distal ureters, bladder, proximal urethra
What part of the urinary tract is found in the perineum?
Distal urethra
What are the contents of the hilum of the kidneys?
Renal artery, renal vein, ureter
What part of the abdomen are the kidneys found in?
In the abdominal cavity behind the peritoneum
What are the layers of tissue that surround the kidneys (from superficial to deep)?
Visceral peritoneum, paranephric fat, renal (deep) fascia, perinephric fat, renal capsule
What muscles are the kidneys related to?
Anterior to quadratus lumborum and lateral to psoas major
What is the relationship of the kidneys to the lower thoracic/upper lumbar vertebral bodies?
Lateral to the vertebral bodies
What vertebral level are the kidneys found at?
Right kidney = L1-L3
Left kidney = T12-L2
Why is the right kidney slightly inferior to the left kidney?
Due to the liver
What ribs are posteriorly related to the kidneys?
Ribs 11 and 12 = offer protection against penetrating injury but can bruise/lacerate the kidneys if they fracture
What sections of the abdomen are the kidneys found in?
Left and right upper quadrants
Left and right hyperchondria
What are the anatomical relationships of the liver and spleen?
In contact with the diaphragm superiorly and the superior poles of the kidneys inferiorly
How do the kidneys move during breathing?
Move inferiorly on inspiration and superiorly on expiration
How would you ballot the right kidney?
Palpate posteriorly within the right flank just below rib 12
Palpate anteriorly within the RUQ
How does breathing aid balloting the kidneys?
As the patient breathes in the kidneys descend and may be trapped for examination between the palpating hands
What structures is the right kidney posterior to?
Liver, hepatorenal recess, second part of the duodenum, right colic flexure, ascending colon
What structures is the left kidney posterior to?
Stomach, tail of the pancreas, hilum of the spleen, splenic vessels
What is significant about the hepatorenal recess?
One of the lowest dependent parts of the greater sac of the peritoneal cavity in the supine patient
What are the renal veins anterior to?
The renal arteries
What are the common iliac arteries anterior to?
Common iliac veins
Where does lymph from the kidneys drain to?
The lumbar nodes = located around the abdominal aorta and the IVC
Where does the abdominal aorta bifurcate?
At the level of the umbilicus
What vessels give branches to supply the ureter?
Renal artery, abdominal aorta, common iliac artery, internal iliac artery, vesical artery
Where does lymph from the ureters drain to?
Lumbar nodes
Iliac nodes = located around the common, internal and external arteries
What are the characteristics of renal stenosis when it is associated with AAA?
Combined with infra-renal AAA = both caused by atherosclerosis
Due to supra-renal occlusion = occlusion of proximal renal artery by the aneurysm
What are some anatomical variations that exists in the upper urinary tract?
Bifid renal pelvis, bifid ureter and unilateral duplicated ureter, horseshoe kidney, retrocaval ureter, ectopic pelvic kidney
What are some causes of a solitary kidney?
Agenesis, nephrectomy (pathology-driven or donation)
What does each kidney consist of?
An outer cortex and inner medulla
What does the medulla of the kidney contain?
Renal pyramids = each pyramid contains around 50,000 nephrons
What gives the renal pyramids their striped appearance?
Nephrons run axially towards the apex of each pyramid
What route does urine drain through the kidney via?
Nephron collecting duct - minor calyx - major calyx - renal pelvis - ureter
What happens to the diameter of the urine drainage tubes at the pelviureteric junction?
The diameter increases = the wider renal pelvis becomes the narrower ureter
Where are the sites of ureteric constriction?
Pelviureteric junction
Ureter crossing anterior aspect of common iliac artery (often crosses bifurcation)
Ureteric orifice
What is the ureteric orifice?
Opening into one corner of the trigone on the floor of the bladder
What are renal calculi?
Kidney stones = usually visible on x-ray
What are filling defects in the kidney suggestive of?
Renal calculi
What are renal calculi formed from?
Urine calcium salts = may obstruct the urinary tract
What can cause obstruction of the ureter?
Internal obstruction = impacted renal stone, blood clot
External compression = expanding mass (tumour)
What is in the walls of the ureter?
Smooth muscle
How does the urinary tract respond to obstruction?
Increased peristalsis proximal to the site of the obstruction in an attempt to flush the obstruction into the bladder
What kind of pain to patients with urinary tract obstruction present with?
Colicky pain = due to the fact that peristalsis comes in waves
What do obstructions cause?
Back up of urine in the tract towards the kidneys
What do obstructions in the calyces or ureter cause?
Unilateral back pressure of urine
What do obstructions within the bladder cause?
Unilateral or bilateral kidney problems
What do obstructions in the urethra cause?
Bilateral kidney problems
How does obstruction of the urinary tract affect urine production?
Urine production continues until the pressure within the urinary tract exceeds the pressures favouring filtration at the glomerulus
What is renal failure?
Failure to adequately filter blood to produce urine
What is hydronephrosis?
Water inside the kidneys
What can hydronephrosis lead to?
Renal failure = due to urine back pressure into the calyces compresses the nephrons within the medullary pyramids
What does acute hydronephrosis cause?
Painful stretching of the renal capsule
