Anatomy of Upper Renal Tract

Question 1

what does urothelium line

Answer 1

• renal pelvis
• ureters
• bladder
• parts of urethra

Question 2

what is the special property of uroepithelium

Answer 2

capable of strecthing eg when the bladder is full

Question 3

define upper and lower urinary tract

Answer 3

• upper: kidneys and ureters
• lower: urethra and bladder

Question 4

what is the vertebral level of the iliac crests

Answer 4

L4/5

Question 5

which part of the urinary tract is found in the perineum

Answer 5

distal urethra

Question 6

outline where in the body the urinary tract components are

Answer 6

Question 7

where are the kidneys found in relation to the peritoneum

Answer 7

• retroperitoneal organs - visceral peritoneum covering on their anterior surface

Question 8

what are the kidneys enclosed in

Answer 8

renal fat/fascia/capsule

renal/nephric are interchangeable

Question 9

how are kidneys sometimes protected from trauma

Answer 9

by muscle guarding

Question 10

Answer 10

Question 11

Answer 11

psoas major

Question 12

Answer 12

quadratus lumborum

Question 13

Answer 13

Question 14

Answer 14

Question 15

decribe the position of the kidney in relation to the quadratus lumborum and psoas major

Answer 15

lateral to psoas major and anterior to q.l

Question 16

what are the verterbal levels of the kidney

Answer 16

• left :T12-L2
• right: L1-3
  
  • lower due to the liver

Question 17

where are the floating ribs in relation to the kidneys, and what is the signficance of this

Answer 17

posteriorly:

• can protect against posteriorly penetrating trauma
• ribs fracture can contuse/lacerate the kidney

Question 18

which quadrants of the abdomen do the kidneys lie in

Answer 18

left and right flank

L/R upper quadrant

Question 19

where should one palpate when balloting the kidneys

Answer 19

• posteriorly in flank just inferior to rib 12
• anteriorly in UQ
• as the patient breathes in the kidney descends and can be palpated between hands

Question 20

how do kidneys move on inspiration and expiration

Answer 20

• inferiorly on inspiration
• superiorly on expiration

Question 21

hepatorenal recess

Answer 21

one of the lowest parts of the peritoneal cavity when the patient is lying supine

Question 22

where does lymph from the kidneys and ureteres drain

Answer 22

• kidneys: lumbar nodes
• ureters: lumbar and iliac nodes
• then to cisterna chyli and thoracic duct

Question 23

at what vertebral level do the renal arteries branch off the aorta

Answer 23

Question 24

where are the renal veins in relation to the arteries

Answer 24

anterior

Question 25

at which vertebral level and surface landmark does the aorta bifurcate

Answer 25

L4 umbilicus

Question 26

what may be associated with renal artery stenosis

Answer 26

AAA - infra or supra renal

Question 27

pelvic kidney

Answer 27

embryologically, kidneys develop in the pelvis and ascend into the abdomen failure of this

Question 28

anatomical variation in the renal system

Answer 28

Question 29

Answer 29

Question 30

describe how urine drains from the kidney

Answer 30

* from the nephrons collecting ducts * minor calyx * many of these form a major calyx * renal pelvis * ureter

Question 31

where are the nephrons found in the kidney

Answer 31

in the renal pyramids

Question 32

renal papilla

Answer 32

apex of renal pyramid

Question 33

Answer 33

Question 34

what happens in the glomerulus

Answer 34

ultrafiltration of blood arriving via branches of renal artery

Question 35

what happens in the collecting duct

Answer 35

passes through the pyramid to drain the modified filtate into the minor calyx as urine - major calyx, renal pelvis, ureter

Question 36

describe the diamter of the urine drainage tubes

Answer 36

progressively increase until the pelviuretic junction: wide renal pelvis becomes narrower ureter

Question 37

name 2 other sites of ureteric constriction

Answer 37

* ureter crossing the anterior aspect of the common iliac artery (can cross at bifurcation) * ureteric orifice - opening into one corner of trigone on floor of the bladder

Question 38

what can renal calculi form from

Answer 38

urine calcium salts - obstruct the urinary tract from within

Question 39

what is a classical x ray sign of a calculus

Answer 39

* small renal calculus in minor calyx * large staghorn calculus in renal pelvis

Question 40

what type of muscle does the ureter have in its walls

Answer 40

smooth muscle

Question 41

what is the response to ureteric obstruction

Answer 41

smooth muscle in ureter walls - increased peristalsis proximal to obstruction in an attempt to remove it by flushing it into the bladder peristalsis causes colicky pain as it comes in waves

Question 42

define renal failure

Answer 42

failure to adequately filter the blood to produce urine

Question 43

in the presence of an obstruction, how long will urine production continue for

Answer 43

until the pressure within the urinary tract exceeds the pressures favouring filtration at the gomerulus

Question 44

hydronephrosis

Answer 44

* swelling of kidney due to build up of urine * back pressure compresses the nephrons in the medullar pyramids leading to renal failure * acute hydronephrosis can cause painful stretching of the renal capsule