anatomy of upper urinary tract Flashcards
role of the kidneys in urinary tract?
-produce urine
role of the ureter in the urinary tract?
-drains urine from the kidney to the bladder
role of the bladder in the urinary tract ?
-stores/ voids (empties) urine
role of the urethra in the urinary tract?
-excretes urine (and semen in males)
what are the parts of the upper urinary tract?
- they kidneys
- the ureters
what are the parts of the lower urinary tract?
- the bladder
- the urethra
what does a lower urinary tract infection involve?
-the bladder and the urethra
which components or the urinary tract are in the abdomen?
- kidneys
- proximal ureters
THESE STRUCTURES ARE ALSO RETROPERITONEAL (SIT BEHIND THE PERITONEAL CAVITY)
what structures of the urinary tract are in the pelvis?
- the distal ureters
- the bladder
- the proximal urethra
what structure of the urinary tract is found in the perineum?
the distal urethra
what does retroperitoneal suggest?
-behind peritoneal cavity
what is lateral to the right kidney?
-anterolateral abdominal wall muscles (3 layers external oblique, internal oblique and transverses abdomens)
what is medial to the right kidney?
-renal hilum/ root of the kidney
right renal vein (most anterior), right renal artery (posteriorly) and right ureter (inferiorly)
what immediately surrounds the kidney?
renal capsule
what is anterior to the kidney?
- renal capsule (immediately surrounds)
- perinephric fat
- renal (deep) fascia
- paranephric fat
- visceral peritoneum
what sits posteriorly to the kidneys?
- posterior abdominal wall muscles
- most posteriorly is quadratus lumborum
- postero medial is psoas major
what can protect the kidneys from trauma?
-muscle guarding (when muscles are held in a partial state of readiness to act)
what structure is highlighted pink?
-abdominal aorta
what structure is highlighted pink?
left renal artery
what structure is highlighted pink?
left kidney
what structure is highlighted pink?
left quadratus lumborum
what structure is highlighted pink?
-vertebral body
what structure is highlighted pink?
muscles of the back
what structure is highlighted pink?
right psoas major
what structure is highlighted pink?
right kidney
what structure is highlighted pink?
right renal vein
what structure is highlighted pink?
inferior vena cava
describe exactly where the kidneys lie?
- lie anterior to quadratus lumborum and lateral to psoas major
- lateral to the lower thoracic/upper lumbar vertebral bodies
- due to the size of the liver the right kidney lies at a slightly inferior vertebral body (L1-L3 vertebra) than the left kidney (T12-L2 vertebra)
- posterior to the floating ribs (11 and 12)
what do the kidneys lie anterior to?
- anterior to quadratus lumborum
- anterior lateral to psoas major muscle
- anterior to muscles of the back
what do the kidneys lie lateral to?
- psoas major
- the lower thoracic/upper lumber vertebral bodies
which kidney sits more inferiorly than the other and why?
-the right kidney lies at a slightly inferior vertebral level (L1-L3 vertebra) than the left kidney (T12-L2) due to the size of the liver
what vertebral level do the kidneys lie in?
right kidney (more inferior due to size of liver) is at L1-L3
left kidney is T12- L2
which are the ‘floating ribs’?
-ribs 11 and 12
which quadrant are the kidneys found in?
left kidney= left upper quadrant
right kidney= right upper quadrant
which regions are the kidneys found in?
the left and right lumbar (or flank) regions
name the regions
red= right hypochondrium
orange= left hypochondrium
green= right lumbar region (flank)
purple= left lumbar region (flank)
light blue= right inguinal region (iliac fossa)
dark blue= left inguinal region (iliac fossa)
what is ‘balloting’ of the kidney?
-the clinical examination for kidneys
what occurs to the kidneys on inspiration and why?
-the diaphragm moves in inferiorly, pushing the liver and spleen inferiorly, the poles of the kidneys are in contact with the liver (right kidney) and spleen (left kidney) so moves the kidney inferiorly
where does the right kidney sit in relation to the liver and hepatorenal recess?
-posterior
so the liver and hepatorenal recess sit anterior to the kidneys
where does the right kidney sit in relation to the duodenum, ascending colon and right colic flexure?
-posterior to the duodenum, ascending colon and right colic flexure
where does the left kidney lie in relation to the stomach, the tail of the pancreas, the hilum of the spleen and the splenic vessels?
-the left kidney lies posterior to the stomach, tail of the pancreas, the hilum of the spleen and the splenic vessels
where do the renal veins sit in relation the renal artery?
-renal vein is anterior to the renal artery
what does the urteric arterial supply branch from?
- the renal artery
- the abdominal aorta
- the common iliac artery
- the internal iliac artery
- the vesical (bladder) artery
where does the lymph from the ureters drain into?
-lumbar nodes and the iliac nodes
what is this?
-bifid renal pelvis (bifucation of ureters that unite again before entering the bladder)
what is this?
bifid ureter and unilateral duplicates ureter
what is this?
-retrocaval ureter (rare congenital abnormality that causes ureter to pass posterior to inferior vena cava)
what is this?
horseshoe kidney (when the kidneys fuse)
what is this?
ectopic pelvis kidney (kidney stays in the pelvis)
what are some causes of a solitary kidney?
- agenesis (didnt form in embryo)
- nephrectomy (due to pathology)
- nephrectomy (due to donation)
what is highlighted pink, blue and green?
pink= renal capsule blue= renal cortex green= renal medulla
what does the renal medulla contain?
-renal medulla contains renal pyramids which contain nephrons (each pyramid contains around 50,000 nephrons)
what gives the renal pyramids in the renal medulla their striped appearance?
-as the renal nephrons in the renal pyramids are regularly arranged giving a striped appearance
how does urine drain from the kidney?
-urine passes from the collecting ducts in the nephrons to the minor calyx to the major calyx to the renal pelvis to the ureter and out
what occurs to the diameter of urine drainage ‘tubes’ as you go down to the ureter?
-it increases in size until a constriction at the pelviureteric junction: the wider the renal pelvis becomes the narrower ureter
where do kidney stones often become lodged and why?
-pelviureteric junction as it is the first narrow site
what are the 3
what are the three anatomical sites of ureteric constriction?
- pelviureteric junction (first)
- ureter crossing anterior aspect of the common iliac artery
- ureteric orifice
what do renal calculi (stones) form from?
-urine calcium salts
can renal calculi (stones) be seen on an Xray?
yes!
what is a ‘staghorn’ calculus?
-a very large renal calculi (kidney stone)
what can result in a ureteric obstruction?
internal obstruction- an impacted renal calculus or a blood clot can cause this
external compression- an expanding mass (e.g. a tumour)
what are the walls of the ureter made up of?
-smooth muscle
what is the urinary tracts response to an obstruction?
- increased peristalsis proximal to the site of obstruction in an attempt to remove it and flush it out of the bladder
- peristalsis comes in waves this is why patients experience colicky pain (that comes and goes)
what are the consequences of urinary tract obstruction?
- obstruction cause urine to ‘back up’ in the tract towards the kidneys
- urine production will continue until the pressure within the urinary tract exceeds the pressure favouring filtration at the glomerulus
- renal failure means failure to adequately filter the blood to produce urine
- if there is back pressure of urine due to an obstruction you can get hydronephrosis
what are the consequences of obstruction within the calyces or ureter?
this causes unilateral back pressure of urine
what are the consequences of obstructions within the bladder?
-this may cause unilateral or bilateral kidney problems
what are the consequences of obstruction to the urethra?
-can cause bilateral kidney problems
what is hydronephrosis?
-water inside the kidney
what causes hydronephrosis?
-urine backpressure into the calyces often due to an obstruction
how can hydronephrosis lead to renal failure?
-urine back pressure in the calyces compresses the nephrons within medullary pyramids leding to kidney failure
what would be seen on clinical examination of hydronephrosis?
- kidney would be enlarged due to ‘water inside the kidney’ and would be palpable
- acute hydronephrosis would cause painful stretching of the renal capsule
