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Renal Year 2 > Anatomy & physiology > Flashcards

Anatomy & physiology Flashcards

1
Q

Kidney’s function

A

Main function is to filter and excrete waste products from the blood. They are also responsible for water and electrolyte balance in the body.

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2
Q

What structure connects the kidneys to the bladder in the transport of urine?

A

Right & left ureters

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3
Q

How is urine expelled from the body in females?

A

Leaves the body via the urethra, which opens out into the perineum in the female

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4
Q

Are the kidneys intraperitoneal or retroperitoneal?

A

Retroperitoneal (behind the peritoneum)

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5
Q

Why is the right kidney positioned lower than the left?

A

Due to the presence of the liver.

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6
Q

What structure lies immediately superior to each kidney?

A

The adrenal glands within a separate envelope of the renal fascia.

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7
Q

The kidneys lie within complex layers of fascia and fat; what are the 4 layers called from deep to superficial?

A

Renal capsule
Perirenal fat
Renal fascia (also known as Gerota’s fascia or perirenal fascia)
Pararenal fat

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8
Q

What is the renal capsule made up of?

A

Tough fibrous capsule.

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9
Q

What is the renal fasica?

A

Also known as Gerota’s fascia or perirenal fascia – encloses the kidneys and the suprarenal glands

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10
Q

The renal parenchyma can be divided into two sections; what are they?

A

The outer cortex and inner medulla.

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11
Q

The cortex extends into the medulla, dividing it into triangular shapes; what are the names for the triangles?

A

Known as renal pyramids

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12
Q

What is the renal pelvis?

A

Urine passes through the major calices into the renal pelvis, a flattened and funnel-shaped structure.

From the renal pelvis, urine drains into the ureter, which transports it to the bladder for storage.

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13
Q

What is the apex of each renal pyramid called?

A

A renal papilla - Each renal papilla is associated with a structure known as the minor calyx, which collects urine from the pyramids

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14
Q

Each renal papilla (apex of renal pyramid) is associated with a structure; what is the name of this structure

A

Each renal papilla is associated with a structure known as the minor calyx, which collects urine from the pyramids

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15
Q

Several minor calices merge to form a major calyx. What is the role of the major calcyx?

A

The major calyx surrounds the apex of the the renal pyramids.

Urine formed in the kidney passes through a papilla at the apex into a minor calyx then into major calyx before passing through the renal pelvis into the ureter.

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16
Q

What is the function of the ureter?

A

Drains urine (from the kidney to the bladder)

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17
Q

What is the function of the bladder?

A

stores/voids urine (voiding = “emptying”)

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18
Q

What is the upper renal tract made up of?

A 
the kidneys (right &left)
the ureters (right & left) - one to drain each kidney
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19
Q

What is the lower renal tract made up of?

A 
the bladder (unpaired midline structure)
the urethra (unpaired midline structure)
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20
Q

What are the ANTERIOR anatomical relations of the left kidney?

A 
Suprarenal gland
Spleen
Stomach
Pancreas
Left colic flexure
Jejunum
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21
Q

What are the ANTERIOR anatomical relations of the right kidney?

A

Suprarenal gland
Liver
Duodenum
Right colic flexure

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22
Q

What are the POSTERIOR anatomical relations of the left kidney?

A

Diaphragm
11th and 12th ribs
Psoas major, quadratus lumborum and transversus abdominis
Subcostal, iliohypogastric and ilioinguinal nerves

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23
Q

What are the POSTERIOR anatomical relations of the right kidney?

A

Diaphragm
12th rib
Psoas major, quadratus lumborum and transversus abdominis
Subcostal, iliohypogastric and ilioinguinal nerves

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24
Q

What arteries supply the kidneys?

A

Renal arteries, which arise directly from the abdominal aorta, immediately distal to the origin of the superior mesenteric artery.

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25
Q

The renal arteries divide into an anterior and posterior renal arteries; these arteries further divide into 5 arteries - what is the name of these arteries?

A

Segmental arteries

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26
Q

The renal artery branches are end arteries; why is this important?

A

There is no communication between vessels. This is of crucial importance; as trauma or obstruction in one arterial branch will eventually lead to ischaemia and necrosis of the renal parenchyma supplied by this vessel.

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27
Q

What is the line of Brodel?

A

The avascular plane of the kidney (line of Brodel) is an imaginary line along the lateral and slightly posterior border of the kidney, which delineates the segments of the kidney supplied by the anterior and posterior divisions.

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28
Q

Why is the line of Brodel important surgically?

A

It is an important access route for both open and endoscopic surgical access of the kidney, as it minimises the risk of damage to major arterial branches.

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29
Q

What is a supernumerary artery?

A

Supernumerary arteries are accessory arteries (present in around 25% of people) that reaches the kidney

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30
Q

What is an aberrant artery?

A

If a supernumerary artery (accessory artery) does not enter the kidney through the hilum, it is called aberrant.

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31
Q

What is the venous drainage of the kidneys?

A

The kidneys are drained of venous blood by the left and right renal veins. They leave the renal hilum anteriorly to the renal arteries, and empty directly into the inferior vena cava.

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32
Q

What is the lymphatic drainage of the kidneys?

A

Lymph from the kidney drains into the lateral aortic (or para-aortic) lymph nodes, which are located at the origin of the renal arteries.

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33
Q

What is a pelvic kidney?

A

In utero, the kidneys develop in the pelvic region and ascend to the lumbar retroperitoneal area.

Occasionally, one of the kidneys can fail to ascend and remains in the pelvis – usually at the level of the common iliac artery.

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34
Q

What is the name of the most common renal cancer?

A

Renal carcinoma

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35
Q

What vertebral level is the right kidney?

A

Due to the size of the liver the right kidney lies at a slightly inferior vertebral level L1-L3 than the left kidney

36
Q

What vertebral level is the left kidney?

A

T12 - L2 vertebrae

37
Q

Why is the position of the floating ribs (11 & 12) important?

A

Floating” ribs 11 and 12 are posteriorly related to the kidneys:
the ribs offer some protection to the kidneys against penetrating trauma

38
Q

In which quadrants are the kidneys located?

A

Left kidney in the LUQ

Right kidney in the RUQ

39
Q

What does the renal medulla (inner kidney parenchyma) contain?

A

Renal pyramids - each pyramid contains around 50,000 nephrons

40
Q

What is a nephron?

A

Each nephron has a glomerulus to filter your blood and a tubule that returns needed substances to your blood and pulls out additional wastes.

Nephrons are the microscopic structural and functional unit of the kidney. Nephrons are composed of a renal corpuscle and a renal tubule. The renal corpuscle consists of a tuft of capillaries called a glomerulus and an encompassing Bowman’s capsule

41
Q

Describe the passage of urine from the kidneys to the bladde

A

Nephrons to collecting duct to minor calyx to major calyx to renal pelvis to ureter to bladder to urethra.

42
Q

What is the pelviureteric junction and why is it important clinically?

A

Between the renal pelvis and ureter - can be a site of ureteric constriction

43
Q

What is the ureteric orifice and why is it important clinically?

A

Opening of the ureter into the trigone in the floor of the bladder - can be a site of constriction

44
Q

What are the consequences of urinary tract obstruction?

A

Obstructions cause urine to “back up” in the tract towards the kidneys

Obstructions within the calyces or ureter cause unilateral back pressure of urine.

Obstructions within the bladder may cause unilateral or bilateral kidney problems

Obstructions to the urethra cause bilateral kidney problems

45
Q

What is a Hydronephrosis?

A

A swelling of one or both kidneys and happens when urine can’t drain from a kidney and builds up in the kidney as a result.

This can occur from a blockage in the ureters or from an anatomical defect that doesn’t allow urine to drain properly.

46
Q

What is the name of the pelvic floor muscles?

A

Levator ani (pelvic diaphragm

47
Q

What is the false pelvis?

A

From iliac crests to pelvic inlet

part of the abdominal cavity

48
Q

What is the True pelvis?

A

pelvic inlet to pelvic floor

49
Q

What is the recto-vesicle pouch?

A

The lowest part of the peritoneal cavity and usually contains loops of small bowel or sigmoid colon. It is a potential space for fluid collection in males. Between the rectum and bladder

50
Q

What is the recto-uterine pouch (of douglas)?

A

This is the most inferior part of the female peritoneal cavity - between the rectum and uterus

51
Q

What is the vesico-uterine pouch?

A

Between the bladder (vesical) and uterus

52
Q

What are the 2 pouches found in females?

A

vesico-uterine pouch & recto-uterine pouch (of douglas)

53
Q

Describe the vascular supply of the pelvis

A

The arteries entering the pelvis are mainly branches from the internal iliac artery (veins drain to the internal iliac vein) includes vaginal artery, middle rectal artery, uterine artery and vesical arteries (to bladder).

54
Q

Describe the formation of the ‘Trigone’ in the bladder

A

The 2 ureteric orifices and the internal urethral orifice form the 3 corners of a triangle shape on the internal aspect of the bladder called the “trigone”

55
Q

What are the name of the fibers at the ureteric orifices and why are they important?

A

Detrusor muscle fibres encircle the ureteric orifices, these fibres tighten when the bladder contracts: another mechanism to prevent reflux of urine superiorly into the ureter

56
Q

What muscle forms the main bulk of the bladder wall?

A

Detrusor muscle

57
Q

What is the internal urethral sphincter muscle made up of and why is it important?

A

Detrusor muscle forms the internal urethral sphincter muscle which contracts during ejaculation to prevent retrograde ejaculation of semen back into the bladder

58
Q

What is the most anterior organ in the pelvis?

A

The bladder is the most anterior organ in the pelvis lying posterior to the pubic bone (when empty)

59
Q

Describe the anatomical relations of the rectum and prostate gland to the bladder in males

A

Prostate gland lies inferior to the bladder and the rectum posterior

60
Q

Describe the anatomical relations of the rectum and uterus to the bladder in females

A

The body of the uterus usually lies superior to the bladder - it is separated from the bladder by the uterovesical pouch. As a result, most of the weight of the uterus is borne by the bladder.

The rectum is posterior to the bladder

61
Q

What is the spermatic cord?

A

A collection of structures which support the functioning of the testis (testicular artery, testicular vein, vas deferens, lymphatic vessels draining testis, nerves)

62
Q

Inside the scrotum, the testis sit within a sac; what is the name of this sac?

A

the tunica vaginalis

63
Q

epididymis function

A

To transport sperm from the rete testes to the vas deferens.

64
Q

Vas deferens function

A

The vas deferens is a long, muscular tube that travels from the epididymis into the pelvic cavity, to just behind the bladder. The vas deferens transports mature sperm to the urethra in preparation for ejaculation.

65
Q

What is a hydrocele?

A

Swelling in the scrotum where excess fluid collects within the tunica vaginalis.

66
Q

What is testicular torsion?

A

Testes rotates and causes twisting of the spermatic cord can disrupt the blood supply to the testis: severe pain & danger of testicular necrosis (cell death)

67
Q

Difference between somatic sensory and visceral afferent nerve fibers

A

Sensations from the body wall (soma) are conveyed to the CNS by nerve fibers called “somatic sensory” nerve fibers

Sensations from our organs are conveyed to the CNS by nerve fibers called “visceral afferent” nerve fibers

68
Q

Difference between somatic motor and other nerve fibers

A

Motor responses to our body wall (soma) are conveyed from the CNS by nerve fibers called “somatic motor” nerve fibers and stimulate skeletal (voluntary) muscles to contract

Motor responses to our organs i.e. our internal environment are conveyed from the CNS by nerve fibers called:
“parasympathetic” nerve fibers or
“sympathetic” nerve fibers

69
Q

What is the characteristics of the pain from the kidneys?

A

dull, achy type pain in the loin (posterior flank region)

70
Q

What is the characteristics of the pain from the ureters?

A

if obstruction, “loin to groin” pain

71
Q

What is the characteristics of the pain from the bladder?

A

usually dull, achy suprapubic pain

72
Q

What is the characteristics of the pain from the urethra?

A

distal urethra (that within the perineum) is felt localised and is a relatively sharp pain within the perineum

73
Q

What is the characteristics of the pain from the testis?

A

often felt in scrotum but can radiate to the groin and the anterior lower abdomen (can also initially present in one of the latter two)

74
Q

What is the pudendal nerve?

A

The pudendal nerve (the nerve of the perineum) arises from the sacral plexus

75
Q

Osmolarity

A

The measure of the number of osmotically active particles in a solute

Increased Osmolarity = increase amount of particles dissolved in the solution

76
Q

Tonicity

A

Tonicity of a solution is related to its effect on the volume of a cell:
> Isotonic (Osmolarity = 300mosmol/L) - no change
> Hypertonic (>300) - cell shrinks
> Hypotonic (<300) - cell swells

77
Q

Tracers

A

Inulin or creatinine clearance is the volume of blood plasma that is cleared of creatinine per unit time and is a useful measure of approximating GFR

78
Q

What are the 3 barriers to filtration?

A

Glomerular capillary endothelium
Basement membrane
Podocytes

79
Q

What are podocytes?

A

Podocytes (inner layer of the bowman’s capsule) = plasma protein barrier

80
Q

What two forces favor filtration?

A
  1. Glomerular capillary blood pressure (55mmHg)

2. Bowman’s capsule oncotic pressure (0mmHg)

81
Q

What two forces favor reabsorption?

A
  1. Capillary oncotic pressure (30mmHg)
  2. Bowman’s capsule hydrostatic pressure (15mmg)

Severe burns cause plasma proteins to leak from the site of injury. This leads to a reduction in capillary oncotic pressure

82
Q

What is the GFR?

A

Rate at which protein free plasma is filtered from the glomeruli into the bowman’s capsule

83
Q

What is the main determinant of GFR?

A

Major determinant of GFR is glomerular capillary pressure - By changing the diameter of the afferent arteriole, we can change the rate of filtration

  • If clearance < GFR = reabsorption
  • If clearance > GFR = secretion
84
Q

The loop of henle is made up of two parts; what are they?

A

The ascending and descending loop

85
Q

Describe the re-absorption of NaCl and water in the descending loop of Henle

A
  1. Does not reabsorb NaCl

2. Highly permeable to water

86
Q

Describe the re-absorption of NaCl and water in the ascending loop of Henle

A
  1. Na+ & Cl- reabsorbed

2. Impermeable to water

Renal Year 2 (3 decks)

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