Anatomy Topic 4 Case 6 Flashcards
Are the kidneys intra- or retroperitoneal?
- Retroperitoneal
Between which vertebral levels do the kidneys extent between?
- T12 to L3
Which kidney is slightly lower and why?
- Right kidney
- Because of its relationship to the liver
Which kidney is longer and more slender?
- Left kidney
Which kidney is closer to the midline?
- Left kidney
For each part of the right kidney, identify the structure that it is related to:
[A] Superior pole
[B] Upper part
[C] Medially
[D] Inferior pole
- [B] Liver
- [C] Descending part of duodenum
- [D] Right colic flexure
For each part of the left kidney, identify the structure that it is related to:
[A] Superior pole
[B] Upper part
[C] Inferiorly
[D] Laterally
[E] Medially
- [A] Left suprarenal gland
- [B] Stomach and spleen
- [C] Pancreas
- [D] Left colic flexure
- [E] Jejunum
Identify the structures that the posterior surfaces of the right and left kidney relate to
- Diaphragm superiorly
- Psoas major, quadratus lumborum and transversus abdominis
The superior pole of the right kidney is anterior to rib [A] while the same region of the left kidney is anterior to rib [B]
- [A] 12
- [B] 11
Describe the arrangement of renal fat and fascia
- Kidney is encircled by perinephric fat
- Which is enclosed within the renal fascia
- Outside of which is paranephric fat, mainly posterolateral to each kidney
What is the hilum of the kidney?
- Located medially
- Point at which renal vessels, lymphatics and nerves enter and leave the kidney
Identify the two main parts of the kidney
- Outer renal cortex
- Inner renal medulla
What are the renal columns?
- Extensions of the renal cortex that project into the inner aspect of the kidney
- And divide the medulla into triangular shaped renal pyramids
What is the renal papilla? What surrounds it?
- Apical projections of renal pyramids
- Which are surrounded by minor calices
What is a renal sinus?
- Cavity within the kidney
- Where minor calices unite
- To form a major calyx
What is the renal pelvis formed od?
- Two or three major calices that unite
Where do the renal arteries branch from the abdominal aorta?
- Laterally
- Just inferior to the origin of the superior mesenteric artery
- Between L1 and L2
Describe the branches of each renal artery
- Renal artery divides into segmental arteries that enter the hilum
- Which give off lobar arteries, one for each pyramid
- Which give off interlobar arteries on each side of pyramid
- Which give off arcuate arteries over the base of each pyramid
- Which give off interlobular artery that ascend in cortex
- Which give off afferent glomerular arterioles
What is the clinical significnace of the left renal vein
- Crosses the midline anterior to abdominal aorta
- And posterior to superior mesenteric artery
- Can be compressed by either of these two vessels
Identify the lymphatic drainage of the kidneys
- Lateral aortic (lumbar) nodes
- Around the origin of the renal artery
Outline the innervation of the kidneys
- Aorticorenal ganglia
- Abdominal prevertebral ganglia
Where is kidney pain referred to?
- Transmitted via least splanchnic nerve (T12)
- To flanks (lateral regions)
What are ureters?
- Muscular tubes
- That transport urine from kidneys to bladder
What are the ureters continuous with superiorly?
- Renal pelvis in the renal sinus
- At the ureteropelvic junction
How is a renal pelvis formed?
- From condensation of two to three major calices
The ureters descend retroperitoneally on the medial aspect of which muscle?
- Psoas major
Which arteries do the ureters cross?
- Common iliac artery
In the pelvis, the ureters cross the [A] in men and the [B] in women
- [A] Ductus deferens
- [B] Uterine artery
Identify the three positions where the ureters become constricted. What is the clinical significance of these?
- Ureteropelvic junction
- Where they cross the common iliac vessels
- Where they enter the wall of the bladder
- Kidney stones become lodged at these constrictions
Outline the arterial supply of the ureters
- Upper end: Renal arteries
- Middle part: Branches from abdominal aorta, testicular and ovarian arteries, common iliac arteries
- Lower end: Internal iliac arteries
- All of which divide into ascending and descending branches forming longitudinal anastomoses
Outline the innervation of the ureters
- Renal, aortic, superior hypogastric and inferior hypogastric plexuses
- Visceral afferents from sympathetic and parasympathetic fibres return to T11-L2
What causes ureteric pain and where is it referred?
- Distension of ureter
- T11 to L2
- Posterolateral abdominal wall
- Pubic region
- Scrotum in males
- Labia majora in females
- Anterior aspect of thigh
How do the left and right suprarenal glands differ from one another?
- Right: Pyramidal and smaller
- Left: Semilunar and larger
What is located anterior to the right suprarenal gland?
- Right lobe of the liver
- Inferior vena cava
What is located anterior to the left suprarenal gland?
- Stomach
- Pancreas
- Spleen (on occasion)
What layer of fat surrounds the suprarenal glands
- Perinephric fat
- Enclosed in renal fascia
Outline the arterial supply of the suprarenal glands
- Superior suprarenal arteries from inferior phrenic arteries
- Middle suprarenal arteries from abdominal aorta
- Inferior suprarenal arteries from renal arteries
