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LR Renal > Anatomy: Upper Urinary Tract > Flashcards

Anatomy: Upper Urinary Tract Flashcards

1
Q

Define the urinary tract

A

The anatomical structures through which urine passes from its production to its excretion from the body

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2
Q

List the 4 main contents of the urinary system

A

Kidneys (bilateral)
Ureters (bilateral)
Bladder
Urethra

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3
Q 
What is the function of the 4 main contents of the urinary system?
Kidneys (bilateral)
Ureters (bilateral)
Bladder
Urethra
A

Kidneys (bilateral): produce urine

Ureters (bilateral): drains urine from the kidneys to the bladder

Bladder: stores urine and voids it into the urethra

Urethra: excretes urine (and semen in males)

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4
Q 
Out of the 4 main contents of the urinary system, which are part of the upper and which are part of the lower urinary tracts?
Kidneys (bilateral)
Ureters (bilateral)
Bladder
Urethra
A

The upper urinary tract = the kidneys + the ureters

The lower urinary tract = the bladder + the urethra

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5
Q

An upper UTI may spread to the…?

A

Kidneys

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6
Q

A lower UTI involves the X and Y?

A

Bladder and urethra

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7
Q

The kidneys are found in the peritoneal cavity. T/F?

A

False

The kidneys are retroperitoneal organs. They are found in the abdominal cavity behind the peritoneum

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8
Q 
Which parts of the urinary system are found in the...
Abdomen
Pelvis
Perineum
...?
A

Abdomen: kidneys, proximal ureters

Pelvis: distal ureters, bladder, proximal urethra

Perineum: distal urethra

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9
Q

Imagine looking at an axial abdominal CT scan…

Name the 5 layers surrounding the anterior kidney

A 
Visceral peritoneum
Paranephric fat
Renal (deep fascia)
Perinephric fat
Renal capsule
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10
Q 
Briefly describe the 5 layers surrounding the anterior kidney:
Visceral peritoneum
Paranephric fat
Renal (deep fascia)
Perinephric fat
Renal capsule
A

Visceral peritoneum: separates the kidneys from the peritoneal cavity

Paranephric fat: more anterior fat layer

Renal (deep fascia): separates the renal fat layers

Perinephric fat: liquid fatty layer in contact with the kidney

Renal capsule: tough fibrous tissue that completely encapsulates the kidney

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11
Q

Imagine looking at an axial abdominal CT scan…

Name the 3 abdominal wall muscles lying lateral to the kidneys

A

The anterolateral abdominal wall muscles:

  • External oblique
  • Internal oblique
  • Transversus abdominis
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12
Q

Imagine looking at an axial abdominal CT scan…

Name the 2 abdominal wall muscles lying posterior/posteromedial to the kidneys

A

Right/left psoas major (posteromedial)

Right/left quadratus lumborum (posterior)

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13
Q

What 3 structures make up the renal hilum/root?

A

Renal artery
Renal vein
Ureter

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14
Q 
Which structure lies...
-Anteriorly
-Posteriorly
-Inferiorly
... in the renal hilum?
A
  • Anteriorly: renal vein
  • Posteriorly: renal artery
  • Inferiorly: ureter
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15
Q

At what vertebral levels is the…
-Left kidney
-Right kidney
… found?

A

Left: T12-L2
Right: L1-L3

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16
Q

Why is the right kidney ~1 vertebral level lower than the left?

A

Due to the large size of the liver pushing the right one down

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17
Q

Which ribs are found posterior to the kidneys?

A

‘Floating’ ribs 11 and 12

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18
Q

Which abdominal quadrants are the kidneys located in?

A

Left: Left flank/LUQ
Right: Right flank/RUQ

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19
Q

Which abdominal regions are the kidneys found in?

A

Left: Left lumbar region/flank
Right: Right lumbar region/flank

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20
Q

Describe how ‘balloting’ of the kidney is carried out during clinical examination (use the right kidney as the example)

A
  • One hand used to palpate posteriorly in the right flank, just inferior to rib 12
  • Other hand used to palpate anteriorly in the RUQ
  • As the patient breathes in, the kidneys descend (as the diaphragm moves down) and may become trapped between the palpating hands for examination
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21
Q

Which structures are in contact with the left and right superior pole of the kidneys?

A

Left: spleen
Right: liver

These structures are in contact with the diaphragm superiorly, and so move down with it during inspiration and move the kidneys down too as a result

22
Q

Describe 5 features of a normal kidney on ‘balloting’

A 
~12 cm long
~6 cm wide
Smooth to touch
Regular texture
Firm to touch
23
Q

What 4 visceral structures does the left kidney lie posterior to?

A
  • Stomach
  • Tail of pancreas
  • Hilum of spleen
  • Splenic vessels
24
Q

What 4 visceral structures does the right kidney lie posterior to?

A
  • Liver (+ hepatorenal recess)
  • 2nd part of duodenum
  • Ascending colon
  • Right colic flexure
25
Q

What is the hepatorenal recess and why is it important?

A

It is the most inferior + dependent part of the greater sac of the peritoneal cavity in the supine patient

This means that abnormal fluid in the peritoneal cavity will collect here when the patient lies down

26
Q

Lymph from the kidneys drains to the lumbar/iliac nodes?

A

Lumbar

located around the abdominal aorta and IVC

27
Q

Lymph from the ureters drains to the lumbar/iliac nodes?

A

Lumbar AND iliac nodes

28
Q

The ureters get their blood supply from multiple sources as they have a long pathway. Arterial blood supply to the ureters comes from branches of which 5 arteries?

A 
Renal artery
Abdominal aorta
Common iliac artery
Internal iliac artery 
Vesical (bladder) artery
29
Q

The renal arteries lie anterior/posterior to the renal veins?

A

Posterior

30
Q

The common iliac arteries lie anterior/posterior to the common iliac veins?

A

Anterior

31
Q

The abdominal aorta bifurcates at what level?

A

The level of the umbilicus (~T10)

32
Q

List 5 anatomical variations of the kidney which may be seen

A

Bifid renal pelvis
Bifid ureter
Retrocaval ureter (passing inferior to IVC instead of laterally)
Horseshoe kidney (two kidneys joined in centre)
Ectopic pelvic kidney (kidney located down in pelvis)

33
Q

How is the kidney structured similarly to the adrenal glands?

A

It has an outer renal capsule, a renal cortex, and an inner renal medulla

34
Q

What is meant by the renal pyramids?

A

The renal medulla contains renal pyramids, each of which are formed by ~50,000 nephrons

35
Q

What are nephrons?

A

The filtering unit of the kidneys

They are composed of a glomerulus (the filter) and a tubule

36
Q

Why do the renal pyramids have a striated appearance?

A

The nephrons are regularly arranged towards the apex of each pyramid

37
Q

Describe the route of urine draining from a nephron to the ureter out of the kidney

A 
Nephron's collecting duct ->
Minor calyx -> 
Major calyx ->
Renal pelvis -> 
Pelviureteric junction -> 
Ureter
38
Q

Define the…
Major calyx
Renal pelvis
Pelviureteric junction

A

Major calyx: where multiple minor calyces meet

Renal pelvis: where the major calyces converge at the core of the kidney

Pelviureteric junction: the first constriction site of the renal system, where the renal pelvis becomes the ureter

39
Q

Describe the change in diameter of the structures draining urine from the kidneys to the ureter

A

Diameter increases until the pelviureteric junction, where the wide renal pelvis becomes the narrower ureter

40
Q

What are the 3 anatomical sites of ureteric constriction?

A

Pelviureteric junction

Where the ureter crosses the anterior aspect of the common iliac arteries + the pelvic rim

Ureteric orifice 
(ureter opening into one corner of the trigone of the floor of the bladder)
41
Q

What are the 3 anatomical sites of ureteric constriction?

A

Pelviureteric junction

Where the ureter crosses the anterior aspect of the common iliac arteries + the pelvic rim

Ureteric orifice 
(ureter opening into one corner of the trigone of the floor of the bladder)
42
Q

What is the clinical significance of the 3 ureteric constriction sites?

A

Renal calculi (stones) can become lodged in them and obstruct the urinary tract

Calculi also often become stuck in the calyces

43
Q

What is a ‘staghorn’ calculus?

A

A large renal stone which becomes stuck in the calyces and renal pelvis, forming the shape of a stag’s antlers

44
Q

What are renal calculi/stones formed from?

A

Urine calcium salts

45
Q

Can renal calculi/stones be seen on xray?

A

Yes, usually

This is done with x-ray and intravenous urogram

46
Q

How does the ureter respond to either internal obstruction or external compression?

A

The smooth muscle within the walls of the ureter contracts (i.e., increases peristalsis) proximal to the obstruction to try to remove it

47
Q

Why does a patient with ureteric obstruction complain of pain that comes and goes?

A

The increased peristalsis adopted to try to remove the obstruction comes in waves

The pain that comes and goes is described as ‘colicky’ pain

48
Q

What is the consequence of urinary tract obstruction?

A

There is back pressure of urine up towards the kidneys

49
Q

What can back pressure of urine cause?

A

Renal failure

This occurs when back pressure within the urinary tract exceeds pressures favouring filtration at the glomerulus

50
Q

What is hydronephrosis?

A

Swelling of the kidneys due to urine back pressure

51
Q

Why is acute hydronephrosis painful?

A

The renal capsule surrounding the kidney is a tough, tight, fibrous tissue and so tries to resist stretch

LR Renal (16 decks)

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