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Medicine Sem 4 > Case 6 Anatomy > Flashcards

Case 6 Anatomy Flashcards

1
Q

what hormones does the kidney produce?

A

erythropoietin and calcitriol

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2
Q

what are the dimensions of the kidney?

A

approximately

  • 10cm long
  • 5cm wide
  • 2.5cm thick
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3
Q

are kidneys primary or secondary retroperitoneal?

A

primary

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4
Q

which organs/structures are primary retroperitoneal?

A
  • suprarenal glands
  • aorta
  • ureters
  • kidneys
  • oesophagus
  • rectum

retroperitoneal organs developed and remain outside of the parietal peritoneum

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5
Q

which organs/structures are secondary retroperitoneal?

A
  • duodenum (except 1st segment)
  • pancreas (except tail)
  • ascending colon
  • descending colon

secondarily retroperitoneal organs were initially intraperitoneal, suspended by mesentery – through the course of embryogenesis, they became retroperitoneal as their mesentery fused with the posterior abdominal wall – thus, in adults, only their anterior surface is covered with peritoneum

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6
Q

where do the kidneys lie?

A

on each side of the vertebral column at the level of T12 – L3 vertebrae

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7
Q

which kidney tends to be slightly inferior?

A

right kidney

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8
Q

what separates the kidneys from the pleural cavity and the 12th ribs?

A

diaphragm

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9
Q

what lies anterior to the right kidney?

A

second part of the duodenum (also in front of IVC)

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10
Q

what are the kidneys crossed posteriorly by?

A
  • subcostal
  • ilioinguinal
  • iliohypogastric
    nerves
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11
Q

which muscles lie posterior to the kidneys?

A
  • quadratus lumborum
  • iliopsoas
  • transversus abdominis
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12
Q

what are the coverings of the kidneys?

A
  • capsule
  • perirenal fat
  • renal fascia
  • pararenal fat

(protection, support and holding in position)

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13
Q

what is the capsule?

A

fibrous covering that is adhered to the outer surface of the kidney

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14
Q

what is the perirenal (perinephric) fat?

A

a fatty layer that surrounds the kidney and extends into the renal sinus

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15
Q

what is the renal fascia?

A

a fibrous connective tissue layer that surrounds the kidney and suprarenal gland

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16
Q

what is the pararenal (paranephric) fat?

A

the region of retroperitoneal fat that surrounds the posterior aspect of the kidney

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17
Q

how mobile are the kidneys? what does movement occur? how much?

A
  • Despite being held in place by these layers the kidney is a fairly mobile structure
  • Movement occurs during respiration and when moving from a supine to an erect position
  • The kidney may descend up to 3cm on inspiration
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18
Q

what is external structure of the kidney?

A
  • When viewed externally, the kidney presents superior & inferior poles, anterior & posterior surfaces and lateral and medial borders
  • A vertical crevice, the hilum, is present on the medial border
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19
Q

what can be seen entering/exiting the kidney at the hilum?

A
  • The renal vessels and ureter can be seen entering/exiting the kidney at the hilum
  • Front to back:
    • Renal vein
    • Renal artery
    • Ureter
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20
Q

what does the renal hilum extend into?

A

the renal sinus (the renal hilum is the entrance to the renal sinus)

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21
Q

what does the sinus contain?

A
  • vessels
  • nerves
  • fat
  • structures that collect and drain the urine
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22
Q

what are the structures that collect and drain the urine?

A
  • renal papilla
  • minor calyx
  • major calyx
  • renal pelvis
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23
Q

what is the renal papilla?

A

the apex of the renal pyramid which projects into the minor calyx

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24
Q

what is the minor calyx?

A

two to three of these structures drain into each major calyx

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25
Q

what is the major calyx?

A

two to three of these structures drain into the renal pelvis

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26
Q

what is the renal pelvis?

A

the expanded superior end of the ureter (the funnel-like dilated part of the ureter) (the pelvis is almost completely enclosed in the sinus)

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27
Q

describe the internal structure of the kidney

A
  • Capsule
  • Cortex
  • Renal column
  • Medulla
  • Medullary pyramid
  • Renal sinus
  • Minor calix
  • Major calix
  • Renal pelvis
  • Ureter
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28
Q

what is the renal column?

A

is a medullary extension of the renal cortex in between the renal pyramids – it allows the cortex to be better anchored – each column consists of lines of blood vessels and urinary tubes and a fibrous material

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29
Q

how many pyramids in each kidney?

A

7-18

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30
Q

what is the blood supply of the kidneys?

A

renal arteries

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31
Q

where do the renal arteries most comonly arise from the aorta?

A

at the level of the intervertebral disc between L1 and L2

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32
Q

which renal artery is longer?

A

right

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33
Q

what is the route of the right renal artery?

A

passes posterior to the IVC

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34
Q

what does each renal artery divide into?

A

five segmental arteries which are distributed to specific segments of the kidney

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35
Q

what are the 5 segmental arteries?

A
  • Apical (superior)
  • Anterosuperior (splits of from anteroinferior)
  • Anteroinferior (splits of from anterosuperior)
  • Inferior
  • Posterior
36
Q

what do the segmental vessels give rise to?

A

a complex vascular network

  • lobar arteries
  • interlobar arteries
  • arcuate arteries
  • interlobular arteries
  • afferent arterioles
  • efferent arterioles
  • peritubular capillaries/vasa rectae
37
Q

what do the lobar arteries arise from? what does each supply?

A

arise from the segmental arteries, each supplies a medullary pyramid

38
Q

what do the interlobar arteries arise from? where are they?

A

arise from the lobar arteries and run on either side of a pyramid to the cortex

39
Q

where do the arcuate arteries run?

A

run between the cortex and medulla arching over the base of the pyramids

40
Q

where are the interlobular arteries?

A

pass through the cortex towards the glomerulus

41
Q

what do the afferent arterioles arise from? what do they give rise to?

A

arise from the interlobular arteries and give rise to the glomerular capillaries

42
Q

what do the efferent arterioles arise from?

A

exit the glomerular capillaries

43
Q

what do the peritubular capillaries arise from? where are they?

A

arise from efferent arterioles and surround the tubules within the cortex

44
Q

what do the vasa rectae arise from? where are they?

A

arise from efferent arterioles and surround the tubules within the medulla

45
Q

what do the peritubular capillaries and vasa recta drain via?

A

via the interlobular veins into the arcuate veins and then into the interlobar veins

46
Q

what forms a single renal vein and where?

A

a number of renal veins unite at the hilum to form a single renal vein

47
Q

what do the right and left renal veins drain into?

A

the IVC

48
Q

what is the renal lobe?

A

portion of a kidney consisting of a renal pyramid and the renal cortex above it – located between renal columns with peripheral limits within medulla being the interlobar arteries

49
Q

what is a renal lobule?

A

part of a renal lobe – consists of the nephrons grouped around a single medullary (refers to destination not location) ray and draining into a single collecting duct

50
Q

what does lymph from the kidneys drain into?

A

the para-aortic (lumbar) lymph nodes which are located around the renal artery

51
Q

what do these para-aortic nodes drain into?

A

lumbar trunks

52
Q

what forms the cisterna chyli?

A

lumbar trunks unite with the intestinal trunks to form an elongated sac-like structure called the cisterna chyli

53
Q

where is the cisterna chyli?

A

lies anterior to the bodies of L1 and L2

54
Q

which fibres innervate the kidney? where do they arise?

A

preganglionic sympathetic fibres arise in the lateral horn of grey matter in segments T10-L1 of the spinal horn (not part of the gut)

55
Q

what do the pre-ganglionic fibres pass in and go to which ganglion?

A
  • pass in the least splanchnic nerve

- to the aorticorenal ganglion

56
Q

what do the post-ganglionic sympathetic fibres supply?

A

the renal vasculature of the cortex and the efferent arterioles of the juxtaglomerular nephrons and the vasa recta

57
Q

what does sympathetic stimulation lead to?

A

vasoconstriction of these vessels

58
Q

where does afferent information from the kdineys enter the spinal cord?

A

at the levels of T10-L1

59
Q

which dermatomes is pain from the kidneys transferred to?

A

T10-L1 dermatomes

60
Q

what is a juxtamedullary nephron?

A

a nephron whose renal corpuscle is near the medulla and whose proximal convoluted tubule and its associated loop of Henle occur deeper in the medulla than cortical nephrons

61
Q

how long are ureters? what is their diameter?

A

approximately 25cm long and 1.25cm in diameter

62
Q

what do the ureters pass through? are they intra or retroperitoneal?

A
  • pass through both the abdominal and pelvic cavities

- retroperitoneal throughout their course

63
Q

what is the course of the ureters?

A
  • Descends from the apex of the renal pelvis at the hilum of the kidney
  • Passes down the anterior surface of the psoas major
  • Crosses the bifurcation of the common iliac artery anterior to the sacroiliac joint
  • Runs down the lateral wall of the pelvis to the level of the ischial spine
  • Turns forward to enter the bladder
64
Q

what are the three regions where the ureter narrows along its course? what are the clinical implications?

A
  • Three regions:
    • At the junction between the renal pelvis and ureter
    • As the ureter crosses the pelvic brim
    • As the ureter enters the bladder
  • This has clinical implications as these regions are sites where renal calculi (kidney stones) may get lodged
65
Q

what is the arterial supply to the ureters provided by?

A

a number of vessels in the abdomen and pelvis:

  • renal
  • gonadal
  • abdominal aorta
  • common iliac
  • internal iliac
  • ovarian
66
Q

what do these vessels that supply the ureters give rise to?

A

small ureteric vessels which form anastomoses along the length of the ureter

67
Q

what is the problem with these anastomoses?

A

they don’t really provide an effective collateral pathway and disruption to the vessels during surgery may lead to ischaemia

68
Q

the veins draining the ureters drain into what?

A
  • renal
  • gonadal
  • common iliac
  • internal iliac
    veins
69
Q

lymph from different levels of the ureter drains into which lymph nodes?

A
  • upper part of ureter = paraortic (lumbar) nodes
  • middle part of ureter = common iliac nodes
  • inferior part of ureter = common, external or internal iliac nodes
70
Q

what type of innervation do the ureters receive? and where from?

A

autonomic innervation from the:

  • renal plexus
  • aortic plexus
  • hypogastric plexuses
71
Q

where is afferent pain from the ureters referred to?

A

the ipsilateral lower quadrant of the abdomen

72
Q

what surrounds the suprarenal gland and what does this do?

A
  • renal fascia

- attaches it to the crus of the diaphragm

73
Q

what shape are the suprarenal glands?

A

the right gland is pyramidal in shape, contrasting with the semi-lunar shape of the left gland

74
Q

what is the right suprarenal gland in contact with?

A
  • liver

- IVC

75
Q

what is the left suprarenal gland in contact with?

A
  • spleen
  • stomach
  • pancreas
76
Q

where do arteries, veins, lymphatics and nerves enter/leave the suprarenal gland?

A
  • veins and lymphatics leave gland at hilum

- arteries and nerves enter glands at numerous sites

77
Q

what does the suprarenal gland consist of?

A

outer cortex and inner medulla

78
Q

cortex of suprarenal gland

  • what is it derived from
  • what colour
  • what secrete
A
  • Derived from the mesoderm
  • Yellow in colour
  • Secretes androgens (male sex hormones mainly DHEA and testosterone)
  • Secretes glucocorticoids (predominantly cortisol) (class of corticosteroid)
  • Secretes mineralocorticoids (aldosterone most important) (class of corticosteroid)
79
Q

medulla of suprarenal gland

  • what derived from
  • colour
  • what does it contain
  • what may be considered as and why
  • what secrete
  • when activated
A
  • Derived from neural crest cells (arise from ectoderm cell layer)
  • Brown in colour
  • Contains chromaffin cells
  • May be considered as a sympathetic ganglion (fibres terminate by synapsing with chromaffin cells)
  • Secretes catecholamines (e.g. dopamine, norepinephrine, epinephrine) (chromaffin cells secrete transmitter)
  • Activated in the fight or flight response
80
Q

what is the arterial supply for the suprarenal gland?

A

suprarenal arteries branch into 50-60 branches which enter the gland by penetrating the capsule

81
Q

how many groups of suprarenal arteries exist? what does each arise from?

A

Three groups of suprarenal arteries exist; superior, middle and inferior:
• Superior group arises from the inferior phrenic artery
• Middle group arises form the abdominal aorta
• Inferior group arises from the renal artery

82
Q

what is the venous drainage of the suprarenal gland?

A

only one large suprarenal vein drains each gland

83
Q

what does the right suprarenal vein drain into?

A

IVC

84
Q

what does the left suprarenal vein drain into?

A

the left renal vein

85
Q

what is the lymphatic drainage of the suprarenal gland? how does it get back to IVC?

A
  • Two lymphatic plexuses drain lymph from the suprarenal glands; one lies under the capsule and the other in the medulla
  • They drain into the lumbar nodes
86
Q

what fibres innervate the suprarenal gland and where do they arise from? where do these fibres terminate?

A
  • Preganglionic sympathetic fibres to the suprarenal gland arise in the lateral horn of grey matter in spinal segments T10-L1 (same as kidney)
  • These fibres terminate by synapsing with the chromaffin cells in the suprarenal medulla

Medicine Sem 4 (23 decks)

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