Gross anatomy Flashcards
location of the kidneys
L: TV11-LV2
R: TV12-LV3
anterior to the subcostal n. iliohypogastric, ilioinguinal n.
inferior pole is more lateral, hilum is anterior-medial
**R is easier to palpate b/c it is lower
iliopsoas test
kidney infection can enter into the fascia of the psoas major
test with thigh extension, if it elicits pain, then there may be an infection within the psoas fascia
paranephric fat
outside capsule (renal fascia) protect and support the kidney
perinephric fat
fat inside the capsule
protect and support kidney
Renal veins
L longer than R because the IVC is more right
L collects blood from gonadal vein L inferior phrenic, and left suprarenal vein
L passes under superior mesenteric a.
always superior to arteries
Renal entrapment syndrome (nut cracker syndrome)
renal vein is compressed by the superior mesenteric a. and aorta as it crosses over
1) L renal v. HTN
2) hematuria (due to rupture of small venules in the kidney)
3) testicular pain ( bc the gonadal v drains back into the L renal v.) develop varicosities which cause sever testicular pain
innervation to the kidneys: Renal plexus
Preganglionic SNS: T10-L1 (via lesser, least and lumbar splanchnics: Vasomotor (control amt of blood to kidney via VC) and **afferent pain fibers
PSNS with the vagus: Motor to smooth muscles in calyces, carry stretch afferent fibers
referred pain from the kidney
from stones or infection
T11-L1
posterior lower back, radiates to lateral abdomen (**flank) into the inguinal region (loin to groin)
ureters
retroperitoneal, run over psoas major, enter the bladder on the posterior side
3 sites of constriction of the ureter
where stones are most likely to get stuck
1) ureter passes over inferior pole (abdominal)
2) over the pelvic brim over the iliac vessels
3) where it passes thru the bladder wall
innervation to upper ureters
T10-12 SNS pre fibers, vasomotor and pain
PSNS from vagus
innervation to the lower ureters
SNS L1-L2 inferior hypogastric: vasomotor and pain
PSNS: pelvic splanchnic nn.: motor to smooth muscle+ primary stretch afferents
Lateral ligament and pubovesical ligaments
holds the bladder in place to prevent a cystocele
innervation to bladder
SNS: T10-L2 (to trigonal muscle, sphincter urethrae)+ afferent pain
PSNS: from pelvic splanchnics (contract detrusor) + pain from non-peritonealized portions of bladder
sphincter urethrae muscle
small muscle that prevents urine from exiting
tonically active
deep: innervated by SNS
Superficial: innervated by Somatic NS
very strong and efficient
Nephrotosis
dropped kidney
caused by deficiency in the fats and fascia surrounding kidney during late stages of starvation
kidneys drop in to pelvis, can be asymptomatic, can present with typical kidney referred pain
Perinephric abscess
cannot spread to contralateral kidney b/c the fascicles attach tightly to renal vessels
but it can spread into the pelvis
Renal aa.
lateral branches of aorta at LV1/LV2
R is longer and passes posterior to IVC
divide into 5 segmental end aa. at the hilum
Arterial supply to ureters
Upper 1/3: renal a/v
middle 1/3: gonadal, aorta, common iliac aa./vv.
lower 1/3: common, ext, int iliac lymph nodes
Detrusor muscle
3 layers of poorly organized smooth muscle
Trigone
triangular area b/w the ureteral orifices and internal urethral orifices
superior= interureteric crest
inferior= uvula
inner muscle= extension of ureteric muscle
outer muscle= typical detrusor muscle
Cystocele
fallen bladder that is a result of weak pelvic diaphragm or ligaments
causes: childbirth, Ob, constipation, heavy lifting
can cause urinary incontinence or incomplete emptying
Micturition process
1) bladder stretches
2) stretch receptors fire
3) signal travels with pelvic splanchnics up to S2-4) ascending fibers up to brain micturition center
5) Activate GVE motor fibers of pelvic splanchnics
6) Causes contraction of detrusor and bladder emptying
7) concurrent relaxation of sphincter urethrae via inhibition of SNS innervated and somatic innervated portions
Lymphatic drainage of ureter
- Upper 1/3 → lumbar lymph nodes.
- Middle 1/3 → common iliac lymph nodes.
- Lower 1/3 → common, external, internal iliac lymph nodes.
