Gross anatomy

Question 1

location of the kidneys

Answer 1

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

Question 2

iliopsoas test

Answer 2

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

Question 3

paranephric fat

Answer 3

outside capsule (renal fascia) 
protect and support the kidney

Question 4

perinephric fat

Answer 4

fat inside the capsule

protect and support kidney

Question 5

Renal veins

Answer 5

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

Question 6

Renal entrapment syndrome (nut cracker syndrome)

Answer 6

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

Question 7

innervation to the kidneys: Renal plexus

Answer 7

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

Question 8

referred pain from the kidney

Answer 8

from stones or infection
T11-L1
posterior lower back, radiates to lateral abdomen (**flank) into the inguinal region (loin to groin)

Question 9

ureters

Answer 9

retroperitoneal, run over psoas major, enter the bladder on the posterior side

Question 10

3 sites of constriction of the ureter

Answer 10

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

Question 11

innervation to upper ureters

Answer 11

T10-12 SNS pre fibers, vasomotor and pain

PSNS from vagus

Question 12

innervation to the lower ureters

Answer 12

SNS L1-L2 inferior hypogastric: vasomotor and pain

PSNS: pelvic splanchnic nn.: motor to smooth muscle+ primary stretch afferents

Question 13

Lateral ligament and pubovesical ligaments

Answer 13

holds the bladder in place to prevent a cystocele

Question 14

innervation to bladder

Answer 14

SNS: T10-L2 (to trigonal muscle, sphincter urethrae)+ afferent pain
PSNS: from pelvic splanchnics (contract detrusor) + pain from non-peritonealized portions of bladder

Question 15

sphincter urethrae muscle

Answer 15

small muscle that prevents urine from exiting

tonically active

deep: innervated by SNS
Superficial: innervated by Somatic NS

very strong and efficient

Question 16

Nephrotosis

Answer 16

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

Question 17

Perinephric abscess

Answer 17

cannot spread to contralateral kidney b/c the fascicles attach tightly to renal vessels

but it can spread into the pelvis

Question 18

Renal aa.

Answer 18

lateral branches of aorta at LV1/LV2
R is longer and passes posterior to IVC
divide into 5 segmental end aa. at the hilum

Question 19

Arterial supply to ureters

Answer 19

Upper 1/3: renal a/v
middle 1/3: gonadal, aorta, common iliac aa./vv.
lower 1/3: common, ext, int iliac lymph nodes

Question 20

Detrusor muscle

Answer 20

3 layers of poorly organized smooth muscle

Question 21

Trigone

Answer 21

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

Question 22

Cystocele

Answer 22

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

Question 23

Micturition process

Answer 23

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

Question 24

Lymphatic drainage of ureter

Answer 24

1. Upper 1/3 → lumbar lymph nodes.
2. Middle 1/3 → common iliac lymph nodes.
3. Lower 1/3 → common, external, internal iliac lymph nodes.