Kidney, Adrenal Gland, Ureter

Question 1

What are the three ways to get kidney damage?

Answer 1

1) fail to properly profuse the kidney with blood
2) disease which directly effect the kidney tissue/electrolyte balances
3) bladder or prostate issues that cause back pressure into the kidney

Question 2

What nerves exit the lumbar plexus?

Answer 2

“I Twice Get Laid on Fridays”

Iliohypogastric (L1)

Ilioinguinal (L1)

Genitofemoral (L1, L2)

Lateral cutaneous nerve (L2, L3)

Obturator (L2, L3, L4)

Femoral (L2, L3, L4)

Question 3

What ligament connects the kidney to the spleen?

Answer 3

splenorenal ligament

Question 4

What part of the pancreas does the splenic artery run along?

Answer 4

The tail

Question 5

What are the 4 layers surrounding the kidney?

Answer 5

renal capsule

Perirenal fat (innermost)

gerota’s fascia

pararenal fat

Question 6

What is the gerota’s fascia continous with?

Answer 6

the transversalis fascia

Question 7

What muscles lie posteriorly to the kidney?

Answer 7

Psoas major muscle

quadratus lumborum muscle

Question 8

What exits the hilum of the kidney?

Answer 8

The ureter, renal blood vessels, lyphatics

Question 9

What is the order of the structures exiting the hilum of the kidney?

Answer 9

superficial = vein

middle = artery

deep = ureter

or “VAP” for vein, artery, pelvis

Question 10

What is the blood supply to the kidney?

Answer 10

Renal artery - four segments on the anterior side and one segment of this on the posterior side

Question 11

Describe the structures within the kidney

Answer 11

Outermost = cortex - contains bowman’s capsules and the glomerulus

middle = medulla- cone shaped medullary pyramids

medulla drains into minor calyx

minor calyx drains into major calyx

Major calyx drains into the renal pelvis

renal pelvis to the ureter

Question 12

What does the medulla of the kidney contain?

Answer 12

these medullas are made up of parallel bundles of urine- collecting tubules

Question 13

What structure lies just anterior to the right renal hilum?

Answer 13

The first part of the duodenum

Question 14

How long is the ureter usually?

Answer 14

30 cm

Question 15

What is the blood supply of the ureter?

Answer 15

RGSI - looks like RCSI but isn;t

Renal

Gonadal

Superior vesical

Inferior vesical (vaginal in women)

Question 16

What sort of surface cells make up the ureter?

Answer 16

transitional epithelium - watertight junctions but distensible

Question 17

Where would pain be refered to from the ureter?

Answer 17

“loin to groin”

Question 18

Where is the ureter susceptible to constriction/stone lodgement?

Answer 18

uteropelvic junction

where it runs over the pelvic inlet

entrance to the bladder

Question 19

What is the nerve supply to the ureter?

Answer 19

Nervous supply to the ureters is delivered via the renal, testicular/ovarian and hypogastric plexuses.

Question 20

What are the majority of kidney stones made of?

Answer 20

majority are calcium oxalate phosphate - which would appear on an x ray

Others include urate, cystine, and struvite - these may not appear on an X ray and require a CT or ultrasound

Question 21

What separates the kidney from the adrenal gland?

Answer 21

The gerota’s fascia

Question 22

What are the two areas of the adrenal gland?

Answer 22

cortex = regulated by pituitary, hypothalamus, and renin-angiotensin axis

medulla = contains chromaffin cells to produce adrenalin and noradrenaline

Question 23

What are the vessels supporting the adrenal gland?

Answer 23

Blood Supply

Superior adrenal artery – arises from the inferior phrenic artery

Middle adrenal artery – arises from the abdominal aorta.

Inferior adrenal artery – arises from the renal arteries.

Right and left adrenal veins drain the glands. The right adrenal vein drains into the inferior vena cava, whereas the left adrenal vein drains into the left renal vein.

Question 24

What is Vesico-Ureteric reflux?

Answer 24

can be due to a number of things

• high pressure voiding states, posterior urethral valves, neuropathic bladder, duplex collecting system, bladder exstrophy,

can cause distention of the ureter, renal pelvis, and calyces,