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Block 2; Week 4 > Kidney Anatomy > Flashcards

Kidney Anatomy Flashcards

1
Q

From an embryological perspective, where do the kidneys develop?

A

posterior to the peritoneal cavity from the urogenital ridge.

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2
Q

What is the embryological gut tube lined w/? What else is this called? What opposes it?

A

The gut tube is lined w/ splanchnic mesoderm. This becomes the visceral layer of the peritoneum. The outside layer of the peritoneal cavity/coelemic cavity is lined w/ the parietal layer of the peritoneum.

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3
Q

How do you access the kidneys generally speaking?

A

You don’t have to go anteriorly or into the peritoneal cavity. This is good b/c going into this cavity can cause infections & adhesions. You access it thru the back in the retroperitoneal space.

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4
Q

What is inside the peritoneal space b/w the organs in the cavity?

A

hopefully nothing except a little bit of serous fluid.

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5
Q

What are some important retroperitoneal structures?

A

Urinary System
Adrenal Glands
Posterior Abdominal Wall
Aorta & IVC

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6
Q

T/F The 11th rib extends over the right kidney.

A

False. The 11th rib only extends over the left kidney.

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7
Q

What are 2 things that make the kidney travel?

A

Inspiration. Makes the kidney go down.

Standing up. I think makes the kidney go down.

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8
Q

Which rib is always covering both kidneys?

A

the 12th rib.

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9
Q

About how much will the kidney move?

A

2-3 cm

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10
Q

What are the 2 layers of fat that cover the kidney?

A

The perirenal fat: inside the renal fascia adjacent to the kidney
The pararenal fat: outside of the renal fascia

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11
Q

What is the renal fascia?

A

An extension sort of…of the fat surrounding the blood vessels that surround the kidneys & the adrenal glands & goes in b/w the 2.

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12
Q

Why are the kidneys & the adrenal glands separable from each other?

A

B/c there is a slit of renal fascia that separates them.

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13
Q

T/F the kidneys & the adrenal glands come from the same developmental structure.

A

False. They come from 2 different developmental structures.

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14
Q

What is the process of the ascent of the kidney?

A

The kidney originates in the pelvis from the urogenital tract. It then ascends as it develops.
Old arteries that were connected to it are called polar arteries or accessory renal arteries.

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15
Q

What is the renal sinus?

A

It is a fat-filled area @ the hylum of the kidney.

This is where the blood vessels & ureter branches into the different segments of the kidney.

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16
Q

What is the difference b/w the lengths of the renal artery & the renal vein that supply the left & right kidneys?

A

The aorta is closer to the left side.
The IVC is closer to the right side.
Therefore, the renal artery that supplies the right kidney is longer than the one that supplies the left.
The renal vein that supplies the right kidney is shorter than the one that supplies the left.

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17
Q

What is the blood supply like to the adrenal gland? Why?

A

The aorta, renal artery, & phrenic artery all supply the adrenal gland. This is important b/c it is an endocrine organ & it needs blood to give its hormones to.

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18
Q

What is another important structure that the renal artery supplies…aside from the kidneys & the adrenal gland?

A

The ureter! Actually it is so long that it has different forms of blood supply all along its length.

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19
Q

Does the renal artery that supplies the right kidney tuck under the IVC or go over the IVC?

A

It goes under it.

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20
Q

From superficial to deep…what is the order of the muscles that you must cross to access the kidney?

A 
Latissimus Dorsi
External Oblique
Internal Oblique
Transversus Abdominis
Quadratus Lumborum
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21
Q

Which of the muscles that you must cross to access the kidney attach to the thoracolumbar aponeuroses?

A

Latissimus Dorsi
External Oblique
Internal Oblique
Transversus Abdominis

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22
Q

What is the latissimus dorsi considered–as in type of muscle?

A

An upper limb muscle

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23
Q

Where does the kidney sit in terms of muscles?

A

On top of the quadrates lumborum & the psoas muscle

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24
Q

Which kidney is lower & why?

A

The right kidney is lower b/c the liver pushes down on it.

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25
Q

Which of the muscles that you must cut thru to get to the kidney are considered anterior abdominal wall muscles?

A

The External Oblique
Internal Oblique
Transversus Abdominis

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26
Q

What are the boundaries of the quadrates lumborum?

A

Top: 12th rib.
Bottom: Iliac crest

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27
Q

What is the relationship b/w the external oblique & the internal oblique? In which direction do they run?

A

The external oblique is more superficial.
They are at a 90 degree angle to one another.
The Externals run medially & downward.
The Internals run medially & upward.

28
Q

What does the left renal vein hook under/over?

A

It hooks under the superior mesenteric artery (which comes off the aorta). it hooks here on its journey to the IVC. Note: the SMA supplies the midgut.

29
Q

If you compressed the left renal vein–what would happen to the drainage back to the heart?

A

It wouldn’t be totally compromised b/c the left renal vein has the connection to the azygos system (an alternate route of drainage that prevents backup).

30
Q

If the left renal vein didn’t have the azygos system…where would we often see a back up of blood?

A

The left testicle.

31
Q

What are the drainage connection for the right renal vein?

A

adrenal veins
diaphragmatic veins
probably some other stuff

32
Q

What are the drainage connections for the left renal vein?

A

adrenal veins
diaphragmatic veins
left gonadal vein
azygos system

33
Q

If the left testicle drains its blood thru the left gonadal vein & into the left renal vein (connection to azygos system yay)…where does the blood from the right testicle drain?

A

To the IVC directly. NOT to the right renal vein.

34
Q

Where do all of the collecting ducts come together? After this where do they drain to?

A

The renal papilla & they drain to the minor calyx.

35
Q

T/F The juxtamedullary nephrons are found in the medulla.

A

FALSE! they are found in the inner cortex or juxtamedullary region…basically it is cortex…that is next to the medulla. This is where these nephrons are found.

36
Q

How many minor calyces does it take to make a major calyx?

A

3-5.

37
Q

Where do the 3-5 major calyces of the kidney drain to?

A

The renal pelvis!

38
Q

What surrounds the renal pelvis?

A

The renal sinus! It is fat-filled.

39
Q

Where does the renal pelvis drain to?

A

the ureter!

40
Q

How many points of narrowing are there in the ureter? Why is this important? What are they?

A

3
where kidney stones get trapped
first one is @ the transition of the renal pelvis to the ureter.
Second one is @ the pelvic brim
third one is @ the entrance to the bladder

41
Q

What is the blood supply of the ureter like?

A 
Amazing--supply from everywhere!
Aorta
renal artery
gonadal artery
vesicular artery
branches of small vessels that supply the bladder.
42
Q

T/F The nerve supply to the ureter is fairly limited.

A

False. It has a long course & a huge nerve supply.

43
Q

T/F the ureter has layers of powerful muscle.

A

True. It is able to contract spasmodically…so much so that it can still add urine to a full bladder & not have back flow.

44
Q

What is significant about the angle at which the ureter enters the bladder?

A

It enters at an oblique angle. This prevents back flow. It is a functional sphincter.

45
Q

T/F You can clearly view the kidneys & renal arteries & veins on a CT scan.

A

True. Remember the orientation.

46
Q

What is the main function of autonomics in the nervous system?

A

They can alter blood flow in the kidney.

47
Q

What is the nerve supply to the kidneys?

A

From thoracic splanchnics: greater, lesser, least & L1 splanchnic…synapses @ renal artery ganglion
Synapse @ aorticorenal ganglion or ganglion near the renal artery
Travel along the renal plexus
Innervate the kidney

48
Q

Which thoracic vertebrae do the lesser & least thoracic splanchnics originate from?

A

Lesser; T10-11

Least: T12

49
Q

When the greater, lesser, & least thoracic splanchnics go thru the diaphragm….are they presynpatic or postsynaptic?

A

They are presynaptic.

50
Q

Do sympathetics & parasympathetics carry afferents from the viscera?

A

Yes.

51
Q

What do you feel from the afferents from the viscera that are carried along the sympathetic fibers?

A

You feel pain that is localizable.

52
Q

What do you feel from the afferents from the viscera that are carried along the parasympathetic fibers?

A

You feel either a dull general feeling of malaise or you just experience reflexes.

53
Q

Where does the lesser thoracic splanchnic synapse?

A

@ the aorticorenal ganglion.

54
Q

Where does the least thoracic splanchnic synapse?

A

@ the renal artery plexus.

55
Q

T/F There is parasympathetic innervation of the ureters & the kidney.

A

True.

56
Q

Describe the 2 sources of parasympathetic innervation of the kidney/ureters.

A

Vagus nerve comes down as presynaptic & synapses near the organ…supplies the ureter & kidney.
Parasympathetics from S2, S3, S4 come up & synapse in the hypogastric plexus near the pelvic brim & supply the ureters & kidneys.

57
Q

Where is the T10 dermatome located anteriorly?

A

The umbilicus.

58
Q

Where can referred pain end up in terms of dermatomes w/ pain of the kidney & the ureters? Ex: if you are passing a stone.

A

T10-L2

59
Q

In what way are the adrenal glands related to the kidneys?

A

They sit on top of them. They are anatomically related; they are not embryologically related.

60
Q

Explain why the adrenal gland is both an endocrine gland & a neuroendocrine gland.

A

Endocrine gland @ its cortex.

Neuroendocrine gland @ its medulla.

61
Q

What is the venous drainage of the adrenal glands?

A

They have one vein…the suprarenal vein. On the right side this drain directly to the IVC. On the left side this drains to the renal vein, which drains to the IVC.

62
Q

What are the 3 sources of blood supply to the adrenal glands?

A

Inferior Phrenic Artery (normally supplies the diaphragm). Has a branch that is the superior suprarenal artery.
Aorta has branches that are the middle suprarenal arteries.
The renal arteries (which came from the aorta) have branches that are the inferior suprarenal arteries.

63
Q

What is the shape of the adrenal gland on a CT scan?

A

It kind of looks like a wishbone.

64
Q

What is the largest of the thoracic splanchnics that come down thru the diaphragm?

A

The greater thoracic splanchnic.

65
Q

When the greater thoracic splanchnic comes thru the diaphragm is it pre gang or post gang?

A

It is pre gang.

66
Q

What nerves supply the adrenal medulla?

A

The greater thoracic splanchnic nerve comes thru diaphragm as preganglionic & either goes to the celiac ganglion in the pre aortic plexus & doesn’t synapse & goes to the adrenal medulla OR it veers off of the rest of the greater thoracic splanchnic that is headed for the celiac ganglion & it just innervates the adrenal medulla. Here: the enterochromaffin cells secrete norepinephrine & epinephrine.

67
Q

What nerves supply the adrenal cortex?

A

Greater thoracic splanchnic nerves that synapse in the celiac ganglion in the pre aortic plexus & then go to the cortex or the blood vessels of the adrenal gland as postganglionic fibers.

Block 2; Week 4 (6 decks)

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