Kidney practical

Question 1

What are the arteries that supply the adrenal gland?

Answer 1

(1) Superior adrenal - from inferior phrenic a
(2) Middle adrenal - from aorta
(3) Inferior adrenal - from renal a

Question 2

Where do the adrenal veins drain?

Answer 2

left drains to left renal v, right drains direct to IVC

Question 3

Describe the sympathetic innervation of the adrenal medulla.

Answer 3

sympathetics in lateral horn of spinal cord (text books vary T5-L1) travel via greater, lesser and least splanchnics and through the coeliac gangion without synapsing. The adrenal medulla receives preganglionic sympathetic fibres.

Question 4

Which hormones are released by the adrenal glands?

Answer 4

Glucocorticoids, mineralocorticoids, sex hormones; adrenalin, noradrenalin

Question 5

Describe the anatomical relationships of the ureters.

Answer 5

They are located anterior to the psoas major muscle and the bifurcation of the common iliac arteries. Gonadal and colic vessels cross anterior to ureters.

Question 6

What are the names of the cortical regions that extend between the medullary pyramids?

Answer 6

Renal column (of Bertin)

Question 7

What is the apex of a renal pyramid named?

Answer 7

Renal papilla.

Question 8

Into what structure do their collecting ducts drain?

Answer 8

Minor calyces and then major calyces.

Question 9

What is the space surrounding the calyces of the kidney called?

Answer 9

Renal sinus.

Question 10

Which structures enter and leave the kidney at its hilum?

Answer 10

Ureter, Renal aa, nn, vv and ll.

Question 11

At which vertebral level is the hilum typically located?

Answer 11

Transpyloric plane - L1

Question 12

Compare and contrast the techniques of intravenous pyelography with retrograde pyelography.

Answer 12

An intravenous pyelogram (IVP) is an X-ray test that provides pictures of the kidneys, the bladder, the ureters, and the urethra. During IVP, a dye called contrast material is injected into a vein in your arm. A series of X-ray pictures is then taken at timed intervals.

The retrograde pyelogram uses a dye to find out whether a kidney stone or something else is blocking your urinary tract. A thin, lighted tube (cystoscope) is inserted into the urethra. A catheter is then inserted through the cystoscope and into a ureter, which carries urine from the kidney to the bladder. Dye is injected through the catheter, and X-rays are taken.

A retrograde pyelogram is performed when an IVP does not show a reason for urinary symptoms, when an individual has clearance problems that prevent the use of contrast dyes, or because an individual is allergic to iodine-based dye.

Question 13

What are the anatomical relationships amongst the renal arteries and veins, aorta, inferior vena cava, and superior mesenteric artery?

Answer 13

The renal veins drain to the IVC at L1. Note the left renal vein travels between the aorta & superior mesenteric artery.

The right and left renal arteries are branches of the abdominal aorta, and the superior mesenteric artery is also a branch of the abdominal aorta. All branch at L1.

Question 14

What structures are located anterior to the left and right kidneys?

Answer 14

Anterior to the right kidney: liver, duodeum, small intestine, suprarenal gland, colon.
Left kidney: descending colon, small intestine, tail of the pancreas, spleen, stomach, suprarenal gland.

Question 15

List the muscles of the posterior abdominal wall. What are the actions of each?

Answer 15

Psoas major, minor, Quadratus lumborum, Iliacus.

Actions: flexion at hip joint (P, I), lateral flexion of trunk (P, QL)

Question 16

What is the function and innervation of the diaphragm?

Answer 16

Motor innervation by the phrenic nerve (C3-5), sensory by the phrenic nerve centrally, and intercostal nerves peripherally.

Question 17

Which structures pass through or posterior to the diaphragm, and for the big ones, at which vertebral levels?

Answer 17

The IVC (T8), and the oesophagus and vagal trunks at T10. The aorta and thoracic duct pass posteriorly at T12.

Question 18

Which muscles and bones are located posterior to the kidneys?

Answer 18

Psoas major, quadratus lumborum, transversus abdominus.

Question 19

What are the various branches of the lumbar plexus, and which anterior (ventral) rami of spinal nerves contribute to each?

Answer 19

Iliohypogastric, ilioinguinal nn (L1)
Genitofemoral n (L1, L2)
Lateral femoral cutaneous n (L2, L3)
Femoral n (L2-L4)
Obturator n (L2-L4)
Lumbosacral trunk (L4-L5) joins sacral plexus

Question 20

Identify the branches of the abdominal aorta, classing them as unpaired visceral, paired visceral and parietal branches.

Answer 20

Unpaired branches: Coeliac, SMA, IMA, Median sacral
Paired branches: Inferior phrenic, Middle adrenal, Renal, Gonadal (testicular/ovarian)
Multiple paired branches: Lumbar

Question 21

How does the abdominal aorta terminate, and at what vertebral level?

Answer 21

Divides into the right and left common iliac aa at L4.

Question 22

List the tributaries of the inferior vena cava classifying them as paired and unpaired

Answer 22

Unpaired tributaries: Right Adrenal, R. Gonadal, Hepatic

Paired tributaries: Renal, Inferior Phrenic, Lumbar (3,4)

Question 23

What is the origin of the IVC and at what level?

Answer 23

The common iliac vv at L5.

Question 24

Summarise the flow of lymph through the major abdominal vessels to the thoracic duct.

Answer 24

internal and external iliac nodes drain to common iliac nodes which drain to lumbar nodes (lateral aortic nodes) also draining into the lumbar nodes are posterior abdominal wall, kidney, adrenal, ureters, gonads, uterus and inferior mesenteric. The lumbar nodes then drain to the lumbar trunks.

Coeliac and superior mesenteric (and inferior mesenteric) nodes drain to the intestinal trunks. Lumbar & intestinal trunks drain to the cisterna chyli then to the thoracic duct which exits abdomen via aortic hiatus terminating at the junction of the left subclavian and internal jugular veins (left venous angle).