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Yr 2 - Renal > Kidneys and Suprarenal Glands - Anatomy > Flashcards

Kidneys and Suprarenal Glands - Anatomy Flashcards

1
Q

What vertebral level are the kidneys located?

A

T12 to L3

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2
Q

Why is the right kidney slightly lower?

A

Due to presence of liver

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3
Q

What is the hepatorenal recess?

A

Space between right kidney and liver

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4
Q

Where are the suprarenal glands found?

A

On superior aspect of R and L kidneys

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5
Q

Are the kidneys intra or retroperitoneal?

A

Retroperitoneal –> parietal peritoneum and substantial amount of fat has to be removed to see kidneys

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6
Q

Where is the hilum of the kidneys?

A

On medial aspect

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7
Q

What is the hilum of the kidneys infiltrated with?

A

Fat (renal sinus)

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8
Q

Describe the layers of fat and fascia surrounding the kidneys?

A

Renal capsule is a tough fibrous capsule encasing the kidneys

  1. Perirenal fat surrounds kidneys
  2. This is surrounded by layer of perirenal fascia
  3. This is surrounded by pararenal fat
  4. Parietal peritoneum overlies this
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9
Q

What structures enter the kidney hilum?

A
  1. Renal vein
  2. Renal artery
  3. Ureter
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10
Q

Describe the order of structures entering and leaving kidney hilum?

A
  1. Renal vein enters most anteriorly
  2. Renal artery just posterior to renal vein
  3. Ureter enters most posteriorly
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11
Q

Where does the renal vein empty into?

A

IVC

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12
Q

Where does the renal artery come from?

A

Abdominal aorta

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13
Q

As the renal artery approaches the hilum, what happens?

A

It branches into segmental arteries that enter the hilum

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14
Q

What side of the abdominal aorta does the IVC lie?

A

On the right (but actually left looking at it)

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15
Q

Describe the route of the left renal vein and the right renal vein?

A

Left –> Crosses over abdominal aorta (due to IVC being on right)

Right –> Goes straight to right kidney

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16
Q

Where do the gonadal arteries emerge from?

A

From abdominal aorta (just below where left renal vein crosses over abdominal aorta)

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17
Q

Where does the right gonadal vein drain into?

A

Directly into the IVC

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18
Q

Where does the left gonadal vein drain into?

A

The left renal vein before entering the IVC (as left renal vein is longer)

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19
Q

What can the kidney parenchyma be divided into?

A
  1. Outer cortex

2. Internal medulla

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20
Q

What is the internal medulla composed of?

A
  1. Renal pyramids
  2. Sections of cortex that project into medulla (renal columns) –> this divides medulla into triangular shapes (the renal pyramids)
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21
Q

What is found at the apex of each renal pyramid?

A

Renal papilla

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22
Q

From the renal papilla, what do we open out into?

A

A minor calyx (surround the apex of the renal pyramids)

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23
Q

What do the minor calyces join to form?

A

2 or 3 minor calyces join to form major calyces

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24
Q

What do major calyces converge to form?

A

The renal pelvis

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25
Q

What is the renal pelvis?

A

Dilated region of the collection system

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26
Q

What does the renal pelvis then narrow to form?

A

Ureter

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27
Q

Where do the suprarenal glands receive blood supply from?

A

3 arteries:

  • Superior suprarenal artery
  • Middle suprarenal artery
  • Inferior suprarenal artery
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28
Q

Where is the superior suprarenal artery derived from?

A

The inferior phrenic artery

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29
Q

Where is the middle suprarenal artery derived from?

A

Directly from the aorta

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30
Q

Where is the inferior suprarenal artery derived from?

A

From the renal artery

31
Q

What is the quadratus lumborum?

A

The deepest abdominal muscle found in the lower back

32
Q

Where is the quadratus lumborum found?

A

Found in the lower back between the top of the pelvis and the lowest rib

33
Q

What is the psoas major and minor?

A

Major –> Found on medial aspect from the lateral aspect of the lumbar vertebra that goes on to attach to femur

Minor –> Tendinous slip sat on anterior surface or psoas major (absent in 20%)

34
Q

Where is the iliacus muscle?

A

In the iliac fossa

35
Q

What does the iliacus muscle join with?

A

The tendon of the psoas muscle (ilio-psoas)

Common attachment point on the femur

36
Q

What are the crura?

A

The crus of diaphragm (pl. crura), refers to one of two tendinous structures that extends below the diaphragm to the vertebral column. There is a right crus and a left crus, which together form a tether for muscular contraction.

37
Q

What nerve underlies rib 12?

A

Subcostal nerve

This goes on to supply some muscles of the lateral abdominal wall

38
Q

What nerve is found at L1?

A

Common stalk splits into iliohypogastric nerve (superior) and ilioinguinal nerve (inferior)

39
Q

What nerve is sat on top of the psoas major?

A

The genitofemoral nerve

40
Q

What does the genitofemoral nerve split into?

A
  1. Genital branch

2. Femoral branch

41
Q

What does the femoral branch supply?

A

The skin of the upper anterior thigh

42
Q

What does the genital branch supply?

A

Enters the deep inguinal ring, inguinal canal and superficial inguinal canal to supply skin around genital region

43
Q

What nerve is found on the medial aspect of the pelvis?

A

Obturator nerve

44
Q

What is the obturator nerve responsible for?

A
  1. The sensory innervation of the skin of the medial aspect of the thigh
  2. The motor innervation of the adductor muscles of the lower limb (external obturator)
45
Q

What does the perirenal fascia enclose?

A

The kidneys and the suprarenal glands

46
Q

What is the job of the minor calyces?

A

Collect urine from the pyramids

47
Q

Where do the renal arteries arise from?

A

The abdominal aorta, immediately distal to the origin of the SMA

48
Q

Which renal artery is longer? Why?

A

The right renal artery is longer due to the anatomical position of the abdominal aorta (slightly to the left of the midline)

The right renal artery crosses the vena cava posteriorly

49
Q

What is the avascular plane of the kidney?

A

An imaginary line along the lateral and slightly posterior border of the kidney, which delineates the segments of the kidney supplied by the anterior and posterior divisions of the renal artery.

It is an important access route for both open and endoscopic surgical access of the kidney, as it minimises the risk of damage to major arterial branches.

50
Q

The renal artery branches are anatomical end arteries. What does this mean?

A

There is no communication between vessels

51
Q

Why is it clinically important that the renal artery branches are anatomical end arteries?

A

Trauma or obstruction in one arterial branch will eventually lead to ischaemia and necrosis of the renal parenchyma supplied by this vessel.

52
Q

What does the renal artery divide into?

A

Anterior and posterior artery

These then divide into segmental arteries

53
Q

What do the branches of the renal artery eventually form?

A

Afferent arterioles that form a capillary network –> the glomerulus (where filtration takes place)

These capillaries then come together to form efferent arterioles

54
Q

In the outer 2/3 of the renal cortex, what do the efferent arterioles form?

A

A peritubular network –> supplying the nephron tubules with oxygen and nutrients

55
Q

What is the inner 1/3 of the cortex and medulla supplied by?

A

Vasa recta (long straight arteries)

56
Q

What are the ureters?

A

2 thick tubes which transport urine from the kidneys to the bladder

57
Q

Where do the ureters arise?

A

As a continuation of the renal pelvis

58
Q

Where does the renal pelvis receive urine from?

A

The major calyces

59
Q

What is the ureteropelvic junction?

A

Where the renal pelvis narrows to form the ureter

60
Q

How do the ureters descend into the pelvic cavity?

A

Through the abdomen, along the anterior surface of the psoas major

At the area of the sacroiliac joints, the ureters cross the pelvic brim, thus entering the pelvic cavity. At this point, they also cross the bifurcation of the common iliac arteries.

61
Q

How do the ureters travel through the pelvic cavity?

A

The ureters travel down the lateral pelvic walls. At the level of the ischial spines, they turn anteromedially, moving in a transverse plane towards the bladder.

62
Q

What happens once the ureters reach the bladder?

A

They pierce its lateral aspect in an oblique manner –> angle creates a one way valve, preventing the backflow of urine

63
Q

Why is the course of the ureters clinically important?

A

They travel close to other structures in the pelvis. They must be identified during pelvic surgery to ensure that they are not accidentally damaged.

64
Q

What care must be taken in regards to the ureters in females?

A

As they cross the pelvic brim, the ureters are in close proximity to the ovaries. Care must be taken not the damage the ureters during an oophorectomy, especially during the ligation of the ovarian arteries.

They also run underneath the uterine artery. Care must be taken not to damage the ureters during a hysterectomy (where uterus and uterine artery are removed).

65
Q

What care must be taken in regards to the ureters in males?

A

In men the vas deferens cross the ureters anteriorly.

66
Q

How have the ureters developed?

A

Has developed via the ureteric bud from the mesonephric duct, and then followed the kidney during its ascend to the final lumbar position in the retroperitoneum.

67
Q

What can the arterial supply to the ureters be divided into?

A

Abdominal and pelvic supply

68
Q

What is the abdominal supply of the ureters?

A

Renal artery, testicular/ovarian artery, and ureteral branches directly from the abdominal aorta

69
Q

What is the pelvic supply of the ureters?

A

Superior and inferior vesical arteries.

70
Q

How is nervous supply to the ureters delivered?

A

Via the renal, testicular/ovarian and hypogastric plexuses

71
Q

Where do sensory fibres from the ureters enter the spinal cord?

A

T11 - L2

Ureteric pain is referred to those dermatomal areas

72
Q

What is a ureteric calculus?

A

A kidney stone

The presence of a solid stone in the urinary tract, formed from minerals within the urine.

73
Q

What are dangers of kidney stones?

A

These can obstruct urinary flow, causing renal colic (an acute and severe loin pain) and haematuria (blood in the urine).

Do a CT scan!

74
Q

Where are the 3 common places for kidney stones to get stuck?

A

3 constrictions of ureters:

  1. Uretopelvic junction
  2. Pelvic brim
  3. Where urethra meets bladder

Yr 2 - Renal (16 decks)

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