L1: Kidney, Ureter, Bladder and Post Abdo wall Flashcards
Urinary system relation to peritoneum
Primarily retroperitoneal (kidney, ureter) except for the bladder (and urethra) which is infraperitoneal with the peritoneum ends and drapes over it.
Describe the surface anatomy of the kidney on both sides
- Sits on top of Psoas and Quad lumborum in the abdo cavity.
- Right kidney sits infront of and below rib 12 which is slightly lower than the left kidney which sits in front of rib 11 and 12. This is due to the liver.
- Kidney have a smooth reddish brown capsule. There is an upper and lower pole (sup and inf) with the suprarenal glands superior to the upper pole.
What is the difference between the Right and Left renal arteries and R and L renal veins
Right renal artery is slightly longer than the left, runs posterior to the IVC.
Left Renal vein is 3x longer than the right, runs anterior to the Aorta, under the SMA and Posterior to the Splenic vein/ body of the pancreas.
Right Renal vein runs posterior to the 2’ duodenum.
What is the nerve supply to the Kidneys (+ superior ureter) and where is pain referred to
Renal plexus:
Sympathetic fibres (t10) T11-12
Parasympathetic: Vagus CNX
Referred pain is Flank/loin pain.
What is the lymphatic drainage of the kidneys, ureters, Urinary bladder and Urethra
Kidney : Para aortic nodes (L1/L2). Urinary bladder and urethra mainly to Internal iliac nodes.
Ureter drains to lots of places but drain both of those above depending if its closer to bladder or kidney.
Describe the path of the ureter (25cm long) and the site of the 3 constrictions along that path which are the most common sites of renal calculus obstruction
- Exits the Kidney at L1 (transpyloric plane).
Constriction) Pelvic ureteric junction: renal pelvis and ureter junction
- Extends vertically down from the hilum on the surface of the psoas muscle, roughly in line with the transverse processes of the lumbar spine
- Passes posteriorly to the gonadal artery and vein, and anteriorly to the genitofemoral nerve
- Crosses the bifurcation of the common iliac artery- at the anterior sacroiliac joint. A 90 degree bend into the pelvis
Constriction) Pelvic inlet: where the ureters cross the pelvic brim
- Passes on the lateral wall of the pelvis (ilium) towards the ischial spine.
- Enters the bladder on the posterior surface at the Trigone
Constriction) Vesicouteric junction: Entrance to the Bladder
What are the 3 Arterial, Venous and Nerve supplies of the ureter sup, mid and inf 1/3 and how is pain referred
Sup 1: All Renal a and v
Mid 2: Gonadal artery and vein (Testicular/ovarian) + common iliac arteries
Inf 3: Superior vesical artery and vein (to the internal iliac)
Nervous supply:
Sup 1: Renal plexus: T11/12 fibres to Inf 3: Superior and inferior Hypogastric plexuses: L1/2 fibres of the terminal symp chain. Therefore pain is referred from Loin to groin.
What is the Blood supply and nerve supply to the bladder and referral of pain
- From the internal iliac artery there are 2 superior and 1 inferior vesical arteries from each side in males. In females inferior vesical artery is uterine artery.
- Venous drainage is to the vesical plexus (->int iliac vein)
- Nerve supply is the ANS inferior hypogastric plexus which has Sacral splanchnic nerves (L1-2) Therefore pain is referred to the suprapubic region- L1/2 dermatome. There is also Parasympathetic Pelvic splanchnic nerve (s2-4) in the plexus.
What are the 4 regions of the male urethra - which are the widest, and how does this compare to the female urethra
Male:
- Pre prostatic: Associated with the internal uretratic sphincter
- Prostatic: Widest part with many ducts emptying in
- Membranous: Thinnest part through the perineal pouch with the ext urethral sphincter- after a 90’ turn
- Spongy/penile: Through the corpus spongiosum to the bulb of the penis. Has another 90’ bend.
This leads to less urinary incontinence than females as longer pathway, larger muscles and 2 bends.
Female:
1. Urethra leaves bladder and passes through the Deep and Superficial perineal pouches (straight)
What are the L1 branches of the Lumbar plexus, general innervation and course/telling points
Iliohypogastric and Ilioinguinal:
Both give motor to transversus abdo and int oblique.
Course: They both emerge at the lateral border of psoas and run obliquely over quad lumb and pierce transversus abdominus.
However: IH is more superior, pierces Trans earlier and does sensory to lat glut and pubic skin
II: pierces the internal oblique to enter the inguinal canal and accompany the spermatic cord through superficial inguinal ring. Sensory for root of penis and medial thigh.
What is the L1 + 2 branches of the Lumbar plexus, general innervation and course/telling points
Genitofemoral nerve:
Sensory to the scrotum and motor to cremaster muscle.
Course: Only one to emerges through and runs on top of psoas. splits into two branches, genital branch will enter spermatic cord to innervate the cremaster muscle and give sensory to genital skin. Femoral branch goes to thigh under inguinal ligament
What is the L2+ 3 branches of the Lumbar plexus, general innervation and course/telling points
Lateral Femoral Cutaneous nerve:
Sensory only for the anterior + lateral thigh.
Course: Emerges from the lateral border of psoas, descends obliquely across the surface of iliacus- way out lateral. Passes under the inguinal lig near the ASIS, - danger of being compressed by inguinal lig.
What are the L2-4 branches of the Lumbar plexus, general innervation and course/telling points
Femoral Nerve and Obturator nerve
Femoral emerges from the lower lateral border of Psoas whereas Obturator emerges from the Medial border. Femoral runs between iliacus and psoas and passes under inguinal lig. to thigh and is FAT.
Obturator goes under the common iliac arteries than lateral to the internal iliac and ureters. It runs along walls of the pelvis to exit via the Obturator foramen- through the obturator canal.
