Renal anatomy Flashcards
When are kidneys palpable
- Kidneys are enlarged
- Low body fat
Where would you examine patient for kidney tenderness
Renal angle
Where is the renal angle
Junction of 12th rib and lateral border of erector spiane
What are the anterior relations to the right kidney
Liver
Part of duodenum
What are the anterior relations to the left kidney
Pancreas
What is the important space behind the right kidney
Hepatorenal space/ pouch of Morrison
When would there be fluid in the hepatorenal pouch
If there has been a trauma
Haemoperioneum
Ascites
Pancreatitis
Which kidney is higher up
The left kidney
Which ribs are the kidneys underneath
11th and 12th
What are the flexors on the posterior abdominal wall
Psoas major
Quadratus abdominus
Transverse abdominus
What level is the subcostal nerve
T12
Which nerve courses across the psoas major
Iliohypogastric
What does iliohypogastric innervate
Transverse abdominus
Sensory to lateral skin region on gluetus
What does ilioinguinal nerve innervate
Sensory information into the medial thigh
Where is the renal capsule
Loosely attached to the surface of the kidney
What surrounds the kidney
Renal capsule (innermost)
Pararenal fat
Renal fascia
What does white area behind the kidney on a contrast scan suggest
Active bleed behind the kidney
In a trauma to one kidney, why would blood be contained to that side
By the renal fascia
How does trauma to kidney lead to haematuria
Blood gone into the pelvis of the kidney and travels through kidney to be excreted with urine
2 main regions of kidney
Outer cortex
Inner medulla
What type of tissue is cortex
Connective tissue
Where are nephrons situated
The medullary pyramids
Where does the aorta through the diaphragm
T12
Which vessel branches off at upper border of L1
Coeliac trunk
Which vessel branches off at the lower border of L1
Superior mesenteric artery
What vessel does the superior mesenteric artery loop over
Left renal vein
Where does the renal artery divide
Hilum
How many segmental arteries does the renal artery divide into
4/5
What do segmental arteries
Lobar arteries
What do lobular arteries divide into once in pyramid
Arcuate arteries
What branches of the arcuate radiate into cortex
Cortical radial branches
What do cortical radial branches becomes
Efferent arterioles
What % of the cardiac output do renal arteries get
1/4
Is the right renal artery anterior or posterior to IVC
Posterior
Where do renal veins arise
L2
Are renal veins anterior or posterior to aorta
Anterior
Why is left renal vein longer than right renal vein
Because it has to course across the abdominal aorta
Where does the left renal vein receive drainage from
Left suprarenal and gonadal veins
Where does visceral nervous supply to kidney arise from
Splanchic nerves
Where does kidney pain refer to
Groin
What are febrile symptoms
Fever
Are ureters retroperitoneal
Yes
Describe the path of the ureters
Pass over pelvic brim at bifurcation of common iliac arteries
Run on lateral wall of pelvis
Opposite ischial spine, curves anteromedailly
Oblique entrance into bladder
How is backflow of urine prevented
One way flap valve when the ureters enter the bladder
How do ureters force urine through
Peristalsis
Name the 3 layers of the ureter wall
- Transitional epithelial mucosa
- Smooth muscle muscularis
- Fibrous connective tissue adventitia
What do ureters activelly propel urine in response to
Bladder stretch
Where do visceral afferent to ureters enter
T11-L1/2
Where is pain in the loin referred to
Along ilioinguinal and iliohypogasstric nerves
Why is pain referred from loin to groin when the kidney stone descends
Because is changes from travelling along iliohypogastric and ilioinguinal to genitofemoral nerve
Where is the bladder positioned
Lies retroperitoneally on pelvic floor posterior to pubic symphysis
Is the bladder higher or lower in children than adults
Higher because the pelvic bones in children are smaller and narrower pushing bladder superiorly
What ligament holds the bladder in place
Median umbilical ligament
What are the 3 layers of the bladder wall
Transitional epithelial layer
Thick muscular layer
Fibrous adventitia
What is the trigone
Triangular area outlined by openings for the ureters and urethra
Why is trigone clinically relevant
Infections occur commonly here
Is there transitional epithelium in the trigone
No- its smooth
What keeps the urethra closed when urine is not being passed through
- Internal urethral sphincter is an involuntary sphincter in the bladder-urethra junction preventing retrograde ejaculation
- External urethral sphincter which is the voluntary sphincter in the membranous floor of the pelvis (levator ani)
What is the position of the urethra in the female
Tightly bound to anterior vaginal wall
