Renal anatomy Flashcards by Alice Scholfield

When are kidneys palpable

Kidneys are enlarged

- Low body fat

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Where would you examine patient for kidney tenderness

Renal angle

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Where is the renal angle

Junction of 12th rib and lateral border of erector spiane

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What are the anterior relations to the right kidney

Liver

Part of duodenum

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What are the anterior relations to the left kidney

Pancreas

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What is the important space behind the right kidney

Hepatorenal space/ pouch of Morrison

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When would there be fluid in the hepatorenal pouch

If there has been a trauma
Haemoperioneum
Ascites
Pancreatitis

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Which kidney is higher up

The left kidney

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Which ribs are the kidneys underneath

11th and 12th

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What are the flexors on the posterior abdominal wall

Psoas major
Quadratus abdominus
Transverse abdominus

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What level is the subcostal nerve

T12

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Which nerve courses across the psoas major

Iliohypogastric

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What does iliohypogastric innervate

Transverse abdominus

Sensory to lateral skin region on gluetus

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What does ilioinguinal nerve innervate

Sensory information into the medial thigh

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Where is the renal capsule

Loosely attached to the surface of the kidney

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What surrounds the kidney

Renal capsule (innermost)
Pararenal fat
Renal fascia

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What does white area behind the kidney on a contrast scan suggest

Active bleed behind the kidney

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In a trauma to one kidney, why would blood be contained to that side

By the renal fascia

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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

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2 main regions of kidney

Outer cortex

Inner medulla

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What type of tissue is cortex

Connective tissue

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Where are nephrons situated

The medullary pyramids

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Where does the aorta through the diaphragm

T12

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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

Are renal veins anterior or posterior to aorta

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