Renal anatomy Flashcards
1
Q
Are the kidneys intra or retroperitoneal?
A
Retroperitoneal
2
Q
What name is given to the medial aspect of the kidney?
A
renal hilum
3
Q
what structures are found at the renal hilum?
A
Blood vessels
ureter
4
Q
Which sits anteriorly, renal vein or artery?
A
renal vein
5
Q
Which abdominal wall muscles lie to the lateral aspect of the kidney?
A
external oblique
internal oblique
transversus abdominis
6
Q
What structures lie anterior to the kidney?
A
visceral peritoneum paranephric fat renal deep fascia perinephric fat renal capsule
7
Q
What deep muscles lie posterior to the kidney?
A
psoas major
quadratus lumborum
8
Q
At what vertebral level does the right kidney lie?
A
L1-L3
9
Q
At what vertebral level does the left kidney lie?
A
T12-L2
10
Q
Which kidney is lower in the body?
A
right
11
Q
Why does the right kidney lie further down than the left kidney?
A
Displacement from the liver
12
Q
Which ribs lie posterior to the kidneys?
A
11 and 12
13
Q
In what abdominal regions are the kidneys located in?
A
Lumbar regions
14
Q
In what direction do the kidneys move when the patients breathe in?
A
Descend
15
Q
Describe the relationship of the right kidney and other abdominal organs?
A
Posterior to the liver and hepatorenal recess, 2nd part of the duodenum, ascending colon and right colic flexure.
16
Q
What is the most dependent (deepest) part of the peritoneal cavity when the patient is supine?
A
Hepatorenal recess
17
Q
Describe the relationship of the left kidney and the other abdominal organs,
A
Posterior to the stomach, tail of the pancreas, hilum of the spleen and splenic vessels
18
Q
At the bifurcation of the aorta, what structure lies anterior, the common iliac arteries or common iliac veins?
A
Iliac arteries
19
Q
Where does ureteric arterial supply come from?
A
renal artery abdominal aorta common iliac artery internal iliac artery vesical artery
20
Q
Where does lymph from the kidneys drain to?
A
lumbar lymph nodes
21
Q
Where does the lymph from the ureter drain to?
A
Lumbar and iliac nodes
22
Q
Where does the aneurysm lie in a suprarenal AAA?
A
Across the level of the renal arteries
23
Q
What structures make up the renal medulla?
A
renal pyramids
24
Q
Why are the renal pyramids stripy?
A
Due to the arrangement of nephrons
25
What is the ultrafiltration unit of the nephron?
glomerulus
26
What part of the nephron drains into the minor calyx?
Collecting duct
27
What structure forms when the minor calyces combine?
Major calyx
28
What structure is formed when major calyces come together?
Renal pelvis
29
What name is given to the area of anatomical constriction between the renal pelvis and ureter?
Pelviureteric junction
30
At what three sites is there anatomical ureteric constriction?
pelviureteric junction
when the ureter crosses the common iliac artery
ureteric orifice
31
What may become stuck at sites of anatomical restriction of the ureter?
renal calculi
32
How does the ureter try to dislodge kidney stones?
peristalsis
33
Describe the false pelvis
from iliac crests to pelvic inlet.
| This is part of the abdominal cavity
34
Describe the true pelvis
pelvic inlet to pelvic floor, contains pelvic viscera
35
What structures separate the true pelvis and perineum?
pelvic floor muscles
36
What muscle forms the pelvic diaphragm?
levator ani
37
Describe the route of the ureters in the pelvis
enter the pelvis passing anterior to common iliac vessels
run anteriorly along the lateral walls of the pelvis
turns medially at the level of the ischial spine, travelling posterior to the bladder
This route is sub peritoneal
38
What does the inferomedial descent of the ureters help prevent?
reflux of urine
39
Does the ureter run superiorly or inferiorly to the uterine tubes and artery?
Inferiorly
Water under the bridge
40
Does the ureter run deep or superficial to the vas deferens?
deep
41
Branches from which artery supply the pelvic viscera?
Internal iliac artery
42
What is the name given to the smooth triangle within the bladder that funnels urine towards the internal urethral orifice?
Trigone
43
What muscles encircle the ureteric orifices and prevent reflux of urine?
detrusor muscle fibres
44
What is the function of the internal urethral sphincter?
Prevents semen entering the bladder during ejaculation
45
Both males and females have internal urethral sphincters. T or F
F
only males have them to prevent retrograde ejaculation
46
Describe the normal positioning of the uterus
Anteflexed
47
what bone lies in front of the bladder?
Pubis
48
Where does an empty bladder sit?
True pelvis
49
Where does a full bladder sit?
Extends out of the true pelvis and into the false pelvis
50
What lies inferior to the bladder in a male?
Prostate
51
Describe the relationship between the peritoneal membrane and the bladder.
Peritoneum is only ever on top of the bladder
52
Is the external urethral sphincter under voluntary of involuntary control?
voluntary
53
Is the urethra longer in males or females?
males
54
What part of the urethra passes within the penis?
spongy urethra, surrounded by corpus spongiosum
55
Where is sperm stored?
epididymis
56
How does the vas deferens access the abdominal cavity?
through the inguinal canal
57
Where does the vas deferens travel in relation to the bladder?
posteriorly
58
Which structures link the reproductive system with the urinary system in males to form the prostatic urethra?
ejaculatory duct and urethra
59
What structures are contained in the spermatic cord?
testicular artery, vein, vas deferens, lymphatic vessels and nerves
60
What name is given by the sac containing the testicles?
tunica vaginalis
61
What two layers make up the tunica vaginalis?
parietal and visceral
62
What name is given to the build up of fluid within the tunica vaginalis?
hydrocele
63
What plexus of veins drains the testicle?
pampinifrom plexus
64
Where do the gonadal arteries arise from?
abdominal aorta
65
Describe the right and left venous drainage of the testicles.
on the right, drains into IVC
On the left, drains into left renal vein
66
Where is sperm produced?
seminiferous tubules
67
What is the function of the prostatic ducts?
Allow prostatic secretions to enter the prostatic urethra
68
Which part of the prostate is most prone to malignancy?
peripheral zone
69
Which part of the prostate is palpated on PR exam?
peripheral zone
70
How many erectile tissue cylinders are present in the penis?
3
71
What names are given to the erectile tissue cylinders running through the penis?
corpus spongiosum
| right and left corpus cavernosum
72
The deep arteries of the penis arise from which artery?
internal pudendal (internal iliac)
73
Blood supply to the scrotum comes from which arteries?
internal and external iliac
74
Where does lymph from the penis drain to?
superficial inguinal lymph nodes
75
Where does lymph from the testis drain to ?
lumbar nodes
76
Describe the position of the bifurcation of the abdominal aorta.
level of the umbilicus
| anterior to the formation of the IVC
77
What artery ate the vesical arteries branches of?
Internal iliac
78
Which nerve emerging lateral to psoas major is not part of the lumbosacral plexus?
Subcostal nerve (T12 anterior ramus)
79
Which nerves from the lumbosacral plexus emerge lateral to psoas major?
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iliohypogastric nerve (superior branch of L1 anterior ramus)
ilioinguinal nerve (inferior branch of L1 anterior ramus)
lateral cutaneous nerve of the thigh (L2,3)
femoral nerve (L2-4)
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80
What nerve of the lumbosacral plexus emerges through psoas major?
genitofemoral nerve (L1,2)
81
What nerve of the lumbosacral plexus emerges medial to psoas major?
obturator nerve (L2-4)
82
What are the 5 types of nerve fibre?
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Somatic sensory
Visceral afferent
Somatic motor
Parasympathetic
Sympathetic
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83
How many pairs of spinal nerves are there?
31
84
Where do sympathetic fibres leave the spinal cord?
T1-L2 (thoracolumbar)
85
How do the sympathetic fibres reach the organs they supply?
cardiopulmonary and abdominopelvic splanchnic nerves
86
Which structure allows the sympathetic nerves to get from the spinal nerve to the sympathetic chain?
rami communicans
87
What part of the spinal nerve do the sympathetic fibres travel in?
anterior ramus
88
How many sympathetic ganglia are found in the cervical spine?
3
89
Describe the route of sympathetic nerve fibres traveling to the kidneys, ureter and bladder.
Leave spinal cord T10-L2.
They enter the sympathetic chain BUT DO NOT SYNAPSE.
They leave the sympathetic chain with the abdominopelvic splanchnic nerves.
The sympathetic fibres synapse at the abdominal sympathetic ganglia.
They then travel on the surface of arteries that are heading to the organs they want to innervate.
90
What level do the parasympathetic nerves leave the CNS at?
CN III, IV, IX and X
S2, 3, 4
(Craniosacral)
91
Describe the route taken by parasympathetic nerve fibres travelling to the kidneys, ureter and bladder.
Vagus nerve supplies all abdominal organs down to the splenic flexure (kidneys). Everything below this is supplied by pelvic splanchnic nerves.
The kidneys and proximal part of the ureter are supplied by the vagus. Bladder is supplies by the sacral spinal nerves, which come together to form the pelvic splanchnic nerves.
92
How do somatic motor fibres get to the kidneys, ureters and bladder?
They don't! Only part of the renal system with somatic motor innervation is external urethral sphincter.
93
Where does loin to groin pain come from?
ureter
94
What route do visceral afferents take back to the CNS?
travel alongside sympathetic fibres. They enter the spinal cord between T11-L1.
95
What spinal levels control urine flow?
S2, 3, 4
96
What nerve fibres are contained in S2, 3, 4?
Parasympathetic (pelvic splanchnic)
visceral afferents
somatic motor and somatic sensory (pudendal)
97
What brings about urination?
Visceral afferents tell the brain the bladder is full. Parasympathetic stimulation tells detruser muscles to contract and the internal urethral sphincter to relax in males. There is a central regulator of this mechanism that is only liften when the time is right. The external urethral sphincter and levator ani muscles relax due to somatic motor innervation The anterolateral abdominal walls contract due to stimulation from somatic motor nerve fibres, forcing urine out.
98
What types of fibre travel in the lumbosacral plexus?
Somatic sensory, somatic motor and sympathetic
99
Name the nerves of the lumbar plexus and what level they leave the spinal cord.
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iliohypogastric (L1)
Ilioinguinal (L1)
Lateral cutaneous nerve of the thigh (L2,3)
Genitofemoral (L1, L2)
Femoral nerve (L2-L4)
Obturator nerve (L2-L4)
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