renal anatomy Flashcards
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where do ureters travel?
pass from retroperitoneum through false pelvis into true pelvis
what seperates false pelvis from true pelvis?
pelvic inlet
pelvic floor?
levator ani
perineum?
compartment between pelvic floor and skin
route of ureters?
* pass anterior to the common iliac vessels + enter pelvis
* run anteriorly (along the lateral walls of the pelvis)
* At level of ischial spine, turn medially to enter posterior aspect of bladder
* enter posterior bladder wall in an inferomedial direction
are ureters retroperitoneal?
Yes until they reach the true pelvis - sub-peritoneal
where can ureter be found in females?
Males?
* Females = runs inferiorly to uterine tubes + uterine artery (water under the bridge)
* males = runs inferiorly to vas deferens
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where do arteries entering the pelvis branch from?
Veins drain?
Internal iliac artery
internal iliac vein
what forms the “trigone” of the bladder
the 2 ureteric orifices and internal urethral orifice
what rests on top of the bladder?
making it…?
visceral peritoneum
* a subperitoneal organ
which muscle forms main bulk of the bladder wall?
function? (2)
detrusor muscle
* encircles ureteric orifices to prevent reflux or urine when bladder contracts
* in males, forms internal urethral sphincter which contracts during ejaculation to prevent reflux of semen into bladder
which sphincter is found in males but not females?
internal urethral sphincter
what is the most anterior organ in the pelvis?
bladder
what is the most dependent part of pelvic cavity?
pouch of douglas (rectouterine) in female
rectovesical pouch in male
2 routes of catheterising patient’s bladder? (2)
* urethral
* suprapubic (bladder has to be full otherwise will pierce peritoneum)
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route of sperm?
* produced in seminiferous tubules
* stored in epididymis
* travels to vas deferens
* combines with seminal gland behind bladder to form ejaculatory duct
* prostatic urethra passes through prostate
* spongy urethra passes thru corpus spongiosum
spermatic cord?
contains testicular artery, testicular vein, vas deferens, lymphatics, nerves (smooth muscle + somatic for cremaster muscle)
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excess fluid in tunica vaginalis?
hydrocele
venous drainage of testis?
pampiniform venous plexus
how do testicular artery/vein, vas deferens, lymphatics and nerves pass into and out of inguinal canal?
deep inguinal ring
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prostatic ducts?
holes in prostatic urethra - allow secretion into proaststic urethra
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inferior aspect of prostate in contact with?
levator ani
which part of prostate is palpates in rectal exam?
peripheral zone - where most prostate cancers arise
3 cylinders of erectile tissue?
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blood supply to penis and scrotum?
penis = deep arteries of the penis from internal pudendal artery from internal iliac
scrotum = dual blood supply from internal and external iliac
lymph drainage from penis and scrotum?
* drains to superficial inguinal lymph nodes
* lymph from testes = lumbar nodes (due to descent of testis)
urinary tract (renal system)?
* Kidney: produces urine
* ureter: drains urine
* bladder: stores/voids urine
* urethra: excretion of urine
upper urinary tract?
Lower urinary tract?
Upper: kidneys + ureters
lower: bladder + urethra
so like upper and lower UTI affects
where is the urinary tract?
what type of organs are the kidneys?
retroperintoneal (anterior surface in contact with visceral peritoneum)
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what does renal hilum contain?
in what order?
renal artery, renal vein and ureter
* vein is most anterior
* then artery
* ureter is most posterior
what fat immediately surrounds kidney?
why does kidney pathology result in pain?
perinephric fat
* renal capsule is very tight and doesn’t permit expansion of kidney
patient’s left = aorta (see renal artery coming out)
Right = IVC (see renal vein)
IVC much more anterior to aorta!! - dont get mixed up with little bit next to aorta
where are kidneys situated?
Which level?
lie anterior to audratus lumborum
and lateral to psoas major
* right = L1-L3 (cause of liver)
* left = T12 - L2
what are posteriorly related to the kidneys?
floating ribs 11 + 12
Which quadrants are kidneys found?
In upper quadrants + lumbar regions (flank)
what is right kidney posterior to?
left kidney?
right kidney posterior to:
* liver
* 2nd part of duodenum
* ascending colon
* right colic flexure
Left kidney
* stomach
* tail of pancreas
* hilum of spleen
what is the most dependent part of the greater sac of the peritoneal cavity in the supine patient?
hepatorenal recess
renal arterial supply?
Ureters?
renal arteries
Uteric supply from
* renal artery
* abdominal aorta
* common iliac
* internal iliac
* vesical artery
anatomical relation of renal arteries and veins?
renal veins are anterior to renal arteries
* however, common iliac arteries are anterior to common iliac veins!
lymph drainage of kidneys?
ureters?
kidneys = lumbar nodes
ureters = lumbar + iliac nodes
where does AA bifurcate?
at level of umbilicus
where does renal artery come from?
Renal vein?
artery from abdominal aorta
Vein from IVC
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when associated with AAA, renal artery stenosis may be?
* combined with infra-renal AAA = both caused by atherosclerosis
* due to suprarenal AAA
anatomical variation in renal system?
solitary kindey
* agenesis
* nephrectomy (pathology/donation)
explain structure of kidney
consists of outer cortex and inner medulla
* medulla contains pyramids
* each pyramid contains 50,000 nephrons
* nephrons give pyramids their striped appearance
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anatomical sites of uteric constriction?
renal calculi?
form from urine calcium salts + obstruct urinary tract
renal calculi causing obstruction
s/s of ureter obstruction?
colicky pain
* ureter has smooth musle in walls so when obstruction, there is increased peristalsis
consequences of urinary tract obstruction?
* urine “back up” -> renal failure
* renal failure = unable to filter blood to produce urine
hydronephrosis?
S/s?
“water inside kidney”
* urine back pressure into the calyces = renal failure
acute hydronephrosis causes painful stretching of renal capsule
hydronephrosis of right kidney
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Juxta = has much longer loop of henle
Cortical = have peritubular capillaries (juxtamedullary have vasa recta, single capillary), follows loop of henle
Juxta = able to produce much more concentrated urine
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Macula densa is salt-sensitive (monitor level of salt in tubular fluid)
Net negative charge – plasma proteins should be contained within the capillary (none should enter lumen of bowman’s capsule)
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urine miscroscopy showing dysmorphic red blood cells (indicates came from glomerulus)
Red cell casts! - red cells held together by tubular protein
PATHOGNOMONIC OF GLOMERULAR BLEEDING
Minimal change nephropathy
* podocytes are all fused together. Foot process fusion—fingers have retraced
focal segmental glomerulosclerosis
glomerulus on the right is affected
membranous nephropathy
* thickened basement membrane
IgA nephropathy
* mesangial cell proliferation and expansion
crescent formation in RPGN
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non-blanching
Goodpasture’s syndrome (pulmonary-renal syndrome)
Anti-GBM disease
KUB showing gas in kidney = emphysematous pyelonephritis
Emphysematous pyelonephritis
perinephric abscess
Haematoma – lower pole of kidney has been torn off upper pole
Butterfly haematoma from urethral injury
urethral injury
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crescent = RPGN (poor prognosis)
granulomas = GPA or sarcoid
FSGS
(pink bit is sclerosis)
