Renal anatomy

Question 1

Where is the renal angle located?

Answer 1

junction of the 12th rib and lateral border of the erector spinae

Question 2

What structures sit anteriorly of the right and left kidneys?

Answer 2

Right:

1. liver
2. duodenum
3. right colic/hepatic flexure

Left:

1. spleen
2. stomach
3. pancreas (body or tail)
4. left colic/splenic flexure
5. small intestine

Question 3

What is the hepatorenal recess/Pouch of Morrison? What is its clinical significance?

Answer 3

• separates the liver from the right kidney - potential space created which, under normal conditions, should not be fluid-filled
• will only be filled in haemoperitoneum, ascites or pancreatitis

Question 4

What structures are posterior to the kidneys?

Answer 4

1. diaphragm –> 11th and 12th rib + costodiaphragmatic recess
2. psoas muscle, quadratus lumborum, transversus abdominis muscle
3. subcostal nerve (T12) and iliohypogastric and ilioinguinal nerves (L1)

Question 5

What is Gerota’s fascia?

Answer 5

renal fascia that attaches to the inner part of the transversus abdominis muscle

Question 6

Describe how the vasculature of the kidney changes throughout the structure.

Answer 6

Renal artery –> segmenta artery –> interlobar artery –> arcuate artery –> interlobular artery –> afferent arteriole –> glomerulus –> efferent vein –> interlobular vein –> arcute vein –> interlobar vein

Question 7

Describe the innervation of the kidneys.

Answer 7

Sympathetic innervation:

• via T10-T12 (lesser [goes to aorticorenal ganglion] and least [goes to renal ganglion] splanchnic nerves)
• cause vasoconstriction and regulate BP –> reduced blood flow to kidneys

Parasympathetic:
- via vagus

Question 8

Are the ureters retroperitoneal or intraperitoneal?

Answer 8

retroperitoneal

Question 9

How do the ureters enter the bladder?

Answer 9

At an oblique angle

one way flap valve to prevent retrograde urine flow

Question 10

What are the different layers of the ureter wall?

Answer 10

1. fibrous coat (connective tissue)
2. muscular coat (smooth muscle)
3. mucosa (transitional epithelia)

Question 11

Where are the 3 constrictions of the ureters?

Answer 11

1. ureteropelvic junction
2. pelvic inlet
3. entrance to bladder

Question 12

What is a pyelogram?

Answer 12

• x-ray technique producing image of renal pelvis and urinary tract by the introduction of the radiopaque fluid
• -> IV or retrograde (catheter)

Question 13

Describe the nerve supply to the ureters.

Answer 13

primary sensation to the ureters is provided by nerves that come from T12-L2

Question 14

Where is pain in the ureters generally referred to?

Answer 14

Dermatomes of T12-L2:

• back and sides of the abdomen
• scrotum (males)
• labia majora (females)
• upper part of the front of the thigh

Question 15

With kidney stones, why can pain descend from the flank to the groin?

Answer 15

As the stones descend there is a changing of nerve segments

- pain now referred through genitofemoral nerve (L1, L2)

Question 16

Is the bladder retroperitoneal or intraperitoneal?

Answer 16

Retroperitoneal

Question 17

What attaches the bladder anteriorly to the umbilicus?

Answer 17

Median umbilical ligament

Question 18

What is the median umbilical ligament a remnant of?

Answer 18

embryonic urachus

Question 19

What are the 3 layers of the bladder wall?

Answer 19

1. transitional epithelium
2. thick muscular layer (detrusor = smooth muscle)
3. fibrous adventitia

Question 20

What is the difference between urethra in males and females? What is the clinical significance of this?

Answer 20

Shorter in females –> more prone to UTIs

Question 21

What are the different sections of the male urethra? What epithelium is found in each section?

Answer 21

1. intramural/pre-prostatic = transitional
2. prostatic = transitional
3. intermediate/membranous = pseudostratified columnar
4. spongy = pseudostratified columnar proximally and stratified squamous distally