Renal Anatomy

Question 1

Where are the kidneys located?

Answer 1

• Found either side of the body extra peritoneal and retro peritoneal, found either side of the lumbar verterbrae.
• They are embedded in periephritic fat and covered by renal fascia - Important in terms of the spread of tumours.
• Medial border is made up of the hilum containing the vessels and the ureter.
• Posterior border lies against the posterior abdo wall
• Anterior on the right is the liver, duodenum and coils o the intestine and left is the pancreas, spleen, stomach and coils of the intestine.

Question 2

What is the posterior wall made up of?

Answer 2

• Diaphragm, psoas major, transverse abdominus and quadratus lumborum.

Question 3

What are the suprarenal glands?

Answer 3

• Endocrine glands that produced adrenaline, cortisol and aldosterone.
• Lie above the kidney buried in the perinephritic fat.
• Right gland is tetrahedral and lies behind the IVC and liver.
• Left gland is crescent shaped and lies behind the stomach and the pancreas.
• Glands are supplied by the 3 arteries and drain into one vein.

Question 4

Where does the posterior abdo wall run from and to?

Answer 4

• From the bottom of the diaphragm to the pelvic brim.

Question 5

What is psoas major?

Answer 5

• Originates from the lumbar vertebrae and inserts into the femur.
• Runs vertically down the spinal column.

Question 6

What is quadratus lumborum?

Answer 6

• Originates from the posterior iliac crest and inserts into the lowest rib and the L1 to L4 vertebrae.
• Deepest of the muscles

Question 7

What runs laterally down the posterior abdo wall?

Answer 7

• The gonadal vessels run down the lateral edge from the IVC towards the pelvis (they originate before the superior mesenteric artery), also the ureters run down from the kidneys.

Question 8

How does the venous supply leave the kidneys?

Answer 8

• The renal and adrenal veins run from the upper border of the kidney and the gonadal vein runs from the inferior border.
• On the left side the veins join together to drain into the IVC where as on the right side they insert into individually into the IVC.
• Larger vein to the left which runs over the top of the aorta.

Question 9

How does the arteries run to the right kidney?

Answer 9

• Under the veins from the aorta.

Question 10

What runs from the coeliac trunk?

Answer 10

• Splenic artery, common hepatic and left gastric

Question 11

Where does the IVC bifurcate?

Answer 11

• L4

Question 12

What is the crura of the diaphragm?

Answer 12

• A tendinous ligament that extends from the vertebral column to the diaphragm.

Question 13

What is the lateral arcuate ligament?

Answer 13

• A tendinous ligament running form the lumbar quadrate muscle to the diaphragm, either side.

Question 14

What is the medial arcuate ligament?

Answer 14

• A tendinous ligament running from the psoas major muscle to the diaphragm.

Question 15

What is the median arcuate ligmanet?

Answer 15

• Runs from the aorta to the diaphragm

Question 16

What is transversus abdominus?

Answer 16

• Keeps the contents of the abdo
• Originates from the iliac crest, costal cartilages
• Inserts into the xiphoid process, linea alba, pubic crest

Question 17

What is the genitofemoral nerve?

Answer 17

• Runs on the anterior surface of psoas major
• Femoral nerve - runs under the inguinal ligament and provides sensory innervation to the inner side of the thigh.
• Genital branch passes through the deep inguinal ring and provides innervation to the muscles in the genital space - also means that when the inside of the inner thigh the testis move upwards.

Question 18

What is iliac muscle?

Answer 18

• Originates from the upper 2/3 of the iliac fossa and inserts in the lesser trochanter of the femur.

Question 19

Where does the lateral cutaneous nerve of the thigh run and appear?

Answer 19

• Emerges from the lateral edge of the psoas muscle and passes over the ilacus muscle and underneath the inguinal ligament to innervate the skin of the thigh.

Question 20

Where does the large femoral nerve run?

Answer 20

• Originates in the groove between the psoas and ilacus muscles and runs underneath the inguinal ligament

Question 21

What is the obtrusor nerve?

Answer 21

• Runs from the medial edge of the psoas muscle and through obtrusor foramen

Question 22

What pouches are found in the female?

Answer 22

• One lies in front of the uterus and is called the uterovesical pouch and one lies behind called the retrovesical pouch or otherwise known as the pouch of douglas.

Question 23

What is left vericocele?

Answer 23

• The left testicular vein drains into the left renal vein so if there is disease of the kidney it can lead to back up of blood drainage meaning the left testicle has varciocoles.

Question 24

What is psoas spasm

Answer 24

• The appendix lies on top of the psoas muscle and means that if it becomes inflammed it can cause the muscle to spasm meaning the patient would be flexed and unable to extend without pain.

Question 25

What causes recurrent UTIs?

Answer 25

• Some patients have duplex ureters, the valve on one may not work correctly allowing urine to flow back through the system causing infection and also prevent the complete expelling of urine causing reoccurance.

Question 26

Spermatic Cord

Answer 26

• Structures making up the spermatic cord include vas deferns, testicular artery and pampiniform plexus of veins, nerves and lymphatics.
• Runs through the deep ring of the inguinal canal, gaining 3 layers of fascia from the muscles before leaving the deep ring.
• Enters the scrotum just above and medial to the pubic tubercle.
• Any hernias will travel in the spermatic cord.

Question 27

Testes

Answer 27

• Male reproductive organs that produce sperm and testosterone.
• Ovoid structures tht are covered by the same 3l ayers as the spermatic cord.
• Partially surrounded by a sac known as tunica vaginalis.
• On the posterior border is a coiled structure that is known as epididymis, with an expanded head on the upper pole, then a body and a pointed tail on the lower pole.
• Vas deferns starts at the tail of the epidermidyis and then runs upwards to join the testicular veseels in the spermatic cord.

Question 28

Scrotum

Answer 28

• A pendulous pouch of skin containing the testes, epididymis and lower the spermatic cord.
• Scrotal skin is wrinkled and thin and more dark.
• Underneath is a layer of superficial fascia, which is derived from fat but contains fat that involve involuntary muscles.
• Extends between the two testes to produce a right and left half.

Question 29

Penis

Answer 29

• Male organ of copulation.
• Expandable distal part known as the glans penis where the urethra reaches the surface and this is the common outlet for urine and semen.
• Body is made up of 3 cylinders of erectile tissue and are enclosed by a dense, strong fascial layer, which limits expanding during erection.
• 3 cylinders of muscle that are seperated by perineal membranes separately and this is the root of the penis.
• The foreskin is known as the prepue and the frenulium is found here.
• The urethra is contained within the corpus spongiosum.
• Membranous urethra, bulber urethra and then penile urethra.

Question 30

What is the pelvis made up of?

Answer 30

• Pelvis contains the pubis, bladder, either female reproductive organs or the prostate, the rectum and the sacrum.

Question 31

What is the rectum made of?

Answer 31

• Made up of haustral folds in the mucosa that are formed by pouches of bowel that are formed by circumferential contractions of the inner muscular layer of the colon.

Question 32

What is the bladder structure?

Answer 32

• 4 surfaces - superior, 2 lateral and the base.
• Apex, base and bladder neck.
• The interior surface is mostly made of rugose but with one triangular area on the base that is smooth.

Question 33

Where do the ureters pass?

Answer 33

• They run from the kidneys, down the medial portion of the psoas muscle following a similar pathway to the common illiac arteries before turning and following the vessels as they split and running laterally to the uterus into the bladder.
• They run down over the pelvic brim over the sacroiliac joints.

Question 34

Where does the uterine artery pass over the ureters?

Answer 34

• Near the area of the broad ligament.

Question 35

What passes over the ureters as the descend into the bladder in males?

Answer 35

Ductus deferns.

Question 36

How is back flow of urine from the bladder to the ureters prevented?

Answer 36

• By there structure as the enter the bladder on the superior surface obliquely, which creates a valve like structure preventing the back flow.

Question 37

Uterus

Answer 37

• This is pear shaped hallow organ.
• Made up of a fundus, body and cervix.
• Communication inferiorly with the vagina, laterally with the uterine tubes (which run below the fundus) and superiorly with the bladder above the body.
• The body and the cervix have an angel in between which is either anterverted or retroverted.
• Cervix has a narrow lumen, it has the cervical canal which communicates internally with the