Renal Prosection

Question 1

Retroperitoneal Space

Answer 1

Part of the body that exists between the muscles and bones of the posterior abdominal wall, and the parietal peritoneum, a serous membrane that lines the walls of the compartment (peritoneal cavity) into which the gut invaginates 
Contains:
-kidneys
-ureters
-suprarenal (adrenal) glands
-abdominal aorta
-inferior vena cava

Question 2

Structures Adjacent to the Kidneys (membranes, fat)

Answer 2

• perirenal fat embeds the kidney and extends superiorly over the suprarenal glands.
• renal fascia surrounds the kidney, it’s perirenal fat and suprarenal glands
• dorsal to the renal fascia is a large quantity of pararenal fat

Question 3

Position of the Kidneys (vertebrae)

Answer 3

-extend between the T12 and L3 vertebrae but the right is slightly lower than the left because of the liver

Question 4

Anterior and Posterior Relationships of the Kidney

Answer 4

-the suprarenal gland is superior to the kidney
-the right kidney is in contact with the serosal surface of the liver, the second part of the duodenum, the right colic flexure, and the jejunum
-the left kidney is in contact with the stomach, spleen, tail of the pancreas, the left colic flexure, and the jejunum
-posteriorly, the 11th and 12th ribs, along with the subcostal (T12) and iliohypogastric (L1) nerves. The muscles that form the posterior abdominal wall are directly behind the kidneys:
Diaphragm
Psoas Major
Quadratus Lumborum
Apneurosis of the transversus abdominis muscle

Question 5

Right Renal Vein

Answer 5

• short

- no tributaries

Question 6

Right Renal Artery

Answer 6

• lies posterior to the right renal vein and inferior vena cava.
• longer than the left renal artery
• the funnel shaped upper end of the ureter is called the renal pelvis which lies posterior to the right renal artery

Question 7

Renal Hilum

Answer 7

-concave medial margin of the kidney containing, from anterior to posterior, the renal vein, the renal artery and the renal pelvis

Question 8

Left Renal Vein

Answer 8

• it crosses anterior to the renal arteries and abdominal aorta
• longer than the right renal vein

Question 9

Nutcracker Syndrome

Answer 9

• the course of the left renal vein leaves it susceptible to compression between the abdominal aorta and superior mesenteric artery, similar to how a nutcracker operates
• This impedes the outflow of blood thru the left renal vein and can lead to hematuria and flank pain

Question 10

Left Renal Artery

Answer 10

• lies posterior to the left renal vein

- the renal artery usually divides before it enters the kidney, and accessory renal arteries are common

Question 11

Ureter

Answer 11

• abdominal part of ureter passes posterior to the testicular (or ovarian) vessels and crosses the anterior surface of the psoas major muscle
• the pelvic part of the ureter crosses the common or external iliac artery near the bifurcation of the common iliac artery
• remaining deep to the peritoneum, it descends along the lateral wall of the pelvis and curves anteromedially to the base of the urinary bladder

Question 12

Abdominal Aorta

Answer 12

3 types of branches:

• unpaired arteries to the GI tract (celiac trunk, superior mesenteric artery, and Inferior mesenteric artery)
• paired arteries to the 3 paired abdominal organs (suprarenal, renal, and testicular (ovarian) arteries)
• paired arteries to the abdominal wall (inferior phrenic and lumbar arteries)

Question 13

Lumbar Artery

Answer 13

• 4 pairs supply the posterior abdominal wall
• trace one to it’s origin from the posterior aspect of the abdominal aorta
• the lumbar arteries pass deep to the psoas major muscle

Question 14

Bifurcation of the Abdominal Aorta

Answer 14

• occurs at L4

- in a thin person, the umbilicus projects superior to the bifurcation of the aorta

Question 15

Common Iliac Arteries

Answer 15

• arise at the bifurcation of the aorta

- The common iliac arteries supply blood to the pelvis and lower limbs

Question 16

Ureteric Arterial Supply

Answer 16

Arterial supply to the abdominal portion of the ureters arises most commonly from the renal arteries, and less commonly from the gonadal arteries, abdominal aorta, or the common iliac arteries

• the ureteric arteries are small and delicate, and may be damaged during abdominal surgery when the ureters are retracted
• loss of the blood supply to the ureters can result in necrosis and urinary obstruction

Question 17

Suprarenal Glands

Answer 17

-if the kidney fails to ascend to it’s normal position during development, the suprarenal gland develops in its normal position lateral to the celiac trunk

Question 18

Urinary Bladder Surface

Answer 18

-covered by peritoneum; the posterior surface is covered by peritoneum on it’s superior part and by endopelvic fascia on it’s inferior part and the 2 inferolateral surfaces are covered by endopelvic fascia

Question 19

Detrusor Muscle

Answer 19

• the wall of the bladder consists of bundles of smooth muscles
• thickness of the wall of the urinary bladder, it’s shape and it’s size varies with degree of distension

Question 20

Apex of Bladder

Answer 20

-directed toward the anterior abdominal wall and can be identified by the attachment of the urachus

Question 21

Body of the Bladder

Answer 21

-between the apex and the fundus

Question 22

Fundus of the Bladder

Answer 22

-also called the base of the urinary bladder

Question 23

Neck of Bladder

Answer 23

• where the urethra exits the urinary bladder.

- here the wall thickens to form the internal urethral sphincter

Question 24

Mucous Membrane of Bladder

Answer 24

-lining all parts of the urinary bladder is thrown into folds to accommodate expansion except for the mucous membrane over the TRIGONE

Question 25

Trigone

Answer 25

• smooth part of mucous membrane of the bladder

- the angles of the trigone are the internal urethral orifice and the 2 orifices of the ureter

Question 26

Male Urethra

Answer 26

• prostatic urethra
• membranous urethra (can’t be easily delineated)
• spongy (penile) urethra
• the external urethral orifice is at the tip of the glans penis

Question 27

Kidney (Bisected)

Answer 27

• Renal Capsule: a fibrous capsule that can be stripped off the surface of the kidney
• Renal Cortex: the outer zone of the kidney (about 1/3 of it’s depth)
• Renal Medulla: the inner zone of the kidney consisting of the renal pyramids and renal columns (about 2/3s of it’s depth)
• Renal Sinus: the space within the Kidney that is occupied by the renal pelvis, calices, vessels, nerves and fat
• Renal Papilla: the apex of the renal pyramid that projects into a minor calyx
• Minor Calyx: a cup-like chamber that is the beginning of the extrarenal duct system. Several minor calyces combine to form a major calyx
• Major Calyx: two or three per kidney that combine to form the renal pelvis
• Renal Pelvis: the funnel-like end of the ureter that lie within the renal sinus
• Ureter: the muscular duct that carries urine from the kidney to the urinary bladder

Question 28

Kidney Stones

Answer 28

May form in the calyces and renal pelvis. Small kidney stones may spontaneously pass thru the ureter into the urinary bladder. Larger kidney stones may lodge at one of three natural constrictions of the ureter:

1. Where the renal pelvis joins the ureter
2. Where the ureter crosses the pelvic brim
3. At the entrance of the ureter into the urinary bladder