Retroperitoneal structures: kidneys and ureter Flashcards

1
Q

what does retroperitoneal mean

A

a structure that lies posterior to the parietal peritoneum - held against the body wall with one surface covered by peritoneum and one surface in contact with the body wall

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2
Q

what is a primary retroperitoneal structure

A

formed on the body wall during development and maintain this relationship with body wall in adult form

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3
Q

give 4 examples of primary retroperitoneal structures

A

kidneys
suprarenal glands
vessels (aorta, IVC)
nerves

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4
Q

what are secondary retroperitoneal structures

A

develop out with the peritoneum but become covered by peritoneum by end of development and seen that way in adult form

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5
Q

give 5 examples of secondary retroperitoneal structures

A
most of duodenum
pancreas
ascending colon
descending colon
upper 2/3 rectum
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6
Q

the kidneys are primary/secondary retroperitoneal

A

primary

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7
Q

the pancreas is primary/secondary retroperitoneal

A

secondary

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8
Q

the ascending colon is primary/secondary retroperitoneal

A

secondary

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9
Q

the upper 2/3 of the rectum are primary/secondary retroperitoneal

A

secondary

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10
Q

the suprarenal glands are primary/secondary retroperitoneal

A

primary

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11
Q

the descending colon is primary/secondary retroperitoneal

A

secondary

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12
Q

most of the duodenum is primary/secondary retroperitoneal

A

secondary

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13
Q

what are the 4 components of the urinary system

A

kidneys
ureters
bladder
urethra

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14
Q

the hilum of the kidneys lies at what vertebral level

A

L1

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15
Q

which kidney lies slightly lower than the other and why

A

right kidney lies slightly lower due to large size of the liver

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16
Q

what are the anterior relations of the right kidney

A

suprarenal gland
liver
2nd part of duodenum
right colic flexure

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17
Q

the upper pole of the right kidney is protected by what posteriorly

A

rib 12

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18
Q

the right kidney lies on the surface of what

A

quadratus lumborum

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19
Q

where does quadratus lumborum pass between

A

muscle of posterior abdominal wall that passes between 12th rib and iliac crest

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20
Q

what are the posterior relations of the right kidney

A
diaphragm
rib 12
psoas
quadratus lumborum
transversus abdominis 
subcostal nerve
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21
Q

the upper pole of the left kidney is protected posteriorly by what

A

ribs 11 and 12

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22
Q

what are the anterior relations of the left kidney

A
suprarenal gland
spleen
stomach 
tail of pancreas
left colic flexure
jejenum
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23
Q

what are the posterior relations of the left kidney

A
diaphragm
ribs 11 and 12
psoas
quadratus lumborum
transversus abdominis
subcostal nerve
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24
Q

describe the gross appearance of the kidney

A

red-brown
smooth outer capsule
10-12cm long
6-8cm wide

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25
Q

what is found at the renal hilum

A

renal artery
renal vein
renal pelvis that becomes ureter
(also lymph and sympathetic fibres)

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26
Q

what are the most posterior structures of the hilum

A

renal pelvis that becomes the ureter

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27
Q

is variation of the renal arteries or veins common

A

variation of veins is rare, but renal artery variation is relatively common

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28
Q

what is the name of an extra arterial vessel that enters the kidney outwith the hilum

A

supernumerary renal artery

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29
Q

how is a supernumerary renal artery formed

A

non-regression of vessels during development

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30
Q

what lies under the capsule of the kidney

A

paler cortex

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31
Q

what is found in the cortex

A

glomeruli

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32
Q

what is below the cortex

A

darker medulla

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33
Q

what is contained in the medulla

A

loop of henle

collecting ducts

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34
Q

the ____ collect urine and channel it to the renal pelvis which becomes the ureter

A

minor calyces –> major calyx –> renal pelvis

35
Q

what surrounds each kidney

A

large peri-renal fat pad

36
Q

where are the renal arteries derived from

A

lateral branches of abdominal aorta at L1 vertebral level

37
Q

describe the divisions of the renal arteries

A

each artery divides into anterior and posterior branches and then smaller segmental arteries

38
Q

which renal artery is longer and why

A

right renal artery is longer than left as it has to travel across from the aorta which is slightly to left of midline

39
Q

the right renal artery passes where in relation to IVC

A

posterior to IVC

40
Q

what is the arterial supply like inside kidneys

A

lobar arteries
interlobar arteries
arcuate arteries
afferent glomerular arterioles

41
Q

renal veins drain where

A

IVC

42
Q

lymph from kidneys drains where

A

lateral aortic nodes (para-aortic nodes) around origin of renal artery (L1)

43
Q

nerves for the kidney and suprarenal glands comes from where

A

renal sympathetic plexus

44
Q

afferent fibres from kidney enter spinal cord where

A

T10-12

45
Q

which renal vein is longer and why

A

left renal vein is 3x longer because it has to pass from left kidney across midline to reach IVC which lies to right side of vertebral bodies

46
Q

the left renal vein lies _____ to the SMA

A

inferior

47
Q

the left renal vein passes ____ to the pancreas

A

posterior

48
Q

the left renal vein passes behind what 2 structures

A

splenic vein

body of pancreas

49
Q

what 2 veins drain into the left renal vein

A

left gonadal

left suprarenal

50
Q

the right renal vein passes _____ the descending duodenum

A

behind

51
Q

where does the right gonadal vein drain

A

directly into IVC

52
Q

where do the ureters pass between

A

renal hilum to the bladder

53
Q

the ureters descend the posterior abdominal wall on what

A

anterior surface of the psoas muscle

54
Q

as the ureters enter the pelvis they cross what

A

bifurcation of common iliac artery anterior to sacro-iliac joint

55
Q

the ureters travel towards the ischial spine along what

A

lateral wall of pelvis

56
Q

where do the ureters enter the bladder

A

inferior surface of bladder as part of trigone area

57
Q

what propels urine towards the bladder

A

contractions of ureter wall and filtration pressure from glomeruli

58
Q

what are the ureters

A

long smooth muscle tubes that pass from renal hilum to the bladder

59
Q

what are the 3 constrictions of the ureters

A

1) at the junction of the ureters and the renal pelvis
2) where the ureters cross the pelvic brim
3) as they enter the bladder wall

60
Q

what landmark can be used to identify the ureters

A

they cross the bifurcation of the common iliac artery as they enter the pelvis

61
Q

in an xray when the psoas muscles cannot be seen, how are the ureters described passing

A

passing the tips of the transverse processes of lumbar vertebra

62
Q

the proximal parts of the ureters receive/drain blood from where

A

renal vessels

63
Q

the middle parts of the ureters receive/drain blood from where

A

gonadal vessels (ovarian or testicular)

64
Q

the distal parts receive/drain blood where

A

superior vesical vessels (also supply/drain bladder)

65
Q

lymph from the ureters drains where

A

para-aortic nodes and iliac nodes

66
Q

afferent nerve fibres from the ureters goes where

A

L1-L2

67
Q

pain from the ureters is referred where

A

inguinal region at top of thigh

68
Q

nerves to the ureters come from where

A

renal, testicular (or ovarian) and hypogastric plexuses

69
Q

where are the supra-renal glands found

A

superior pole of kidney

70
Q

what is the gross appearance of the supra-renal glands

A

yellow cortex

brown medulla

71
Q

the right supra-renal glands is what shape

A

pyramid shaped

72
Q

the left supra-renal glands is what shape

A

crescent moon shape

73
Q

the cortex of the supra-renal glands makes what

A

corticoids (fluid, electrolyte)

glucocorticoids (carbohydrates, fats, proteins)

74
Q

the medulla of the supra-renal glands makes what

A

epinephrine and norepinephrine

75
Q

where is the right supra-renal gland found

A

behind right lobe of liver

76
Q

where is the left supra-renal gland found

A

behind pancreas, stomach and lesser sac

77
Q

the supra-renal glands are what kind of glands

A

endocrine

78
Q

describe the blood supply of the supra-renal glands

A

3 arteries on each side: a superior suprarenal, a middle suprarenal and an inferior suprarenal

79
Q

the superior suprarenal artery is a branch of

A

inferior phrenic artery (first abdominal branch of aorta)

80
Q

the middle suprarenal artery is a branch of

A

direct from aorta

81
Q

the inferior suprarenal artery is a branch of

A

renal artery

82
Q

there is usually _ veins on each side

A

1

83
Q

the suprarenal vein drains where

A

directly into IVC on right

into renal vein on left

84
Q

the lymph from the suprarenal glands drains where

A

paraaortic nodes at L1