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MSS - Renal Exam 1 > Review of the Kidney/Anatomy of the Urinary Tract > Flashcards

Review of the Kidney/Anatomy of the Urinary Tract Flashcards

1
Q

left kidney level?

A

TV11 - LV2

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2
Q

right kidney level?

A

little bit lower
TV12 - LV3

-more easily palpated**
pushed down by liver

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3
Q

nerves posterior to kidney?

A

subcostal ventral ramus T12
iliohypohastric ventral ramus L1
ilioinguinal ventral ramus L1

all three, motor and sensory

don’t want to damage during surgery**

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4
Q

iliopsoas test

A

pain upon extension of thigh

  • infection can spread from kidney to psoas
  • also ureters, pancreas
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5
Q

anterior to right kidney?

A

liver
ascending colon and right colic flexure
duodenum

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6
Q

anterior of left kidney?

A 
spleen
pancreas
stomach
descending colon and left colic flexure
small bowel
jejunum
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7
Q

peritoneum

A

serous membrane of abdomen

kidney lies posterior to this
therefore, considered retroperitoneal

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8
Q

renal fascia?

A

posterior and anterior

fuse and invest kidney and suprarenal gland

blend medially with adventitia of renal vessels

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9
Q

renal fat

A

some outside capsule and inside

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10
Q

renal sinus

A

open space of kidney
where things enter and leave

contains renal calyces, renal pelvis, vessels, nerves, and lymphatics

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11
Q

paranephric fat

A

outside capsule

external to renal fascia

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12
Q

perinephric fat

A

inside capsule
between kidney and renal fascia

PER-“I”-NEPHRIC = Inside

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13
Q

suprarenal gland

A

above kidney within fascia

  • septum separation
  • renal infection won’t necessarily affect suprarenal gland
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14
Q

at hilum?

A

renal vein - most anterior
renal artery - posterior and superior
renal pelvis - posterior and inferior

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15
Q

cortex

A

where the nephrons reside

also where the medullary rays are

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16
Q

nephron

A

functional unit of the kidney

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17
Q

renal column of bertin

A

invaginations of cortex to medulla

still nephron tissue

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18
Q

medulla

A

mostly organized into renal pyramids

contain mainly collecting tubules

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19
Q

vasopression

A

control collecting tubules

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20
Q

renal papilla

A

end of medulla

-drips urine into minor calyx

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21
Q

calyx

A

minor empty to major

tubular and do have some smooth muscle

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22
Q

renal pelvis

A

forms from merge of major calyx

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23
Q

left renal vein

A

slightly longer
picks up blood from other structure

-passes between aorta and superior mesenteric artery

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24
Q

branches of renal artery?

A

segmental arteries
-end arteries - so blockage will kill part of kidney

don’t memorize

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25
Q

renal vein entrapment syndrome

A

left renal vein gets compressed between aorta and superior mesenteric artery

hematuria, abdominal pain, left testicular pain

aka nutcracker syndrome

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26
Q

three sign of renal vein entrapment

A

1 - left renal vein HTN
2 - bleeding in urine (hematauria)
3 - testicular pain (because testicular vein drains to the left renal vein as well

27
Q

kidney innervation?

A

renal plexus

sympathetic - preganglionic fibers T10-L1 (lateral horn)

  • via lesser, least, lumbar splanchnic nerves
  • mainly vasomotor and also carry pain fibers

parasympathetic - preganglionic fibers with vagus nerve

  • motor to smooth muscle of calyx
  • primary stretch afferent fibers
28
Q

kidney

A

mainly hormonally controlled

29
Q

kidney referred pain

A

dermatone - lower back to flank to inguinal to groin

patients present with pain localized here

30
Q

spinal nerve levels of kidney?

A

T10-L1

31
Q

kidney stones

A

can result in referred pain
-from crystals often calcium

pain that refers loin to groin

32
Q

ureters

A

muscular tube transport urine from urine to urinary bladder

retroperitoneal
-course inferomedially along posterior abdominal wall, descend over brim to enter pelvis, along lateral pelvic wall to enter posterior bladder wall

33
Q

three sites of constriction?

A

where kidney stone likely to be an obstruction

1 - ureter passes over inferior renal pole (abdominal part)
2 - ureter crosses over external iliac vessels (pelvic part)
3 - ureter traverses bladder wall (intramural part)

34
Q

blood supply of ureter

A

aorta, gonadal artery, iliac vessels contribute

35
Q

upper ureter innervation

A

sympathetic - preganglionic T10-T12 via lesser and least, and lumbar splanchnic nerves
-vasomotor, also carry pain fibers

parasympathetic - vagus nerve preganglionic

  • motor to smooth muscle (peristalsis)
  • carry primary stretch afferent fibers
36
Q

lower ureter innervation

A

pelvic plexus

sympathetic - L1-2 via lumbar splanchnic
-vasomotor and pain fibers

parasympathetic - pelvic splanchnic nerves

  • motor to smooth muscle (peristalsis)
  • primary stretch afferent receptors
37
Q

referred pain from ureter?

A

same as kidney

“loin to groin”

38
Q

urinary bladder

A

store urine until urination
-very stretchable

-apex posterior to pubic symphysis (attachment of umbilical ligament)
base = fundus
-neck continuous with urethra

39
Q

wall of urinary bladder

A
  • outer - adventitia (not superior surface - peritoneum)
  • detrusor muscle layer - 3 layers
  • submucosa
  • mucosa (lamina propria to transitional epithelium)

has rugae folds that allow stretching

40
Q

trigone

A

posterior in urinary bladder
-different development than bladder

apex opens toward urethra opening

sympathetic innervation to its muscle (sphincter)
-prevents reflux of urine to urinary bladder

inner - extension of uteric muscle
outer - typical detrusor muscle

41
Q

supportive ligaments of bladder?

A

pubovesicle (puboprostatic in male)

lateral ligament of urinary bladder

42
Q

cystocele

A

bladder herniates through floor of pelvis
-weakening of ligaments

common cause childbirth
also, obesity, chronic constipation, heavy lifting

can cause urinary incompetence

43
Q

innervation to bladder?

A

sympathetic - preganglionic T10-L2 via lumbar splanchnic nerves

  • trigonal muscle
  • sphincter urethrae muscle
  • vasomotor and pain

parasympathetic - preganglionic pelvic splanchnic nerves

  • detrusor muscles
  • vasomotor
  • primary stretch afferent fibers
  • pain fibers
44
Q

urethra

A

bladder to external environment

45
Q

male urethra

A

sphincter urethral muscle

also has bulbourethral gland (cowpers) and urethral (mucuous secretion)

46
Q

sphincter urethral muscle

A
  • muscle for urinary continence
  • has sphincter and transverse portion
  • and external portion
  • and deep portion

skeletal and smooth muscle components

47
Q

female urethra

A

shorter

  • sphincter urethral muscle
  • sphincter and transverse
  • external
  • deep

pelvic and perineal portion

paraurethral gland (skenes) homolog to male prostate

48
Q

micturition process

A

bladder fills

  • stretch receptors fire
  • travel to spinal cord with pelvic splanchnic nerves S2,3,4

ascending fibers then travel through spinal cord to brainstem micturition center

descending fibers from brainstem that activate motor component of pelvic splanchnic fibers

  • contraction of detrusor muscle and empty of bladder
  • also get descending pathway to inhibit sympathetic tone to sphincter urethral muscle AND the somatic nerve to sphincter urethra
49
Q

function of kidney

A

filter blood and produce urine
erythropoietin and renin secretion
calcitriol production

50
Q

nephrotosis

A

dropped kidney
-deficiency of fats and fascia surrounding the kidney (late stage of starvation)

  • kidney drops into pelvis
  • often asymptomatic
  • acute pain in flak region that radiates to groin
51
Q

spread of perinephric abscesses

A

renal fascia attaches tightly to renal vessels at renal hilum

thus, peripephric abscess cannot spread to contralateral kidney

they can spread inferiorly to the pelvis

52
Q

renal arteries

A

lateral, paired visceral branches of aorta
-at LV1-2 level

right longer than left, passes posterior to IVC

divide to 5 segmental arteries

53
Q

posterior to ureters

A

psoas major

common iliac vessels

54
Q

anterior to ureters

A

gonadal vessels

colic vessels

55
Q

upper 1/3 arterial to ureter

A

renal artery/vein

56
Q

middle 1/3 arterial to ureter

A

gonadal, aorta, common iliac artery/veins

57
Q

lower 1/3 arterial to ureter

A

internal iliac artery/vein

58
Q

upper 1/3 lymph drain ureter

A

lumbar lymph node

59
Q

middle 1/3 lymph drain ureter

A

common iliac lymph node

60
Q

lower 1/3 lymph drain ureter

A

common, external, internal iliac lymph nodes

61
Q

intramural urethra

A

extends through neck of bladder

male

62
Q

prostatic urethra

A

extends through prostate

male

63
Q

membranous urethra

A

another portion

male

64
Q

spongy urethra

A

penile

male

MSS - Renal Exam 1 (8 decks)

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