Sem 1 - N - Retroperitoneal structures - List of stuctures, urinary tract, kidneys, ureters, adrenal glands

Question 1

What does retroperitoneal mean?

Answer 1

Retroperitoneal means a structure that lies posterior to the parietal peritoneum - it is only covered by peritoneum on one surface

Question 2

Retroperitoneal structures can either be primary or secondary retroperitoneal What is the difference?

Answer 2

Primary retroperitoneal structures have developed posterior to the peritoneum and have remained that way Secondary retroperitoneal are structures that did not originate posterior to the peritoneum however by the end of developed are posterior to the peritoneum and are seen that way in the adult

Question 3

Name the primary retroperitoneal structures? (clue KIA) Name the secondary retroperitoneal strucutres? (clue (DAD PR)

Answer 3

Primary retroperitoneal structures KIA - * Kidneys (+adrenal glands), * IVC, * Aorta Secondary retroperitoneal structures DAD PR - * Descending colon * Ascending colon * Duodneum (2nd,3rd,4th parts) * Pancreas - except tail * Rectum (upper 2/3rds)

Question 4

Why is the lower 1/3rd of the rectum not retroperitoneal?

Answer 4

The lower 1/3rd of the rectum sits inferior to the peritoneum and is therefor described as infraperitoneal (subperitoneal)

Question 5

Where do the suprarenal glands (adrenal glands) sit in relation to the kidney? At what vertebral level is the hilum of the kidney?

Answer 5

The suprarenal glands lie superioromedially to the kidney The hilum of the kidney is at the L1 vertebral level

Question 6

What is the approximate length and width of the kidney? What rib level and what vertebral level do both kidneys sit at?

Answer 6

The kidney is approximately 10-12 cm in length and 6-8 cm in width Right kidney Sits at L1-L3 vertebral level and is protected by rib 12 Left kidney Sits at T12-L2 vertebral level and is protected by ribs 11 and 12

Question 7

What are the anatomical relations of the right kidney? (anterior and posterior)

Answer 7

Anteriorly - suprarenal gland, 2nd part of the dudodneum (descending), liver and right colic flexure (hepatic flexure) Posteriorly - diaphragm, rib 12, quadratus lumborum, psoas major, transversus abdominus, sobcostal nerve

Question 8

What are the anatomical relations of the left kidney? (Anterior and posterior)

Answer 8

Anterior - Suprarenal gland, spleen, stomach, pancreas, left colic flexure (splenic flexure), jejunum Posteriorly - diaphragm, ribs 11 and 12, quadratus lumborum, psoas major, tranversus abdominus, subcostal nerve

Question 9

The kidney tends to have a red-brown smooth outer capsule What are the structures found in the hilum of the kidney?

Answer 9

Renal vein anteriorly Renal artery posteriorly Ureter inferiorly Also lymph and sympathetic fibres

Question 10

What is the function of the kidneys? What are the layers from peritoneum to kidney?

Answer 10

Function of the kindey is to filtre blood to create urine * Visceral peritoneum * Paranephric fat * Renal (deep fascia) * Perinephric fat * Renal capsule * Kidney

Question 11

What level does the renal arteries come from the abdominal aorta? Renal artery variation is very common What is normal and abnormal variation?

Answer 11

The renal arteries come from the lateral aspect of the aorta at L1 vertebral lvl Normal renal artery variation is when there is more than one artery entering the hilum Abnormal renal artery variation is when there are accessory arteries entering the superior or inferior poles of the kidney

Question 12

The kidney has darker areas and lighter areas, what is the difference?

Answer 12

The darker areas of the kidney are the renal medulla The lighter areas of the kidney are the renal cortex

Question 13

How does urine travel from the collecting ducts in the medulla to the ureter?

Answer 13

Urine travels from the collecting ducts to drain directly via papilla into a minor calyx Multiple minor calyx join together to form a major calyx and these join to together to form the renal pelvis The renal pelvis is continuous with the ureter which drains to the bladder

Question 14

Important to be able to label an axial CT Start with the arrow at 1oclock

Answer 14

Starting at 1oclock yellow arrow Abdominal aorta Left renal artery Left kidney Left Quadratus lumborum Vertebrae Right Psoas major Right kidney Right renal vein IVC

Question 15

What happens to the renal arteries as they approach the hilum of the kidney and then as they enter the hilum?

Answer 15

The renal arteries usually come from the lateral apsect of the oarta at L1 They divide into anterior and posterior branches that divide into segmental branches as they enter the hilum of the kidney

Question 16

Which renal artery is longer? and why?

Answer 16

The right renal artery is longer than the left, this is because the aorta is on the left hand side and therefore the right renal artery must ravel posterior to the IVC to reach the hilum of the kidney

Question 17

Where do the renal veins drain to? Where does lymph from the kidneys drain to?

Answer 17

The right and left renal vein bothdrain to the inferior vena cava Lymph from the kidneys draiins to the para-aoertic nodes at L1 (lateral aortic nodes around the origin of the renal artery)

Question 18

What is the nerve supply to the kidney? (state the nerve spinal nerve level, nerve names and where the ganglia it synapses is) What level does the afferent fibres from the kidney enter the spinal cord?

Answer 18

Nerves from renal sympathetic plexuses supply the kidney The afferent fibres of the nerves enter at spinal level T10-12 The lesser splanchnic nerve (T10,11) and the least splanchnic nerve (T12) are the two sympathetic nerves supplying the kindey - both synpase in the aorticorenal ganglia

Question 19

What is different about the right and left renal vein?

Answer 19

The left renal vein is approx 3 times the length of the right renal vein The left renal vein passes behind the splenic vein and body of the pancreas The right renal vein passes behind the descending duodenum

Question 20

What other veins drain into the left renal vein? How does varicose veins in the left aspect of the scrotum relate to the left renal vein?

Answer 20

The left gonadal vein and the left suprarenal vein drain into the left renal vein The left renal vein passes under the superior mesenteric artery causing a point of constriction - because of this blood flowing from the left renal vein may not be able to be drained, as the left gonadal vein empites into the left renal vein, this can cause a backflow of blood causing varciose veins int he scrotum

Question 21

As said the left gonadal and left supraenal veins drain into the left renal vein Where does the right gonadal and suprarenal vein drain into?

Answer 21

Right gonadal vein - drains into the IVC Right suprarenal vein - drains directly into the IVC as well

Question 22

The ureters pass vertically down from the hilum of the kidneys posterior to the parietal peritoneum What muscle do the ureters travel on top off? Where do they cross?

Answer 22

The ureters travel on the surface of the psoas major and cross the bifurcation of the common iliac arteries anterior to the sacroiliac joint

Question 23

At what vertebral level does the aorta bifurcate? At what vertebral level is the IVC formed? Once the ureter crosses the birfucation of the common iliac arteries it travels along the lateral pelvic wall towards the ischial spine before turning medially to enter the bladder Where does the ureter enter the bladder?

Answer 23

The aorta birfurcates into the common iliac arteries at the L4 vertebral level The common iliac veins join together to form the inferior vena cava at the L5 vertebral level The ureter enters the bladder at the inferior surface known as the trigone (triangle between 2 ureteric orifices and internal urethral orifice)

Question 24

What is the length of the ureter? What propels urine along the ureter?

Answer 24

The ureter is roughly 25 cm in length Urine is propelled along the ureter by contractions of the ureter wall and filtration pressure from the glomeruli

Question 25

What are the three anatomical constrictions of the ureter?

Answer 25

At the junction of the ureters and renal pelvis - the pelviureteric junction Where the ureter crosses the bifurcation of the common iliac arteries to enter the pelvic brim Where the ureter enters the wall of the bladder - vesicoureteric junction

Question 26

Blood supply/drainage, lymph drainage and nerve supply to the ureter change from proximal to distal ureter Blood supply of ureter has many branches from different arteries What are the three main branches?

Answer 26

Proximally - branches from the renal artery As you descend to roughly L2 vertebral level - branches from the gonadal arteries As the ureter enters the pelvis - branches from the superior vesical artery

Question 27

The venous drainage of the ureter corresponds to the arterial supply What is the lymph drainage of the ureter? What is the nerve supply to the ureter? What spinal levels do afferent fibres arise from?

Answer 27

Lymphatic drianage - * to lateral aortic nodes at L1 when near the pelvis * towards iliac nodes when distal ureter Nerve supply to ureter - Nerves from renal, gonadal or hypogastric plexuses Afferent fibres from L1-L2

Question 28

At the superior pole of the kidneys is the adrenal medulla - yellow cortex, brown medulla What is the function of the suprarenal glands?

Answer 28

The adrenal cortex produces mineralocorticoids and glucocorticoids The adrenal medulla produces noradrenaline and adrenaline

Question 29

What is the differences in shape/location of the right and left adrenal glands?

Answer 29

Right adrenal gland - pyramidal in shape and is located behind the liver Left adrenal gland - cresenteric in shape and is located behind the spleen, pancreas and lesser sac

Question 30

What is the arterial supply to the suprarenal glands?

Answer 30

There is a superior, midddle and inferior branch supply the suprarennal glands Superior - suprarenal branch of the inferior phrenic artery Middle - suprarenal branch form the abdominal aorta Inferior - suprarenal branch form the renal artery

Question 31

As said, first artery when aorta passes through the diaphragm is the inferior phrenic artery Suprarenal branch of inferior phrenic supplies suprarenal gland Suprarenal branch of abdominal aorta and suprarenal branch of renal artery What is the venous drianage of the suprarenal gland?

Answer 31

There is a single vein on each side The right suprarenal vein drains directly into the IVC The left suprarenal vein drains into the left renal vein which drains into the IVC

Question 32

Where is the lymph drainage of the suprarenal gland? What is the nerve supply to the suprarenal gland?

Answer 32

Lymph drainage is to the para-oaortic nodes Nerve supply - pre-ganglionic sympathetic fibres from splanchnic nerve synapse mostly in the medulla of the adrenal gland

Question 33

Which specific splanchnic nerve innervates the adrenal gland? What are its nerve roots?

Answer 33

This would be the greater splanchnic nerve - T5-T9 paravertebral ganglia