Session 1 - Anatomy

Question 1

State the levels of the hilum, kidneys and ureter

Answer 1

L1- hilum and ureter
11-12 rib for left (higher)
12- highest for right

Lower poles:
L2-3 (L)
L3-L4 (R)

Question 2

Ureter pathway

Answer 2

Arise from renal pelvis, narrows to form ureter (PUJ - where pelvis meets ureter)

Go down following transverse tips and along psoas major and become retroperitoneal (located behind peritoneum)

At SIJ , ureter cross pelvic brim entering pelvic cavity (cross bifurcation of iliac arteries)

Travels down lateral pelvic walls at level of ichial spine and move in towards bladder obliquely (prevents backflow of urine)

Question 3

What do the entry points of the ureter form the corners of and what’s its function

Answer 3

Trigone

Very sensitive so when stretched sends signals to brain to empty

Question 4

In male and females what is the ureter crossed by

Answer 4

Vas in male

Uterine artery in female

Question 5

Why is the renal angle important and what muscles covers it

Answer 5

If diseased it will be tender

Will be able to feel kidney when patient breaths in

Erector spinae muscle

Question 6

Why is fat important in the kidney

Answer 6

Important because kidney has no ligaments or anything to anchor it down so it uses the fat around it to stay anchored

The fascia stops them from flopping around (keeps structure) and is important when entering the retroperitoneal space posteriorly

Question 7

What are the 3 layers of kidney fat

Answer 7

First layer- para nephrotic (in line with kidney) and associated with lumbar region

2nd- renal fascia aka garottas fascia

3rd- peri nephrotic fat (inside garottas) close to kidney hilum

Question 8

What helps propels urine to the bladder in the ureter

Answer 8

Peristaltic waves (smooth muscle fibres)

Question 9

Where is the ureter located

Answer 9

Retroperitineal

Question 10

Where does the ureter divide into intramural abdominal and pelvic parts

Answer 10

Beyond the pelviureteric junction PUJ

Question 11

What is the most common area for ureteric injury

Answer 11

Near the pelvic brim

Question 12

What vessels are ureters crossed by

Answer 12

Gonadal (testicular or ovarian)- site of pain

Question 13

What is the significance of the intramural segment of the ureter and what prevents urine reflux since there are no sphincters

Answer 13

Runs obliquely through the bladder preventing reflux
Flaps and angle

This is where ureter meets detrusor muscle

Question 14

What is urothelium and where is it found

Answer 14

Specialised epithelial cells only found in the urinalysis system (outlines ureter) that can squeeze in a myogenic fashion to push urine

Also in bladder, ureter, and bladder of the kidney

Question 15

Where does the ureter start and end

Answer 15

Kidney to bladder

Question 16

What are some variations of ureter insertion

Answer 16

Some wrapped around IVC (rare)
Some double ureters on one side, if one does not enter bladder then problems with urine dribbling but otherwise no problems if both urethra in bladder

Question 17

What is the function of the internal urinary sphincter in women and men

What nervous system controls it

Answer 17

Women- no function
Men- need cuz other would have retrograde ejaculation (under sympathetic control for contraction)

Involuntary and prevents urine from seeping out

Question 18

When does the prostatic urethra become the spongy

Answer 18

When it passes the urogenital diaphragm then becomes bulbous

Question 19

What is the function of the external urinal sphincter

Where is it found

Answer 19

Maintains continence

Found within urogenital diaphragm

Voluntary

Question 20

Describe a few things the nephron does

Answer 20

Filters blood
Reabsorption salts and water in DY and most substances in PCT
Loss of waste products

Question 21

What is the difference between cortical and juxtamedullary nephrons

Answer 21

Just a go all the way down to medulla and have longer loops of Henley (remember the two layers of the cortex: cortisol and juxtamedular)

Question 22

Blood supply of kidneys

Answer 22

Left renal vein go over aorta to reach IVC whereas right right next to it

Testicular vein reach LRV instead of IVC cuz closer right drains to IVC

Question 23

Describe the blood supply internally to kidneys

Answer 23

Aorta 
Renal artery 
Segmental 
Inter LOBAR (between pyramids) 
Arcuate (between cortex and medulla) 
InterLOBULAR (things coming off arcuate into glomerulus an into efferent arterioles) 
Efferent 
Peritubular 

Veins