Session 1: Case Studies Flashcards
Why are the kidneys described as being retroperitoneal?
Because they are not in the peritoneal cavity. They are located behind the parietal peritoneum.
Why is the left kidney usually higher than the right kidney?
Because on the right side the liver pushes the right kidney down.
At what vertebral levels would you find the left kidney?
Upper pole sits around T11 to T12 The lower pole sits around L3 to L4
At what vertebral levels would you find the right kidney?
Upper pole site around T12 and the lower lobe sits around L4
Where is the pelviureteric junction also known as PUJ?
It is where the renal pelvis meets the ureter.
It’s got a bit of a bend and can be slightly obstructed. If is obstructed it is usually congenital due to a narrowing of the PUJ.
This means that urine will flood in the kidney and can cause renal stones or cause renal disease.
From the hilum, describe the course of the ureter until it enters the bladder.
It arises from the renal pelvis. It will then descend through the abdomen anterior to psoas major and the transverse processes of the lumbar vertebrae. At this point the ureter is retroperitoneal. It moves under the gonadal arteries (water under the bridge).
At the sacroiliac joint it will then cross the pelvic brim to go into the pelvic cavity. Here it will also cross the bifurcation of the common iliac arteries.
The ureters will keep to descend down the lateral walls of the pelvis and at the point of the ischial spines they turn anteromedially to transversely move towards the bladder.
The ureter will then pierce the bladder through the intramural muscles (detrusor muscle). It will do so obliquely to create a on way valve and prevent any renal reflux.
Where is the vesicoureteric junction?
The most distal part of the ureter where it meets the bladder.
List the three common sites where renal stones can lodge due to non-uniformity in lumen diameter of the ureter.
Pelviureteric junction
Vesicoureteric junction
Ureteral crossing of the iliac vessels.
Which bony landmarks could you use on an X-ray to approximate the course of the ureter?
L1 where the ureter exits and goes anterior to the lateral transverse processes.
Sacroiliac joint where the ureter crosses the pelvic brim to enter the pelvic cavity.
Ischial spine where the ureter turns anteromedially.
How long is the urethra in the adult male and female?
Male = 20 cm ish
Female = 4 cm ish
