Upper Urinary Tract Flashcards
What are the components of the upper urinary tract?
Kidneys
Ureters
What are the components of the lower urinary tract?
Bladder
Urethra
Which structures of the urinary tract are located in the abdomen?
Kidneys
Proximal ureters
Which structures of the urinary tract are located in the pelvis?
Distal ureters
Bladder
Proximal urethra
Which structures of the urinary tract are located in the perineum?
Distal urethra
What structures lie directly anterior to the kidneys?
Visceral peritoneum Paranephric fat Renal (deep) fascia Perinephric fat Renal capsule Kidney
What muscles lie lateral to the kidney?
Anterolateral abdominal wall muscles:
External oblique
Internal oblique
Transversus abdominis
What muscle lies medial to the kidney?
Psoas major
What muscles lie posterior to the kidney?
Quadratus lumborum
Back muscles
Where do the kidneys lie in relation to the vertebrae?
Right = L1 - L3 Left = T12 - L2
Which ribs are posteriorly related to the kidneys?
11 and 12
Which regions/quadrants are the kidneys found in?
Lumbar regions (flanks) Upper quadrants
Why do the kidneys move on breathing?
In contact with liver/spleen, which are in contact with diaphragm
Which direction do the kidneys move with breathing?
Inspiration = inferiorly Expiration = superiorly
Which structures does the right kidney lie posterior to?
Liver (+ hepatorenal recess)
Duodenum
Ascending colon
Right colic flexure
Which structures does the left kidney lie posterior to?
Stomach
Tail of pancreas
Hilum of spleen
Splenic vessels
What is the clinical significance of the hepatorenal recess?
Deepest part of the peritoneal cavity in a supine patient
Site for fluid collection in ascites etc.
What are the structures of the renal hilum and what is their arrangement?
Renal artery (posterior) Renal vein (anterior) Ureter (inferior)
Where does the abdominal aorta bifurcate and what does this give?
Umbilicus
Common iliac arteries
Where doe the common iliac arteries lie in relation to the veins?
Arteries are anterior to the veins
Where does lymph from the kidneys drain?
Lumbar nodes
What is the arterial blood supply to the ureter (superior to inferior)?
Branches of: Renal artery Abdominal aorta Common iliac artery Internal iliac artery Vesical (bladder) artery
Where does lymph from the ureters drain?
Lumbar nodes and iliac nodes
Where are the lumbar lymph nodes located?
Abdominal aorta and IVC
Where are the iliac lymph nodes located?
Common, internal and external iliac vessels
How is renal artery stenosis associated with AAA?
Combined with infra-renal AAA (both due to atherosclerosis)
Due to supra-renal AAA (occlusion of proximal renal artery by the aneurysm)
Give some anatomical variations in the renal system?
Bifid renal pelvis Bifid ureter Unilateral duplicated ureter Retrocaval ureter Horseshoe kidney Ectopic pelvic kidney
What are the causes of a solitary kidney?
Agenesis
Nephrectomy - pathology or donation
Where are nephrons located?
Within the pyramids of the adrenal medulla
What are the two main parts of the kidney?
Outer cortex
Inner medulla
What is the structure of a nephron?
Glomerulus Proximal convoluted tubule Loop of Henle Distal convoluted tubule Collecting duct
What is the route of urine drainage from the kidney?
Collecting duct Minor calyx Major calyx Renal pelvis Ureter
What are the anatomical sites of ureteric constriction?
Pelviureteric junction
Ureter crossing anterior aspect of common iliac artery (at pelvic rim)
Ureteric orifice
What are renal calculi and why are they clinically significant?
Form from urine calcium salts
Obstruct urinary tract from within
What can cause a ureteric obstruction?
Internal obstruction (renal calculus or blood clot) External compression (e.g. tumour)
What is the urinary tracts response to obstruction and what is the clinical outcome?
Increased peristalsis proximal to the obstruction
Gives colicky pain
What is the result of an obstruction within the calyces or ureter?
Unilateral back pressure of urine
What is the result of an obstruction within the bladder?
Unilateral or bilateral kidney problems
What is the result of an obstruction within the urethra?
Bilateral kidney problems
What is the consequence of back pressure of urine?
Urine production continues until pressure within the urinary tract exceeds pressure favouring filtration at the glomerulus
Compresses nephrons within the medullary pyramids leading to renal failure
What is renal failure?
Failure to adequately filter the blood to produce urine
What is hydronephrosis?
Water inside the kidney
Acutely causes a painful stretching of the renal capsule
