Upper Urinary Tract

Question 1

What are the components of the upper urinary tract?

Answer 1

Kidneys

Ureters

Question 2

What are the components of the lower urinary tract?

Answer 2

Bladder

Urethra

Question 3

Which structures of the urinary tract are located in the abdomen?

Answer 3

Kidneys

Proximal ureters

Question 4

Which structures of the urinary tract are located in the pelvis?

Answer 4

Distal ureters
Bladder
Proximal urethra

Question 5

Which structures of the urinary tract are located in the perineum?

Answer 5

Distal urethra

Question 6

What structures lie directly anterior to the kidneys?

Answer 6

Visceral peritoneum 
Paranephric fat 
Renal (deep) fascia 
Perinephric fat 
Renal capsule 
Kidney

Question 7

What muscles lie lateral to the kidney?

Answer 7

Anterolateral abdominal wall muscles:
External oblique
Internal oblique
Transversus abdominis

Question 8

What muscle lies medial to the kidney?

Answer 8

Psoas major

Question 9

What muscles lie posterior to the kidney?

Answer 9

Quadratus lumborum

Back muscles

Question 10

Where do the kidneys lie in relation to the vertebrae?

Answer 10

Right = L1 - L3 
Left = T12 - L2

Question 11

Which ribs are posteriorly related to the kidneys?

Answer 11

11 and 12

Question 12

Which regions/quadrants are the kidneys found in?

Answer 12

Lumbar regions (flanks) 
Upper quadrants

Question 13

Why do the kidneys move on breathing?

Answer 13

In contact with liver/spleen, which are in contact with diaphragm

Question 14

Which direction do the kidneys move with breathing?

Answer 14

Inspiration = inferiorly  
Expiration = superiorly

Question 15

Which structures does the right kidney lie posterior to?

Answer 15

Liver (+ hepatorenal recess)
Duodenum
Ascending colon
Right colic flexure

Question 16

Which structures does the left kidney lie posterior to?

Answer 16

Stomach
Tail of pancreas
Hilum of spleen
Splenic vessels

Question 17

What is the clinical significance of the hepatorenal recess?

Answer 17

Deepest part of the peritoneal cavity in a supine patient

Site for fluid collection in ascites etc.

Question 18

What are the structures of the renal hilum and what is their arrangement?

Answer 18

Renal artery (posterior) 
Renal vein (anterior) 
Ureter (inferior)

Question 19

Where does the abdominal aorta bifurcate and what does this give?

Answer 19

Umbilicus

Common iliac arteries

Question 20

Where doe the common iliac arteries lie in relation to the veins?

Answer 20

Arteries are anterior to the veins

Question 21

Where does lymph from the kidneys drain?

Answer 21

Lumbar nodes

Question 22

What is the arterial blood supply to the ureter (superior to inferior)?

Answer 22

Branches of:
Renal artery 
Abdominal aorta 
Common iliac artery 
Internal iliac artery 
Vesical (bladder) artery

Question 23

Where does lymph from the ureters drain?

Answer 23

Lumbar nodes and iliac nodes

Question 24

Where are the lumbar lymph nodes located?

Answer 24

Abdominal aorta and IVC

Question 25

Where are the iliac lymph nodes located?

Answer 25

Common, internal and external iliac vessels

Question 26

How is renal artery stenosis associated with AAA?

Answer 26

Combined with infra-renal AAA (both due to atherosclerosis) | Due to supra-renal AAA (occlusion of proximal renal artery by the aneurysm)

Question 27

Give some anatomical variations in the renal system?

Answer 27

``` Bifid renal pelvis Bifid ureter Unilateral duplicated ureter Retrocaval ureter Horseshoe kidney Ectopic pelvic kidney ```

Question 28

What are the causes of a solitary kidney?

Answer 28

Agenesis | Nephrectomy - pathology or donation

Question 29

Where are nephrons located?

Answer 29

Within the pyramids of the adrenal medulla

Question 30

What are the two main parts of the kidney?

Answer 30

Outer cortex | Inner medulla

Question 31

What is the structure of a nephron?

Answer 31

``` Glomerulus Proximal convoluted tubule Loop of Henle Distal convoluted tubule Collecting duct ```

Question 32

What is the route of urine drainage from the kidney?

Answer 32

``` Collecting duct Minor calyx Major calyx Renal pelvis Ureter ```

Question 33

What are the anatomical sites of ureteric constriction?

Answer 33

Pelviureteric junction Ureter crossing anterior aspect of common iliac artery (at pelvic rim) Ureteric orifice

Question 34

What are renal calculi and why are they clinically significant?

Answer 34

Form from urine calcium salts | Obstruct urinary tract from within

Question 35

What can cause a ureteric obstruction?

Answer 35

``` Internal obstruction (renal calculus or blood clot) External compression (e.g. tumour) ```

Question 36

What is the urinary tracts response to obstruction and what is the clinical outcome?

Answer 36

Increased peristalsis proximal to the obstruction | Gives colicky pain

Question 37

What is the result of an obstruction within the calyces or ureter?

Answer 37

Unilateral back pressure of urine

Question 38

What is the result of an obstruction within the bladder?

Answer 38

Unilateral or bilateral kidney problems

Question 39

What is the result of an obstruction within the urethra?

Answer 39

Bilateral kidney problems

Question 40

What is the consequence of back pressure of urine?

Answer 40

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

Question 41

What is renal failure?

Answer 41

Failure to adequately filter the blood to produce urine

Question 42

What is hydronephrosis?

Answer 42

Water inside the kidney | Acutely causes a painful stretching of the renal capsule