Urinary 1 Flashcards
How many Kidneys are found in the human body?
Where are they located?
How much does each kidney weigh?
2 kidneys
Retroperitoneal organs
Lateral to vertebrae (T11 to L3)
Left higher than right
150g each
What structures immediately surround each kidney?
Enclosed by a capsule (which also encloses the suprarenal glands)
Suprarenal glands separated from kidneys by a septum
All enclosed in perirenal fat and pararenal fascia
Label the lines according to the structures that overly the kidneys at each point
From top left anticlockwise:
Right suprarenal gland
Liver
Desc. Duodenum
R. Colic flexure
Small intestine
Jejunum
Desc. Colon
Left colic flexure
Pancreas
Spleen
Stomach
Left suprarenal gland
What are the posterior relations of the kidneys?
Left kidney
Top 1/3:
- Rib XI and XII
- Diaphragm
Lower 2/3 (From medial to laterally)
- Psoas major
- Quadratus lumborum
- Transversus abdominis
Right Kidney:
- As above but excluding Rib XI (R. Kidney lower)
Describe the Hilum of the Kidneys
Vertical clefts in the medial margins
Renal arteries, Veins and the ureters enter/leave here
VAU (vein, artery, ureter) Anterior to posterior
Describe the Venous drainage of the kidneys
What is the clinical relevance?
Renal veins drain both kidneys into the IVC
Left renal vein must cross the midline, lies between Superior mesenteric artery and the aorta
Clinical:
Aneurysm in the abdominal aorta could compress left renal vein
Describe the Renal arteries
What is the most common anomaly and the clinical significance of this anomaly?
Normally one renal artery to each kidney supplied by the Abdominal aorta
Right renal artery passes inferior to IVC
Multiple renal arteries to one kidney is a common anomaly
These multiple arteries are end arteries that do not anastomose and so occlusion of one will lead to kidney tissue ischaemia/necrosis
Label the black boxes
From top left anticlockwise:
Pyramid in renal medulla
Renal cortex
Renal papilla
Renal sinus
Minor calyx
Ureter
Renal Pelvis
Renal vein
Renal artery
Major Calyx
Renal Column
Through which structures does filtrate/urine pass in kidneys before reaching the bladder?
Filtrate in the cortex is filtered throught the nephrons to the collecting ducts in the medulla
Urine passes throught collecting ducts in the renal pyramids to the papillae at the apex of each pyramid
Papillae drain into minor calyx, which in turn drains into the major calyx
Major calices drain to the renal pelvis, then through the ureters to the bladder
Follow the course of a red blood cell from the left renal artery to the left renal vein
Hint: Make sure to go into detail of vasculature surrounding each nephron
Arterial:
Renal Vein
Segmental artery
Interlobar artery
Arcuate artery
Interlobular artery
Afferent arterioles
Glomerulur tuft
Efferent arteriole
THEN EITHER
Peritubular capillaries which drain into cortical venules
OR
Vasa recta, which drain into the venae recta
Venous:
Cortical venules or venae recta
Interlobular vein
Arcuate vein
Interlobar vein
Segmental vein
Renal vein
Where can the kidney recieve abberant blood supply from?
Extra renal arteries
Superior mesenteric artery
Suprarenal artery
Testicular or ovarian arteries
What 3 constrictions are present in the ureters as they travel from kidney to bladder?
- The Junction of the renal pelvis
- At pelvic brim
- Where it pierces the bladder wall
At what level do the ureters cross the pelvic brim?
What is the closest major vasculare structure at this level?
At the level of the sacro-iliac joint
The ureter pasess anterior to the bifurcation of the common iliac artery at this level
Describe the course of the ureters from Hilum to Bladder
Descends anterior to psoas major
crosses pelvic brim at level of sacro-iliac joint
In Women:
Uterine artery passes over the ureter (water under the bridge)
In Men:
Ureter passes under the vas deferens
Then:
- Ureters enter the posterolateral aspect of the bladder and run obliquely throught the bladder wall
Given the most likely cause of trauma to the ureters
During hysterectomy or oophorectomy in women damage to the ureters can occur
Apart from trauma, what is the other major clinical aspect of ureters? Explain in detail
Uretic stones can be passed from kidney
Can get caught at uretic constrictions causing renal colic
Smooth muscle spasms that are normally a function of peristalsis try to clear the stone
This can cause pain from visceral sensory nerves T11 to L2
This presents as groin, loin and flank pain
Givea a very brief description of bladder structure (3 points)
Hollow
Distensible (transitional epithelium)
Muscular walls
Where is the bladder found and how is it shaped?
Hint: Different states
Empty:
Lies in the lesser pelvis inferior to the peritoneum
It is a tetrahedron
Posterior base, superior side and two inferolateral sides
Full:
Rises into the greater pelvis and above the pubic bone, may reach as high as the umbilicus. Still lies inferior to peritoneum
Spherical in shape
Give short descriptions of the specific regions/structures of interest within the bladder (5 points)
Apex (anterior angle):
Connection here to urachus, seen as the median umbilical ligament
Trigone:
Defines posterior wall, oblique openings to the ureters and internal urethral opening in a triangle shape, smooth walled
Interureteric fold:
Ridge between two ureter openings
Neck:
Where base and inferolateral sides meet
Involuntary internal sphincter:
Circular region of detrusor muscle at neck acting as sphincter
Describe the bladder walls (3 points)
Rugae in mucosa except within trigone
Transitional epithelium
Detrusor muscle is the muscularis propria, formed of longitudinal, circular and oblique fibres
