Urinary System Flashcards
How does the blood supply of the right and left kidney differ?
Right is supplies by the right renal artery directly from aorta, and renal vein directly into IVC
Left renal vein is longer than the right and received x2 tributaries, the adrenal and gonadal.
The left renal vein passes in front of the aorta immediately below the origin of the SMA
Right renal artery passes behind the IVC, and is lower than the left as the right kidney sits slightly lower due to position of the liver
IVC sits to the right of the aorta
Describe the path of the ureters in the abdomen and pelvis in a male patient
They leave the renal pelvis and descend onto psoas major
The right ureter lies close to the lateral side of IVC
Enter pelvis by crossing bifurcation of CIA – anterior to it
Run down ischial spine, crossing obturator nerve and anterior branches of the internal iliac artery
Turning medially to reach the bladder and pass below the Vas Def just before entering the bladder
At which points in the ureter are renal stones likely to become lodged?
PUJ
Pelvic brim / Bifurcation CIA
VUJ
Describe the external structure of the kidney?
Bean-shaped – convex and concave border
Recessed area on concave border = hilum – artery / vein / ureter
Capsule – tough fibrous tissue surrounding
Perirenal fat -> renal fascia (gerotas fascia) -> pararenal fat
Anterior surface = peritoneum
Posterior surface = transversalis fascia
Internal Structure of the Kidney?
Capsule
Calyces – Major = upper, middle, lower – minor calyces within
Upper middle and lower pole
Cortex – outer, medulla – inner/pyramid (minor calyces at bottom)
Nephron – filtrating unit, crossing cortex and medulla
Describe the surrounding relations of the kidney?
Left:
Anteriorly: adrenal gland, spleen, splenic flexure, stomach, pancreas, jejunum
Posterior: psoas muscle, 11th / 12th ribs, diaphragm, costodiaphragmatic recess pleura, Quadratus lumborum, transversus abdominis muscle
Right:
Ant: Adrenal gland, Liver, Hepatic flexure, D2
Post: Diaphragm, 12th rib, psoas muscle, costodiaphragmatic recess pleura, Quadratus lumborum, transversus abdominis muscle
Describe the path of the ureters:
Leave the renal PELVIS
Descend down anterior to the psoas muscle
Enter the pelvis by crossing anterior to the bifurcation of the common iliac arteries
Follow along down the ischial spine and cross obturator nerve
Curve forward and enters the bladder at the right and left of the posterior base = posteroinferiorly on the lateral walls of pelvis -> curve anteromedially to enter bladder
What is the blood supply of the ureters during their course:
Upper ureter = Renal artery
Middle ureter = CIA, direct br from AA, gonadal arteries
Lower: Internal iliac, superior Vesicular artery, uterine artery, middle rectal, vaginal artery, inferior vesical artery (men only)
Why is ureteric pain felt at the back and sides of the abdomen?
Related to the nerve supply to the ureters – which travel alongside BV
Primary sensation from nerves from T12-L2 segments SC
Referred pain to dermatones T12-L2 = back and sides abdomen, scrotum / labia majora, upper part thigh
