Week 1 - A - Anatomy of the Upper Renal Tract

Question 1

The urinary tract has an upper and lower region What makes up the upper urinary tract?

Answer 1

The right and left kidneys The right and left ureters

Question 2

What does the lower urinary tract involve? (are there paired structures)

Answer 2

Lower urinary tract involves the bladder and urethra Both are unpaired midline structures

Question 3

Is the kidney an intraperitoneal or retroperitoneal organ? What do both of these mean?

Answer 3

Kidney is a retroperitoneal organ Intraperitoneal organ - almost completely covered by visceral peritoneum Retroperitoneal organ - only anterior aspect is covered by visceral peritoneum

Question 4

Name other retroperitoneal organs?

Answer 4

SAD PUCKER - Suprarenal (adrenal) glands Aorta/IVC Dudodenal - second and third segments Pancreas Ureters Colon (ascending and desceding) Kidneys Eosophagus Rectum

Question 5

Which part of the colon lies intraperitoneal?

Answer 5

The sigmoid and transverse colon

Question 6

Name some intraperitoneal organs?

Answer 6

Stomach Spleen Ileum Jejunum Duodenum - first third Sigmoid and transverse colon Tail of the pancreas

Question 7

What connects the liver to the anterior abdominal wall? What comes off this? remnant of the umbilical vein

Answer 7

The falciform ligament Ligamentum teres projects from falciform ligament The coronary ligament attaches the liver to the diaphragm

Question 8

The aorta and inferior vena cava are also retroperitoneal Is the abdominal aorta or the inferior vena cava on closer to the right hand kidney?

Answer 8

Aorta is located on the left hand side of the inferior vena cava IVC is therefore closer to the right hand kidney

Question 9

Like the lungs, the kidney has a hilum What are the major (vessel) contents of the renal hilum? Where do these structures lie in relevance to one another?

Answer 9

The renal vein anteriorly The renal artery posteriorly The ureter inferiorly

Question 10

At what level of the abdominal aorta do the renal arteries arise? What else arises at this level?

Answer 10

Usually arisee at L1 The superior mesenteric artery also arises at this level

Question 11

Laterally to the kidneys we have the structures relating to the anterolateral abdominal walls, what are the muscles of the anterolateral abdominal wall? What aspect of the kidney do they protect? (anterior, inferior, posterior, superior)

Answer 11

External oblique Internal oblique Transversus abdominus Protect the lateral aspect of the kidneys

Question 12

What are the two posterior abdominal wall muscles protecting the posterior aspect of the kidneys? What other muscles help posteriorly protect the kidneys?

Answer 12

The psoas major and the quadratus lumborum The back muscles also help pretect

Question 13

What is kidney enclosed in to prevent expansion?

Answer 13

Enclosed by the renal capsule

Question 14

The anterior aspect of the kidneys has a few layers covering it What are the layers protecting the anterior aspect of the kidney? (from superficial to deep) (remmeber the two fat layers)

Answer 14

Have the Visceral peritoneum Paranephric fat Renal (deep) fascia Perinephric fat Renal capsule

Question 15

Does the paranephric or perinephric fat surround the kidney?

Answer 15

The perinephric fat surrounds it The paranephric is located between the visceral peritoneum and the renal (deep) fascia

Question 16

It is important to know what the features on an axial CT slice of the kidney are Name what each of the arrows are pointing to

Answer 16

https://s3.amazonaws.com/classconnection/403/flashcards/11907403/png/picture1jpg-15AA54D69F544ED5A2C.png

Question 17

The anterlateral abdominal wall muscles are external oblique, internal oblique and then transversus abdominus The posterior abdominal wall muscles protecting the kidney are the quadratus lumborum and the psoas major Firstly, which muscles are insicised during a nephrectomy? Which compartment of the lower limb does the psoas major lie in? and function of this compartment?

Answer 17

All three anterolateral wall muscles Pasos major is part of the iliopsoas in the anterior abdominal wall and they act as flexors of the thigh

Question 18

Which kidney sits at a lower vertebral level? Why is this?

Answer 18

The right kidney sits lower This is due to the presence of the liver

Question 19

Which vertebral level do both kidneys sit at? Which ribs protect the kidneys? (rib fracture could cause laceration of the kidney) Do the ribs protect the anterior or posterior kidney?

Answer 19

Right kidney - sits at vertebral level L1-L3 Left kidney - sits at vertebral level - T12-L2 Both kidneys are protected by ribs 11&12 - the floating ribs They protect the posterior aspect of the kidneys

Question 20

The kidneys are protected by the psoas major and the quadratus lumborum from the posterior abdominal wall muslces Where does the kindey lie in relation to these muscles?

Answer 20

The kidneys lie anterior to the quadratus lumborum and lateral to the psoas major

Question 21

Which region of the abdomen do the kidneys lie in?

Answer 21

The light in the right and left flanks (lumbar region)

Question 22

What can done to palpate the kidneys if they are enlarged?

Answer 22

Ballot the kidneys When patient is lying supine, place one hand on anterior and posterior of the lumbar region and ballot

Question 23

Do the kidneys move inferiorly or superiorly with inspiration and why? This makes balloting easier when the kidney is enlarged

Answer 23

Inspiration - causes the diaphragm to descend pushing the liver and spleen lower which in turn causes the descent of the kidneys - therefore not contained by the ribs

Question 24

What separates the liver from the right kdiney and is important for being the most inferior space when a patient is supine? Give both names for this space

Answer 24

This is the hepatorenal recess - can fill with fluid during ascites Also known as the Pouch of Morrisons

Question 25

Which parts of the colon lie anterior to the right kidney? Still a retroperitoneal organ however

Answer 25

The ascending colon and the the hepatic flexure of the colon are anterior to the kidney 2nd part of duodenum also sits anteriorly to kidney And liver

Question 26

What is the recess which is the most inferior when a patient lies supine and sits anterior to the kidney also when standing?

Answer 26

The hepatorenal recess (pouch of Morrison’s)

Question 27

Which structures lie anterior to the left kidney?

Answer 27

The stomach The hilum of the spleen The tail of the pancrease The splenic flexure

Question 28

What does the coeliac trunk trifurcate into? What mdiline abdominal aorta branch lies very close to the renal artery branches?

Answer 28

Coeliac trunk - common hepatic artery, left gastric artery and splenic artery Superior mesenteric(L1) artery is very close to where the renal arteries arise (also L1)

Question 29

Do the renal veins (from the IVC) or the renal artery (from the abdominal aorta) lie anteriorly to one another?

Answer 29

The renal veins are anterior to the renal arteries

Question 30

What do the Inferior vena cava (IVC) and the Abdominal Aorta bifurcate into? WHich of the bifurcations lie anterior? At what level is this bifurcation?

Answer 30

The abdominal aorta and inferior vena cava bifurcate into the right and left common iliac artery and vein The bifurcation occurs at the level of the umbilicus

Question 31

What are the nodes surrounding the aorta and the IVC which lymph drains into?

Answer 31

They are known as the lumbar nodes

Question 32

The ureter has blood supply from different arteries as it extends from the abdomen (proximal part) to the pelvis (distal part) Where do the branches supply the ureter arise? (name in order)

Answer 32

Branhces from Renal artery Abdominal aorta Common iliac artery Internal iliac artery The vesicle (bladder) artery

Question 33

The lymph from the ureter drains into the iliac and lumbar nodes depending on which segment of the ureter When discussing abdominal aortic aneursyms, they can be described in relationship to the renal arteries What can be the two ways to desribe them?

Answer 33

Suprarenal AAA or Infrarenal AAA

Question 34

Aneursyms are due to weak blood vessel walls and prevent the flow of blood AAA can cause renal artery stensosis What is the difference in the stenosis caused by a suprarenal and infrarenal?

Answer 34

Suprarenal causes occlusion of the proximal renal artery due to the aneurysm Renal artery stenosis combined with an infrarenal AAA is usually due to astherosclerosis affecting both

Question 35

What is the treatment of an unruptured abdominal aortic aneurysm?

Answer 35

If unruptured - Offer open surgical repair DO NOT OFFER EVAR for unruptured AAA even if open surgical repair unsuitable

Question 36

There is anatomical variation in the renal system What can cause a solitary kidney?

Answer 36

Renal agenesis - where one kidney simply does not develop Organ donation of a kidney Nephrectomy due to pathology

Question 37

What are the two regions of the kidney?

Answer 37

Have the outer renal cortex and the inner renal medulla

Question 38

What is located in the renal medulla containing nephrons?

Answer 38

The renal pyramids

Question 39

The renal cortex has columns projecting in between the renal medullas What are these renal columns of the cortex also knwon as?

Answer 39

The column of bertin - where the renal blood supply and venous drainage is

Question 40

What structure receives all the blood from the renal artery? for ultrafiltration of the blood

Answer 40

Enters the glomerulus for ultrafilitration of the blood

Question 41

The glomerulus is contained in the bowmans capsule, what is the structure contianing the bowman’s capsule and glomerulus knwon as?

Answer 41

This is known as the renal corpuscle

Question 42

Describe the regions of the nephron from Bowman’s capsule to collecitng duct?

Answer 42

Bowman’s capsule - proximal convoluted tubule, loop of Henle, distal convoluted tubule and finally collecting duct

Question 43

Which of the nephron structures are located in the renal cortex and which in the renal medulla?

Answer 43

Renal cortex Renal corpuscle (capsule and glomerulus), proximal and distal convoluted tubules Renal medulla Loop of Henle and collecting duct

Question 44

How does the collecting duct take fluid to the ureter? What structrue does the fluid from the collectin duct exit?

Answer 44

Collecting duct fluid exits the renal medulla via the renal papilla and passes into the minor calyx Two or more minor calyx form to join a major calyx which form to join the renal pelvis which drains into the ureter

Question 45

Where does the inital constrcition of the ureter take place?

Answer 45

Takes place at the pelviureteric junction

Question 46

What are the three anatomical sites of ureteric constriction ?

Answer 46

The pelviureteric junction The ureter crossing over the common iliac artery - has a wee change in direction The uretic orifice

Question 47

What are the stones that can get stuck at uretic constriction sites known as?

Answer 47

These are the renal caliculi (kidney stones)

Question 48

Why are the renal caliculi usually visible on xray?

Answer 48

Because of their high calcium content Risk factors include high calcium in blood and dehydration

Question 49

The pain in renal caliculi obstructing the ureter comes in waves, why is this? What can cause external compression of the ureter?

Answer 49

increased peristalsis proximal to the site of the obstruction in an attempt to remove it (flush it into the bladder) as peristalsis comes in waves, a patient with a ureteric obstruction tends to experience pain that “comes and goes” (“colicky”) Masses such as tumours

Question 50

obstructions cause urine to “back up” in the tract towards the kidneys obstructions within the calyces or ureter cause unilateral back pressure of urine Do obstructions within the bladder cause unilateral or biltaeral back pressure of urine?

Answer 50

obstructions within the bladder may cause unilateral or bilateral kidney problems obstructions to the urethra cause bilateral kidney problems

Question 51

urine production will continue until the pressure within the urinary tract exceeds the pressures favouring filtration at the glomerulus What does this cause to the kidney?

Answer 51

This causes renal failure which means the kidneys are failing to adequately filter the blood to produce urine

Question 52

urine back pressure into the calyces compresses the nephrons within the medullary pyramids leading to renal failure What condition can this cause which causes painful stretching of the kidney capsule due to build up of urine inside the kidneys?

Answer 52

This can cause hydrnephrosis (water inside the kidney)