Notesale: Turn your study into money

Document Preview

Extracts from the notes are below, to see the PDF you'll receive please use the links above

---

Kidneys, ureters and suprarenal glands


Kidney produce urine for conveying via the ureters to the bladder



Suprarenal gland on superior aspect of each kidney, separated by a
weak fascial septum



Superior urinary organs (kidneys and ureters) and suprarenal glands are
retroperitoneal structures, located on the posterior abdominal wall



Perinephric fat (perirenal fat capsule) surrounds the kidneys and their
vessels and extends into the renal sinuses



Renal fascia encloses the kidneys and perinephric fat (except inferiorly)
o Sends collagen bundles through the paranephric fat
o Continues medially to ensheath the renal vessels
o Extends inferiomedially along the ureter as the peri-uteric fascia
o Continuous superiorly with diaphragmatic fascia



Paranephric fat is located external to the renal fascia



The renal fascia, collagen bundles, perinephric and paranephric fat
hold kidneys in a relatively fixed position
o Some movement during respiration and position change

Taken from Moore et al, Clinically Oriented Anatomy
...
, Seventh Edition

Kidneys


Remove excess water, salts and wastes of protein metabolism from the
blood and return nutrients and chemicals



Located retroperitoneally on posterior abdominal wall either side of the
vertebral column (T12-L3)



Renal hilum contains the entrance to the renal sinus where the vessels,
nerves and ureters pass



Kidneys lie approx
...
2
...
, Seventh Edition



Anatomical relations
o Superior aspects are associated with the diaphragm, posterior
aspects with the psoas major and quadratus lumborum muscles
o Subcostal nerves and vessels and the iliohypogastric and
ilioinguinal nerves pass diagonally across posterior surface
o Anterior to the right kidney is liver, duodenum and ascending
colon
o Anterior to the left kidney is the stomach, spleen, pancreas,
jejunum and ascending colon



Renal sinus occupied by renal pelvis, calices, vessels, nerves and fat



Kidneys are obliquely placed, lying at an angle to one another



Kidneys have a convex lateral margin and a concave medial margin



Renal pelvis is flattened funnel shaped expansion of the superior end of
the ureter



Apex of the renal pelvis is continuous with the ureter
o Receives one or two major calices, which subdivide into two or
three minor calices
o Each minor calice is intended by the apex of the renal pyramid
(renal papilla)



Pyramids and cortex of the kidneys form the lobes of the kidney

Taken from Moore et al, Clinically Oriented Anatomy
...
, Seventh Edition

Ureters


Muscular ducts with narrow lumen, carry urine from kidney to the
bladder



Run inferiorly from apex of renal pelves at the hila of the kidney and
pass over the pelvic brim where the common iliac arteries bifurcate



Run along the lateral wall of the pelvis to enter the bladder



Abdominal parts of the ureters adhere closely to the parietal
peritoneum and remain retroperitoneal throughout their course



Lie in a sagittal plane intersecting the tips of the transverse processes of
the lumbar vertebrae



When examining them radiographically using contrast medium, the
ureters normally demonstrate relative constriction in three places
o Junction of ureters and renal pelves
o Where ureters cross the brim of the pelvic inlet
o During passage through the wall of the urinary bladder



The above sites are potential areas for obstruction by uteric stones
(calculi)



Common to have congenital abnormalities of the kidneys and ureters

Taken from Moore et al, Clinically Oriented Anatomy
...
, Seventh Edition

Vessels and nerves of kidneys, ureters and suprarenal glands
Renal arteries and veins


Renal arteries arise at L1-L2 vertebrae level



Longer right renal artery passes posterior to the IVC



Typically each artery divides close to the hilum into five segmental
arteries (end arteries; no anastomoses)
o Superior (apical) segmental artery
o Anterosuperior segmental artery
o Antero-inferior segmental artery

o Inferior segmental artery
o Posterior segmental artery


Common to have multiple renal arteries; usually enter the hilum but
can also enter the external surface, usually at the poles



Several renal veins unite to join the right and left renal veins
o Lie anterior to the renal arteries


Longer left renal vein
o Receives input from the left suprarenal vein, left gonadal
(testicular or ovarian) vein and communicates with ascending
lumbar vein
o Traverses the acute angle between the superior mesenteric
artery (anteriorly) and aorta (posteriorly)



Both renal veins drain into the IVC

Arterial supply and venous drainage of the ureters


Arterial branches to the abdominal section of the ureters arise from the
renal arteries (sometimes branches also from testicular/ovarian arteries)



Arterial branches approach the ureters medially and form ascending
and descending branches
o Form a longitudinal anastomosis on the ureter wall



Uretic branches are small and delicate – disruption can lead to
ischemia despite anastomoses



Veins draining the abdominal section of the ureters drain into the renal
and gonadal (testicular or ovarian) veins

Suprarenal arteries and veins


Suprarenal arteries branch before entering each gland, covering the
surface



Suprarenal arteries arise from
o Superior suprarenal arteries from the inferior phrenic arteries
o Middle suprarenal arteries from the abdominal aorta
o Inferior suprarenal arteries from the renal arteries



Venous drainage via the suprarenal veins
o Short right suprarenal vein drains to the IVC
o Longer left suprarenal vein drains to the left renal vein

Taken from Moore et al, Clinically Oriented Anatomy
...
, Seventh Edition

Lymphatics of kidneys, ureters and suprarenal glands


Renal lymphatic vessels follow the venous drainage, draining into the
right and left lumbar (caval and aortic) lymph nodes



Lymphatic vessels from different sections of the ureter drain to different
lymph nodes
o Superior ureter: caval/aortic or lumbar nodes
o Middle ureter: common iliac lymph nodes
o Inferior ureter: common, external or internal iliac lymph nodes



Suprarenal lymphatic vessels drain to the lumbar lymph nodes

Taken from Moore et al, Clinically Oriented Anatomy
...
, Seventh Edition

Clinical note
Palpation of the kidneys




Often unpalpable
Right kidney only palpable in lean individuals (more inferior than left)
Left kidney only palpable if enlarged/retroperitoneal mass has
disappeared

Perinephric abscess




Attachment of the renal fascia determines the path of extension of a
perinephric abscess
Securely attached at the hilum, preventing spread to the contralateral
side
Loosely attached anterior and posterior layers may permit spread into
the pelvis

Nephroptosis







As the layers of renal fascia do not fuse inferiorly, abnormally mobile
kidneys may descend more than usual when standing
When the kidneys descend, the suprarenal glands remain in place due
to being in a separate fascial compartment, with firm attachment to
the diaphragm
Nephroptosis (dropped kidney) has a normal length ureter with loose
coiling/kinks due to reduced distance to the bladder
In contrast, an ectopic kidney (congenitally misplaced kidney) will have
a short ureter linking it to the bladder
May get intermittent pain in the renal region due to traction on the
renal vessels, relieved on lying down

Renal transplantation




Preferred treatment for select cases of chronic renal failure
Kidney can be removed from the donor without damaging the
suprarenal gland due to weak septum of renal fascia
Transplanted kidneys often placed in the iliac fossa, due to
o Improved inferior support versus lumbar region
o Availability of major vessels
o Access to the bladder

Renal cysts




Common finding in cadavers
Adult polycystic disease of the kidneys is an autosomal dominant trait
that can cause chronic renal failure
Marked enlargement and distortion of cysts

Pararenal pain



Kidneys are in close relation to the psoas muscle
Extension of the hip joint can increase pain from inflammation in the
pararenal areas

Renal vein entrapment syndrome





Longer left renal vein traverses the acute angle between the superior
mesenteric artery and the aorta to get to the IVC
Downward traction on the superior mesenteric artery can compress the
left renal vein – known as ‘nutcracker syndrome’
Symptoms may include haematuria, proteinuria, abdominal pain,
nausea and vomiting
Men may also get left testicular pain, due to left testicular artery
draining into the left renal vein prior to the compression site – may get a
left sided varicocele

Congenital abnormalities of kidneys and ureters








Bifid renal pelvis and ureter are fairly common
Can be unilateral or bilateral
Separate openings to the bladder are however uncommon
Due to division of the uteric bud, the primordium of the renal pelvis and
ureter
Can also get a retrocaval ureter, where it passes posterior to the IVC
(uncommon)
Failure of the kidneys to separate during foetal development can result
in a horseshoe kidney – usually no symptoms
Ectopic pelvic kidneys can occur from failure of the to enter the
abdomen - lie anterior to the sacrum in the pelvis

Renal and uretic calculi









Calculi are composed of salts of organic and inorganic acids or of
other materials
Can form in the calices of the kidneys, ureters or bladder
Renal calculus may pass into the ureter; excessive distension may cause
pain and/or complete/partial obstruction of flow
Pain may be referred to the lumbar or inguinal region, or external
genitalia (cutaneous areas innervated by T11-L2, which also receive
visceral afferents from the ureter)
Pain passes inferoanteriorly as the stone progresses through the ureter
Ureteric caliculi can be observed and removed with a nephroscope
Lithotripsy can also be used – sends a shockwave to break the caliculus
into short fragments

Taken from Moore et al, Clinically Oriented Anatomy
...
, Seventh Edition

Taken from Moore et al, Clinically Oriented Anatomy
...
, Seventh Edition

Pelvic viscera – urinary organs


Pelvic viscera includes the distal parts of the urinary system and GI
tract, plus the reproductive system



the bladder and rectum are true pelvic viscera (sigmoid colon and
bowel are extensions of the abdominal viscera)



Pelvic urinary organs are
o Pelvic portions of the ureters (transport urine from kidney)
o Urinary bladder (temporary storage of urine)
o Urethra (conducts urine from bladder to exterior)

Ureters


Muscular tubes connecting the kidney to the bladder



As they cross the bifurcation of the common iliac artery, they pass over
the pelvic brim and enter the pelvis



Pelvic parts of the ureters run on the lateral walls of the pelvis, parallel
to the anterior margin of the greater sciatic notch, between the pelvic
peritoneum and the internal iliac arteries



Curve anteromedially superior to levator ani and enter the urinary
bladder



Inferior ends of the ureters surrounded by the vesical venous plexus



Oblique passage into the bladder, creating a one-way flap valve
o Prevents internal pressure of the filling bladder from causing
collapse of the intramural passage



Contraction of bladder musculature acts as a sphincter preventing
reflux into the ureters when the bladder contracts
o Increasing internal pressure during micturition



Urine transported down ureters by peristalsis



Males
o Vas deferens passes between the ureter and peritoneum
o Ureters posterolateral to the vas deferens
o Ureter enters bladder superior to the seminal gland



Females
o Ureter passes medial to the uterine artery, then crossed by the
uterine artery at level of the ischial spine
o Passes close to vaginal fornix to enter the bladder

Taken from Moore et al, Clinically Oriented Anatomy
...
, Seventh Edition

Innervation


Nerves derive from adjacent autonomic plexuses (renal, aortic, superior
and inferior hypogastric)



Mostly superior to the pelvic pain line



Afferent pain fibres follow sympathetic fibres to T10-L2



Ureteric pain usually referred to ipsilateral lower quadrant of the
abdomen and groin

Taken from Moore et al, Clinically Oriented Anatomy
...
, Seventh Edition

Taken from Moore et al, Clinically Oriented Anatomy
...
, Seventh Edition

Proximal (pelvic) male urethra


Muscular tube conveying urine from the internal urethral orifice of the
bladder to the external urethral orifice on tip of glans penis
o Also an exit for semen



Divided into four parts; intramural (preprostatic), prostatic, intermediate
(membranous), spongy



Intramural part varies in diameter and length, depending on fill status



Prostatic part has a urethral crest (ridge) between the prostatic sinuses
o Prostatic ducts empty into the prostatic sinuses
o Seminal colliculus emerges in the crest, opens into prostatic
utricle
o Ejaculatory ducts open into the prostatic urethra

Taken from Moore et al, Clinically Oriented Anatomy
...
, Seventh Edition

Reference
1
...
Clinically Oriented Anatomy
...




---