Podcast
Questions and Answers
What structures separate the right kidney from the 12th rib and pleura?
What structures separate the right kidney from the 12th rib and pleura?
Which muscle lies inferior-medially to the right kidney?
Which muscle lies inferior-medially to the right kidney?
What is found in the renal sinus?
What is found in the renal sinus?
What structure narrows to form the ureter?
What structure narrows to form the ureter?
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Which of these nerves are found between the kidney and the Quadratus Lumborum?
Which of these nerves are found between the kidney and the Quadratus Lumborum?
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Which statement accurately describes the location of the kidneys?
Which statement accurately describes the location of the kidneys?
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How does the right kidney compare to the left kidney in terms of position?
How does the right kidney compare to the left kidney in terms of position?
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What is the primary significance of segmental arteries in the kidneys?
What is the primary significance of segmental arteries in the kidneys?
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Where are the three constriction points located along the ureter?
Where are the three constriction points located along the ureter?
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What term describes the anatomical feature of the kidney positioned towards the spine?
What term describes the anatomical feature of the kidney positioned towards the spine?
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What anatomical relationship does the renal fascia have with the kidneys?
What anatomical relationship does the renal fascia have with the kidneys?
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What characteristic of the bladder is compared between a newborn and an adult?
What characteristic of the bladder is compared between a newborn and an adult?
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Which statement distinguishes the urethra in males from females?
Which statement distinguishes the urethra in males from females?
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What are the main structures that keep the kidney in place?
What are the main structures that keep the kidney in place?
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Which of the following is NOT a contributing factor to stabilizing the position of the kidney?
Which of the following is NOT a contributing factor to stabilizing the position of the kidney?
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Where is the abdominal part of the ureter located in relation to the psoas major muscle?
Where is the abdominal part of the ureter located in relation to the psoas major muscle?
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Which of the following best describes the location of the ureter in the abdominal cavity?
Which of the following best describes the location of the ureter in the abdominal cavity?
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What is the approximate length of the ureter?
What is the approximate length of the ureter?
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Which of the following is NOT a structure that receives lymphatic drainage from the kidney?
Which of the following is NOT a structure that receives lymphatic drainage from the kidney?
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What is the main source of sympathetic innervation to the kidney?
What is the main source of sympathetic innervation to the kidney?
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What is the approximate spinal cord level associated with afferent fibers that innervate the kidney?
What is the approximate spinal cord level associated with afferent fibers that innervate the kidney?
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Flashcards
Renal Sinus
Renal Sinus
An area in the kidney containing fat, calyces, and renal pelvis.
Renal Capsule
Renal Capsule
A fibrous layer surrounding the kidney that has a glistening appearance.
Calyx
Calyx
A cup-like structure in the kidney that collects urine from renal pyramids.
Right Kidney Relations
Right Kidney Relations
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Inferomedial Relations
Inferomedial Relations
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Location of Kidneys
Location of Kidneys
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Kidney Size
Kidney Size
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Kidney Poles
Kidney Poles
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Surface Markings of Kidneys
Surface Markings of Kidneys
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Kidney Levels
Kidney Levels
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Ureters Relationship to Peritoneum
Ureters Relationship to Peritoneum
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Constriction Points of Ureter
Constriction Points of Ureter
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Bladder Anatomy Comparison
Bladder Anatomy Comparison
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Blood Supply of Kidneys
Blood Supply of Kidneys
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Lymphatic Drainage of Kidneys
Lymphatic Drainage of Kidneys
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Kidney Stability Factors
Kidney Stability Factors
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Renal Plexus
Renal Plexus
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Afferent Fibers
Afferent Fibers
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Renal Caliculi Symptoms
Renal Caliculi Symptoms
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Ureters Description
Ureters Description
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Ureters Course
Ureters Course
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Study Notes
Urinary Tract Lecture
- The lecture was presented by Prof. Altayeb Ahmed at King Saud bin Abdulaziz University for Health Sciences.
- The lecture focused on the anatomy of the urinary system.
- Copyright of the material belongs to King Saud bin Abdulaziz University for Health Sciences.
- Any reproduction or communication of the material may be subject to copyright.
Anatomy of Urinary System - Learning Objectives
- Describe the location, relationships, features, and neurovascular supply of the kidneys.
- Describe the relationship of the renal fascia to the kidneys and suprarenal glands.
- Define end artery and explain its significance to segmental arteries of the kidneys.
- Describe the structure, length, course, and relationships of the ureters, including relationship to the peritoneum.
- Describe the locations of the three constriction points along the ureter and their relationship to ureteric colic.
- Describe the location and relationships of the bladder in both sexes, its internal and external features, and neurovascular supply.
- Compare the location and shape of the bladder in newborns and adults, and the relationship of a filling bladder to the overlying peritoneum.
- Understand the range of developmental anomalies related to kidneys, ureters, and bladder development.
- Compare and contrast the urethra in males and females, and describe the location and innervation of the urethral sphincters.
- Compare and contrast the urethra in males and females and describe the location and innervation of the urethral sphincters.
Kidneys - Location
- Location: Retroperitoneal, paravertebral gutters on the posterior upper abdominal wall (retroperitoneal, in paravertebral gutters).
- Surface marking: Epigastric, hypochondrial, lumbar, and umbilical regions.
- Color: Reddish brown.
- Size: Approximately 10 x 5 x 2.5 cm.
- Each kidney has: 2 poles (superior, thicker, rounder), 2 surfaces (anterior, posterior), and 2 borders (medial, lateral).
- Levels: Approximately T12-L3. Right kidney is ½ inch lower than left. Left kidney reaches to the 11th rib; right kidney to the 11th intercostal space.
- Hilum of left kidney lies near the transpyloric plane (L1), approximately 5 cm from the median plane.
- Transpyloric plane passes through the superior pole of the right kidney, which is approximately 5.5 cm lower than the left pole (due to the presence of the liver).
- The inferior pole of the right kidney is approximately a finger's breadth superior to the iliac crest.
Kidneys - External Features, Blood supply
- Renal capsule: Dense, fibrous, glistening appearance, extends into renal sinus.
- Renal hilum: 1 cm long cleft on medial border, through which structures enter/exit; leads to renal sinus.
- Structures passing through hilum include renal artery and vein, renal pelvis, nerves, and lymphatics.
- L renal vein is longer, passes in the angle between SMA and abdominal aorta.
- R renal artery passes behind IVC.
Kidneys - Internal Features
- Renal cortex: light reddish brown, granular appearance.
- Renal columns: extend between renal pyramids.
- Renal medulla: collection of renal pyramids (8-15 average =12).
- Renal pyramids contain collecting tubules that open at renal papillae (apex of pyramid).
- Renal papillae indent each minor calyx which joins to form major calyces, which form the renal pelvis (funnel-shaped) and narrows to form the ureter.
- Renal sinus contains fat, minor and major calyces, renal pelvis, branches of renal arteries, tributaries of renal veins, nerves, and lymphatics.
Kidneys - Posterior Relations
- Superior: Diaphragm separating kidneys from 12th rib and pleura (right kidney) and 11th and 12th rib and pleura (left kidney).
- Inferomedial: Psoas major, Quadratus lumborum.
- Lower Middle: Subcostal nerves and vessels (between kidney and QL), iliohypogastric nerve (between kidney and QL), ilioinguinal nerve (between kidney and QL), Transversus abdominus.
Kidneys - Anterior Relations
- Superomedial: Suprarenal gland (extends to hilum), right lobe of liver (separated by peritoneum), parietal peritoneum (runs as hepatorenal ligament to liver).
- Upper Middle: Potential for injury during laparoscopic nephrectomy. Excessive downward traction on kidney may lead to capsule tear.
- Inferolateral: Right colic (hepatic) flexure/ascending colon, Jejunum.
- Inferomedial: Right colic (hepatic) flexure/ascending colon, Jejunum.
Ureters - Abdominal Part
- Course: Retroperitoneal, almost vertical on psoas major in the abdominal cavity, separated from transverse processes of lumbar vertebrae.
- Relationship to other abdominal structures: central tendon of diaphragm, inferior phrenic artery and plexus, hepatic veins, inferior phrenic artery, inferior vena cava, right suprarenal gland, right and left renal veins, hilum of right and left kidney, subcostal artery and nerve, Transversus abdominus, Quadratus lumborum, iliohypogastric and ilio-inguinal nerves, right and left common iliac arteries, iliacus, lateral cutaneous nerve of thigh, psoas major, femoral nerve, psoas fascia, genitofemoral nerve, external iliac artery and vein.
Ureters - Pelvic Part
Course: Midpoint enters pelvis by crossing bifurcation of common iliac artery in front of sacroiliac joint.
- Extraperitoneal; from pelvic brim, passes posterolaterally on pelvic wall, then medially and anteriorly passes obliquely through posterolateral wall of bladder base.
- Externally ~5cm apart and internally ~2.5cm apart
- Relationship to other pelvic structures: Inferior vena cava, tips of transverse processes of L2-L5 vertebrae, genitofemeral nerve, right and left common iliac artery
Ureters - Pelvic relation in Female
- Laterally: Obturator internus fascia, external iliac vessels, superior vesical artery, obturator nerve and vessels, inferior vesical vein, and middle rectal artery.
- Posteriorly: Internal iliac artery, commencement of anterior trunk of internal iliac artery, lumbosacral trunk, and sacroiliac joint.
- Pelvic relationship to other female structures: posterior to ovarian vessels, inferior to uterine artery.
Ureters - Pelvic Relation in Male
- Laterally: obturator internus fascia, external iliac vessels, superior vesical artery, obturator nerve and vessels, inferior vesical vein, and middle rectal artery.
- Posteriorly: internal iliac artery, commencement of anterior trunk of internal iliac artery, lumbosacral trunk, and sacroiliac joint.
- Relationship to other male structures: inferior to ductus deferens (water under bridge) near base of bladder.
Urinary Bladder - Location, Shape
- Empty bladder in adult: entirely within pelvic cavity
- Empty bladder in newborn: in abdominal cavity
- Normal bladder capacity: 500 ml; desire to void ~250-300 ml
- Shape: boat-shaped when empty, spherical as it fills.
Urinary Bladder - External Features
-
Structure: lined by transitional epithelium, smooth muscle
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Superior surface covered by peritoneum in males only
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The two inferolateral surfaces rest on the pubic bone, and levator ani and obturator internus muscles.
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The base (fundus) faces posteriorly as an inverted triangular shape
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Ureters enter the posterolateral aspect of base; urethra exits inferiorly
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The apex lies anteriorly and connects to the umbilicus via the urachus/median umbilical ligament. The neck (lowest part) is fixed by ligaments (e.g., puboprostatic ligaments in males and pubovesical ligaments in females), and the smooth muscle of the neck forms the sphincter vesicae (internal urethral sphincter).
Urinary Bladder - Internal Features
- Rugae: folds of mucous membrane that disappear with bladder distension.
- Trigone: a triangular area posteriorly between the 2 ureteric orifices and an internal urethral orifice. Triangular area.
- Uvula vesicae (bulge above internal urethral orifice): present only in males
- Internal urethral orifice (commencement of urethra)
- Internal urethral sphincter (superior): between bladder neck and prostate
- External urethral sphincter (inferior): within deep perineal pouch/urogenital diaphragm.
Urethra - Female
- Course: begins at internal urethral orifice, ends at external urethral orifice within the vestibule (space between labia minora). ~4 cm long and distensible.
- Passes anteriorly and inferiorly through pelvic diaphragm.
- External urethral sphincter present.
- Fused with anterior vaginal wall.
Urethra - Male
- Course: begins at internal urethral orifice, ends at external urethral orifice (~20 cm long).
- Parts: Preprostatic urethra (passing through bladder neck), Prostatic urethra (widest and most distensible, with posterior ridge & seminal colliculus (receives ejaculatory ducts)), Membranous urethra (narrowest part; includes external sphincter), & Penile/Spongy urethra (narrowest part in flaccid state).
Arterial Supply of Urinary Bladder
- Superior vesical (males) and vaginal (females) arteries, originating from internal iliac.
- Small branches from obturator and inferior gluteal arteries also contribute.
Venous Supply of Urinary Bladder
- In males, vesical venous plexus communicates with the prostatic plexus, leading to internal iliac vein
- In females, vesical venous plexus communicates with vaginal or uterovaginal venous plexus.
Lymph Drainage of Urinary Bladder
- Internal (base, neck, and posterior) and external iliac drainage, superior and lateral surfaces of urinary bladder
- Lymph from the upper part of the urinary bladder drains to the lateral aortic and iliac nodes.
- Lymph from the middle part of the urinary bladder drains to the common iliac nodes.
- Lymph from the lower part of the urinary bladder drains to the common, external, or internal iliac nodes.
Nerve Supply of Urinary Bladder
- Inferior hypogastric plexuses.
- Sympathetic: from L1 and L2 ganglia.
- Parasympathetic: from S2-S4 segments (visceral afferents).
- Inhibiture contraction of the detrusor muscle which stimulates sphincter vesicae closure; stimulate contraction of detrusor muscle and inhibit sphincter vesicae action.
Kidney Mobility (Nephroptosis)
- Kidney drop, often found in slender individuals.
Ascent of the Kidney
- Kidney movement during respirations
Kidney Trauma
- Injuries that cause kidney damage
Malignant Tumors
- Cancerous growths in the kidneys.
Renal Pain
- Pain in the kidneys (kidney pain)
Renal Abscess
- Pus collection in the kidneys
Tumors (e.g., Wilms Tumor)
- Kidney tumors
Ureters- Obstructions
- Three constriction points for ureters-
- Start (at junction of pelvis and ureter)
- Middle (at pelvic brim).
- End (where ureter joins bladder).
Complications of Prostatic Hyperplasia
- Enlargement of prostate, leading to issues like hydronephrosis, hydroureter, pain, urinary frequency.
Factors in etiology of cystitis (female)
- Infection. Invasion or trauma to urinary tract.
- Descending infection (uterus)
- From neighbouring organs e.g. appendicitis, colorectal disease
- Surgery.
- Urinary tract calculus/stone.
Factors in etiology of cystitis (male)
- Infection. Invasion or trauma to urinary tract.
- Descending infection (uterus)
- From neighbouring organs e.g. appendicitis, colorectal disease
- Surgery.
- Urinary tract calculus/stone.
Urethra - Catheterisation
- Placement of a catheter into the urethra to collect urine or perform related procedures
- Techniques (suprapubic or urethral), steps and considerations for patient safety.
Clinical Notes for Urinary Bladder Stone
- Diagnosis through imaging.
- Can cause obstruction leading to pain & inflammation.
- Staghorn stone: Large, branching stone in the renal pelvis.
Clinical Notes for Urethra Rupture
- Rupture of urethra above perineal membrane.
- Rupture of urethra below perineal membrane.
Micturition
- Young children: simple spinal reflexes
- Adult: cerebral cortex inhibits reflex
- Afferents in pelvic splanchnics; S2-4 micturition centers.
References
- K.L. Moore, A. Dalley: Clinically Oriented Anatomy 9th Ed.
- Netter's Clinical Anatomy
- Netter F: Atlas of Human Anatomy 2nd Ed.
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Description
This quiz explores the anatomical structures and relationships of the right kidney. Questions cover muscles, nerves, and the renal sinus. Test your knowledge of renal anatomy and its surrounding structures.
