Podcast
Questions and Answers
Which of the following structures is not located on the posterior abdominal wall?
Which of the following structures is not located on the posterior abdominal wall?
- Iliacus
- Quadratus lumborum
- Rectus abdominis (correct)
- Psoas minor
The transpyloric plane typically intersects which vertebral level?
The transpyloric plane typically intersects which vertebral level?
- T12
- L2
- L1 (correct)
- L4
Which nerve is not part of the lumbar plexus?
Which nerve is not part of the lumbar plexus?
- Sciatic nerve (correct)
- Iliohypogastric nerve
- Subcostal nerve
- Obturator nerve
At what vertebral level does the hilum of each kidney typically lie?
At what vertebral level does the hilum of each kidney typically lie?
Which of the following structures is an anterior relation of the left kidney?
Which of the following structures is an anterior relation of the left kidney?
Which rib does not relate to the posterior aspect of BOTH kidneys?
Which rib does not relate to the posterior aspect of BOTH kidneys?
The costodiaphragmatic recess extends posterior to the kidneys. During a biopsy of the kidney, what complication might occur if you are not careful?
The costodiaphragmatic recess extends posterior to the kidneys. During a biopsy of the kidney, what complication might occur if you are not careful?
Which characteristic is not associated with the renal capsule?
Which characteristic is not associated with the renal capsule?
Which of the following structures is located within the renal medulla?
Which of the following structures is located within the renal medulla?
Which structure is located most anteriorly at the hilum of the kidney?
Which structure is located most anteriorly at the hilum of the kidney?
Which statement is accurate regarding the renal arteries?
Which statement is accurate regarding the renal arteries?
Which of the following is not a typical point of constriction in the ureter?
Which of the following is not a typical point of constriction in the ureter?
Visceral afferent pain fibers from the ureter return to which spinal cord levels?
Visceral afferent pain fibers from the ureter return to which spinal cord levels?
What would you expect to see on a plain X-ray film of kidney stones that consist of Calcium Oxalate?
What would you expect to see on a plain X-ray film of kidney stones that consist of Calcium Oxalate?
What type of anomaly is vesico-ureteric reflux related to?
What type of anomaly is vesico-ureteric reflux related to?
According to the Weigert-Meyer rule, in a duplex collecting system, where does the upper pole ureter typically insert in relation to the lower pole ureter?
According to the Weigert-Meyer rule, in a duplex collecting system, where does the upper pole ureter typically insert in relation to the lower pole ureter?
Which statement about lymphatic drainage of the kidneys is correct?
Which statement about lymphatic drainage of the kidneys is correct?
Which of the following is not a clinical presentation resulting from dysfunction of the outer cortex of the adrenal gland?
Which of the following is not a clinical presentation resulting from dysfunction of the outer cortex of the adrenal gland?
The ureters descend retroperitoneally along which anatomical structure?
The ureters descend retroperitoneally along which anatomical structure?
The left suprarenal vein drains directly into which vessel?
The left suprarenal vein drains directly into which vessel?
Which of the following is a potential cause of hydronephrosis due to a clinical scenario that can cause reflux?
Which of the following is a potential cause of hydronephrosis due to a clinical scenario that can cause reflux?
A patient presents with a kidney stone lodged in the ureter. Where would the pain most likely be referred?
A patient presents with a kidney stone lodged in the ureter. Where would the pain most likely be referred?
What structure is most closely associated with the outer cortex of the kidneys?
What structure is most closely associated with the outer cortex of the kidneys?
Where does the left renal vein pass to reach the inferior vena cava?
Where does the left renal vein pass to reach the inferior vena cava?
What type of tissue lines the ureters, allowing them to stretch and distend?
What type of tissue lines the ureters, allowing them to stretch and distend?
Which vessel is the most likely source of the inferior suprarenal artery?
Which vessel is the most likely source of the inferior suprarenal artery?
Damage to a single segmental artery of the kidney is most likely to result in:
Damage to a single segmental artery of the kidney is most likely to result in:
Which option correctly lists the structures located anterior to the right kidney, from superior to inferior?
Which option correctly lists the structures located anterior to the right kidney, from superior to inferior?
Which structure is located in the perinephric space?
Which structure is located in the perinephric space?
Which of the following nerves is most closely associated with the medial aspect of the psoas muscle?
Which of the following nerves is most closely associated with the medial aspect of the psoas muscle?
You are reviewing a CT scan and note that the patient has a retroaortic left renal vein. This variant increases the risk of which condition?
You are reviewing a CT scan and note that the patient has a retroaortic left renal vein. This variant increases the risk of which condition?
A patient is diagnosed with a tumor in the renal pelvis. Which lymph nodes would most likely be involved in the initial spread of the tumor?
A patient is diagnosed with a tumor in the renal pelvis. Which lymph nodes would most likely be involved in the initial spread of the tumor?
Which statement BEST describes the path of the ureter in the pelvis?
Which statement BEST describes the path of the ureter in the pelvis?
Following a traumatic injury, a patient is found to have a complete transection of the right ureter at the level of the pelvic brim. What other structure is also likely to be damaged?
Following a traumatic injury, a patient is found to have a complete transection of the right ureter at the level of the pelvic brim. What other structure is also likely to be damaged?
A surgeon is performing a nephrectomy (kidney removal) and needs to ligate the renal vessels. What is the MOST common branching pattern to expect?
A surgeon is performing a nephrectomy (kidney removal) and needs to ligate the renal vessels. What is the MOST common branching pattern to expect?
Which of the congenital abnormalities of the genitourinary system is related to the upper pole ureter being ectopic?
Which of the congenital abnormalities of the genitourinary system is related to the upper pole ureter being ectopic?
Which of the following accurately describes the location of the kidneys in relation to the peritoneum?
Which of the following accurately describes the location of the kidneys in relation to the peritoneum?
Which of the following statements about the adrenal glands is TRUE?
Which of the following statements about the adrenal glands is TRUE?
The hilum lies on the medial margin of each kidney. What vertebral level is the hilum of the left kidney located?
The hilum lies on the medial margin of each kidney. What vertebral level is the hilum of the left kidney located?
Which vessel is not part of the blood supply to the ureter?
Which vessel is not part of the blood supply to the ureter?
A patient presents with a ureteric stone. What is not somewhere that you would expect the ureter to be constricted at?
A patient presents with a ureteric stone. What is not somewhere that you would expect the ureter to be constricted at?
A patient with a known history of kidney stones presents to the emergency department with excruciating flank pain. Imaging reveals a ureteric stone at the pelvic brim. Which anatomical relationship BEST explains the pain referral pattern in this patient?
A patient with a known history of kidney stones presents to the emergency department with excruciating flank pain. Imaging reveals a ureteric stone at the pelvic brim. Which anatomical relationship BEST explains the pain referral pattern in this patient?
During a radiological imaging review, you observe a patient with a duplex collecting system and infer that they follow the Weigert-Meyer rule. Considering this congenital anomaly, which of the following is the MOST likely anatomical outcome?
During a radiological imaging review, you observe a patient with a duplex collecting system and infer that they follow the Weigert-Meyer rule. Considering this congenital anomaly, which of the following is the MOST likely anatomical outcome?
A 50-year-old male undergoes a surgical procedure requiring ligation of the right renal artery. Postoperatively, the patient develops a localized area of ischemic necrosis in the kidney. Given the anatomical characteristics of the renal arterial supply, which statement BEST explains this outcome?
A 50-year-old male undergoes a surgical procedure requiring ligation of the right renal artery. Postoperatively, the patient develops a localized area of ischemic necrosis in the kidney. Given the anatomical characteristics of the renal arterial supply, which statement BEST explains this outcome?
A patient is diagnosed with Waterhouse-Friderichsen syndrome due to adrenal gland haemorrhage. Considering the anatomical location and function of the adrenal glands, which of the following complications is LEAST likely?
A patient is diagnosed with Waterhouse-Friderichsen syndrome due to adrenal gland haemorrhage. Considering the anatomical location and function of the adrenal glands, which of the following complications is LEAST likely?
During a nephrectomy, the surgeon must carefully consider the relationships of the surrounding structures to avoid iatrogenic injury. Which of the following statements accurately describes the anatomical relationships of the left kidney?
During a nephrectomy, the surgeon must carefully consider the relationships of the surrounding structures to avoid iatrogenic injury. Which of the following statements accurately describes the anatomical relationships of the left kidney?
Which of the following structures is located at the same vertebral level as the transpyloric plane?
Which of the following structures is located at the same vertebral level as the transpyloric plane?
A patient is undergoing a procedure near the posterior abdominal wall. Which muscle is LEAST likely to be encountered?
A patient is undergoing a procedure near the posterior abdominal wall. Which muscle is LEAST likely to be encountered?
Which nerve of the lumbar plexus is located lateral to the psoas major muscle?
Which nerve of the lumbar plexus is located lateral to the psoas major muscle?
With respect to surface anatomy, which of the following statements accurately describes the typical position of the kidneys?
With respect to surface anatomy, which of the following statements accurately describes the typical position of the kidneys?
Which of the following muscles is directly posterior to the kidneys?
Which of the following muscles is directly posterior to the kidneys?
During a surgical procedure, a surgeon must consider the structures posterior to the superior pole of the kidneys. Which structure is of primary concern?
During a surgical procedure, a surgeon must consider the structures posterior to the superior pole of the kidneys. Which structure is of primary concern?
The renal capsule provides protection for the kidney. Which is a characteristic of the renal capsule?
The renal capsule provides protection for the kidney. Which is a characteristic of the renal capsule?
A researcher is studying the microscopic anatomy of the kidney. Which structure would they expect to find within the renal medulla?
A researcher is studying the microscopic anatomy of the kidney. Which structure would they expect to find within the renal medulla?
When viewing the hilum of the kidney from anterior to posterior, how are the structures typically arranged?
When viewing the hilum of the kidney from anterior to posterior, how are the structures typically arranged?
Which statement accurately describes a key difference between the right and left renal arteries?
Which statement accurately describes a key difference between the right and left renal arteries?
A surgeon is navigating the ureter during a complex abdominal surgery. At which location is the ureter LEAST likely to be constricted?
A surgeon is navigating the ureter during a complex abdominal surgery. At which location is the ureter LEAST likely to be constricted?
A patient reports pain originating from a ureteric stone. Visceral afferent pain fibers from the ureter would be expected to return to which spinal cord levels?
A patient reports pain originating from a ureteric stone. Visceral afferent pain fibers from the ureter would be expected to return to which spinal cord levels?
A urologist is reviewing X-ray images for kidney stones. Which type of kidney stone is LEAST likely to be visible on a plain X-ray film?
A urologist is reviewing X-ray images for kidney stones. Which type of kidney stone is LEAST likely to be visible on a plain X-ray film?
A pediatric urologist is evaluating a child with recurrent urinary tract infections. The diagnostic workup reveals vesico-ureteric reflux. What is the MOST likely underlying cause of this condition?
A pediatric urologist is evaluating a child with recurrent urinary tract infections. The diagnostic workup reveals vesico-ureteric reflux. What is the MOST likely underlying cause of this condition?
In a complete duplex collecting system following the Weigert-Meyer rule, where would you expect the upper pole ureter to insert in relation to the lower pole ureter?
In a complete duplex collecting system following the Weigert-Meyer rule, where would you expect the upper pole ureter to insert in relation to the lower pole ureter?
A patient undergoes a nephrectomy, and during the procedure, the surgeon notes the lymphatic drainage pathways. Where does the kidney primarily drain lymphatically?
A patient undergoes a nephrectomy, and during the procedure, the surgeon notes the lymphatic drainage pathways. Where does the kidney primarily drain lymphatically?
Which of the following is an expected clinical presentation associated with adrenal cortex dysfunction?
Which of the following is an expected clinical presentation associated with adrenal cortex dysfunction?
As the ureters descend from the kidneys to the bladder, along which anatomical structure do they travel retroperitoneally?
As the ureters descend from the kidneys to the bladder, along which anatomical structure do they travel retroperitoneally?
The left suprarenal vein has a specific drainage pattern that is clinically significant. Into which vessel does the left suprarenal vein directly drain?
The left suprarenal vein has a specific drainage pattern that is clinically significant. Into which vessel does the left suprarenal vein directly drain?
A patient is diagnosed with hydronephrosis due to an obstruction at the ureteropelvic junction. Which of the following is the most likely cause of this?
A patient is diagnosed with hydronephrosis due to an obstruction at the ureteropelvic junction. Which of the following is the most likely cause of this?
A patient presents with severe flank pain due to a ureteric stone. If the stone is located in the mid-ureter, where would you expect the pain to radiate?
A patient presents with severe flank pain due to a ureteric stone. If the stone is located in the mid-ureter, where would you expect the pain to radiate?
When examining the kidneys, which structure is most intimately associated with the outer cortex?
When examining the kidneys, which structure is most intimately associated with the outer cortex?
A surgical team is planning a procedure involving the abdominal aorta and its major branches. Where does the left renal vein pass in relation to the aorta and the superior mesenteric artery (SMA)?
A surgical team is planning a procedure involving the abdominal aorta and its major branches. Where does the left renal vein pass in relation to the aorta and the superior mesenteric artery (SMA)?
The ureters are lined by a specialized type of epithelium that allows for distension as urine passes through. What type of tissue is this?
The ureters are lined by a specialized type of epithelium that allows for distension as urine passes through. What type of tissue is this?
Which of the following vessels is the MOST common origin of the inferior suprarenal artery?
Which of the following vessels is the MOST common origin of the inferior suprarenal artery?
A patient experiences a blockage in one of the segmental arteries of the kidney. What is the MOST likely outcome, given the nature of renal arterial supply?
A patient experiences a blockage in one of the segmental arteries of the kidney. What is the MOST likely outcome, given the nature of renal arterial supply?
List the structures located anterior to the right kidney from superior to inferior?
List the structures located anterior to the right kidney from superior to inferior?
Which of the following anatomical spaces contains the kidneys and adrenal glands?
Which of the following anatomical spaces contains the kidneys and adrenal glands?
Which nerve is closely associated with the medial aspect of the psoas muscle and could be at risk during surgical procedures in that area?
Which nerve is closely associated with the medial aspect of the psoas muscle and could be at risk during surgical procedures in that area?
A patient is diagnosed with a retroaortic left renal vein during radiological imaging. What is a potential clinical consequence of this anatomical variation?
A patient is diagnosed with a retroaortic left renal vein during radiological imaging. What is a potential clinical consequence of this anatomical variation?
If a tumor originates in the renal pelvis, which lymph nodes are MOST likely to be the initial site of metastasis?
If a tumor originates in the renal pelvis, which lymph nodes are MOST likely to be the initial site of metastasis?
Which statement BEST describes the course of the ureter in the male pelvis?
Which statement BEST describes the course of the ureter in the male pelvis?
During a surgical resection of the ureter near the pelvic brim, which other structure is MOST at risk of iatrogenic injury?
During a surgical resection of the ureter near the pelvic brim, which other structure is MOST at risk of iatrogenic injury?
A surgeon is preparing to perform a nephrectomy. What arterial branching pattern is MOST commonly encountered?
A surgeon is preparing to perform a nephrectomy. What arterial branching pattern is MOST commonly encountered?
Which congenital abnormality of the genitourinary tract is MOST likely associated with an ectopic (abnormally located) ureteral orifice?
Which congenital abnormality of the genitourinary tract is MOST likely associated with an ectopic (abnormally located) ureteral orifice?
Which statement BEST describes the relationship of the kidneys to the peritoneum?
Which statement BEST describes the relationship of the kidneys to the peritoneum?
Regarding the adrenal glands, which statement is TRUE?
Regarding the adrenal glands, which statement is TRUE?
Which area does the kidney drain lymphatically?
Which area does the kidney drain lymphatically?
Where would a kidney stone NOT likely be constricted?
Where would a kidney stone NOT likely be constricted?
A patient presents with a ureteric stone and is experiencing pain. Where can pain from the ureter be referred to?
A patient presents with a ureteric stone and is experiencing pain. Where can pain from the ureter be referred to?
Consider a patient with a duplex collecting system and infer that they follow the Weigert-Meyer rule. What is likely the anatomical outcome?
Consider a patient with a duplex collecting system and infer that they follow the Weigert-Meyer rule. What is likely the anatomical outcome?
A patient undergoes surgical ligation of the right renal artery. Postoperatively, the patient develops a localized area of ischemic necrosis in the kidney. What best explains this?
A patient undergoes surgical ligation of the right renal artery. Postoperatively, the patient develops a localized area of ischemic necrosis in the kidney. What best explains this?
With the diagnosis of Waterhouse-Friderichsen, what complications is LEAST likely?
With the diagnosis of Waterhouse-Friderichsen, what complications is LEAST likely?
A patient is diagnosed with a kidney tumor. Understanding the renal fascia's role in staging cancer, which of the following statements BEST describes its significance?
A patient is diagnosed with a kidney tumor. Understanding the renal fascia's role in staging cancer, which of the following statements BEST describes its significance?
During a surgical approach to the posterior abdominal wall, a medical student is asked to identify a nerve that runs laterally alongside the psoas major muscle. Which of the following nerves is MOST likely being referenced?
During a surgical approach to the posterior abdominal wall, a medical student is asked to identify a nerve that runs laterally alongside the psoas major muscle. Which of the following nerves is MOST likely being referenced?
A patient presents with left flank pain radiating to the groin. Imaging reveals a ureteric stone. Considering common sites of ureteric constriction, at which location is the stone MOST likely to be lodged?
A patient presents with left flank pain radiating to the groin. Imaging reveals a ureteric stone. Considering common sites of ureteric constriction, at which location is the stone MOST likely to be lodged?
A surgeon is planning to ligate the renal arteries during a nephrectomy (kidney removal). Knowing the anatomical variations of the renal arteries, which of the following is the MOST important consideration?
A surgeon is planning to ligate the renal arteries during a nephrectomy (kidney removal). Knowing the anatomical variations of the renal arteries, which of the following is the MOST important consideration?
During a radiological review, a duplex collecting system is identified in a young patient presenting with recurrent UTIs. Assuming the Weigert-Meyer rule applies, what associated anatomical outcome is MOST likely?
During a radiological review, a duplex collecting system is identified in a young patient presenting with recurrent UTIs. Assuming the Weigert-Meyer rule applies, what associated anatomical outcome is MOST likely?
Flashcards
Osteology of the Posterior Abdominal Wall
Osteology of the Posterior Abdominal Wall
Five lumbar vertebrae, sacrum, pelvic bones, ribs (11-12)
Muscles of the Posterior Abdominal Wall
Muscles of the Posterior Abdominal Wall
Psoas major and minor, quadratus lumborum, iliacus
Transpyloric plane
Transpyloric plane
Located at L1, 1/2 way from suprasternal notch to symphysis pubis (1/2 way from xiphoid to umbilicus)
Structures at the Transpyloric Plane
Structures at the Transpyloric Plane
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Lumbar plexus formation
Lumbar plexus formation
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Nerves Lateral to Psoas Major
Nerves Lateral to Psoas Major
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Nerves Medial to Psoas Major
Nerves Medial to Psoas Major
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Nerves Through Psoas Major
Nerves Through Psoas Major
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Kidney Position
Kidney Position
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Anterior Relations of the Right Kidney
Anterior Relations of the Right Kidney
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Anterior Relations of the Left Kidney
Anterior Relations of the Left Kidney
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Posterior relations of the kidneys
Posterior relations of the kidneys
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Posterior Rib Relations of Kidneys
Posterior Rib Relations of Kidneys
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Diaphragm and kidneys
Diaphragm and kidneys
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Renal capsule
Renal capsule
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Adipose capsule
Adipose capsule
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Renal (Gerota's) fascia
Renal (Gerota's) fascia
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Renal cortex
Renal cortex
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Renal medulla
Renal medulla
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Minor calyx
Minor calyx
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Major calyx
Major calyx
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Renal pelvis
Renal pelvis
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Hilum of the kidney
Hilum of the kidney
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Structures at the Hilum
Structures at the Hilum
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Renal Arteries
Renal Arteries
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Renal Veins
Renal Veins
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Renal artery division
Renal artery division
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Ureters
Ureters
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Ureter start
Ureter start
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Ureters course
Ureters course
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Ureters end
Ureters end
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Blood supply to the ureters
Blood supply to the ureters
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Ureter lining
Ureter lining
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Ureters innervation
Ureters innervation
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Ureters on X-ray
Ureters on X-ray
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Vesico-Ureteric Reflux (VUR)
Vesico-Ureteric Reflux (VUR)
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Causes of Vesico-Ureteric Reflux
Causes of Vesico-Ureteric Reflux
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Hydronephrosis
Hydronephrosis
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Bifid collecting system
Bifid collecting system
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Duplex systems
Duplex systems
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Weigert-Meyer Rule
Weigert-Meyer Rule
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Kidney Congenital Anomalies
Kidney Congenital Anomalies
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Adrenal Gland position
Adrenal Gland position
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Adrenal Cortex regulation
Adrenal Cortex regulation
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Adrenal Medulla
Adrenal Medulla
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Medial of Left Adrenal Gland
Medial of Left Adrenal Gland
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Medial relation of Right Adrenal Gland
Medial relation of Right Adrenal Gland
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Lateral to the Right Adrenal Gland
Lateral to the Right Adrenal Gland
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Renal (Gerota's) Fascia importance
Renal (Gerota's) Fascia importance
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Renal pyramids
Renal pyramids
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Hilum Definition
Hilum Definition
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Ureteropelvic junction
Ureteropelvic junction
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Second constriction of ureter
Second constriction of ureter
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Third constriction of ureter
Third constriction of ureter
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Visceral efferents
Visceral efferents
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Visceral afferents pain
Visceral afferents pain
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Kidney stone composition
Kidney stone composition
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Calcium stones on X-ray
Calcium stones on X-ray
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First constriction of ureter
First constriction of ureter
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Weigert-Meyer Rule definition
Weigert-Meyer Rule definition
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Adrenal glands function
Adrenal glands function
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Lateral of Left Adrenal Gland
Lateral of Left Adrenal Gland
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Pelvic brim crossing definition
Pelvic brim crossing definition
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Subcostal vessels and nerves
Subcostal vessels and nerves
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Study Notes
Learning Outcomes
- Describe the anatomy of the kidney, adrenal gland and surrounding tissues.
- Describe the anatomy of the ureters, including course, innervation and blood supply.
- Discuss urinary calculi, including their clinical presentation and consequences.
- Identify the kidney, adrenal gland, and ureter on radiological imaging.
- Understand the main congenital abnormalities that may occur in the renal system like horseshoe kidney, vesico-ureteric reflux, and duplex ureter.
Posterior Abdominal Wall - Osteology
- The posterior abdominal wall includes the five lumbar vertebrae, sacrum, pelvic bones, and ribs 11-12.
Posterior Abdominal Wall - Muscles
- The muscles of the posterior abdominal wall are the psoas major and minor, quadratus lumborum, and iliacus.
Transpyloric Plane
- The transpyloric plane passes through L1.
- It is found halfway from the suprasternal notch to the symphysis pubis, or halfway from the xiphoid to the umbilicus.
- The linea semilunaris cuts the costal margin at the 9th costal cartilage at this level.
- Other structures typically at this level include the fundus of the gallbladder, pylorus of the stomach, first part of the duodenum, neck of the pancreas, portal vein formation, and superior mesenteric artery origin.
- Hila of kidneys are at this level, with the left kidney's hilum higher than the right.
- The hilum of the spleen is also at this level.
Nerves of the Posterior Abdominal Wall
- The lumbar plexus is formed by the anterior rami of L1-3 (L4) with a contribution from T12.
- Lateral to the psoas are the subcostal nerve (T12), ilio-hypogastric nerve (L1), ilio-inguinal nerve (L1), lateral cutaneous nerve of the thigh (L2-3), and femoral nerve (L2-4).
- Medial to the psoas are the obturator nerve (L2-4) and lumbosacral trunk (L4-5).
- The genitofemoral nerve (L1-2) passes through the psoas.
Surface Anatomy and Position of Kidneys
- Kidneys are bean-shaped and are located in the posterior abdominal region, retroperitoneal, and lateral to the vertebral column.
- They extend from approximately the T12 vertebra to the L3 vertebra.
- The right kidney is typically lower than the left.
- The hilum of each kidney is located around L1.
Anterior Relations of the Kidneys
- The right kidney is anterior to the right adrenal gland, liver, peritoneum, right colic flexure, and duodenum.
- The left kidney is anterior to the left adrenal gland, stomach, spleen, pancreas, left colic flexure, and descending colon.
Posterior Relations of the Kidneys
- The muscles of the posterior abdominal wall are the psoas, quadratus lumborum, and transversus abdominis.
- The left kidney is adjacent to the 11th and 12th ribs.
- The right kidney is adjacent to the 12th rib.
- Subcostal vessels and nerves, along with the iliohypogastric and ilioinguinal nerves, also relate posteriorly.
Diaphragm - Relation to Kidneys
- The diaphragm is posterior to the superior pole of the kidneys.
- The pleural sacs and the costodiaphragmatic recesses extend posterior to the kidneys.
- Biopsies in this region must be done carefully to avoid causing pneumothorax.
Fascia of the Kidney
- The renal capsule adheres directly to the surface of the kidney and prevents infections in surrounding regions from spreading.
- The adipose capsule cushions the kidney and helps attach it to the body wall.
- Perinephric fat immediately outside the renal capsule completely surrounds the kidney.
- Paranephric fat is posterior and posterolateral to each kidney.
- The renal (Gerota’s) fascia is a dense fibrous connective tissue that anchors the kidney and is important for determining the stage of renal cancer.
- The suprarenal glands are also enclosed in this fascial compartment, typically separated from the kidneys by a thin septum.
Internal Anatomy of the Kidney
- The renal cortex is a band of pale tissue that surrounds the renal medulla and extends between pyramids and forms renal columns.
- The renal medulla is the inner portion of the kidney which is divided into triangular-shaped tissue - the renal pyramids - with bases directed outward and apices projecting inward.
- The apical projection (renal papilla) contains the openings of the papillary ducts and is surrounded by a minor calyx.
- Minor calyces receive urine from the papillary ducts.
- Major calyces are formed by the unification of several minor calyces.
- The renal pelvis is the funnel-shaped superior end of the ureters formed by the unification of 2-3 major calices.
Hilum of the Kidney
- The hilum is a deep vertical slit on the medial margin of each kidney, serving as the entry and exit point for renal vessels, lymphatics, and nerves.
- The vein is anterior, the artery is middle, and the ureter is posterior.
- Renal arteries arise around L1-L2.
- The left renal artery usually arises a little higher than the right.
- The right renal artery is longer and passes posterior to the inferior vena cava (IVC).
- The left renal vein is longer and passes between the abdominal aorta and the superior mesenteric artery (SMA).
Renal Arteries
- Each renal artery divides into anterior and posterior branches.
- The branches are end arteries that do not form anastomoses.
- Trauma or obstruction in one arterial branch can lead to ischaemia and necrosis of the renal parenchyma supplied by that vessel.
Ureters - General Info
- The ureters are muscular tubes that transport urine from the kidneys to the bladder.
- The ureter starts at the renal pelvis and carries urine from renal pelvis to the bladder.
- They descend inferiorly and medially by ~30cm.
- The renal pelvis narrows as it passes inferiorly through the hilum of the kidney and becomes continuous with the ureter as it exits the kidney
- Ureters descend retroperitoneally on the medial aspect of the psoas major muscle and along tips of transverse processes of L1-L5 vertebrae.
- At the pelvic brim, the ureters cross either the end of the common iliac artery or the beginning of the external iliac artery and enter the pelvic cavity.
- They enter the bladder at the level of the ischial spine.
Ureter - Relations
- In males, the ureter is crossed by the vas deferens.
- In females, the ureter is crossed by the uterine artery.
Ureters - Constrictions
- Ureters are constricted at three points: the ureteropelvic junction; where the ureters cross the pelvic brim; and where the ureters enter the wall of the bladder.
Ureters - Blood Supply, Histology, and Innervation
- Blood supply comes from the renal, gonadal and common iliac arteries, internal iliac artery and its branches, and the abdominal aorta.
- Histologically, the ureters are made of transitional epithelium that is waterproof and distensible.
- Innervation: via the renal, aortic, superior hypogastric, and inferior hypogastric plexuses.
- Visceral efferents are both sympathetic and parasympathetic.
- Visceral afferents return to T11 to L2 spinal cord level.
- Pain is referred to cutaneous areas supplied by T11 to L2 (posterior and lateral abdominal wall and genitals, 'loin to groin' pain).
Ureteric Calculi
- The ureters can be identified along the tips of the L1-L5 transverse processes and the sacroiliac joint on x-ray.
- Kidney stones (urinary calculi) are commonly made of calcium oxalate +/- phosphate, and should appear on a plain X-Ray film.
- Others can be made of urate, cystine, and struvite that may not appear on a plain X-Ray film.
Vesico-Ureteric Reflux
- Vesico-ureteric reflux is the retrograde flow of urine from the bladder to the ureter or kidney.
- Primary VUR is congenital, where the intramural region of the ureter is too short and there’s no valve effect.
- Secondary VUR is due to high pressure voiding states, posterior urethral valves, or neuropathic bladder, and duplex collecting system.
- Associated with recurrent UTIs.
Hydronephrosis
- Hydronephrosis is the distention and dilatation of the renal pelvis & calyces.
- Clinical scenarios that can cause reflux include an aberrant renal artery crossing over the ureteropelvic junction, stone, enlarged prostate, pregnancy and cancer of the cervix.
Bifid Collecting System
- This adds complexity to upper pole obstruction, calculi and reflux disease.
- The Weigert-Meyer Rule applies to duplex collecting systems where, the upper pole ureter is the ectopic ureter, and its orifice inserts inferomedially in the bladder in relationship to the lower pole normal ureter.
Kidney Defects
- Kidney defects include pelvic kidney, horseshoe kidney, and duplex collecting ducts.
Adrenal Glands - General Info
- Lie immediately superior and anterior to the superior pole of each kidney, but are functionally unrelated to them.
- The adrenal glands are surrounded by perinephric fat and enclosed by renal fascia.
- They consist of an outer cortex and inner medulla.
- The cortex is regulated by the pituitary, hypothalamus and renin-angiotensin axis.
- Medulla - Contains chromaffin cells to produce adrenaline and noradrenaline (catecholamines)
- Clinical conditions include Cushing's Syndrome, Conn's Disease, Addison's Disease, Phaeochromocytoma, and Waterhouse Friderichsen.
Adrenal Glands - Relations
- Medially, the left adrenal is adjacent to the coeliac trunk and left crus of diaphragm.
- Laterally, the left adrenal is adjacent to the medial kidney aspect & upper pole and renal hilum.
- Anteriorly, it’s adjacent to the lesser sac and stomach.
- Posteriorly, it's adjacent to the diaphragm
- The right adrenal is medially close to the inferior vena cava, laterally to the upper renal pole, anteriorly to the bare area of the liver, and posteriorly to the diaphragm.
Adrenal Glands - Blood Supply
- The blood supply comes from 3 main sources: superior suprarenal arteries (via inferior phrenic artery), middle suprarenal artery (directly from abdominal aorta), and inferior suprarenal arteries (via renal artery).
- The venous drainage is via the suprarenal vein.
- The right suprarenal vein is short and drains directly into the IVC which the left drains into the left renal vein.
Lymphatic Drainage
- The kidney lymphatic drainage is to lumbar nodes around the origin of the renal artery
- The upper ureter drains to lumbar nodes.
- The middle ureter drains to common iliac nodes.
- The inferior ureter drains to external and internal iliac nodes.
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Description
Learn about the anatomy of the kidney, adrenal gland, and ureters, including their surrounding tissues, course, innervation, and blood supply. Also, learn about urinary calculi, their clinical presentation and consequences. Identify these structures on radiological imaging and understand congenital abnormalities in the renal system.
![[OS 206] E03-T02-Kidney, Ureter, and Bladder Anatomy_compressed](https://images.unsplash.com/photo-1618939279360-762c59d86c4f?crop=entropy&cs=srgb&fm=jpg&ixid=M3w0MjA4MDF8MHwxfHNlYXJjaHwyfHxraWRuZXklMjBhbmF0b215JTJDJTIwcmVuYWwlMjBwaHlzaW9sb2d5JTJDJTIwZXhjcmV0b3J5JTIwc3lzdGVtJTJDJTIwYW5hdG9teXxlbnwxfDB8fHwxNzQwNDg1ODkyfDA&ixlib=rb-4.0.3&q=85&w=300&fit=crop&h=200&q=75&fm=webp)
