Anatomy (Renal Module)

Front 1

Shape of kidney

Back 1

Bean-shaped

Hint 1

Front 2

Length of kidney

Back 2

4.5 inch

Front 3

Breadth of kidney

Back 3

2.5 inch

Front 4

Thickness of kidney

Back 4

1.5 inch

Front 5

weight of kidney

Back 5

150 grams

Front 6

Position of kidney

Back 6

Retroperitoneal

Front 7

In supine position, kidney extend from? To?

Back 7

From T12 superiorly to L3 inferiorly

Front 8

Anterior relation of right kidney

Back 8

1) Small intestine impression of jejunum

2) Right colic flexure impression of Colon

3) Hepatic impression of liver

4) Suprarenal impression of suprarenal glands

5) Duodenal impression of duodenum

Hint 8

Saya Cakap Henry Suka Drugs

Front 9

Posterior relation of left & right kidneys

Back 9

Front 10

Peritoneal covering of anterior surface of right kidney

Back 10

1) Hepatic surface

2) Small intestine area

Except: Suprarenal surface, duodenal surface, and colic surface (SDC)

Front 11

Peritoneal covering of anterior surface of left kidney

Back 11

1) Small intestine area

2) Spleenic surface

3) Gastric surface

Except: suprarenal surface, pancreatic area, descending colic area (SPC)

Hint 11

3

Front 12

Covering of kidney

Back 12

1) Fibrous capsule

2) Perirenal fat

3) Renal fascia (Zuckercandle)

4) Paranephoic fat

Front 13

Fibrous capsule of covering of kidney

Back 13

→ innermost covering

→ surrounds kidney

→ continues to renal sinus

Front 14

Perirenal fat covering of kidney

Back 14

→ covers fibrous capsule

→ acts as cushion

→ helps to hold kidney in relatively fixed position

→ rapid loss fat can causes renal ptosis (kidney displacement)

Front 15

Renal fascia (Zuckercandle) covering of Kidney

Back 15

→ condensation of connective tissue

→ lies outside perirenal fat

→ encloses kidneys and suprarenal glands

→ continuous laterally with fascia transversalis

Front 16

Paranephric fat of covering of kidney

Back 16

→ lies external to renal fascia

→ contains a large quantity of fat

→ forms part of retroperitoneal fat

Front 17

Which covering of kidney continuous laterally with fascia transversalis?

Back 17

Renal fascia ( Zuckercandle fascia)

Front 18

Which loss of covering of kidney causes renal ptosis or kidney displacement?

Back 18

Perirenal fat

Front 19

Which covering of kidney surround kidney and continues to renal sinus?

Back 19

Fibrous capsule

Front 20

Which covering of kidney form part of retroperitoneal fat?

Back 20

Paranephric fat

Front 21

Blood supply of kidney

Back 21

1) Renal artery

2) Renal vein

Front 22

Renal artery arises from

Back 22

Abdominal aorta at level Of L2.

Each renal artery usually divides into 5 segmental arteries

Front 23

Renal vein emerges from? And drains into?

Back 23

Renal veins emerge from the hilum in front of the renal artery and drain into inferior vena cava

Front 24

Left renal vein also receive from?

Back 24

1) Left adrenal vein

2) Branch of inferior phrenic vein

3) Left gonadal vein

Front 25

Lymphatic drainage of kidney

Back 25

Pass to para-aortic lymph nodes

Front 26

Function of ureters

Back 26

Two muscular tubes whose peristaltic contractions convey urine from kidneys to urinary bladder

Front 27

Length of ureters

Back 27

Each one about 25 to 30 cm

Front 28

Thickness of ureters

Back 28

Thick-walled and narrow lumen, with 3mm diameter

Front 29

Beginning of ureters

Back 29

Funnel-shaped renal pelvis, which lies within the hilum of kidney at level of L1

Front 30

Termination of ureters

Back 30

At posto-superior angles of base of urinary bladder

Front 31

Course of Ureters

Back 31

1) In front psoas major muscle

2) Birfurcation of common iliac artery

3) Internal iliac artery

4) At Ievel of ischial spine

Front 32

How to identify ureters in computerized tomography (CT) of abdomen?

Back 32

By the relation of psoas major muscle

Front 33

Ureter has three parts which are:

Back 33

1) Abdominal part

2) Pelvic part

3) Intramural part

Front 34

Posterior relation of abdominal part of left and right ureter

Back 34

1) Median border of psoas major and minor muscles

2) Tips of transverse processes of L2,3,4,5

3) Genito-femoral nerve

Front 35

Anterior relation of abdominal part of right ureter

Back 35

1) 2nd, 3rd parts of duodenum

2) Three vessels : right colic vessels, right ileo colic vessels, right gonadal vessels

3) Three mesenteric related structures: root of mesentery, superior mesenteric vessels, coils of small intestine

Front 36

Anterior relation of abdominal part of left ureter

Back 36

1) Three vessels : left colic vessels, sigmoidal vessels and left gonadal vessels

2) Apex of sigmoid mesocolon

3) Coils of pelvic colon

Front 37

Medial relation of abdominal part of right ureter

Back 37

Inferior vena cava

Front 38

MediaI part of abdominal part of left ureter

Back 38

Inferior Mesenteric vein

Front 39

Relation of pelvic part of ureter

Back 39

1) External iliac artery and vein

2) Obturator nerve

3) Obturator artery

4) Obturator vein

Hint 39

3OE

Front 40

Relation of Pelvic part of ureter in male

Back 40

Ureter is crossed by vas deferens

Front 41

Relation of pelvic part of ureter in female

Back 41

The ureter passes above lateral fornix of vagina

Front 42

Why the relation between Ureter and ovarian and Uterine blood vessels is very important in female?

Back 42

During Oophorectomy (removal of ovary) and hysterectomy (removal of uterus). To remove any organ from body, you have to ligate (tie) its blood supply. If ureters accidentally ligated with blood vessels, it will result in post-operative renal impairment, Which require immediate surgical intervention to relieve ligature from ureters

Front 43

Intramural part of ureter

Back 43

The ureters pierce the postro-superior angles of the base of the urinary bladder and run obliquely through its wall for a distance of 1.5–2.0 cm before opening at the ureteric orifices

Front 44

Importance of arrangement in intramural part of ureter

Back 44

To prevent the reflux of urine into ureter when the bladder is full, since intramural ureters are thought to be occluded during increases in bladder pressure at time of micturition.

Front 45

Three normal constructions of Ureter course⁷

Back 45

1) At pelvic-ureteric ajunction

2) At bifurcation of common iliac artery

3) At utero-vesical junction

Front 46

The sites of ureteric anatomical constrictions represent

Back 46

most common site of renal stones impaction

Front 47

Arterial blood supply of abdominal part of ureter

Back 47

The abdominal part of ureter is supplied by arteries, originating medial to ureter, renal artery, gonadal artery and branches from abdominal aorta.

Front 48

Arterial blood supply of pelvic part of ureter

Back 48

The pelvic part of ureter is supplied by vessels, originating lateral to ureter by common iliac, internal iliac, vesicle and uterine arteries

Front 49

Venous drainage of ureters

Back 49

Same as arterial supply

Front 50

Why ureter can be safely transected at any level intra operatively?

Back 50

Because there's a good longitudinal anastomosis between these branches along the wall of the ureter.

Front 51

Lymphatic drainage of ureter

Back 51

1) Upper abdominal Part : the collecting lymph vessels join with renal collecting vessels or pass directly to lateral aortic nodes, near the Origin of gonadal artery

2) Lower abdominal part of ureter: drain to common iliac nodes

3) Pelvic part of ureter drain to common, external or internal iliac nodes.

Front 52

Nerve supply of ureter

Back 52

1) Delivered via the renal, testicular/ovarian and hypogastric plexuses

2) Sympathetic plexus ; from nerve cells lie in T12, L1, L2 from spinal segments.

3) Parasympathetic plexus, from S2, S3, S4 nerves, which reach kidney through pelvic splanchnic nerves

Front 53

Reservoir of urine is?

Back 53

Urinary bladder

Front 54

Urinary bladder's size, shape, position and relations are vary according to?

Back 54

Age, amount of content and state of neighbouring viscera

Front 55

Urinary bladder lies posterior to?

Back 55

Pubic bones and pubic symphysis

Front 56

Nerve supply of Urinary Bladder

Back 56

Autonomic fibers from:

a) Sympathetic (from 11th, 12th thoracic spinal segments and upper two lumbar segments) - inhibitory to muscle wall and motor to sphincter

b) Parasympathetic (from pelvic splanchnic nerve S2, S3,S4) -motor to muscle wall and inhibitory to sphincter

Front 57

Atonic bladder results from lesion to sacral spine cord segments or sacral spine nerve roots. Explain its progression.

Back 57

Loss of pelvic splanchnic motor innervation causes loss of contraction of detrusor muscle, which results in a full bladder with continuous dribble of urine.

Front 58

Spastic bladder results from lesions of Spinal cord above the sacral spinal cord levels. Explain.

Back 58

There's a loss of inhibition to parasympathetic innervation to detrusor muscle during filling stage. Thus, the detrusor muscle respond to a minimum amount of stretch, causing urge incontinence (involuntary leakage of urine) .

Front 59

Arterial supply of urinary bladder

Back 59

1) Superor vesicle arteries

→ branch of internal iliac artery

→ supply apex and superior part of bladder

2) Inferior vesicle arteries

→ supply base and neck of urinary bladder in male

3) Vaginal arteries

→ branch of uterine arteries

→ supply base and neck of urinary bladder of female

4) Obturator arteries

→ branch of internal iliac artery

→ provide arterial twigs

Hint 59

SIVO

Front 60

When the bladder is empty, it lies entirely in the lesser pelvis, but as it distends it...

Back 60

it expands antero-superiorly into the abdominal cavity

Front 61

Lymphatic drainage of urinary bladder

Back 61

Drains into the common, external or internal iliac nodes.

Front 62

Venous drainage of Urinary bladder

Back 62

→ don't follow arteries

→ create complex plexus on inferolateral surfaces near prostate in male

→ enters backwards in posterior ligaments of urinary bladder to drain into internal iliac veins

→ vesical venous plexus interacts with prostatic venous plexus in male

→ vesical venous plexus interacts with veins at base of broad ligament of uterus in female

Front 63

Empty bladder has an apex, neck, base, superior surface and two inferolateral surface. Which of them is the same in relation of Urinary bladder in male and female?

Back 63

Apex: median umbilical ligament, attached to anterior abdominal wall

Inferolateral surface: Obturator internus muscle, levator ani muscle, obturator nerve, obturator artery and vein, superior vesical artery and vein

Hint 63

SOLO

Front 64

Base of Urinary bladder in male

Back 64

1) Recto-vesical pouch

2) Loops of ilium

3) Two seminal vesicles

4) Two vas deferens

Hint 64

2TLR

Front 65

Base of urinary bladder in female

Back 65

1) Cervix

2) Anterior wall vagina

Hint 65

AC

Front 66

Relation of neck of urinary bladder in male

Back 66

Rests on:

1) Prostate

2) Prostatic venous plexus

3) Ejaculatory duct

Hint 66

PEP

Front 67

Neck of urinary bladder in female

Back 67

Vagina (Posteriorly)

Front 68

Superior surface of Urinary bladder in male

Back 68

Peritoneum, loops of ileum and sigmoid colon

Hint 68

PLS!

Front 69

Superior surface of urinary bladder in female

Back 69

1) Uterus

2) Utero-vesical pouch

3) loops of ileum

4) Sigmoid colon

Hint 69

SUUL

Front 70

Peritoneal covering of urinary bladder in male

Back 70

Peritoneum covers superior surface and upper part of base of bladder. Then, reflected to rectum, forming recto-vesical pouch.

Front 71

Peritoneal covering of urinary bladder in female

Back 71

Peritoneum covers anterior part only of superior surface of bladder then reflected to anterior surface of uterus, forming utero-vesical pouch

Front 72

True ligament of urinary bladder

Back 72

In Male and female:

1) Lateral true ligaments

→ stretch from lateral wall of bladder to pelvic fascia

2) Median umbilical ligament

→ fibrous remnant of urachus

→ goes from apex of bladder to umbilicus

→ keeps bladder in positon anteriorly and superiorly

3) Posterior ligaments

→ 2 in number (left and right)

→ as sheet of loose areolar tissue from side of base of bladder to lateral pelvic wall

→ enclose vesical venous plexus

In male only:

1) Lateral pubo-prostatic ligaments

→ connect neck of bladder and prostatic sheath with tendinous arch of pelvic fascia

2) Medial pubo-prostate ligaments

→ connect neck of bladder and prostate sheath with back of pubic bone

In female;

1) Lateral pubo-vesical ligaments

→ connect neck of bladder to tendinous arch of pelvic fascia

2) Medial pubo-vesical ligaments

→ connect the neck of bladder to back of pubic bone

Front 73

False ligaments of urinary bladder

Back 73

a) Median umbilical fold

→ fold of peritoneum over Median umbilical ligament

b) Two medial umbilical folds

→ folds of peritoneum over obliterated umbilical arteries

C) Two posterior false ligaments

→ two peritoneal folds from back of urinary bladder and pass backward on each side of rectum to attach to the front of sacrum

False ligaments: (1) Median umbilical fold, (2) Medial umbilical fold, (3) Lateral false ligaments, (4) Posterior false ligaments

Hint 73

4

Front 74

Lymphatic drainage of kidney

Back 74

Pass to para-aortic lymph nodes

Front 75

In renal cell carcinoma, tumor destroy renal vein. If it's in left side, damage of left renal vein results in defect in venous drainage of left gonadal veins, which result in?

Back 75

Dilatation of veins surrounding left testes, resulting in varicose of left testis.

Front 76

Factors which stabilize kidneys to stay in position

Back 76

1) Intra-abdominal pressure and arrangement of adjacent organs

2) Extension of covering fascia and fat

3) Renal vessels connecting kidneys to abdominal aorta and inferior vena cava

Front 77

Rapid loss of pre-renal fat tissue may result in drop of kidney in pelvis, which is called ptosis of kidney. This condition can result in?

Back 77

Kinking of ureters (sharp twist), results in severe pain.

Front 78

Nerve supply of kidney

Back 78

1) Renal sympathetic plexus

→ afferent fibers that travel through renal plexus

→ enter spinal cord in 10th, 11th and 12th thoracic nerves

2) Parasympathetic fibers

→ from vagus nerve

→ reach kidney through plexus

Front 79

How can you differentiate between left and right kidney?

Back 79

1) Medial border is concave, containing hilum while lateral border is convex.

2) In hilum, renal vein is most anterior structure and renal pelvis is posterior, while renal artery is in between.

3) The ureter passes downward along lower part of medial border

Front 80

Surface anatomy of kidney on front of abdomen

Back 80

1) The hilum lies on the transpyloric plane, 5 cm from middle line.

2) The upper pole lies 2.5 cm away from middle line and 5 cm above hilum

3) Lower pole lies in below hilum and 7.5 cm from middle line

Front 81

Transpyloric plane is

Back 81

Addison's plane: an imaginary horizontal plane

→ located halfway between suprasternal notch of manubrium and upper border of symphysis pubis

→ at level of first lumbar vertebrae L1

Front 82

Renal angle

Back 82

→ located on either side of human back between lateral border of erector spinal muscles and inferior borders of 12th ribs

→ kidney can be felt at this location

Front 83

empty bladder is pyramidal in shape, it has?

Back 83

an apex, base (posterior surface or fundus), neck, a superior surface and two inferolateral surfaces .

Front 84

In females, Superior relation of urinary bladder with uterus, increase the urgency of urination in pregnant females due to

Back 84

compression caused by the enlarged uterus over the urinary bladder, so decreasing its capacity

Front 85

In females, posterior relation (base) of the urinary bladder with cervix carries an important clinical correlate in cases of cancer cervix. Explain,

Back 85

The invasion of the cervical cancer posteriorly to the bladder will result in occlusion of the urinary bladder

Front 86

Shape of inferolateral surface of urinary bladder

Back 86

Triangle

Front 87

Superior surface of urinary bladder forms

Back 87

The roof of urinary bladder

Front 88

Neck of bladder

Back 88

3 to 4 cm. Where base and inferolateral sides meet inferiorly. It is traversed by internal urethral opening .The detrusor muscle runs circularly around the neck, which acts as an involuntary internal sphincter.

Front 89

Apex or anterior angle of urinary bladder

Back 89

site of attachment of urachus-fibrous remnant of fetal allantois, which is seen as the median umbilical ligament

Front 90

Base of urinary bladder, forms the posterior surface :

Back 90

1- two ureteric openings at supero - lateral angles

- Internal urethral orifice at the inferior angle

2 - Internal urethral orifice at the inferior angle→ it is surrounded by an internal sphincter, which is an involuntary innervated by autonomic nerves

→ it is surrounded by an internal sphincter, which is an involuntary innervated by autonomic nerves

3 - Vesical Trigon;

→ which is a smooth triangular area

→ formed by three opening, two ureteric, and one urethral opening

→ The ridge between the two ureteric openings is the interureteric ridge and forms the upper limit of the trigon

Hint 90

VIT

Front 91

The part of the urogenital ridge that gives rise to the urinary system is called

Back 91

Nephrogenic cord

Front 92

After folding of the embryo, the intermediate mesoderm is carried

Back 92

ventrally

Front 93

the urogenital ridge is formed on each side of

Back 93

the dorsal aorta

Front 94

The pronephroi phase

Back 94

→transitory, nonfunctional structures appear in the 4th week

→represented as a few cell clusters and tubular structures in the neck region opposite to the 7th to the14th somites

→pronephric ducts run caudally and open into the cloaca

→ rudimentary pronephroi are degenerate

→ most of the pronephric ducts persist and are utilized by the next set of the kidneys and its name is changed and called mesonephric ducts

Front 95

The Mesonephroi phase

Back 95

→large; elongated; excretory organs appear late in the 4th week caudal to the rudimentary pronephroi

→appears at a lower-level opposite to 14th to 28th somites in the thoracic and upper lumbar region of the embryo

→well developed and function as transient kidneys for about 4 weeks

→consists of glomeruli and mesonephric tubules ( tubules open into the mesonephric ducts which open into the cloaca )

→ mesonephroi degenerate toward the end of the 1st trimester

Front 96

What's the difference of mesonephric tubules development in male and female?

Back 96

☆ In male, the mesonephric tubules become the efferent ductules of the testes.

☆ Mesonephric duct gives rise to PADDU PCCES

→ paradidymis → appendix of epididymis → duct of epididymis → ductus deferens→ ureter → pelvis → calices→ collecting tubules; ejaculatory duct and seminal gland

☆ In female, the mesonephric tubules become the Epoophoron and Paroophoron

☆The mesonephric duct gives rise to ADDUP2C

→ appendix vesiculosa → duct of epoophron → duct of Gartner → ureter → pelvis → calices and collecting tubules

Front 97

Metanephroi phase

Back 97

→ primordia of permanent kidneys which begin to develop early in the 5th week and start to function about 4 weeks later

→ permanent kidneys develop from 2 sources: ureteric bud & metanephric mass

→ primordia of the metanephros are of mesodermal origin

Front 98

Permanent kidneys develop from 2 sources, Which are

Back 98

ureteric bud and metanephric mass

Front 99

Expanded cranial and of stalk of mesonephric duct becomes?

Back 99

Renal pelvic

Front 100

straight collecting tubules undergo repeated branching, forming ?

Back 100

generations of tubules, major calices, minor calices and collecting tubules

Front 101

Fetal kidneys

Back 101

→divided into lobes

→ lobulation diminishes toward the end of fetal period, but the lobes are still inducated in the kidneys of a newborn infant

→lobulation disappears by the end of the first postnatal year during infancy as the nephrons increase and grow

→increase in kidney size after birth results mainly from the elongation of the proximal convoluted tubules as well as an increase of interstitial tissue

→ functional maturation of the kidneys occurs after birth

Front 102

Positional Changes of Kidneys

Back 102

→ Initially the metanephric kidneys lie close to each other in the pelvis ventral to the sacrum

→As the abdomen and pelvis grow, the kidneys gradually come to lie in the abdomen and move farther apart and attain their adult position by 9th week

→Initially the hilum faces ventrally however, as the kidney ascends it rotates medially 90 degrees

→By the 9th week the hilum is directed anteromedially

Front 103

Congenital Anomalies of the kidney CHER

Back 103

1) Cystic kidney disease

(A) Polycystic kidney

(B) Multi-cystic dysplastic kidney disease

Horseshoe kidney

2) Horseshoe kidney3) Ectopic pelvic kidney4) Renal agenesis

3) Ectopic pelvic kidney

Horseshoe kidney3) Ectopic pelvic kidney4) Renal agenesis

Horseshoe kidney3) Ectopic pelvic kidney4) Renal agenesis

Horseshoe kidney3) Ectopic pelvic kidney4) Renal agenesis

4) Renal agenesis

Front 104

Polycystic kidney

Back 104

→ is cystic kidney disease

→ autosomal disorder

→diagnosed at birth by ultrasonography

→ both kidneys contain many hundred small cysts which results in renal insufficiency.

→ death of infant usually occurs short after birth

Front 105

Horseshoe kidney

Back 105

→results from fusion of caudal ends of both kidneys

→interconnecting bridge becomes trapped behind the inferior mesenteric artery so that the kidneys come to rest in low lumbar region

Front 106

Ectopic pelvic kidney

Back 106

→kidney is arrested in some part of its normal ascent

→usually is found at the pelvic brim

Front 107

Renal agenesis

Back 107

→unilateral renal agenesis results due to absence of formation of one ureteric bud

→often causes no symptoms

→ Bilateral renal agenesis is associate with oligohydramnios

→ absence of one or both kidneys

Front 108

The urogenital system develops from

Back 108

Intraembryonic mesoderm

Front 109

Development of the kidneys passes through 3 stages, which are?

Back 109

1) The pronephroi

2) The mesonephroi

3) The metanephroi

Front 110

Metanephric diverticulum development

Back 110

→ outgrowth from the mesonephric duct near its entrance into the cloaca

→primordium of the ureter → renal pelvis → calices and collecting tubules

→as it elongates, it penetrates the metanephric mass of the intermediate mesoderm

→ the stalk of it becomes the ureter and its expanded cranial end forms the renal pelvis. → the straight collecting tubules undergo repeated branching, forming generations of tubules, major calices, minor calices and collecting tubules

Front 111

Metanephric tubules (primordia of nephron) development

Back 111

→ mass of the intermediate mesoderm derived from the caudal part of the nephrogenic cord

→end of each arched collecting tubule form metanephric vesicles

→metanephric vesicles elongate and become metanephric tubules

→proximal ends of these tubules are invaginated by glomeruli

→glomerular filtration begins around the 9th fetal week

→ their number increases until the 32 week with increase in the rate of filtration after birth

→renal corpuscle and its proximal convoluted tubules; loop of Henle and distal convoluted tubule constitute a nephron

→ nephrons become continuous with the collecting tubules to form the uriniferous tubules

Front 112

Changes in Blood Supply of kidneys

Back 112

➢ Initially, the renal arteries are branches of the common iliac and median sacral arteries

➢ As the kidneys ascend, they receive their blood supply from the distal end of the aorta.

➢ Then, they receive new branches from the aorta.

➢ The most cranial arterial branches from the abdominal aorta become the permanent renal arteries

➢When the kidneys become in contact with the suprarenal glands in the 9th week their ascend stops

➢ Normally, the caudal branches undergo involution and disappear

Front 113

Multi-cystic dysplastic kidney disease (MDK)

Back 113

→ results from dysmorphology (defect) during development of the renal system

→ outcome is generally good

Front 114

The stalk of mesonephric duct becomes?

Back 114

Ureter