Auer Ch 64 Kidney Ureter

Front 1

Location of kidney:

Back 1

right: below dorsal extent of last 2 to 3 ribs and first lumbar transverse process; left: caudal to the right

Front 2

Size of kidney:

Back 2

6-7 inches long, 6 inches wide, 2-2.5 inches height, left kidney is not as wide

Front 3

Vascular supply to kidney:

Back 3

renal arteries branching from aorta, accessory renal arteries from caudal mesenteric, testicular, ovarian, or deep circumflex iliac arteries

Front 4

Size of ureters:

Back 4

2-3 inches in diameter, 28 inches long

Front 5

Function of ureter:

Back 5

muscular tubes that induce contraction to move bolus of urine from renal pelvis to bladder

Front 6

Functional unit of kidney:

Back 6

nephron

Front 7

Innervation of kidney:

Back 7

sympathetic nerves from aorticorenal and renal ganglia

Front 8

Receptors of kidney vasculature:

Back 8

alpha & beta adrenergic, dopaminergic

Front 9

Innervation of ureters:

Back 9

alpha 1 and beta 2 adrenergic receptors

Front 10

Congenital disorders of ureters:

Back 10

ectopic ureter, ureteral defects or tears, vascular anomalies to urinary tract

Front 11

When do ectopic ureters develop?

Back 11

Ureteric bud (metanephric duct) fails to be incorporated into the urogenital sinus or fails to migrate cranially to bladder neck or when mesonephric duct fails to regress

Front 12

Locations of ectopic ureters:

Back 12

with ureteric bud failure, open near urethral papilla in females and colliculus seminalis in males; with mesonephric duct failure, open anywhere in the vagina, cervix or uterus

Front 13

Clinical sign of ectopic ureter:

Back 13

urinary incontinence

Front 14

Diagnosis of ectopic ureter:

Back 14

visual examination, endoscopic examination +/- IV administration of phenol red dye, contrast studies, CT, MRI

Front 15

Surgical treatment of ectopic ureter:

Back 15

ureterocystotomy (reimplantation of ectopic ureter into bladder), unilateral nephrectomy if preferred

Front 16

What needs to be determined before surgical correction of ectopic ureter?

Back 16

Whether it is bilateral or unilateral, if there is UTI present

Front 17

Term for ureter defect or tears:

Back 17

ureterorrhexis

Front 18

What results from ureter defects?

Back 18

Retroperitoneal accumulation of urine or uroperitoneum

Front 19

Treatment of ureter defects:

Back 19

suturing defect around indwelling catheter, unilateral nephrectomy

Front 20

Acquired renal or ureteral disorders:

Back 20

calculi, pyelonephritis, ureterorrhexis, neoplasia

Front 21

Treatment of renal & ureteral calculi:

Back 21

if disease is unilateral, unilateral nephrectomy

Front 22

Treatment of pyelonephritis:

Back 22

if disease is unilateral, unilateral nephrectomy

Front 23

What should be determined before performing nephrectomy for pyelonephritis?

Back 23

Absence of azotemia and absence of bacteria in unaffected ureter

Front 24

Most common renal neoplasia:

Back 24

renal cell carcinoma

Front 25

Treatment of renal neoplasia:

Back 25

if unilateral, unilateral nephrectomy

Front 26

Disadvantage of nephrectomy for renal neoplasia:

Back 26

disease is likely to be metastatic and large size of neoplastic kidney is difficult to remove without complications

Front 27

Approaches to nephrectomy:

Back 27

open (right: 16th or 17th rib resection, 16th or 15th ICS; left: 17th or 18th rib resection, dorsal flank; foal: caudal VMC), laparoscopic, hand-assisted laparoscopic

Front 28

Most common approach to nephrectomy:

Back 28

17th rib resection

Front 29

Describe rib resection nephrectomy:

Back 29

incision made over rib to periosteum, periosteum elevated circumferentially, rib resected 2-5 cm distal to costovertebral articulation and disarticulated at costochondral junction, medial periosteum incised, self retaining retractors inserted, kidney mobilized by digital blunt dissection, ureterovascular pedicle isolated, artery, vein, ureter double ligated, kidney removed, ureter mobilized, ligated as far distal as possible, transected, penrose or closed suction drain place prior to closure

Front 30

Portal location for laparoscopic nephrectomy:

Back 30

between 17th & 18th rib at ventral border of TC, ½ way between 18th rib and dorsocranial border of TC and 8 cm distal

Front 31

Order of ligation for laparoscopic nephrectomy:

Back 31

artery, vein, ureter

Front 32

Complications of laparoscopic nephrectomy:

Back 32

pneumothorax, hemorrhage from accessory renal arteries

Front 33

Disadvantages of laparoscopic nephrectomy:

Back 33

technically challenging

Front 34

Describe hand assisted laparoscopic nephrectomy:

Back 34

incision made in PLF with modified grid, scope portal made dorsal to open incision, combination of hand and laparoscopic dissection to free kidney, renal artery and vein double ligated with 1 hand ties, vessels transected, kidney exteriorized, ureter double ligated and transected

Front 35

Complications of hand assisted laparoscopic nephrectomy:

Back 35

hemorrhage from accessory renal arteries

Front 36

Benefits of hand assisted laparoscopic nephrectomy:

Back 36

tactile sensation for dissection, hand retraction, smaller incision, no GA

Front 37

Describe nephrotomy:

Back 37

approach as for open nephrectomy, kidney mobilized, incision made to exposed collecting system, obstructions removed, parenchymal pressed together, renal capsule closed with simple continuous pattern

Front 38

Indications for ureterotomy:

Back 38

calculi

Front 39

Approaches for ureterotomy:

Back 39

flank laparotomy+/- endoscopic guidance

Front 40

Removal of ureteral calculi:

Back 40

primary incision of ureter to remove, endoscopic guided dislodgement through ureter

Front 41

Complication of kidney or ureter surgery:

Back 41

pneumothorax if through a flank approach and penetration of crura of diaphragm, hemorrhage, infection

Front 42

Complication of kidney or ureter surgery:

Back 42

pneumothorax if through a flank approach and penetration of crura of diaphragm, hemorrhage, infection

Front 43

Ruminant nephrectomy:

Back 43

PLF approach just caudal to last rib (13th) for right, mid-PLF for left, blunt dissection of kidney, ligation of artery, vein, ureter, remove kidney; standing for cattle, lateral recumbency for small ruminants