Kidneys, Ureters, And Suprarenal Glands

Front 1

what are retroperitoneal organs?

Back 1

those that reside behind the peritoneum, not in the peritoneal cavity (on post abdominal wall)
-kidneys->ureters->urinary bladder->urethra
-suprarenal (adrenal) glands sit on top of each kidney

Front 2

what are the adrenal glands separated from the kidney by?

Back 2

weak fascial septum
-can do adrenalectomy w/o affecting the kidneys

Front 3

do the adrenal glands have the same function as the kidneys?

Back 3

NO-they fxn as separate organs
--the adrenal gland functions as part of the endocrine system and is a neuro-endocrine gland

Front 4

where is perinephric fat located and what is its function?

Back 4

surrounds the kidneys and vessels
-unlike love handles which are white fat, this is brown fat which is used as an accessory energy source-->it is well developed in the fetus and less developed in the adult

Front 5

where is the renal fascia located?

Back 5

it encapsulates the perinephric fat (thus, kidneys and vessels) connecting it to the air sac wall

Front 6

what is periuteric fascia?

Back 6

an extension of the renal fascia to the ureters
-renal fascia and periuteric fascia are one in the same just diff locations

Front 7

where is paranephric fat and what is its function?

Back 7

posterior and external to the renal fascia
-actually reside outside of fascial lining=fascial covering
-it serves as padding for the kidneys

Front 8

what is renal fascia attached to superiorly?

Back 8

the diaphragm

Front 9

do the kidneys move during respiration?

Back 9

YES-since the renal fascia that covers kidneys and attaches to the diaphragm, the kidney has a 3cm excursion during respiration
-kidneys move up and down during respiration and to an even greater degree during forced insp and exp

Front 10

do the kidneys move when changing body position?

Back 10

the kidneys may also move when changing from supine to standing

Front 11

what is are 5 functions of the kidneys?

Back 11

1. filters blood
2. regulates fluid and electrolyte balance (via renal hormones: aldosterone, angiotensin, renin, ADH)
3. regulates BP (via regulation of fluid volume)
4. acid/base regulation
5. regulates Hct (EPO is produced in the kidney and this hormone is released when there is low O2 in bld)
**if damage kidney lose all of the above!

Front 12

where are the kidneys located?

Back 12

-retroperitoneal (on post abdominal wall)
-on each side of vertebral column from T12-L3

Front 13

why is the right kidney slightly inf to the left kidney?

Back 13

the right kidney is diplaced downward b/c the liver pushes down on it

Front 14

what is the shape and size of the kidney?

Back 14

ovoid (shaped like a kidney bean)
10cm X 5cm X 2.5cm

Front 15

what is the superior aspect of the kidney?

Back 15

superior aspect is connected to the diaphragm via renal fascia--the diaphragm separates kidneys from pleural cavities and 12th pair of ribs

Front 16

what is the posterior aspect of the kidney?

Back 16

-quadratus lumborum mm
-iliohypogastric nn.
-ilioinguinal nn.

Front 17

what is the anterior aspect of the kidneys?
1. right
2. left

Back 17

-RIGHT KIDNEY
1. liver
2. duodenum
3. ascending colon
-LEFT KIDNEY
1. stomach
2. spleen
3. pancreas
4. jejunum
5. descending colon

Front 18

what is the renal hilum and what does it provide?

Back 18

the medial concavity of the kidney that provides an entrance to the renal sinus, a space within the kidney

Front 19

what runs through the renal hilum and where are they located in relation to each other?

Back 19

1. renal A enters(ant, sup)
2. renal V leaves (inf)
3. ureters (post)

Front 20

the renal hilum is an entrance to an open space within middle portion of the kidney called the renal sinus...what is the renal sinus occupied by?

Back 20

1. renal pelvis (expansion of superior end of ureter)
2. calices (renal pelvis receives calices)
3. vessels and nn's that enter or exit kidney

Front 21

why are the kidneys obliquely placed? why does this matter?

Back 21

they lie along side of the lumbar and thoracic vertebrae and the lumbar vert protrude into the abdominal cavity
-therefore, when looking at the kidneys via US you cannont go in a flat plane in back (AP view) or you won't be able to see complete kidney
--must view from side to see the renal sinus

Front 22

the R renal artery passes post to ______.

Back 22

IVC

Front 23

the renal arteries branch into ________arteries that supply renal ________.

Back 23

-segmental
-segments or regions of the kidney

Front 24

why is it a good thing that the renal arteries are non-anastomosing?

Back 24

since there is no connection btwn them, each segmental A is a surgical resectible unit or renal segment

Front 25

what are the names of the 5 renal segments or regions of the kidney/segmental A's?

Back 25

1.superior(apical)
2.anterosuperior
3.anteroinferior
4.inferior
5.posterior
--each distinct region of the kidney has its own bld supply

Front 26

where do renal V's exit the renal hilum in relation to the renal A's?

Back 26

exit the renal hilum ant to renal A's

Front 27

the L renal vein may receive bld from what 3 veins?

Back 27

1. L suprarenal V
2. L gonadal V
3. ascending Lumbar V

Front 28

what is the order of flow throughout the nephron to form urine?

Back 28

1. bowmans capsule
2. proximal tubule
3. loop of henle (descending then ascending)
4. distal tubules
5. 1000's of collecting ducts at apex of every renal pyramid (dome, triangular shaped area that contains the nephrons)
6. minor calices
7. major calyx
8. renal pelvis
9. ureter

Front 29

what is the renal pelvis?

Back 29

flattened, funnel shaped extension of the superior ureter where it joins the renal sinus

Front 30

what are ureters?

Back 30

muscular ducts
-smooth mm: there is a certain degree of peristalsis in ureters that will constantly filtrate urine down to the bladder

Front 31

where do ureters begin and end?

Back 31

begin at renal pelvis and extend to urinary bladder and are retroperitoneal throughout their course

Front 32

what are ureters lined with?

Back 32

transitional epithelium

Front 33

where do the ureters pass in relation to the common iliac A's?

Back 33

ureters pass ant to the bifurcation of the common iliac A's called the pelvic brim

Front 34

the ureters are normally constricted to a variable degree in 3 places...where are they?

Back 34

1. at the jxn of the ureters and renal pelves (they do not come out in a straight line, they bend)
2. where the ureters cross over the brim of the pelvic inlet
3. during their oblique passage through the wall of the urinary bladder

Front 35

the 3 constricted areas of the ureters are potential sites of what?

Back 35

obstruction by ureteric (kidney)stones

Front 36

what arteries are the ureters primarily supplied by? secondarily?

Back 36

-primarily: branches of renal arteries
-secondarily: branches of common iliac, gonadal, or AbAo

Front 37

what is the venous drainage of the ureters?

Back 37

renal V or gonadal V

Front 38

what is the lymphatic drainage of ureters?

Back 38

1. R or L lumbar lymph nodes
2. common iliac lymph nodes
3. int. iliac lymph nodes

Front 39

what are the renal columns and what do they primarily contain?

Back 39

light area btwn the renal pyramids and contain primarily BV's and nn's BUT not exclusively

Front 40

where are the suprarenal (adrenal) glands located in relation to the kidneys and diaphragm?

Back 40

-superomedial aspects of kidneys (separate from kidneys)
-inf to diaphragm (attached to diaphragm)

Front 41

what are the adrenal glands surrounded by?

Back 41

-perinephric fat
-renal fascia

Front 42

where is the Right suprarenal gland located?

Back 42

-more apical than L
-ant.lat. to right crus of diaphragm
-contacts the IVC and liver

Front 43

where is the Left suprarenal gland located?

Back 43

-more medial than R
-contacts the spleen, stomach, pancreas, and left crus of diaphragm

Front 44

why is the hilum of the suprarenal glands not really a hilum

Back 44

b/c there are multiple sites for A's and nn's to enter
-multiple arterial feeds: arteries and nn's enter glands at multiple sites
-veins and lymphatics are the only exiting structures

Front 45

what are the 3 arteries that supply the suprarenal glands?

Back 45

1. superior suprarenal A: from inferior phrenic A
2. middle suprarenal A: from AbAo
3. inferior suprarenal A: from renal A

Front 46

what is the venous drainage of suprarenal glands?

Back 46

1. R suprarenal V: into IVC
2. L suprarenal V: into L renal vein (with inferior phrenic V)

Front 47

the suprarenal glands is composed of 2 distinct organs called? this is much like what?

Back 47

1. cortex (outside)
2. medulla (inside)
-much like the pancreas

Front 48

what is the cortex of suprarenal glands derived from?

Back 48

mesoderm

Front 49

what is the medulla of suprarenal glands derived from?

Back 49

neuroectoderm
-therefore, a nn more than an organ
-derived from the exact same tiss that gives rise to SC

Front 50

what are the 3 zones of the cortex of suprarenal glands and what does each zone secrete?

Back 50

1. zona glomerulosa: mineralocortocoids(aldosterone)
-->SALTY
2. zona fasciculata: glucocortocoids(cortisol)
-->SWEET
3. zona reticularis: androgens (testosterone)
-->SEX

Front 51

what does the medulla of suprarenal glands secrete?

Back 51

EPI/NE

Front 52

where does renal lymphatic vessels drain into?

Back 52

LUMBAR LYMPH NODES:
1. aortic
2. caval

Front 53

where does superior lymph vessles of superior ureter drain?

Back 53

LUMBAR LYMPH NODES:
1. aortic
2. caval

Front 54

where does middle lymph vessles of middle ureter drain?

Back 54

into common iliac lymph nodes

Front 55

where does inferior lymph vessles of inferior ureter drain?

Back 55

anything below the pelvic brim drains into internal iliac lymph nodes

Front 56

where do lymph vessels from the suprarenal glands drain?

Back 56

LUMBAR LYMPH NODES:
1. aortic
2. caval

Front 57

from the lumbar lymph nodes, where does the lymph drain?

Back 57

1. cistern chyle (in abdominal cavity)
2. thoracic duct (in thoracic cavity)
3. venous system at venous angle

Front 58

renal nn. plexus
1. where is it found?
2. what type of fibers does it contain?
3. what is it supplied by? what type of fibers does its supply contain?
4. what does it supply

Back 58

1. found on renal A
2. contains sym and parasym fibers
3. supplied by abdominopelvic splanchnic nn's which only have symp fibers
4. supplies the kidney

Front 59

the nn's of ureters derive from what plexi?

Back 59

1. renal plexus
2. AbAo plexus
3. sup. hypogastric plexus

Front 60

what nn fibers provide pain sensation in ureters? when are these fibers activated and what kind of pain is felt?

Back 60

visceral afferent fibers conveying pain sensation follow the sym fibers retrograde to spinal ganglia and SC segments T11-L2
-activated during obstruction thus, distension
-usually pain felt in ipsilateral lower quadrant of the ant abdominal wall and especially to the groin and back
-since these fibers have a greater degree of divergence thy are not localized fibers like cutaneous nn.=poor localization of pain
(i.e. kidney stone)

Front 61

suprarenal glands:
1.what are suprarenal glands innervated by?
2. what kind of fibers do these nn's contain?
3. where are the cell bodies of these fibers?
4. what is the path of these nn's and what do they innervate?
5. what do the chromaffin cells in the medulla act as? why?

Back 61

1. celiac plexusand abdominopelvic splanchnic nn's (greater, lesser and least)
2. contain myelinated presynaptic symp fibers
3. cell bodies in IML of T10-L1
4. the presynaptic symp fibers do NOT synapse: they run through both paravertebral and prevertebral ganglia to innervate the chromafin cells in the medulla of the suprarenal gland
5. act as postsynaptic sym fibers b/c they prdce NE/EPI

Front 62

why do the kidneys need innervation?

Back 62

b/c they need BLOOD FLOW
-ANS regulates renal bld flow
-renal bld flow regulates BP
-BP regulates ANS

Front 63

what is different about the blood supply to the kidney? why?

Back 63

an afferent arteriole takes bld to the kidney and an efferent arteriol takes bld away from the kidney
-this is b/c when blod leaves the glomerular caps it enters into another cap bed rather than going back to the heart

Front 64

how is most systemic circulation organized? how is renal circulation organized?

Back 64

most systemic circulation:
1. artery
2. arteriole
3. cap
4. venule
5. vein
renal circulation:
1. artery
2. afferent arteriole
3. glomerulus
5. efferent arteriole
6. peritubular cap and vasa recta (2cap beds)
7. venule
8. renal vein