Download 2017 Kidney Lab STUDENT

Lab 7: Kidney
Objectives:
-Describe the location of the kidneys, ureters, urinary
bladder and urethra.
-Describe the arterial blood supply, venous return and
innervation of the kidney.
-Describe the location of the prostate gland.
-Describe the functional anatomy of the uretero-vesical
junction.
-Compare the urethras of males and females.
-Identify the structures and regions in a gross midsagittal section of the kidney.
Christopher Ramnanan, Ph.D.
[email protected]
Location of the Kidneys
T11
T12
L1
L2
L3
L4
-Left kidney typically ~1.5 cm superior to level of right kidney
-Left kidney typically extends from T11/T12 level to L2/L3 level
-Right kidney typically extends from T12/L1 level to L3/L4 level
-Kidneys also descend during inspiration 2-3 cm
-Right kidney may be palpable ~2-3 finger’s breadth above supracristal
plane; left kidney usually not palpable unless enlarged/displaced
-Kidneys offered protection from 11th and 12th ribs
-Note: Ureters approximated by the plane of the transverse processes of
lumbar vertebrae
The Kidneys and Ureters are Retroperitoneal
The Abdominal Cavity consists of the
peritoneal cavity (potential space,
analagous to pericardial and pleural
cavities). Organs that protrude
anteriorly/create invaginations in
peritoneal cavity are ‘intraperitoneal’
(ex. intestines)
The kidneys and ureters
are amongst the structures
that are pushed back
against the body wall are
considered
‘retroperitoneal’ (typically
covered by peritoneum on
their anterior surface,
‘behind the curtain’).
Kidneys lie in
paravertebral gutters.
Liver
(removed)
Anterior Relationships of the Kidneys
Pancreas
Tail
Ascend.
Colon
(removed)
Area for
Spleen
(not shown)
Descend. Colon
Duodenum
(Removed)
Spleen
RK
RK
Clemente
Fig. 334
LK
Pancreas
Tail
Anterior to the Right
Kidney (RK):
Liver
Duodenum
Ascending Colon
Anterior to the Left
Kidney (LK):
Tail of the Pancreas
Spleen
Descending Colon
Kidneys, Ureters, and Bladder in situ
Superior to the Kidneys:
Suprarenal glands, Diaphragm
Medial to the Kidneys:
Structures entering/exiting hilum of
the kidney; superficial to deep:
-renal vein
-renal artery
-ureter
Posterior to the Kidneys:
Back body wall (Diaphragm, Psoas
major, Quadratus lumborum)
Renal Fascia
(PARA-Sagittal Section through Right Kidney)
Perirenal fat: internal to
renal fascia
Pararenal fat:
external to renal
fascia (retroperitoneal
fat)
Renal fascia: further
compartmentalizes the
kidney and suprarenal gland
from other retroperitoneal
structures; gives rise to
capsule around suprarenal
gland
Fibrous capsule of
Kidney (Renal capsule): Tough,
external layer to kidney; offers
protection; separates kidney from
suprarenal gland
Peritoneum
Renal Fascia
(Transverse Section through L2 vertebra)
Fibrous capsule Renal fascia Peritoneum
of kidney
Perirenal fat
Pararenal fat
(Retroperitoneal)
Fibrous capsule
(Renal capsule)
Blood Supply
Left and Renal Arteries Arising from
Aorta (~L1)
Note: Renal Arteries also supply inferior
suprarenal arteries
Left and Right Renal Veins Draining to IVC
Note: Asymmetry; Left Renal Vein is Longer and Passes b/w Aorta and Superior
Mesenteric Artery
Clinically: “Nutcracker Syndrome” impairs drainage of left renal vein (left kidney, left
suprarenal gland, left gonad all affected; may result in blood in the urine, testicular
varicocele)
Anterior View
Posterior View
Superior
Anterior
Superior
Posterior
Anterior
Inferior
Inferior
Each Renal Artery typically subdivides into 5 segmental arteries (usually
before the hilum) 4 anterior segmental a., 1 posterior segmental a.
Each Segmental Artery is essentially an ‘end artery’ with little to no
significant anastomoses (each responsible for the blood supply of a given
segment).
Innervation of the Kidney
and Upper Ureter
(Conceptual)
Vagus Nerve
(presynaptic
parasympathetic
fibers)
Parasympathetic supply: Vagus
Nerve
T10-L1 of
spinal cord
Sympathetic supply: Lesser,
Least and Lumbar Splanchnics
(T10-L1 level)
Sensory fibers: travels back to
~T10-L1 level
Lesser, Least and Lumbar
Splanchnic Nerves
Vagus nerve fibers synapse and
postsynaptic fibers located in wall of
tissue
Splanchnic Nerves synapse in
aorticorenal and renal ganglia;
postsynaptic fibers travel with
arteries to organs
Referred Pain of Abdominal Viscera: Focus on Kidney
(other organs revisited next year)
Pain fibers are sensed at level
corresponding to that organ’s
sympathetic supply (for kidney,
T10-L1); pain
interpreted/associated with the
corresponding dermatome
Internal Features of the Kidney
Renal Columns
(Cortex): cortical tissue
b/w adjacent pyramids
Renal pyramids
(Medulla)
Renal papilla:
apex of pyramids;
open into minor
calyx
Note: Renal sinus =
fat-filled, internal
cavity;
Renal hilum = site
where structures
enter/exit kidney
Major calyx: formed
by union of 2-3 minor
calices
Renal pelvis: dilated
superior part of ureter
formed by union of 23 major calices
Ureter (proper):
narrow muscular tube
at terminal end of
renal pelvis
Ureters
Retroperitoneal course:
-descends medially from the renal
pelvis
-passes posterior to gonadal
vessels in abdomen
-crosses external iliac arteries
just beyond iliac bifurcation
(pelvic brim)
-course along lateral wall of
pelvis to enter urinary bladder
from posterior aspect
Note: in females, the ureter
course towards bladder by
passing inferior to the uterine
artery
Ureter blood supply
Superiorly: blood supply comes from
medial aspect (arterial br. from aorta)
Inferiorly: blood supply derived from
lateral aspect (arterial br. from
internal iliac artery)
Arteries delicate, easily damaged
(relevant to traction of the ureter
during surgery)
Ureter constrictions
1)
2)
3)
At junction with renal
pelvis (uretopelvic
junction)
As ureter crosses pelvic
brim
As ureter passes through
wall of urinary bladder
T-12 vertebra
12th rib
Minor calyx
Renal (ureteric) pelvis
Right kidney
Right ureter
Color-enhanced
Renal Pyelogram
Urinary bladder
Detrusor
Muscle
Note:
The detrusor muscle makes up the muscular walls of the bladder
Ureter conveying
urine to bladder
“water under the
bridge”
Superior View, Female Pelvis
Uterine artery
Sagittal View, Female
Note:
The most common position of the uterus
is to be anteverted, anteflexed upon the
bladder
The female urethra opens up in the
vestibule posterior to the clitoris,
anterior to the vagina
Male Pelvis:
ID Pelvic portion of
Ureter, Bladder,
Prostate, Urethra
Ureter
Bladder
Penis
Notes:
-Ureter penetrates bladder at
angle, forming ureterovesicle
valve (preventing backflow)
-Anterior aspect of bladder is
in proximity to pubic bone
and anterior body wall
-Prostate is located inferior to
bladder and anterior to the
rectum
Prostate
Posterior View
Sagittal View
Male Urethra (~20 cm)
Prostatic
Urethra
Membranous
Urethra
Spongy
(Penile)
Urethra
Female Urethra (4-5 cm)
Urethra is much
shorter in females
LAB CHECKLIST – THE KIDNEY
NB: Items italicized are conceptual, those denoted with a * are FYI
-
STRUCTURES
Suprarenal glands
Renal capsule
Renal fascia
Perirenal fat
Pararenal fat
Fibrous capsule
Peritoneum
Kidney
- Renal pyramids (medulla)
- Renal papilla
- Major calyx
- Minor calyx
- Renal columns (cortex)
- Renal pelvis
- Ureter
- Renal sinus
- Renal hilum
- Uretopelvic junction
- Pelvic brim
- Uretero-vesical junction
- Urinary bladder
- Detrusor muscle
- Trigone
- Internal urethral opening
- Sphincter
- Urethra (male versus female)
- Prostatic urethra
- Membranous urethra
- Spongy urethra
- Prostate
ARTERIAL SUPPLY
- Renal artery
- Aorta
- Blood supply of ureters
VENOUS SUPPLY
- Renal vein
- Inferior vena cava
-
INNERVATION
Vagus n.
Lesser splanchnic
Least splanchnic
Lumbar splanchnic
Aorticorenal ganglia
Renal ganglia
Sensory fibers
Referred pain