Notes

Gross Anatomy of Upper Urinary System
Kidneys are retroperitoneal and posterior of the abdominal cavity.
Abdominal wall contents: skin + fat, anterior and posterior abdominal wall muscles, transversalis fascia, and parietal peritoneum
Peritoneum: serous membrane that lines abdominal cavities, divided between greater and lesser sacs.
The retroperitoneal space is between T12 and lower pelvis. Lined by fascia and fat. Floor made of posterior wall muscles: psoas major/minor, quadratus lumborum, transversus abdominus, and thoracic diaphragm
Contents of retroperitoneal space (SAD PUCKER): supradrenal glands, aorta, duodenum, pancreas, ureters, colon, kidneys, and rectum.
Kidneys surrounded by (superficial to deep):
- Pararenal fat: adipose tissue to cushion kidneys, renal facetious: thin fibrous tissue covering kidney and enclose supradrenal glands, perineal fat: adipose tissue that cushions kidney, renal capsule: dense connective tissue
Location and size of kidneys: located between T12 and L3. Right kidney is slightly lower due to lower. Superior pole is more medial and posterior than inferior pole
Siding Kidneys: Superior pole is flat and covered by adrenal glands. Inferior pole is pointed. Lateral border is convex and medial border is concave. Anterior surface is convex and posterior is flat.
Connections of renal hilum (VAP): Vein (ventral), artery (between), pelvis (posterior)
Anterior Relations of L and R Kidneys:
Right: gastric, splenic, pancreatic, jejunal (small intestine), colic. Left: hepatic, duodenal (small intestine), colic
Posterior Relations of L and R Kidneys:
No peritoneum, fat + fascia, L1 transverse process, posterior abdominal wall muscles
Since the aorta is on the left side of the body, the right renal artery is longer, posterior to IVC. Since the IVC is on the right side of the body, the left renal vein is longer, anterior to aorta.
Arterial flow in the Kidneys:
Aorta gives of right and left renal arteries which then divide into five segmental arteries. Segmental arteries divide into lobar arteries (one per pyramid). Lobar arteries divide into interlobar arteries (two per lobe). Interlobar arteries divide into acruate arteries which arch over the base of the pyramid. Acruate arteries divde into interlobular arteries in the cortex, which in turn supply the afferent arterioels.
Venous drainage is the reverse:
Efferent arteriole --> peritubular capillaries & vasa recta -> interlobular vein
Nerve supply:
Kidneys receive sympathetic and parasympathetic innervation. The renal plexus is derived from the celiac plexus, celiac ganglion, aortic plexus, and splanhnic nerve.
Ureters:
Distensible muscular tubes that connect kidneys with the bladder. Run posterior to bladder, entering it obliquely. There are three potential sites of constrict: the narrowing of the uretic pelvis, crossing of the pelvic inlet, and coursing through bladder wall. On its way to the bladder, the ureter crosses the bifurcation of common iliac artery.
Blood supply of ureters:
renal, gonadal, and superior vesical arteries. Veins are similar.
Nerve supply:
renal, hypogastric, and testicular plexuses