Clinical science passmedicine
p53
p53 is a tumour suppressor gene located on chromosome 17p. It is the most
commonly mutated gene in breast, colon and lung cancer
p53 is thought to play a crucial role in the cell cycle, preventing entry into the S phase
until DNA has been checked and repaired. It may also be a key regulator of apoptosis
Li-Fraumeni syndrome is a rare autosomal dominant disorder characterised by the
early onset of a variety of cancers such as sarcoma, breast cancer and leukaemias.
It is caused by mutation in the p53 gene.
Renal anatomy
Each kidney is about 11cm long, 5cm wide and 3cm thick. They are located in a deep
gutter alongside the projecting vertebral bodies, on the anterior surface of psoas
major. In most cases, the left kidney lies approximately 1.5cm higher than the right.
The upper pole of both kidneys approximates with the 11th rib (beware
pneumothorax during nephrectomy). On the left hand side the hilum is located at the
L1 vertebral level and the right kidney at level L1-2. The lower border of the kidneys is
usually alongside L3.
Relations
The tables below show the anatomical relations of the kidneys:
Relations Right Kidney Left Kidney
Posterior Quadratus lumborum, diaphragm, Quadratus lumborum, diaphragm,
psoas major, transversus psoas major, transversus
abdominis abdominis
Anterior Hepatic flexure of colon Stomach, Pancreatic tail
Superior Liver, adrenal gland Spleen, adrenal gland
If we consider relations according to whether they are in direct contact or whether
there is peritoneum in-between:
,Right kidney
Direct contact Layer of peritoneum in-between
Right suprarenal gland Liver
Duodenum Distal part of small intestine
Colon
Left kidney
Direct contact Layer of peritoneum in-between
Left suprarenal gland Stomach
Pancreas Spleen
Colon Distal part of small intestine
,Fascial covering
Each kidney and suprarenal gland is enclosed within a common layer of investing
fascia, derived from the transversalis fascia. It is divided into anterior and posterior
layers (Gerotas fascia).
Renal structure
Kidneys are surrounded by an outer cortex and an inner medulla which usually
contains between 6 and 10 pyramidal structures. The papilla marks the innermost
apex of these. They terminate at the renal pelvis, into the ureter.
Lying in a hollow within the kidney is the renal sinus. This contains:
● 1. Branches of the renal artery
● 2. Tributaries of the renal vein
● 3. Major and minor calyces
● 4. Fat
, Diagram showing the main structures of the kidney
Structures at the renal hilum
The renal vein lies most anteriorly, then the renal artery (it is an end artery) and the
ureter lies most posteriorly.
Obesity: physiology
Leptin
Leptin is thought to play a key role in the regulation of body weight. It is produced by
adipose tissue and acts on satiety centres in the hypothalamus and decreases
appetite. More adipose tissue (e.g. in obesity) results in high leptin levels.
p53
p53 is a tumour suppressor gene located on chromosome 17p. It is the most
commonly mutated gene in breast, colon and lung cancer
p53 is thought to play a crucial role in the cell cycle, preventing entry into the S phase
until DNA has been checked and repaired. It may also be a key regulator of apoptosis
Li-Fraumeni syndrome is a rare autosomal dominant disorder characterised by the
early onset of a variety of cancers such as sarcoma, breast cancer and leukaemias.
It is caused by mutation in the p53 gene.
Renal anatomy
Each kidney is about 11cm long, 5cm wide and 3cm thick. They are located in a deep
gutter alongside the projecting vertebral bodies, on the anterior surface of psoas
major. In most cases, the left kidney lies approximately 1.5cm higher than the right.
The upper pole of both kidneys approximates with the 11th rib (beware
pneumothorax during nephrectomy). On the left hand side the hilum is located at the
L1 vertebral level and the right kidney at level L1-2. The lower border of the kidneys is
usually alongside L3.
Relations
The tables below show the anatomical relations of the kidneys:
Relations Right Kidney Left Kidney
Posterior Quadratus lumborum, diaphragm, Quadratus lumborum, diaphragm,
psoas major, transversus psoas major, transversus
abdominis abdominis
Anterior Hepatic flexure of colon Stomach, Pancreatic tail
Superior Liver, adrenal gland Spleen, adrenal gland
If we consider relations according to whether they are in direct contact or whether
there is peritoneum in-between:
,Right kidney
Direct contact Layer of peritoneum in-between
Right suprarenal gland Liver
Duodenum Distal part of small intestine
Colon
Left kidney
Direct contact Layer of peritoneum in-between
Left suprarenal gland Stomach
Pancreas Spleen
Colon Distal part of small intestine
,Fascial covering
Each kidney and suprarenal gland is enclosed within a common layer of investing
fascia, derived from the transversalis fascia. It is divided into anterior and posterior
layers (Gerotas fascia).
Renal structure
Kidneys are surrounded by an outer cortex and an inner medulla which usually
contains between 6 and 10 pyramidal structures. The papilla marks the innermost
apex of these. They terminate at the renal pelvis, into the ureter.
Lying in a hollow within the kidney is the renal sinus. This contains:
● 1. Branches of the renal artery
● 2. Tributaries of the renal vein
● 3. Major and minor calyces
● 4. Fat
, Diagram showing the main structures of the kidney
Structures at the renal hilum
The renal vein lies most anteriorly, then the renal artery (it is an end artery) and the
ureter lies most posteriorly.
Obesity: physiology
Leptin
Leptin is thought to play a key role in the regulation of body weight. It is produced by
adipose tissue and acts on satiety centres in the hypothalamus and decreases
appetite. More adipose tissue (e.g. in obesity) results in high leptin levels.
