1. Kidney and Urinary Tract Anatomy Flashcards
The kidneys, adrenal glands and the abdominal portion of each ureter lie along the ____ abdominal wall from roughly ____
posterior
T12 to L3
Kidneys, ureters and adrenals are ____ RETROPERITONEAL
viscera, lying outside the
____
primary
peritoneal sac
The kidneys lie obliquely in the ____ gutters, surrounded by fat and ____
Note how difficult the kidneys are to ____ on physical examination
paravertebral
fasciae
palpate
Renal fascia
(anterior layer)
Renal fibrous capsule
Encloses the renal ____
Renal fascia
(posterior layer)
aka Gerota’s fascia
– connective-tissue fascial sac that enclose the ____fat, portions of the abdominal aorta and ____ close to the kidney, and the proximal ureter; subdivided into a ____ anterior layer and a ____ posterior layer
parenchyma perirenal inferior vena cava thin thicker
Within the capsule
of renal fascia, each kidney is surrounded by
____
perirenal fat
Surrounding the capsule of renal fascia is abundant ____
pararenal fat
Both perinephric and paranephric fat cushion and protect the ____, which do not benefit from much protection by elements of the ____
kidneys
rib cage
Both ____ attachments of the diaphragm and ____ abdominal muscles lie ____ to each kidney and its associated fat and fasciae
posterior
posterior
posterior
Anterior relations of the kidney
YA
Branches of the abdominal aorta arise and distribute in three planes
- ____ branches arise anteriorly and supply the ____and digestive glands
- ____ visceral branches arise bilaterally and supply the ____ (i.e. kidneys, adrenals & gonads)
- ____ parietal branches arise posteriorly and supply the ____ and posterior abdominal wall
unpaired GI tract paired primary retroperitoneal viscera paired diaphragm
The left and right renal arteries arise most commonly at the ____ level of the spine
L1-L2
The renal arteries lie ____ to, and normally obscured by the left and right renal ____
The right renal artery normally passes posterior to the ____ to reach the right kidney
posterior
veins
inferior vena cava
Renal vessels course bilaterally to enter each kidney through an indentation called the ____, the entrance to a fat filled cavity called the ____
• The kidneys actually lie \_\_\_\_ to the sagittal plane
renal hilum
renal sinus
oblique
Like the lung, each kidney has a HILUM medially through which vasculature passes to and from the organ
• Renal artery from the ____
• Renal vein to the ____
aorta
renal vein
Within the renal hilum, each renal artery divides into ____ and ____branches
Within the ____, segmental branches arise from these vessels
- Each of these supplies a distinct ____ segment of the organ and lacks peripheral ____ (they are ____)
renal hilum anteroir posterior vascular anastomoses end-arteries
… thus obstruction of a segmental artery leads to death of that ____ of the kidney
segment
Interlobar and Arcuate arteries ascend to the ____ via cortical extensions called the ____ (C]
renal cortex
renal columns
The renal cortex contains ____, the initial blood filtering components of the nephron, at the interface between the renal ____ and the ____ of the urinary tract
renal corpuscles
blood vessels
excretory portion
____
contain the structures of the nephron responsible for maintaining the salt and water balance of the blood, including ____ and descending limbs of the renal tubules and ____ leading to the ____
medullary pyramids
ascending
collecting ducts
renal papillae
Urine draining from the papilla at the apex of each pyramid (P) fills the____ embedded in the ____ packing the ____
minor calyces
fat
renal sinus
In turn, each
____ CALYX
receives
urine drained from 2-3 ____
major
minor calyces
At the hilum, the
____
receives urine from the major calyces
And funnels it into the ____
The ____ is indistinct
renal pelvis
ureter
ureteropelvic junction
Smooth muscle in the ____, pelvis and ____ undergoes ____ contraction to move urine
calyces
ureter
peristaltic
Initially pelvic organs, the kidneys “____” along the posterior abdominal wall
via ____ and ____
Note the simultaneous descent of the ____ (testis or ovary)
ascend
differential growth
migration
gonad
____ or supernumerary renal arteries are common, reflecting the ascent of
the kidney during development
without regression of all
earlier, more ____ vessels
However, ____
by such a vessel is possible
accessory
caudal
ureteral compression
Normal variation in the
anatomy of kidney and ureter
• Physical migration superiorly x growth of posterior abdominal wall x
elongation of spine…. = variation in anatomy of kidney and ureter
• Left pic:
• Right kidney has failed to ascend – literally hung up in pelvis
• ***Insert radio (next slide)
• Referred to as a pelvic kidney.
• Top right: horseshoe kidney result of anomaly in development
• Left and right kidney fail to ____ from common primordial mass
• Even though development remain connected here across the ____
• The presence here of isthmus connecting left and right helps ____
how far the kidneys can ascend!
• Restrained from further movement by ____
(level of L3)
separate
midline
ascend
inferior mesenteric artery
The URETERS
Smooth muscular tubes extending from the ____ to the posterior surface of the
____
The abdominal portion of each ureter descends the posterior abdominal wall anterior to the ____ muscle in proximity to the ____ vessels before crossing the ____ artery and vein and entering the true ____
renal pelvis
urinary bladder
PSOAS MAJOR
gonadal
external iliac
pelvis
Ureteric smooth muscle is arranged in a spiraling configuration of ____ and ____ layers to propel urine toward the bladder
Several drops of urine are transported by peristaltic contractions at intervals of ____ seconds
circular
longitudinal
12-20
Obstruction of the ureter at any of three points of constriction by ____ may produce ____ proximal to the site of the blockage, with reflux of urine into the kidney leading to ____ of the renal pelvis
ureteric calculi
hydronephrosis
inflammation
NEPHROLITHIASIS. URETEROLITHIASIS and VESICOLITHIASIS
Entry of a stone into the ureter leads to powerful contraction of smooth muscle in the wall in an effort to expel the stone producing the sharp pain of ____
Four main types of stones:
• Calcium oxalate: Most ____; formed when calcium
combines with ____ in the urine. Inadequate calcium
and ____ intake may contribute to stone formation.
• Uric acid: Another common type. Foods such as organ
____ and shellfish have high concentrations of purines; high purine intake leads to a higher production of ____, which may form stones.
• Struvite: Less common; caused by ____ in the upper urinary tract.
• Cystine: Rare; tend to run in ____
ureteral colic common oxalate fluid meats purine infections families
The referred pain of such stones is experienced
“____”
loin to groin
The ureters have a complex blood supply with \_\_\_\_ between branches of the following arteries: • \_\_\_\_ • \_\_\_\_ • \_\_\_\_ • \_\_\_\_
anastomoses renal gonadal iliac vesicular
____
PELVIC portion of ureter
intravenous pyelogram
No matter one’s sex, in considering the pelvic portion of the ureter, the “____” always runs under a “____”
• Male: Before ureter reaches bladder it passes inferior to ____
(ductus deferens)
• Smooth muscular tube conveying sperm from testis epididymis to
elements ejaculatory system (posterior to urinary bladder)
• Female: pelvic portion of ureter passes under the ____
• Supplies uterus and is critical for delivering blood to organ (periods
ew - endometrial lining ripens) should the need for raising an
embryo parasite arise
water
bridge
vas deferens
uterine artery
The ____ portion of the ureters pass obliquely though the muscular wall of the urinary bladder in an ____direction…
…forming a one-way “____” in which the internal pressure of the filling bladder causes the intramural passage to ____,
preventing the possibility of ____ and ____
intramural inferomedial flap valve collapse urinary reflux retrograde flow
The urinary bladder is a hollow, distensible pelvic organ in the adult, varying in size, shape, position and relationships according to the ____ of its contents and the state of neighboring ____
It is an abdominal organ, even when empty, in the very young, becoming an organ of the true pelvis only after ____
That said, the full bladder may ascend as high as the ____ in some adults!
volume
viscera
puberty
umbilicus
The urinary bladder is a ____ organ
subperitoneal
he organ may be ruptured as a result of certain
____
pelvic fractures
The bladder drains into the ____ in both sexes
urethra
The fundus (base) of the bladder lies posteriorly (facing the \_\_\_\_)
The two inferolateral surfaces:
• Meet anteriorly at the ____ deep to the pubis
• Meet inferiorly at the ____
rectum
apex
neck
URINARY BLADDER
(Lateral view)
- apex
- neck
- fundus
- body
YA
The walls of the bladder feature ____ layers of tissue; the middle of which is comprised of smooth muscle
- mucosa
- ____
- adventitia
three
detrusor
The mucosa is fixed only at the ____, where contraction of the detrusor in micturition helps close the ____
trigone
ureteric orifices
At the neck of the bladder, smooth muscle fibers continuous with the detrusor encircle the ____
internal urethral orifice
In the male, these fibers form an “____” ____ aka sphincter vesicae
anatomical
internal urethral sphincter
In the female, the internal urethral sphincter is described as more of a “____” sphincter
Constriction of
sphincter vesicae
in both sexes enables
the bladder to fill with and ____ urine, but in males…
The internal urethral sphincter contracts during ____ to prevent ____ ejaculation (ejaculatory reflux)
physiological
retain
ejaculation
retrograde
… as the male bladder drains urine into the
____…
… which also receives a mixture of ____ and ____ fluid from the ejaculatory ducts
prostatic urethra
sperm
seminal
The ____ and ____prostate surround the upper prostatic urethra
Site of ____
The PERIPHERAL PROSTATE - site of most ____ elements.. … is most susceptible to the formation of
____
central periurethral BPH glandular prostatic adenocarcinoma
The male urethra features four distinct parts: • \_\_\_\_ • \_\_\_\_ • \_\_\_\_ • \_\_\_\_ (spongy)
The membranous portion is surrounded by the fibers of the ____ (aka sphincter urethrae)
prostatic membranous bulbar penile external urethral sphincter
Internal urethral sphincter
• ____
• ____ muscle
• ____
EXTERNAL URETHRAL SPHINCTER surrounds the membranous urethra • \_\_\_\_ • \_\_\_\_ muscle • \_\_\_\_ fibers from LMN's in the ventral horn of S2-4 maintain \_\_\_\_ contraction via branches of the \_\_\_\_
involuntary
smooth
GVE
voluntary skeletal GSE tonic pudendal nerve
____ is a component of the “urogenital diaphragm” in both sexes
Sphincter vesicae
- prevents ____
Sphincter urethrae
- main provider of ____
sphincter urethrae
retrograde ejaculation
tonic continence
In contrast, the ____ female urethra is more ____ than that of the male, containing considerable ____ tissue as well as smooth muscle, easing ____ and cystoscopy
shorter
distensible
elastic
catheterization
The shorter FEMALE urethra passes through the “urogenital diaphragm” where it is encircled by ____ and opens into the vestibule just anterior to the vaginal orifice
URINARY TRACT INFECTIONS
Females are more vulnerable due to the shorter urethra and exposure to pathogens during sexual activity
among other factors, possibly leading to …
• ____ (bladder inflammation)
• ____ (kidney infection)
Note that some of the musculature of the female “UG diaphragm” surrounds the ____ as well as the urethra
sphincter urethrae
cystitis
pyelonephritis
vaginal canal
URINARY STRESS INCONTINENCE
May result not only from decreased function of the ____ and other ____ floor muscles but from weakening of the ____ and related condensations of connective tissues of the pelvic floor (____), involuntary loss of urine with increased____.
sphincter urethrae pelvic pubovesical ligaments endopelvic fasciae thoracoabdominal pressure
Innervation of the bladder is by the ____, consisting of the anterior component of the ____
vesical plexus
inferior hypogastric plexus
Preganglionic sympathetics from ____ synapse in the ____ ganglion or cross the pelvic brim in the ____ plexus to synapse in ganglia in the ____ plexus
Postganglionic
sympathetics
facilitate constriction of the
____ (internal sphincter) permitting the bladder to fill and and preventing retrograde ejaculation.
Some of these fibers inhibit contraction of the ____ but this appears to be a minor function
T11-L2
inferior mesenteric
superior hypogastric
inferior hypogastric
sphincter vesicae
detrusor
Pelvic splanchnics convey ____ fibers from ____ to the ____ plexus. These fibers synapse on ____ ganglia in the plexus and on the walls of the ____
Postganglionic parasympathetics
facilitate emptying of the bladder by:
• Inducing contraction of the ____
• Inducing relaxation of the ____ (internal sphincter)
preganglionic parasympathetic S2-4 inferior hypogastric terminal bladder
detrusor
sphincter vesicae
Inferior hypogastric plexus also carries ____ FIBERS from pelvic viscera
GVA fibers accompanying sympathetics carry ____ sensations from the ____ and bladder
GVA fibers accompanying parasympathetics respond to distension of the ____ and convey a sense and awareness of ____
visceral afferent pain ureter bladder fullness
Afferent pathways for conscious bladder sensations
Note:
The urethra enjoys some ____ afferent
innervation, hence the “____” sensation
on urination associated with certain infectious and inflammatory processes
somatic
burning
MICTURITION
• The process by which urine flows from the bladder into the \_\_\_\_ • Micturition is mediated by the micturition or \_\_\_\_ reflex. • The reflex is facilitated by : – \_\_\_\_ nerves – \_\_\_\_ nerves – \_\_\_\_ (via the \_\_\_\_nerve) • The reflex has two components: – \_\_\_\_ stage – urinary continence – \_\_\_\_ stage - voiding
urethra vesical parasympathetic sympathetic somatic pudendal filling emptying
FILLING stage
– Stretch receptors in the wall of the bladder innervated by visceral ____ in the ____ nerves respond to the accumulation of urine and the degree of stretch of the bladder wall
– A bladder storage center is activated in the CNS, which stimulates ____ nerves to inhibit the ____ to allow the bladder to continue to stretch AND keep the ____ contracted
– As the bladder fills, the walls of the bladder compress the ____, preventing reflux of urine
– At or near a micturition threshold, conscious perception of bladder fullness is appreciated via ____
– Pain fibers which accompany ____ elements in the pelvis are stimulated by bladder fullness and refer pain over the ____dermatomes
afferents pelvic splanchic sympathetic detrusor sphincter vesicae ureteric orifices pelvic splanchics sympathetic T11-L1
EMPTYING stage
Once the micturition threshold is reached and a CNS micturition center is activated:
– ____ facilitate contraction of the ____, raising pressure within the bladder as the ____ is raised, creating a funnel at the internal urethral orifice
– The urethra is ____
– The sphincter vesicae and sphincter urethrae are ____, THE LATTER BY INHIBITION OF ____ NEURONS
– Urine passes through the length of the urethra
– In both sexes, the diaphragm and abdominal muscles ____ to increase intrapelvic pressure on the bladder, ____ the flow of urine
– In the male, ____ contracts to expel urine from the penile urethra
pelvic splanchnics detrusor trigone dilated relaxed somatic motor contract accelerating bulbospongiosus
As the micturition reflex may be volitionally controlled following “____” we must consider the role of ____in deciding where and when to void urine like a switch turning continence off!
When activated by afferent inputs, including
from ____, the ____, a collection of neurons located in the ____, is thought to relax the sphincters and contract the detrusor to ____ urination.
The process requires:
1) ____ bladder sensation
2) assessment and integration of ____,
emotional, and ____ aspects, that it is safe,
appropriate, and comfortable to micturate,
3) release of the ____ micturition reflex, and
4) adequate ____ function to relax the ____ and pelvic floor muscles
These SUPRASPINAL CENTERS permit you to ____ AND ____
Does lack of adequate cortical input = “____?”
toilet training
supraspinal control center
prefrontal cortex
pontine mictuirition center (PMC)
initiate
conscious environmental social bulbospinal sensorimotor sphincter urethrae
start
stop
shy bladder
