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BS V, Module III > 1. Kidney and Urinary Tract Anatomy > Flashcards

1. Kidney and Urinary Tract Anatomy Flashcards

1
Q

The kidneys, adrenal glands and the abdominal portion of each ureter lie along the ____ abdominal wall from roughly ____

A

posterior

T12 to L3

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2
Q

Kidneys, ureters and adrenals are ____ RETROPERITONEAL
viscera, lying outside the
____

A

primary

peritoneal sac

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3
Q

The kidneys lie obliquely in the ____ gutters, surrounded by fat and ____

Note how difficult the kidneys are to ____ on physical examination

A

paravertebral
fasciae
palpate

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4
Q

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

A 
parenchyma
perirenal
inferior vena cava
thin
thicker
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5
Q

Within the capsule
of renal fascia, each kidney is surrounded by
____

A

perirenal fat

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6
Q

Surrounding the capsule of renal fascia is abundant ____

A

pararenal fat

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7
Q

Both perinephric and paranephric fat cushion and protect the ____, which do not benefit from much protection by elements of the ____

A

kidneys

rib cage

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8
Q

Both ____ attachments of the diaphragm and ____ abdominal muscles lie ____ to each kidney and its associated fat and fasciae

A

posterior
posterior
posterior

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9
Q

Anterior relations of the kidney

A

YA

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10
Q

Branches of the abdominal aorta arise and distribute in three planes

  1. ____ branches arise anteriorly and supply the ____and digestive glands
    1. ____ visceral branches arise bilaterally and supply the ____ (i.e. kidneys, adrenals & gonads)
  2. ____ parietal branches arise posteriorly and supply the ____ and posterior abdominal wall
A 
unpaired
GI tract
paired
primary retroperitoneal viscera
paired
diaphragm
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11
Q

The left and right renal arteries arise most commonly at the ____ level of the spine

A

L1-L2

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12
Q

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

A

posterior
veins
inferior vena cava

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13
Q

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
A

renal hilum
renal sinus
oblique

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14
Q

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 ____

A

aorta

renal vein

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15
Q

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 ____)

A 
renal hilum
anteroir
posterior
vascular
anastomoses
end-arteries
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16
Q

… thus obstruction of a segmental artery leads to death of that ____ of the kidney

A

segment

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17
Q

Interlobar and Arcuate arteries ascend to the ____ via cortical extensions called the ____ (C]

A

renal cortex

renal columns

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18
Q

The renal cortex contains ____, the initial blood filtering components of the nephron, at the interface between the renal ____ and the ____ of the urinary tract

A

renal corpuscles
blood vessels
excretory portion

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19
Q

____
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 ____

A

medullary pyramids
ascending
collecting ducts
renal papillae

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20
Q

Urine draining from the papilla at the apex of each pyramid (P) fills the____ embedded in the ____ packing the ____

A

minor calyces
fat
renal sinus

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21
Q

In turn, each
____ CALYX
receives
urine drained from 2-3 ____

A

major

minor calyces

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22
Q

At the hilum, the
____
receives urine from the major calyces

And funnels it into the ____

The ____ is indistinct

A

renal pelvis
ureter
ureteropelvic junction

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23
Q

Smooth muscle in the ____, pelvis and ____ undergoes ____ contraction to move urine

A

calyces
ureter
peristaltic

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24
Q

Initially pelvic organs, the kidneys “____” along the posterior abdominal wall
via ____ and ____

Note the simultaneous descent of the ____ (testis or ovary)

A

ascend
differential growth
migration
gonad

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25
Q

____ 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

A

accessory
caudal
ureteral compression

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26
Q

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)

A

separate
midline
ascend
inferior mesenteric artery

27
Q

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 ____

A

renal pelvis
urinary bladder

PSOAS MAJOR
gonadal
external iliac
pelvis

28
Q

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

A

circular
longitudinal
12-20

29
Q

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

A

ureteric calculi
hydronephrosis
inflammation

30
Q

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 ____

A 
ureteral colic
common
oxalate
fluid
meats
purine
infections
families
31
Q

The referred pain of such stones is experienced

“____”

A

loin to groin

32
Q 
The ureters have a complex blood supply with \_\_\_\_ between branches of the following arteries:
• \_\_\_\_
• \_\_\_\_
• \_\_\_\_
• \_\_\_\_
A 
anastomoses
renal
gonadal
iliac
vesicular
33
Q

____

PELVIC portion of ureter

A

intravenous pyelogram

34
Q

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

A

water
bridge

vas deferens
uterine artery

35
Q

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 ____

A 
intramural
inferomedial
flap valve
collapse
urinary reflux
retrograde flow
36
Q

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!

A

volume
viscera
puberty
umbilicus

37
Q

The urinary bladder is a ____ organ

A

subperitoneal

38
Q

he organ may be ruptured as a result of certain

____

A

pelvic fractures

39
Q

The bladder drains into the ____ in both sexes

A

urethra

40
Q 
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 ____

A

rectum
apex
neck

41
Q

URINARY BLADDER
(Lateral view)

  • apex
  • neck
  • fundus
  • body
A

YA

42
Q

The walls of the bladder feature ____ layers of tissue; the middle of which is comprised of smooth muscle

  • mucosa
  • ____
  • adventitia
A

three

detrusor

43
Q

The mucosa is fixed only at the ____, where contraction of the detrusor in micturition helps close the ____

A

trigone

ureteric orifices

44
Q

At the neck of the bladder, smooth muscle fibers continuous with the detrusor encircle the ____

A

internal urethral orifice

45
Q

In the male, these fibers form an “____” ____ aka sphincter vesicae

A

anatomical

internal urethral sphincter

46
Q

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)

A

physiological
retain
ejaculation
retrograde

47
Q

… as the male bladder drains urine into the
____…

… which also receives a mixture of ____ and ____ fluid from the ejaculatory ducts

A

prostatic urethra
sperm
seminal

48
Q

The ____ and ____prostate surround the upper prostatic urethra
Site of ____

The PERIPHERAL PROSTATE - site of most ____ elements.. … is most susceptible to the formation of
____

A 
central
periurethral
BPH
glandular
prostatic adenocarcinoma
49
Q 
The male urethra features four distinct parts:
• \_\_\_\_
	• \_\_\_\_
	• \_\_\_\_
	• \_\_\_\_ (spongy)

The membranous portion is surrounded by the fibers of the ____ (aka sphincter urethrae)

A 
prostatic
membranous
bulbar
penile
external urethral sphincter
50
Q

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 \_\_\_\_
A

involuntary
smooth
GVE

voluntary
skeletal
GSE
tonic
pudendal nerve
51
Q

____ is a component of the “urogenital diaphragm” in both sexes

Sphincter vesicae
- prevents ____

Sphincter urethrae
- main provider of ____

A

sphincter urethrae
retrograde ejaculation
tonic continence

52
Q

In contrast, the ____ female urethra is more ____ than that of the male, containing considerable ____ tissue as well as smooth muscle, easing ____ and cystoscopy

A

shorter
distensible
elastic
catheterization

53
Q

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

A

sphincter urethrae
cystitis
pyelonephritis
vaginal canal

54
Q

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____.

A 
sphincter urethrae
pelvic
pubovesical ligaments
endopelvic fasciae
thoracoabdominal pressure
55
Q

Innervation of the bladder is by the ____, consisting of the anterior component of the ____

A

vesical plexus

inferior hypogastric plexus

56
Q

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

A

T11-L2
inferior mesenteric
superior hypogastric
inferior hypogastric

sphincter vesicae
detrusor

57
Q

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)

A 
preganglionic parasympathetic
S2-4
inferior hypogastric
terminal
bladder

detrusor
sphincter vesicae

58
Q

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 ____

A 
visceral afferent
pain
ureter
bladder
fullness
59
Q

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

A

somatic

burning

60
Q

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
A 
urethra
vesical
parasympathetic
sympathetic
somatic
pudendal
filling
emptying
61
Q

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

A 
afferents
pelvic splanchic
sympathetic
detrusor
sphincter vesicae
ureteric orifices
pelvic splanchics
sympathetic
T11-L1
62
Q

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

A 
pelvic splanchnics
detrusor
trigone
dilated
relaxed
somatic motor
contract
accelerating
bulbospongiosus
63
Q

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 = “____?”

A

toilet training
supraspinal control center

prefrontal cortex
pontine mictuirition center (PMC)
initiate

conscious
environmental
social
bulbospinal
sensorimotor
sphincter urethrae

start
stop
shy bladder

BS V, Module III (8 decks)

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