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Anatomy Topnotch > 12. Adrenals, Ureter and Bladder > Flashcards

12. Adrenals, Ureter and Bladder Flashcards

1
Q

paired endocrine glands situated over the medial aspect of the upper poles of each kidney.

A

adrenal glands

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2
Q

shape of right adrenal gland

A

pyramidal in shape

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3
Q

shape of left adrenal gland

A

semi-lunar

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4
Q

encloses the adrenal glands and the kidneys. This fascia attaches the glands to the crura of the diaphragm.

They are separated from the kidneys by the perirenal fat.

A

renal fascia /perinephric fascia

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5
Q

The adrenal glands consist of

A

capsule
cortex
medulla

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6
Q

Veins and lymphatics leave each adrenal gland via

A

hilum

arteries and nerves enter the glands at numerous sites.

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7
Q

adrenal cortex is derived from

A

embyronic mesoderm

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8
Q

adrenal medulla is derived from

A

ectodermal neural crest cells

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9
Q

this portion of adrenal gland is yellowish in color

A

cortex

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10
Q

cortex can be divided into 3 zones

superficial -> deep

A
  1. zona glomerulosa
  2. zona fasciculata
  3. zona reticularis
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11
Q

produces and secretes mineralocorticoids such as aldosterone.

A

Zona glomerulosa

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12
Q

produces and secretes corticosteroids such as cortisol. It also secretes a small amount of androgens.

A

Zona fasciculata

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13
Q

produces and secretes androgens such as dehydroepiandrosterone (DHES). It also secretes a small amount of corticosteroids.

A

Zona reticularis

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14
Q

dark brown in colour

portion of the adrenal gland

A

medulla

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15
Q

medulla contains this cells

A

chromaffin cells

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16
Q

secrete catecholamines (such as adrenaline) into the bloodstream in response to stress

also secrete enkephalins which function in pain control.

A

chromaffin cells

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17
Q

adrenal glands have a rich blood supply via three main arteries

A

Superior adrenal artery – arises from the inferior phrenic artery
Middle adrenal artery – arises from the abdominal aorta.
Inferior adrenal artery – arises from the renal arteries.

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18
Q

venous drainage of the adrenal glands

A

Right and left adrenal veins drain the glands.

The right adrenal vein drains into the inferior vena cava, whereas the left adrenal vein drains into the left renal vein.

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19
Q

innervation of the adrenal gland

A

coeliac plexus
greater splanchnic nerves.

Sympathetic innervation to the adrenal medulla - mainly from the T10 to L1 spinal cord segments.

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20
Q

lymphatic drainage of adrenal glands

A

lumbar lymph nodes by adrenal lymphatic vessels.

These vessels originate from two lymphatic plexuses – one deep to the capsule, and the other in the medulla.

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21
Q

a tumour of the adrenal medulla or preganglionic sympathetic neurones. It secretes adrenaline and noradrenaline uncontrollably, causing blood pressure to greatly increase.
Patients may present with palpitations, headaches and diaphoresis (profuse sweating).

A

pheochromocytoma

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22
Q

competitive, irreversible antagonist of adrenaline, can be used in treatment to reduce blood pressure by binding to adrenaline receptors, making less available for adrenaline to act upon.

A

phenoxybenzamine

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23
Q

adrenal gland

normal weight

A

4 grams

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24
Q

75% of the cortex is the

A

zone fasciculata

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25
Q 
adrenocortical insufficiency 
characterized by :
inc. pigmentation
muscular weakness
weight loss 
hypotension
A

Addison disease

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26
Q

cortical hyperplasia due to adenoma or carcioma of the cortex

A

cushing syndrome

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27
Q

cushing syndrome

manifestations

A

moon shaped face
truncal obesity
abnormal hairiness/ hirsutism
hypertension

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28
Q

•excessive androgen production during fetal period
•in femals -> masculinization of the external genitlia - enlargement of clitoris - virilization
- fused labia majora

A

Congenital Adrenal Hyperplasia

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29
Q

bronze tone of the skin

A

Addison disease

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30
Q

are two thick tubes which act to transport urine from the kidney to the bladder.

A

ureters

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31
Q

length of ureters

A

25 cm

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32
Q

arise in the abdomen as a continuation of the renal pelvis, and terminate in the pelvic cavity – where they empty into the bladder.

A

ureters

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33
Q

anatomical course of the ureters can therefore be divided into

A
  • abdominal

* pelvic components

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34
Q

a funnel like structure located within the hilum of the kidney.

A

renal pelvis

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35
Q

The point at which the renal pelvis narrows to form the ureter is known as

A

ureteropelvic junction.

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36
Q

adrenal glands
and ureters are
a. intraperitoneal
b. retroperitoneal

A

b. retroperitoneal

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37
Q

Once within the pelvic cavity, the ureters travel down the lateral pelvic walls. At the level of the this structure, they turn anteromedially, moving in a transverse plane towards the bladder.

A

ischial spines

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38
Q

Upon reaching the bladder wall, the ureters pierce its lateral aspect in an ____ manner.

A

oblique

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39
Q

Ureters have a one way valve, where high ______ collapses the ureters – preventing the back-flow of urine.

A

intramural pressure

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40
Q

Approximately 2cm superior to the ischial spine, the ureters run underneath the____

A

uterine artery.

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41
Q

The ureter is a structure that has developed via this bud

A

ureteric bud from the mesonephric duct

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42
Q

The arterial supply to the ureters can be divided into abdominal and pelvic supply:

A

Abdominal – renal artery, testicular/ovarian artery, and ureteral branches directly from the abdominal aorta
Pelvic – superior and inferior vesical arteries.

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43
Q

nervous supply to the ureters

A

renal, testicular/ovarian and hypogastric plexuses.

Sensory fibres from the ureters enter the spinal cord at T11-L2, with ureteric pain referred to those dermatomal areas.

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44
Q

the presence of a solid stone in the urinary tract, formed from minerals within the urine. These can obstruct urinary flow, causing renal colic (an acute and severe loin pain) and haematuria (blood in the urine).

A

ureteric calculus

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45
Q

three locations where the ureters are at their narrowest – this is where a stone is more likely to become stuck:

A

Uretopelvic junction
Pelvic brim
Where the ureter enters the bladder

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46
Q

The gold standard investigation for suspected ureteric calculus is

A

CT scan of the kidneys, ureters and bladder (CT-KUB).

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47
Q

severe type of colicky pain and is referred through T11 - L2 dermatomes;
pain may radiate from the back above the iliac crest, through the ingunal region and into the scrotum or labia majora

A

renal colic

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48
Q

relation of ureter to the ovarian artery

A

below

water under the bridge

49
Q

ureter lie ___ to ovarian vessels

A

medial

50
Q

ureter passes ___ to uterine vessels

A

inferiorly

51
Q

in vaginal hysterectomy, ureter lies ____ to uterine cervix

A

lateral

52
Q

at the bifurcation, common iliac arteri on each side is crossed ___ by the ureter

A

anteriorly

53
Q

right and left common iliac arteries arise at this level

A

L4

54
Q

external iliac artery enters the thigh under the inguinal ligament to become

A

femoral artery

55
Q

branches of external iliac atery

A

inferior epigastric

deep circumflex iliac banches

56
Q

this artery passes down into pelvis in front of sacroiliac join to supply pelvic organs

A

internal iliac artery

57
Q

The bladder is an organ of the urinary system. It plays two main roles:

A
  1. Temporary storage of urine

2. Assists in the expulsion of urine

58
Q

folded internal lining of the bladder is known as

A

rugae

59
Q

capacity of the bladder

A

400-600 mL

60
Q

external features of the bladder

A
  1. apex
  2. body
  3. fundus/ base
  4. neck
61
Q

Apex of the bladder – located superiorly, pointing towards the pubic symphysis. It is connected to the umbilicus by the

A

median umbilical ligament

62
Q

a remnant of the urachus

A

median umbilical ligament

63
Q

a triangular area located within the fundus of the bladder

A

trigone

64
Q

Urine enters the bladder through the left and right ureters, and exits via the urethra. Internally, these orifices are marked by the

A

trigone

65
Q

trigone is developed by the integration of two _______ at the base of the bladder

A

mesonephric ducts

66
Q

In order to contract during micturition, the bladder wall contains specialised smooth muscle – known as

A

detrusor muscle

67
Q

two muscular sphincters located in the urethra

A

Internal urethral sphincter

External urethral sphincter

68
Q

In Male – consists of circular smooth fibres, which are under autonomic control. It is thought to prevent seminal regurgitation during ejaculation.

A

Internal urethral sphincter

69
Q

In Females – thought to be a functional sphincter (i.e. no sphincteric muscle present). It is formed by the anatomy of the bladder neck and proximal urethra.

A

Internal urethral sphincter

70
Q

has the same structure in both sexes. It is skeletal muscle, and under voluntary control.

A

External urethral sphincter

71
Q

The vasculature of the bladder is primarily derived from

A

internal iliac vessels

Arterial supply is via the superior vesical branch of the internal iliac artery.

In males, supplemented :inferior vesical artery
females – vaginal arteries.

In both sexes, the obturator and inferior gluteal arteries may also contribute small branches.

72
Q

Venous drainage of the blader

A

vesical venous plexus -> internal iliac veins

The vesical plexus in males is in continuity at the retropubic space with the prostate venous plexus (plexus of Santorini), which also receives blood from the dorsal vein of the penis

73
Q

lymphatics of the bladder

A

The superolateral aspect of the bladder -> external iliac lymph nodes.
The neck and –> internal iliac, sacral and common iliac nodes.

74
Q

Neurological control is complex, with the bladder receiving input from both the

A

Sympathetic – hypogastric nerve (T12 – L2). It causes relaxation of the detrusor muscle, promoting urine retention.

Parasympathetic – pelvic nerve (S2-S4). Increased signals from this nerve causes contraction of the detrusor muscle, stimulating micturition.

Somatic – pudendal nerve (S2-4). It innervates the external urethral sphincter, providing voluntary control over micturition.

75
Q

is a primitive spinal reflex, in which micturition is stimulated in response to stretch of the bladder wall. It is analogous to a muscle spinal reflex, such as the patella reflex.

A

Bladder Stretch Reflex

76
Q

In this case, the afferent signals from the bladder wall are unable to reach the brain, and the patient will have no awareness of bladder filling. There is also no descending control over the external urethral sphincter, and it is constantly relaxed.

There is a functioning spinal reflex

A

Reflex Bladder – Spinal Cord Transection Above T12

77
Q

A spinal cord transection at this level will have damaged the parasympathetic outflow to the bladder. The detrusor muscle will be paralysed, unable to contract. The spinal reflex does not function.

In this scenario, the bladder will fill uncontrollably, becoming abnormally distended until overflow incontinence occurs.

A

Flaccid Bladder – Spinal Cord Transection Below T12

78
Q

is a medical emergency, as the bladder has a “normal” functional capacity with is pushed to the limit due to accumulation of urine in an acutely obstructed reservoir. The patient feels increasingly excruciating pain and the placement of a urinary catheter alleviates the symptoms immediately.

A

Acute retention

79
Q

is a gradual procedure due to incomplete obstruction of the urine outflow. This leads to accumulation of residual urine in the bladder through months or even years; the bladder is therefore progressively distended in volumes that exceed 1-1.5 lt of urine.

A

Chronic retention

80
Q

empty bladder is in this shape

A

pyramidal

81
Q

neck of the bladder is held in position by

A
  • males : puboprostatic ligaments

* females: pubovesical ligaments

82
Q

True ligaments of the bladder

A

pubo-vesical

recto-vesical

83
Q

false ligaments of the bladder

A

medial umbilical

median umbilical

84
Q

Ureteric bud/metanephric diverticulum or duct

is the primordium of

A

ureter
renal pelvis
renal calices
collecting tubules

85
Q

Metanephric tubule forms the

A

nephron (renal corpuscle, PCT, Loop of Henle, DCT)

86
Q

gives rise to the urinary bladder

A

vesical part of the urogenital sinus

87
Q

divisible into a dorsal rectum, and ventral urogenital sinus thru urorectal septum

A

cloca

88
Q

UG sinus 3 parts

A
  1. cranial VESICAL -> urinary bladder
  2. middle PELVIC ->urethra in the bladder nek
    -> prostatic and membranous parts in males
    and entire part in females
    plus the lower part of vagina
  3. caudal PHALLIC
    -> genital tubercle
89
Q

tubular sheath of fascia enclosing the three erectile tissue in the body of penis

A

Buck’s fascia

90
Q

vessel responsible for transporting urine from the bladder to an external opening in the perineum

A

urethra

91
Q

urethra is lined by

A

stratified columnar epithelium

•protected from the corrosive urine by mucus secreting glands.

92
Q

male urethra approximate length

A

15-20 cm

93
Q

a fluid containing spermatozoa and sex gland secretions.

A

semen

94
Q

male urethra can be divided into 3 parts

A
  1. Prostatic urethra
  2. Membranous urethra
  3. Penile (bulbous) urethra
95
Q

Begins as a continuation of the bladder neck and passes through the prostate gland.

A

Prostatic urethra

96
Q

Receives the ejaculatory ducts (containing spermatozoa from the testes and seminal fluid from the seminal vesicle glands) and the prostatic ducts (containing alkaline fluid).

A

Prostatic urethra

97
Q

It is the narrowest and least dilatable portion of the urethra.

A

Membranous urethra

98
Q

It is the widest and most dilatable portion of the urethra.

A

Prostatic urethra

99
Q

Passes through the pelvic floor and the deep perineal pouch.

Surrounded by the external urethral sphincter – which provides voluntary control of micturition.

A

Membranous urethra

100
Q

Passes through the bulb and corpus spongiosum of the penis, ending at the external urethral orifice (the meatus).

A

Penile (bulbous) urethra

101
Q

Receives the bulbourethral glands proximally.

A

Penile (bulbous) urethra

102
Q

In the glans (head) of the penis, this dilates to form the navicular fossa

A

urethra

103
Q

considered by some authors as a fourth anatomic part of the urethra.

A

part of the urethra that passes through the bladder neck

104
Q

The arterial supply to the male urethra is via several arteries

A

Prostatic urethra – supplied by the inferior vesical artery (branch of the internal iliac artery which also supplies the lower part of the bladder).
Membranous urethra – supplied by the bulbourethral artery (branch of the internal pudendal artery)
Penile urethra – supplied directly by branches of the internal pudendal artery.

105
Q

nerve supply to the male urethra is derived from the

A

prostatic plexus- contains a mixture of sympathetic, parasympathetic and visceral afferent fibres.

106
Q

lymph drainage of the male urethra

A
  • prostatic and membranous portions drain to the obturator and internal iliac nodes
  • penile urethra drains to the deep and superficial inguinal nodes.
107
Q

is the process of inserting a tube through the urethra and into the bladder.

A

urinary catherisation

108
Q

this angle can be diminished by holding the penis upwards during urinary catheterisation.

A

prepubic angle

109
Q

three constrictions in the male urethra

A

the internal urethral sphincter, external urethral sphincter, and external urethral orifice.

110
Q

female urethra

length

A

4 cm

111
Q

female urethra opens directly onto the

A

perineum

112
Q

The distal end of the female urethra is marked by the presence of two mucous glands that lie either side of the urethra

A

skene’s glands

113
Q

arterial supply to the female urethra is via the

A

internal pudendal arteries, vaginal arteries and inferior vesical branches of the vaginal arteries.

114
Q

nerve supply to the female urethra arises from the

A

vesical plexus and the pudendal nerve

115
Q

Lymphatic drainage of the female urethra

A

proximal female urethra is to the internal iliac nodes

distal urethra drains to the superficial inguinal lymph nodes

116
Q

homologous to the prostate glands in males

A

skene’s glands / lesser vestibular glands

117
Q

secrete a substance to lubricate the urethra opening

A

skene’s glands / lesser vestibular glands

118
Q

are two pea sized compound alveolar glands located slightly posterior and to the left and right of the opening of the vagina. They secrete mucus to lubricate the vagina and are homologous to bulbourethral glands in males.

A

Bartholin’s glands (also called Bartholin glands or greater vestibular glands)

Anatomy Topnotch (26 decks)

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