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3002 > 44 Structure of the urinary system including bladder > Flashcards

44 Structure of the urinary system including bladder Flashcards

1
Q

What is the kidney encapsulated and protected by?

A
  1. Perirenal/ perinephric fat
  2. Renal fascia (derived from extraperitoneal fascia)
  3. Pararenal/ paranephric fat
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2
Q

What does the nephron consist of?

A
  1. Renal corpuscle
  2. Proximal convoluted tubule
  3. Loop of Henlé
  4. Distal collecting tubule
  5. Collecting duct
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3
Q

What is the function of nephron?

A
  • Ultrafiltration

- Reabsorption

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4
Q

Hilum (anterior to posterior)

A
  • Renal vien
  • Renal artery
  • Renal pelvis
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5
Q

Kidney: blood supply,
venous,
lymphatic drainage

A
  1. Renal arteries
    - from aorta at L1
    - posterior to renal veins
    - divide at hilum
  2. Renal veins
    - inferior vena cava
  3. Lymph to lumbar lymph nodes
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6
Q

Kidney: segmental,

lobal and interlobar arteries

A
  • Each renal artery divides into 5 segmental arteries that enter kidney at its hilum
  • Lobar arteries arise form each segmental artery (1 for each renal pyramid)
  • Before entering the renal substance, each lobar artery gives off 2 or 3 interlobular arteries
  • Interlobular arteries run towards the cortex on each side of the pyramids
  • At junction of cortex and medulla the interloper artier give off the arcuate arteries that arch over the bases of the pyramids
  • Arcuate arteries give off several interlobular arteries that ascend in the cortex
  • The afferent glomerular arterioles (give blood directly into the renal corpuscle) arise as branches of the interlobular arteries
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7
Q

Kidney: nerve supply

A
  • Derived from T12 and L1
  • Referred pain to back and lumbar region as well as loin to groin
  • Afferents in vagus nerve (CN X) may cause nausea and vomiting associated with such pain
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8
Q

What levels are kidneys located?

A
  • Right lower than left
  • Right L1-L4
  • Left T12-L3
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9
Q

What overlies the hilum of right kidney!

A

2nd (descending) part of duodenum

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10
Q

Ureter function

A

Muscular tube that transports urine from kidney to bladder

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11
Q

How long and wide is the ureter?

A

25-30 cm long

3mm wide

with narrowings

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12
Q

Ureter narrowings?

A
  1. Pelvi-Ureteric junction
  2. Crossing the pelvic brim/ inlet
  3. Passing through the bladder wall
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13
Q

Relations of ureter?

A

Anterior to psoas major, branches of lumbar plexus

Cross bifurcation of common iliac artery

Medial to sacroiliac joints and iliac spines

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14
Q

Difference between pelvic relations of the ureter in males and females?

A

Male: between vas/ ductus deferens and seminal vesicle

Female: posterior to ovary, inferior to uterine artery, passing cervix and lateral fornix of vagina

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15
Q

Relations of ureter in pelvis?

A

Lateral to:

  • Internal iliac vessels and branches
  • Lumbosacral trunk
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16
Q

Ureter: blood, nerve supply and lymphatic drainage?

A

Lymph to lumbar and iliac nodes

Good longitudinal anastomosis

Nerve supply:

  • supply more at lower end of ureters
  • derived segmentally: T10, T11, T12, L1, S2, S3, S4 from aortic, renal and pelvic plexuses
  • referred pain: T11 to L2 from loin to groin and scrotum or labia
17
Q

What is the relevance of the ureters oblique entry into the bladder?

A

Creating a flap valve -prevents urine in bladder from backing up & returning into ureter (ureteric reflux)

18
Q

What does pressure of urine in full bladder do?

A

Forcing ureters to close

19
Q

Walls of ureters and bladder?

A

Muscular

20
Q

How is urine propelled down ureter? What pain does it cause of ureteric calculi?

A

Peristaltic waves

Colicky pain

21
Q

How does bladder fill?

A

Relaxation of detrusor muscle

22
Q

How is bladder emptied?

A

Contraction of detrusor muscle

Aided by raised intra-abdominal pressure

Internal urethral sphincter at proximal urethra opening

23
Q

What is the epithelial lining of bladder?

A

Transitional epithelium or urothelium

Urine-rpoof and allows distension

24
Q

Detrusor muscle nerve supply?

A

Mainly under control of parasympathetic nerves derived from S2, S3, S4

25
Q

External urethral sphincter

A

Around distal urethra

Striated

Under voluntary control

26
Q

Anatomically, how do men prevent semen back flow into bladder?

A

Preprostatic smooth muscle (involuntary) internal urethral sphincter (sympathetic) at the bladder neck that contracts during ejaculation to prevent semen backflowing into the bladder that is known as retrograde ejaculation

27
Q

How does female anatomy relate to urinary continence

A

Bladder neck is above the pelvic floor so that the pressure of pelvic organs as well as the levator ani contribute

28
Q

Female urethra

A
  • Internal urethral sphincter (bladder neck and proximal urethra)
  • External urethral sphincter (striated muscle - voluntary at distal urethra)
  • 4cm long and 6mm wide
  • Embedded in anterior vaginal wall
  • Opens in vulva
29
Q

4 parts of male urethra?

A
  1. Preprostatic at bladder neck (position of smooth muscle internal urethral sphincter)
  2. Prostatic
  3. Membranous - surrounded by striated muscle external urethral sphincter
  4. Spongy or penile
30
Q

Arterial supply of bladder and urethra?

A

Internal iliac artery branches (superior and inferior vesicle, middle rectal)

Branches from arteries to adjacent structures (e.g. vaginal)

Internal pudendal

31
Q

Venous drainage of bladder and urethra?

A

Vesical (& prostatic) plexuses converging on internal iliac veins

Internal pudendal

32
Q

Lymph drainage of bladder and urethra?

A

Internal & external iliac nodes

33
Q

From the prostate there are communications (Batson venous plexus) with the internal vertebral venous plexus that may facilitate ______ _______

A

Tumour spread

34
Q

Nerve supply of bladder and urethra

A
  • Somatic motor for control of striated muscle (external urethral sphincter)
  • Autonomic sensory & motor for both sympathetic (male internal urethral sphincter contraction) & parasympathetic (detrusor muscle contraction)
  • Somatic motor from S2, S3, S4 pudendal nerve & its branches
  • Sympathetic & parasympathetic in pelvic plexus (inferior hypogastric)
35
Q

What are the 3 stages of micturition?

Simultaneous relaxation/contraction

A
  1. Storage:
    - Parasympathetic to detrusor “switched off” in spinal cord to allow bladder to relax & fill
    - Usual volume (male) about 400ml; if reach 500ml, pain in lower abdomen & perineum
  2. “Full” causes desire to micturate/ urinate:
    - Afferents (sensory) to spinal cord, then “M” Centre in pons: stimulates preganglionic, parasympathetic neurones at S2, S3, S4
  3. Void:
    - 1y neurons stimulate 2y neurons in bladder wall ganglia causing detrusor contraction
    - Simultaneous relaxation of external urethral sphincter (striated muscle) – pudendal nerve (S2, S3, S4) & contraction of abdominal wall; sensation of urine in urethra maintains the reflex

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