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AUA Core Curriculum > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Main arterial supply to the bladder

A

Superior and inferior vesical pedicles from anterior trunk of internal iliac artery

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2
Q

Sympathetic innervation of the bladder

A

Hypogastric nerve T10-L2, innervates trigone, bladder neck

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3
Q

Parasympathetic innervation of the bladder

A

Pelvic nerve S2-4, innervates bladder

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4
Q

Somatic innervation of the bladder

A

Pudendal & Pelvic nerve, mainly S2, external sphincter/bladder

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5
Q

Embryologic structure that gives rise to the ureter, renal pelvis, collecting ducts

A

ureteral bud (also a derived from the mesonephric duct)

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6
Q

Embryologic structure that gives rise to the trigone

A

mesonephric duct, mesodermal structure

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7
Q

Embryologic structure that give rise to the bladder

A

urogenital sinus (an endodermal structure)

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8
Q

Describe the supraspinal vesicovesical (vesico-bulbo-vesical) reflex

A
  1. Bladder filling activates stretch receptors in the bladder wall that reach the spinal cord via pelvic nerve.
  2. Fibers connect in the dorsal horn that project to periaqueductal gray matter (PAG).
  3. PAG activates the pontine micturition center (PMC) that project directly to the bladder via preganglionic neurons in the Sacral PNS then back to pelvic nerves to activated PNS in the pelvic plexus releasing Ach stimulating M2 M3 receptors.
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9
Q

Describe the Vesico-spinal-vesical reflex

A

Occurs when there is a lesion rostral to the to lumbosacral level that interrupts the vesico-bulbo-vesical reflex. An automatic vesico-spinal-vesical micturition relex develops.

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10
Q

Describe the somatic storage reflex (pelvic to pudendal reflex)

A

Also called the guarding reflex
During normal storage, this reflex is initiated when there is a sudden increase in valsalva or intraabdominal pressure. Afferent signals travel to the spinal cord (also to the PAG then PMC) via pelvic nerve which activate efferent somatic urethral motor neurons in the Onufs nucleus. Motor neurons in this nucleus are activated which have axons that travel in pudendal nerve and release Ach which activates the rhabdosphincter.

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11
Q

What is the Pronephros?

A

Initial phase of embryologic kidney development. develops first 4 weeks of gestation. Degenerates by the end of the 5th week.

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12
Q

What is the Mesonephros?

A

2nd phase of embryologic kidney development. Develops as a persistence of the pronephros duct. Drains into the urogenital sinus and serves as primary excretory organ in weeks 4 -8. Mesonephric tubules develop by 16 weeks while mesonephros regresses.

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13
Q

Which elements of the mesonephros persists at week 16 of gestation?

A

Efferent tubules of the testis in men, nonfunctional mesosalpingeal in women (Epoohoron, and paroophoron)

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14
Q

What is the metanephros?

A

Final phase of embyrologic kidney development. Starts in sacral region as the ureteric bud originates from mesonephric duct. Metanephric mesenchyme condenses from intermediate mesoderm during 5th week which is induced by the ureteric bud to form the metanephric kidney.

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15
Q

When is nephrogenesis completed?

A

32 - 34 weeks gestation.

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16
Q

Which structures are derived from the metanephric mesenchyme?

A

glomerulus, proximal tubule, Loop of henle, and distal tubule

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17
Q

Ultimate fate of the ureteric bud

A

After successive division will develop to form the collecting system consisting of the collecting duct, calyces, renal pelvis, and ureter.

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18
Q

Length of right renal pelvis

A

2 - 4 cm

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19
Q

Length of the left renal pelvis

A

6 - 10 cm

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20
Q

Embryologic germ layer forming the adrenal cortex

A

Mesoderm

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21
Q

What are the layers of the adrenal gland and their associated function

A

Zona glomerulosa: - produces mineralcorticoids (aldosterone).
Zone fasiculata: - produces glucocorticoids (cortisol)
Zona Reticularis: - Synthesizes sex hormones (androgens)

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22
Q

Embryologic germ layer forming the adrenal medulla

A

ectoderm and develops from migrating cells of the neural crest.

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23
Q

Function of the adrenal medulla

A

Secretes neuroactive catecholamines (under sympathetic control).

24
Q

Which nerves provide innervation to the adrenal gland

A

Sympathetic visceral nervous system

  • preganglionic sympathetic fibers from lower T and L spinal cord via sympathetic chain innervates cortex
  • Visceral afferent fibers from the celiac ganglia traverse cortex to the medulla.
25
Q

What are chromaffin cells

A

Found in the adrenal medulla, are post ganglionic sympathetic neurons that have lost their axons and dendrites

26
Q

General length of ureters

A

22 - 30 cm, 1.5 - 6 mm in diameter

27
Q

Blood supply to the ureter

A

Upper: arterial branches from renal artery, gonadal artery, abdominal artery, common iliac,
Lower: Internal iliac, including vesical, uterine, middle rectal, vaginal arteries.

28
Q

Does normal ureteral peristalsis require autonomic input?

A

No. Peristalsis is thought to originate and propagge from intrinsic from smooth muscle pacemaker sites in the minor calyces of the collecting system.

29
Q

3 segments of the ureter

A

Upper: renal pelvis to upper boarder of sacrum
Middle: Upper to lower boarder of the sacrum
Lower: Lower sacrum to bladder

30
Q

Innervation to the female urethra

A

Somatic and autonomic nerves that travel near urethra in vaginal walls.
Smooth muscle control under parasympathetic control
Pudendal and pelvic somatic nerves innervate striated urethral sphincter.

31
Q

Lymphatic drainage female urethra. Distal vs proximal.

A

Distal urethra and labia drain to the superficial and deep inguinal nodes

Proximal urethra drains to iliac, obturator, pre-sacral, para-aortic nodes

32
Q

Blood supply to the female urethra

A

Internal pudendal, vaginal , and inferior vesical arteries

33
Q

Blood supply to male urethra

A

Internal pudendal artery becomes common penile artery

  1. two become dorsal artery and urethral artery to supply the male urethra
  2. Prostatic branches off of the inferior vesical and middle rectal arteries to supply the prostatic urethra
34
Q

Lymphatic drainage of male urethra

A

Distal: superficial inguinal LN
Bulbar, membranous, prostatic urethra: iliac, obturator, presacral LN

35
Q

Innervation to the male urethra

A

Pudendal nerve supply motor and sensory innervation. Autonomic innervation arises from pelvic plexus.

36
Q

Penis blood supply:

A

Arises from femoral artery–> left/right superficial ext pudendal–> skin of penis

Internal pudendal

  1. First branch–> bulbourethral artery supplies the perineal membrane, and enters sponsgiosum to supp;ly the urethra, spongiosum and glans.
  2. Cavernosal arteries
  3. Dorsal artery: travels b/t deep dorsal vein and dorsal nerve. Circumflex artery branches off and supplies spongiosum and urethra
37
Q

Penile lymphatic drainage

A

Skin and shaft drain to bilateral superficial inguinal nodes

Glans drain to deep inguinal lymph nodes.

38
Q

Blood supply to prostate and seminal vesicles

A

Inferior vesical artery. First prostatic branch of the artery is the urethral artery that enters the gland posteriorlaterally at 5 & 7 o clock

39
Q

Venous drainage of the Prostate and seminal vesicles

A

composed of inferior vesical veins that feed into the internal iliac vein.

40
Q

Batsons venous plexus

A

network of valveless veins that connect the internal iliac to the vertebral vein plexus. This is thought to provide a route for bony mets.

41
Q

Lymphatic drainage of the prostate

A

Obturator and internal iliac lymph node chains. Additional drainage through the external iliac and pre-sacral nodes.

42
Q

4 factors that alter GFR

A
  1. Transglomerular hydrostatic pressure
  2. Renal plasma flow
  3. Glomerular permeability
  4. Oncotic pressure
43
Q

Transglomerular hydrostatic pressure

A

Most significant determinant of GFR. regulated by afferent and efferent arterioles which are independent of systemic blood pressure.

44
Q

Directly related to GFR

A

renal plasma flow. When RPF increases GFR increases and vice cersa

45
Q

3 Phases of Unilateral ureteral obstruction

A

Phase 1: 1-2h, both RBF and Ureteral pressure increases + vasodilation of afferent arteriole increases RBF.

Phase 2: lasts 2-3h. Increased rise in ureteral pressure, RBF begins to decrease. ACE-I mitgates the decline in GFR and RBF,

Phase 3: 5 hours after obstruction. RBG and ureteral pressure decline. d/t increase in afferent arteriole resistance. RBF shifts from outer cortex to medullary regions resulting in lack of perfusion to the glomeruli –> reduced GFR. RBF gradually decreases over time.

46
Q

Physiologic changes of bilateral ureteral obstruction

A

Early: RBF increases only slightly for 90 minute via NO. Followed by extreme decrease in RBF (Thromboxane, endothelin, angiotensin II). Ureteral pressure is much higher in bilateral obstruction and remains elevated for 24h. Thought to be d/t ANP

47
Q

Proposed mechanisms or post obstructive diuresis

A
  1. Impaired Na reabsorption d/t tubular damage
  2. Impaired urinary concentration ability
  3. Solute diuresis to excretion of retain urea
  4. Presence of a circulating natriuretic factor (ANP)
48
Q

How is primary hyperaldosteronism diagnosed

A

An ARR≥20 along with a concomitant aldosterone concentration above 15 ng/mL suggest the diagnosis of primary hyperaldosteronism

A positive ARR screen should prompt 24 hour study with salt loading to assess for primary aldosteronism

49
Q

Screening Guidelines for hyperaldosternonism (8)

A
  1. Any patient with sustained blood pressure above 150/100 on three separate measurements taken on different days
  2. Hypertension resistant to 3 antihypertensives
  3. Hypertension controlled with four or more medications
  4. Hypertension and low potassium
  5. Hypertension and a newly diagnosed adrenal incidentaloma
  6. Hypertension and concomitant sleep apnea
  7. Hypertension and a family history of early onset hypertension or stroke before age 40
  8. All first-degree relatives of patients with a diagnosis of primary aldosteronism
50
Q

Blood supply to the Vas

A

Vesiculodeferential artery (branch from superior vesical artery)

Inferior vesical artery provides collateral supply

51
Q

Drainage pathway for sperm.

A
  1. tubuli recti–> rete testis–> efferent ductules (head of epididymis)–>ductus epidiymis–> vas
52
Q

When should sex hormone testing be performed with adrenal masses?

A

not warranted unless the patient is suspected of having an adrenocortical carcinoma (mass > 4 cm) and/or obvious clinical stigmata of feminization or virilization.

Measure DHEA with 17-Ketosteroids

For women: Get serum testosterone

For men get 17B-estradiol

53
Q

Stages of sperm production

A

spermatogonium, primary spermatocyte, 2nd spermatocyte, spermatids, spermatozoa

54
Q

Testicular blood supply

A
  1. Testicular artery (aka internal spermatic or gonadal artery),
  2. cremasteric artery (from inferior epigastric)
  3. vas deferens artery
55
Q

Testicular lymphatic drainage

A

Right side: interaortacaval nodes–> precaval, preaortic.

Left: para-aortic and pre-aortic lymph nodes followed by the interaortacaval nodes.

More common for lymphatic drainage of the right testis, and rare with left sided tumors to cross the midline and exhibit bilateral lymph node mets.

56
Q

layers of the scrotum and spermatic cord (superficial - deep)

A

Skin, dartos fascia, external spermatic fascia (from scarpas), cremasteric fascia (from internal oblique), cremasteric muscle, internal spermatic fascia (transversalis fascia), tunica vaginalis (parietal then visceral), tunica albuginea

AUA Core Curriculum (4 decks)

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