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Renal System > Anatomy > Flashcards

Anatomy Flashcards

1
Q

What are the muscles of the posterior abdominal wall (from superficial to deep)?

A

1) Erector Spinae (& Latissimus Dorsi lateral)
2) Quadratus Lumborum
3) Psoas Major

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2
Q

What are the muscles of the anterior abdominal wall (from superficial to deep)?

A

1) External oblique
2) Internal oblique
3) Transversus abdominis

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3
Q

What are the muscles that form the hip-flexor muscle?

A

Psoas major and iliacus (form Ilio-psoas)

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4
Q

What muscle in the abdomen is frequently absent?

A

Psoas minor

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5
Q

What muscle is directly inferior to the Quadratus lumborum?

A

Iliacus

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6
Q

What are the nerves in the posterior abdominal wall (root from superior to inferior)?

A

1) Subcostal (T12)
2) Iliohypogastric (L1)
3) Ilioinguinal (L1)
4) Genitofemoral (L1-2)
5) Lateral cutaneous nerve (L2/3)
6) Femoral (L2-4)

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7
Q

What spinal segment does the subcostal nerve arise from?

A

T12

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8
Q

What spinal segment does the Iliohypogastric nerve arise from?

A

L1

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9
Q

What spinal segment does the Ilioinguinal nerve arise from?

A

L1

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10
Q

What spinal segment does the Lateral Cutaneous nerve arise from?

A

L2/3

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11
Q

What spinal segment does the Femoral nerve arise from?

A

L2-4

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12
Q

What spinal segment does the Genitofemoral nerve arise from?

A

L1/2

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13
Q

Which is deeper/outside the renal fascia? Perinephric or paranephric fat?

A

Paranephric

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14
Q

The abdominal aorta is a continuation of the _________.

A

Descending aorta

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15
Q

The abdominal aorta divides into the _______________.

A

R and left common iliac arteries

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16
Q

What are the paired branches of the abdominal aorta (5)?

A

1) Phrenic
2) Middle suprarenal
3) Renal
4) Gonadal
5) 4 Lumbar arteries

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17
Q

What are the unpaired branches of the abdominal aorta (4)?

A

1) Coeliac
2) Superior mesenteric
3) Inferior mesenteric
4) Median sacral

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18
Q

What are the anterior branches of the abdominal aorta (5)?

A

1) Coeliac
2) Superior mesenteric
3) Inferior mesenteric
4) Gonadal
5) Phrenic

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19
Q

The IVC is formed at the union of _________ at which spinal segment?

A

formed @ union of R and L common iliac veins at L5

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20
Q

The IVC is located (right/left) of the midline and thus pierces of the (right/left) horn of the ______ of the diaphragm.

A

Right of midline
Pierces right horn of central tendon

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21
Q

What veins drain into the IVC (5)?

A

1) R and L renal veins
2) R gonadal
3) R suprarenal
4) Median sacral
5) Hepatic

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22
Q

How blood from the left gonad flow back into the heart?

A

Into the L renal vein then into the IVC → RA
(R gonadal vein drains directly into IVC)

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23
Q

What are the posterior relations of the IVC in the abdomen(3)?

A

1) Lumbar vertebrae
2) R sympathetic trunk
3) R psoas muscles

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24
Q

What are 4 functions of the kidney?

A

1) Excretion of organic wastes from blood (eg. urea, uric acid)
2) Homeostasis of blood pressure/volume (Renin: BP, EPO: RBC, Water loss via urine)
3) Homeostasis of plasma ion conc. (eg. Na, K, CL, Ca)
4) Homeostasis of blood pH (H+ secretion and HCO3- reabsorption

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25
Q

Where are the kidneys located?

A

Abdominal cavity
- against posterior abdominal wall
- retroperitoneal (outside of peritoneum)
- L kidney T12-L3 level
- R kidney lower (compressed by liver)
- directly inferior to adrenal glands

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26
Q

What structure is directly superior to the kidneys?

A

Adrenal glands

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27
Q

True or false: the kidneys lie within the abdominal and peritoneal cavity.

A

False. Kidneys are within the abdominal but outside of the peritoneal cavity (retroperitoneal)

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28
Q

Which kidney is normally higher than the other?

A

Left (right is compressed by liver)

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29
Q

What are 3 layers of connective tissue that stabilise, protect and cushion the kidneys (superficial to deep)?

A

1) Renal fascia
2) Perirenal fat
3) Renal capsule

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30
Q

Describe the flow of blood in renal circulation from the Aorta to the Right Atrium.

A

1) Aorta
2) Abdominal aorta
3) Renal arteries
4) Segmental arteries
5) Interlobar arteries
6) Arcuate arteries
7) Cortical radiate arteries
8) Afferent arterioles

9) Glomerulus
10) Efferent arterioles
11) Peritubular capillaries

12) Cortical radiate veins
13) Arcuate veins
14) Interlobar veins
15) Renal veins
16) IVC
17) Right atrium

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31
Q

What are the components of the renal corpuscle?

A

1) Glomerulus: capillary bed
2) Bowman’s capsule: double walled sac

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32
Q

What are the vascular and tubular pole of the renal corpuscle?

A

Vascular pole: afferent and efferent (smaller) arterioles
Tubular pole: PCT

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33
Q

True or false: The bowman’s capsule is continuous with the tubular epithelium of the PCT.

A

True

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34
Q

What are the parietal and visceral layers of the renal corpuscle?

A

Parietal:
- basement membrane
- squamous epithelium

Visceral:
- basement membrane
- podocytes

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35
Q

What is the order of ultrafiltration in the renal corpuscle?

A

1) Plasma in afferent arterioles
2) Fenestration in capillaries
3) Basement membrane
4) Filtration slits between pedicles of podocytes
5) Capsular space
6) PCT

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36
Q

The renal tubule starts at the _____ pole of the renal corpuscle and ends at the _________ (tip of renal ______)

A

Start: tubular pole
End: renal papilla (end of renal pyramid)

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37
Q

What are the morphological/histological features of the PCT?

A

1) Simple cuboidal epithelial cells with brush border (“hazy-looking” lumen → cilia)
2) Larger cells than DCT → less nuclei per cross section
3) Stronger stained cytoplasm (PCT > eosinophilic)

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38
Q

What is the main function of the PCT?

A

Reabsorption of water, ions, glucose, amino acids, plasma
(dysfunction → glycosuria)

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39
Q

What are the differences between the descending and ascending limbs of the loop of Henle?

A

Descending:
1) Thin
2) Squamous cells
3) More water reabsorption

Ascending:
1) Thick
2) Cuboidal cells
3) More solutes secreted via active transport
4) more mitochondria

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40
Q

What are the morphological/histological features of the DCT?

A

1) Cuboidal epithelium, no brush border/cilia
2) Large and clearly defined lumen
3) Smaller cells than PCT
4) Cells have pale stained cytoplasm (< eosinophilic than PCT)

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41
Q

What is the main function of the DCT?

A

Secretion of ions (eg. K, H, HCO3) and toxins
(site of action of aldosterone: ↑ Na+ reabsorption)

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42
Q

What are the morphological/histological features of the collecting duct?

A

Cuboidal cells:
1) Principle Cells
- light stained

2) Intercalated cells
- dark stained

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43
Q

What are differences between the types of cells in the collecting duct?

A

Principal cells:
- Light stained
- Reabsorb Na+, secrete K+
- Receptors for both ADH and aldosterone (Water retention)

Intercalated cells:
- Dark stained
- reabsorb HCO3-, secrete H+ (maintain plasma pH)

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44
Q

Outline the path urine takes in the Pelvicalyceal system.

A

1) Collecting duct
2) Renal papilla
3) Minor calyx
4) Major calyx
5) Renal pelvis
6) Ureter

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45
Q

The Juxtaglomerular Apparatus is a triangle zone formed by _______________ and 3 types of cells: ____________.

A

Triangle zone formed by DCT, Afferent and Efferent arterioles

3 types of cells:
1) Macula densa
2) Juxtaglomerular (JG) cells
3) Mesangial cells

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46
Q

What are the 2 main functions of the Juxtaglomerular Apparatus?

A

Maintain blood volume and pressure

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47
Q

What is function of mesangial cells?

A

Form a mesangial matrix to regulate blood flow through the glomerulus

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48
Q

What are JG cells?

A

Specialised smooth muscle cells in the walls of afferent and efferent arterioles.

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49
Q

What are the functions of JG cells?

A

1) Secrete renin in response to paracrine signaling from Macula Densa
2) Constrict/Dilate arterioles to regulate GFR

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50
Q

What is the Macula Densa?

A

Initial portion of DCT between the afferent and efferent arterioles

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51
Q

What are the functions of the Macula Densa?

A

1) Sense changes in [Na+]
2) Induce JG cells to produce renin via paracrine signalling

52
Q

How long is a human ureter?

A

~25cm

53
Q

Describe the position of the ureter.

A
  • Retroperitoneal
  • Attached to posterior abdominal wall
  • enters pelvic cavity by crossing in front of sacroiliac joint
  • in pelvis, runs inferiorly and posteriorly, lateral to the ischial spine
  • turns anteriorly and medially to the base of the bladder where it enters obliquely
54
Q

Where are the physiological constrictions of the ureter?

A

1) Ureteropelvic junction
2) Pelvic inlet (where it enters pelvic cavity)
3) Entrance to bladder

55
Q

What is the clinical significance of constrictions in the ureter?

A

Most likely location for stones to be lodged
→ create backpressure on kidneys
→ hydronephrosis

56
Q

What form of epithelium lines the ureter and bladder?

A

Urothelium/Transitional epithelium

57
Q

What are the histological features of the urothelium?

A

Resemble stratified squamous epithelium but have intact visible nuclei throughout
(stratified squamous have squished long nuclei that can disappear on section towards lumen)

58
Q

What are the 3 layers of the ureter (superficial to deep)?

A

1) Mucosa
- transitional epithelium
- lamina propria

2) Muscularis
- Inner longitudinal layer
- Circular outer layer

3) Adventitia
- Outer connective tissue layer

59
Q

Where is the urinary bladder located?

A
  • On the floor of the pelvic cavity
  • Inferior to the peritoneum
  • Posterior to the pubic symphysis
    M: btwn pubic symphysis and rectum;
    F: btwn pubic symphysis, uterus (superior) and vagina (posterior)
60
Q

Where does the bladder expand into when full?

A

Superiorly into the abdomen

61
Q

What are the layers of the urinary bladder (4) (superficial to deep)?

A

1) Mucosa
- Urothelium
- Rugae (“waves” of bladder)

2) Submucosa
- Fibroelastic connective tissue

3) Detrusor: Smooth muscles
- Inner longitudinal
- Middle circular
- Outer longitudinal

4) Adventitia
- External connective tissue
- Arteries, veins, lymphatics, and nerves (stretch receptors)

62
Q

Where is the trigone area of the urinary bladder?

A

Between the 2 urethral openings and the internal urethral orifice

63
Q

How is the trigone area different from the rest of the urinary bladder wall?

A

It has no rugae

64
Q

What are the 2 sphincters of the bladder and how are they different?

A

Internal: involuntary smooth muscle
External: Voluntary skeletal muscle

65
Q

How are the male and female urethra different?

A

Male is 15-20cm, Female 3-4cm
Female is short, straight and larger in diameter
Female is more susceptible to infection

66
Q

What are the 3 segments of the male urethra?

A

1) Prostatic
- passes through the prostate gland
- prostate secretion during ejaculation

2) Membranous
- passes through the urogenital diaphragm
- external sphincter (where micturition is voluntarily controlled)

3) Spongy (penile)
- longest segment
- passes through the penis to the external urethral orifice

67
Q

What are the components of the hip bone (3)?

A

1) Ilium
2) Ischium
3) Pubis

68
Q

What is the joint that connects the spine to the hip bone?

A

Sacroiliac joint

69
Q

Where does the femur connect to the hip bone to form the hip joint?

A

At the acetabulum (socket in hip bone @ junction of all 3 parts: ilium, pubis, ischium)

70
Q

What the joint formed between the 2 symmetrical halves of hip bones?

A

Pubic symphysis (between both pubis bones)

71
Q

The ischium has a protrusion on its _______ surface known as the _________________.

A

Interior surface
Ischial spine

72
Q

The hole bounded by the pubis and ischium is known as?

A

Obturator foramen

73
Q

What muscle covers the obturator foramen?

A

Obturator internus

74
Q

What muscles form the pelvic floor/diaphragm?

A

Coccygeus and Levartor Ani

75
Q

What are the 2 major function of the muscles of the pelvic floor?

A

1) Provide support and prevent prolapse
2) Continence mechanisms to urethral, anal, and vaginal orifices (in females)

76
Q

What muscle lies posterior to the obturator internus, originates from the sacrum and attaches to the trochanter of the femur?

A

Piriformis

77
Q

What are the muscles of the pelvic wall (4)?

A

1) Piriformis
2) Obturator internus
3) Coccygeus
4) Levartor Ani

78
Q

Are the external genital organs are located within the pelvic cavity or perineum?

A

Perineum

79
Q

What structure separates the pelvic cavity and the perineum?

A

Urogenital diaphragm

80
Q

What is the order of structures in the pelvis in a male from anterior to posterior?

A

1) Pubic bone
2) Urinary bladder
3) Rectovesical pouch of the pelvic cavity
4) Rectum
5) Sacrum

81
Q

What structure lies inferior to the urinary bladder in males?

A

Prostate

82
Q

What is the order of structures in the pelvis in a female from anterior to posterior?

A

1) Pubic bone
2) Urinary bladder
3) Vagina/cervix/uterus (with vesico-uterine pouch of pelvic cavity anterior and superior to bladder)
4) Rectouterine pouch of pelvic cavity
5) Rectum
6) Sacrum

83
Q

What is the embryological origin of the peritoneum?

A

Intraembryonic coelom

84
Q

What are the anatomical pouches of the peritoneum/pelvic cavity?

A

Male:
- Rectovesical (btwn bladder and rectum)

Female:
- Vesico-uterine (shallower; superior to bladder and anterior to uterus)
- Rectouterine (deeper; between uterus and rectum)

85
Q

What occupies the anatomical pouches of the peritoneum/pelvic cavity?

A

Small intestine and peritoneal fluid

86
Q

The neck of the bladder is formed by the convergence of which 2 surfaces?

A

The base/fundus and the inferolateral surfaces.

87
Q

Embryologically, the trigone of the bladder is derived from _____________, while the rest of the bladder is __________.

A

Trigone: mesodermal
Rest of bladder: endodermal

88
Q

What forms the upper boundary of the trigone?

A

The inter-ureteric crest (elevated region of tissue located between both ureteric apertures)

89
Q

How do the internal and external urethral sphincter differ?

A

Internal: smooth muscle (autonomic control)
External: skeletal muscle (somatic: S2-4 Pudendal nerve)

Internal: In males, prevent retrograde ejaculation

90
Q

What are the posterior relations of the male urinary bladder (5)?

A

1) Ureters
2) Vas deferens
3) Seminal vesicles
4) Recto-vesical pouch
5) Rectum

91
Q

What are the anterior relations of the female urinary bladder?

A

Pubic bone + anterior pelvic muscles

92
Q

What are the posterior relations of the female urinary bladder (3)?

A

1) Uterus
2) Cervix
3) Rectum

93
Q

What are the superior relations of the female urinary bladder (4)?

A

1) Peritoneum
2) Vesico-uterine pouch
3) Small intestine
4) Uterus

94
Q

The abdominal aorta bifurcates into the L and R common iliac arteries at L4. From which, both common iliac arteries bifurcate into the ___________ at the level of ________.

A

Internal and external iliac arteries
at level of sacroiliac joint

95
Q

The internal iliac artery is the primary artery which supplies the ______________.

A

Internal pelvic structures (eg. pelvic wall, pelvic viscera)

96
Q

What do the external iliac arteries supply?

A

The lower limbs

97
Q

What are the common and differing blood vessels that supply the bladder in males and females?

A

Both: superior vesical, obturator
Male: inferior vesical
Female: Uterine arteries

98
Q

Where does lymph from the bladder flow to?

A

Mostly into internal iliac nodes, few from superolateral surface drain into external iliac nodes

99
Q

True or false: the veins of the bladder follow the arteries.

A

False, they form a plexus that converges on the vesico-prostate plexus

100
Q

Where is the vesico-prostate plexus?

A

In the groove between the bladder and the prostate

101
Q

Where do the veins of the bladder drain to?

A

Backwards across the pelvic floor into the internal iliac veins.

102
Q

Describe the nervous supply of the bladder.

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.

Sympathetic (from trunk hypogastric nerve) + Parasympathetic (from pelvic splanchic nerve) = inferior hypogastric plexus

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

103
Q

What is the effect of parasympathetic stimulation on the bladder?

A

Contracts detrusor muscle and relaxes internal urethral sphincter

104
Q

What is the effect of sympathetic stimulation on the bladder?

A

Relaxes detrusor muscles and contracts internal urethral sphincter

105
Q

How is retrograde ejaculation prevented in males?

A

Sympathetic activation
→ contraction of internal urethral sphincter
→ prevent reflux into bladder

106
Q

How does micturition differ from infants and adults?

A

Both: Stretch receptors on bladder wall → S2-4

Infants: (Immature cerebral cortex: Primitive spinal reflex)
- Interneurons → parasympathetic efferent → micturition

Adults: (Mature CNS: voluntary control)
- ascends spinal cord
- pontine micturition center → communicate with cerebral cortex
- lift inhibition if deemed appropriate → micturition

107
Q

True or false. The bladder is in the pelvis throughout a person’s lifetime.

A

False. Only descends completely from abdomen until puberty.

108
Q

How is the position of the bladder different when it is empty and full?

A

Empty: entirely within pelvis, posterior to pubic symphysis

Full: extends upward into abdominal cavity, pushing the peritoneum superiorly

109
Q

Why are females more prone to UTIs?

A

1) Shorter urethra
2) Proximity to anus

110
Q

How does damage to the spine above T12 affect the bladder?

A

Reflex/autonomic bladder:
- spinal reflex arc
- micturition w/o conscious control or awareness

111
Q

How does damage to the spine below T12 affect the bladder?

A

Flaccid/atonic bladder:
- damage to parasympathetic outflow to the bladder
- detrusor muscle paralysed
- non-functional spinal reflex
- bladder fill uncontrollably → abnormally distended until overflow incontinence occurs

112
Q

True or false: The apex of the bladder points towards the pubic symphysis.

A

True

113
Q

True or false: The peritoneum covers the superior surface of the bladder.

A

True

114
Q

True or false: The bladder wall is thicker at the neck.

A

True

115
Q

True or false: The internal urethral sphincter is under voluntary control.

A

False. Involuntary control

116
Q

True or false: The parasympathetic supply to the bladder is via pelvic splanchnic nerves.

A

True

117
Q

True or false: The bladder mucosa is lined by urothelium.

A

True

118
Q

True or false: The detrusor muscles is in the submucosa of the bladder.

A

False: Muscular layer (deep to submucosa)

119
Q

True or false: The female urethra is longer than the male urethra.

A

False

120
Q

True or false: Micturition is primarily controlled by the PNS.

A

True

121
Q

True or false: The external urethral sphincter is formed of skeletal muscle.

A

True

122
Q

True or false: The pontine micturition center in the brainstem plays a critical role in coordinating micturition throughout life.

A

False. Only in adults

123
Q

True or false: Micturition can occur without involvement of higher brain centers.

A

True

124
Q

True or false: The trigone is located on the posterior wall of the bladder.

A

True

125
Q

True or false: The trigone is derived from the endoderm.

A

False: Mesoderm

126
Q

True or false: The external iliac artery is the primary supply of the pelvis and perineal structure.

A

False: Internal

127
Q

True or false: The vesical venous plexus drains into the internal iliac veins

A

True

Renal System (8 decks)

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