Anatomy Flashcards
Where are the kidneys located?
Retriperitoneal in the posterior abdominal wall
What organs are retroperitoneal?
DOCTORS AND DENTISTS ALWAYS PREFER KISSING A VOLUPTUOUS REDHEAD
- Duodenum (except part 1)
- Ascending colon
- Descending colon
- Adrenal glands
- Pancreas
- Kidneys
- Aorta
- Vena Cava (IVC)
- Rectum
What plane are the kidneys located in?
Transpyloric (superior right renal hilum and inferior left renal hilum….the left kidneys is a little higher than the right)
What vertebral level are the kidneys at?
T12-L2
What ribs are behind the kidneys?
11 and 12
What do the ureters travel in front of?
Trasnverse processes
What 3 nerves are posterior to the kidneys?
- Subcostal (below T12)
- Iliohypogastric (By L1, above ilioinguinal)
- Ilioinguinal (By L1)
What other big structure sits behind the kidneys on either side?
Diaphragm
What part of the kidney is at risk if an ulcer in the descending duodenum perforates posterior?
The hilum of the right kidney
What 2 structures sit in front of the superior pole of the left kidney?
Stomach and spleen
What structure sits in front of the superior pole of the right kidney?
Liver
What is a psoas abscess associated with?
TB or osteomyelitis in the spione (discitus)
What is the type of spread that would happen between the spine and psoas major?
Contiguous
What can a psoas abscess do to the renal system?
It can compress the ureters and cause hydronephrosis
What is the function of perirenal fat?
It is good for absorption and helps to support the kidney
What is another name for renal fascia?>
Gerota’s (anterior and posterior)
What connects the renal fascia to the capsule?
Trabeculae
Do the kidneys have ligaments to keep them in place?
NOPE…vasculature and fat help to do this (not much keeping the kidneys stable)
What else does the renal fascia extend to cover?
Aorta, IVC, and ureters
Is there usually a continuous connection of renal fascia across the midline?
NOPE
If you have a perinephric abscess, what is the typical treatment?
Antibiotics and percutaenous drainage
What keeps a perinephric abscess localized?
The capsule as well as fat and fascia
What is the order of structures in the renal hilum from anterior to posterior?
Vein, artery, pelvis
What structures are in the internal aspect of the kidney?
Cortex, medulla, pyramid, renal columns, papillae, minor calyces, major calyces, renal pelvis, ureter, renal sinus
If you had to pick a kidney to transplant, which would it be?
The left one because it has longer vasculature (vein)
Where is a new kidney transplanted?
In the pelvis (so it is supposed and doesn’t fall)
Where do you attach a transplanted kidney in terms of vasculature?
To one of the common iliac vessels
How many branches does the renal artery divide into?
5 (these are essentially end arteries)
What are the 4 branches in the anterior division of the renal artery?
- Apical
- Anterior superior
- Anterior inferior
- Inferior
What is the branch in the posterior division of the renal artery?
Posterior
What are the lines that separate the vascular segments of the kidney?
Line of Brodel (these segments correspond to the 5 branches from the renal artery)
How do the branches from each segmental artery divide down?
They go into interlobar, then arcuate, then smaller arteries
Where do the renal veins drain into?
The IVC
What vein drains into the left renal vein?
The left testicular vein
What vessel supplies the ureters?
They get branches as it goes down from other arteries (Renal, common iliac, inernat iliac, testicular, ect.)
Where do ureters pierce the bladder?
At the posterolateral edge
What angle do the ureters run through the muscular wall of the bladder?
Oblique
What happens to prevent backflow of urine?
When the bladder expands, it punches off the opening of the ureter (to prevent vesicouretral reflux)
What is it called when you have a swollen kidney?
Hydrpnephrosis
What is it called when you have a swollen ureter?
Hydroureter
What are some general symptoms of renal cell carcinoma?
Hematuria, pain in loin, mass
What else can renal cell carcinoma commonly invade?
The renal VEIN (potentially IVC and R atrium as well but this is rare)
What is a common presentation of carcinoma in the left renal vein?>
Varicocele (because the left testicular vein drains into the left renal vein)
What is the levels of sympathetic innervation to the kidney and upper ureter?
T10-L1
What is the sympathetic innervation to the bladder and lower ureter?
T11-L2
What is the parasympathetic innervation to the upper ureter?
VAGUS
What is the parasympathetic innervation to the lower ureter?
S2-S4 (pelvic splanchnics)
What is the parasympathetic innervation to the bladder?
Pelvic splanchnics (S2-S4) (motor to the detrusor muscle)
Can ureteric nerves be removed with no loss of function?
Yes
Where do kidney stones cause pain if they are in the upper ureter?
T10-L1 area …AKA FLANK PAIN
What are the 4 sites of constriction along the ureter where stones are most likely to lodge?
- Where the renal pelvis turns into the ureter (ureteropelvic junction)
- Where vessels cross over the ureter
- Where the ureter goes over the pelvic rim (pelvic inlet)
- As the ureter enters the bladeer
What happens is the left renal vein is obstructed or clamped in a male?
Varicocele
A vesicoureteral reflux can result in what?
Hydroureter or hydronephrosis (urine is flowing retrograde back up the ureter into the bladder)
What is SMA syndrome?
When the superior mesenteric artery is more acutely angled and can apply pressure on the 3rd part of the duodenum and left renal vein
What are symptoms of SMA syndrome?
Bilioous vomiting, pain after eating, varicocele
What is another name for SMA syndrome?
Nutcracker syndrome
When doing a digital rectal examination what are you palpating?
The posterior love
What are the 5 lobes of the prostate?
Posterior anterior middle right lateral left lateral
What does the median lobe of the prostate sit above?
The posterior lobe and the ejaculatory duct
What happens to the prostate as a man ages?
It may undergo benign hypertrophy (benign prostatic hypertrophy)
What BPH result in?
A blockage of urine flow by putting pressure on the prosthetic urethra
What procedure can be done for prostate cancer ot BPH that is causing blockage of urine flow?
Transurethral resection of the prostate (TURP)
What is a concern with a transrectal biopsy?
Contamination because the biopsy goes through the rectal wall into the posterior lobe (give prophylactic antibiotics)
What is the blood supply to the prostate?
- Inferior vesical
- Internal pudendal
- Middle rectal
What is the venous drainage of the prostate?
Prostatic venous plexus which communicates with the vesicular plexus and internal vertebral plexus
What is the PS innervation to the prostate?
Pelvic splanchnic nerves
What is the S innervation to the prostate?
L1-L2, inferior hypogastric plexus
What is the blood supply to the urinary bladder?
- Super vesical artery
- Inferior vesical artery (male)
- Vaginal artery (female)
- Minor artery from obturator/inferior gluteal
What is the venous drainage of the urinary bladder?
Accompanying veins, vesical venous plexus, prostatic venous plexus
What are the 4 parts of the male urethra?
- Preprostatic
- Prostatic
- Membranous
- Spongy/penile
Where is the preprostatic urethra located?
Before it leaves the bladder… the bladder neck
What part of the urethra does the ejaculatory and prostatic ducts empty into?
Prostatic
Describe the prostatic part of the urethra?
It is the widest and most dilatable, closer to the anterior aspect of the prostate
What surrounds the membranous urethra?
Sphincter urethra
What does the spongy/penile urethra receive?
The bulbourethral glands (it’s located in the corpus spongiosum)
What is the blood supply to the male urethra?
- Inferior vesical
- Middle rectal
- Internal pudendal
What is the urethral crest?
Part of the posterior wall of the prostatic urethra that extends down from the trigone
What is the sminal colliculus and what does it present?
It is a large bump in the middle of the posterior wall of the prostatic urethra
- Prostatic utricle
- Openings of the ejaculatory duct (just below urtricle, one on each side)
What is the prostatic uricle?
Embryological remnant of vagina
What is the prostatic sinus?
It’s on either side of the colliculus and has the openings of the prostatic ducts
Why do females get cystitis more often than males?
They have a shorter urethra
What is the path of the female urethra?
It runs from the bladder (internal urethral orifice) anterior to the wall of the vagina and opens anterior to the vagina and posterior to the clitoris
What does the female urethra receive?
The openings of the urethral glands
Where do the paraurethral ducts open?
At the margin of the external urethral orifice
If the urethra is ruptured above the UGD where does urine leak?
Into the pelvic cavity, below the peritoneum
If the urethra is ruptured, but Buck’s fascia remains intact, where is urine restricted to?
The penis shaft
If the urthera is ruptured and Buck’s fascia is also torn, where is urine found?
In the superficial perineal space (urine can spread under Colles’ fascia into the scrotum, underneath the superficial fascia of the penis (but superficial to Buck’s fascia) and underneath scarpas fascia in the abdomen
What is the other place a urethra can be ruptured?
The membranous urethra (deep perineal space)
What is the PS effect on micturition?
S2-S4 is excitatory to the detrusor muscle and inhibitory to the internal sphincter (PS innervation required for normal micturition)
What is the S effect on micturition?
T11-L2 is inhibitor to the detrusor and excitatory to the internal sphincter
What controls the external sphincter?
Pudendal nerve (under voluntary control)
Are pain fibers involved with micturition S or PS?
BOTH
Where do ureter (pelvic portion lymphatics drain)
Iliac nodes
Where do bladder lymphatics drain?
External iliac nodes (also internal iliac nodes)
Where do urethra lymphatics drain (female, prostatic/membranous)?
Internal iliac nodes
Where do urethra lymphatics drain (spongy/penile)?
Inguinal nodes
Where do prostate lymphatics drain?
Internal iliac/sacral nodes
Where do kidney, abdominal part of the ureter, and suprearenal gland lymphatics drain?
Lumbar nodes (lateral aortic)
What is the urinary bladder?
Muscular sac for urine storage (it’s pyramid shape)
If the bladder is full, where can it be palpated?
3-4inches above the pubic symphysis
When the bladder is empty where can it be palpated?
Over the pubic symphysis (suprapubic lithotomy)
What situations is the bladder prone to rupture?
Abdominal trauma and anterior pelvic fracture
What is cystitis?
A bladder infection (females are more prone because of short urethra)
What is the retropubic space?
Behind the pubis and anterior to the bladder
The empty bladder has what shape and what surfaces?
Tetrahedron shape: Surfaces: 1. Fundus 2. Neck 3. Apex 4. Superior surface 5. 2 Inferolateral surfaces
What is the bladder neck stabilized by?
Ligaments and thickenings of endopelvic fasica
Men: Puboprostatic
Female: Pubovesical
What the bladder posteriorly stabilized by?
Rectovesical ligaments
What attaches the bladder to the umbillicus?
The median umbilical ligament
What are the folds of peritoneum that serve to steady the bladder?
False ligaments
Describe the internal structure of the bladder?
The internal muscous layer is loosely attached to the muscular layer and can fold when contracted
Is the muscous layer foldable over the trigone?
NOPE… over the trigone the mucous layer is tightly bound and always smooth
What is the muscle of the bladder called?
Detrusor
What contracts the detrusor muscle?
PS stimulation by pelvic splanchnics (the detrusor expands as the bladder fills)
What is the sympathetic innervation to the bladder?
T11-T12 (L1-L2)
How many bends are in the male urethra?
2
Lymph drainage in anal canal above pectinate line?
Internal iliac nodes
Lymph drainage in anal canal below pectinate line?
Superficial inguinal nodes
Superior ureter lymph drainage?
Lumbar nodes
Middle ureter lymph drainage?
Common iliac
Lower ureter lymph drainage?
External and internal iliac
Bladder lymph drainage?
External iliac
Prostate lymph drainage?
Internal iliac, external iliac, sacral
Overy and testes lymph drainage
Lumbar
Body, fundus and tube of uterus lymph drainage?
Lumbar, internal iliac, external iliac, and superficial inguinal nodes
Cervix lymph drainage?
Eternal, internal, common iliac nodes
Upper vagina lymph drainage?
External and itnernal iliac nodes
Middle vagina lymph drainage?
Internal iliac
Lower vaginal lymph drainage?
Superficial inguinal nodes
External genitailia lymph drainage?
Superficial inguinal nodes (deep structures like erectile tissues drains to iliac nodes)
