Anatomy Flashcards
What are the kidneys’ Function ?
1) EXCRETION of waste products
2) CONTROL the water and electrolyte balance
Where are Kidneys located ?
1) LIE ON the upper part of posterior abdominal wall , lateral to the vertebral column
2) EXTEND FROM the 12 thoracic vertebra TO the third lumbar vertebra
Kidneys location relating to peritoneum :
Retroperitoneal Organ
The long axis of each kidney is directed …………….. and ………………… .
Downward , laterally
The ……………… kidney is somewhat lower than the …………….. kidney .
Right , left ( Right have R then LoweR )..
Kidneys Shape :
Bean-shaped organs
Kidneys Size : “ مو كتير مهم للامتحان “
Thick : 3 cm
Wide : 6 cm
Length : 12 cm
Kidneys description :
2 Surfaces : Anterior & Posterior Surfaces
2 Borders : lateral & Medial borders
2 Ends : Upper & Lower poles
How to differentiate btwn the kidneys’ borders :
The lateral border is CONVEX
The medial border is CONVEX ( adjacent to the poles ) & CONCAVE ( between the poles )
وال medial border هو يلي فيه الhilum
Define the hilum of the kidney :
A Vertical Slit , at the medial border of the kidneys , through which renal vessels and nerves as well as lymphatics enter and leave the kidneys & it opens into the Renal Sinus …..
Components of renal sinus :
1) Renal pelvis & it’s calicies
2) Segmental branches of the renal arteries and its accompanying veins
3) Renal nerves
4) adipose tissue
What is the function of Adipose tissue in the Renal Sinus :
It helps stabilise the position of these structures within the renal sinus
How to differentiate between the anterior and posterior surfaces of the kidneys :
Anterior surface : irregular and related to the abdominal organs
Posterior surface : flat and related to the posterior abdominal wall
What are the anterior relations of the right kidney ?
Right suprarenal gland , second part of duodenum , right lobe of the liver , right colic flexure , coils of jejunum
How many parts is the right kidney divided into ? And what covers these parts are :
Upper part and covered by the right lobe of the liver
Lower part ; its lateral surface is covered by right colic flexure and it’s medial surface is covered by coils of jejunum
What area does the duodenum cover regarding the right kidney ?
Part close to the hilum
Anterior relations of the left kidney ?
Left suprarenal gland , stomach , Spleen , body of pancreas and splenic vessels , left colic flexure and descending colon , coils of jejunum
How many parts is the left kidney divided into ? And what covers each of them ?
Upper part and covered by stomach and spleen
Middle part and covered by body of pancreas
Lower part , its lateral part covered by left colic flexure and descending colon and its medial part covered by coils of jejunum
The part covered by Suprarenal glands in both kidneys is :
Anterior aspect of the upper pole
Posterior relation of both kidneys :
Muscular structures : Diaphragm , Psoas Major , Quadrates lumborum , Transversus abdominis
Neurovascular structers : Subcostal nerve and vessels , iliohypogastric nerve and ilioinguinal nerve
The four layers enclosing the kidneys are :
1) Renal capsule
2) perirenal fat
3) renal fascia ; anterior and posterior layers
4) Pararenal fat
Arterial Supply of the kidneys :
By renal artery which branches into anterior and posterior parts And Accessory renal arteries above and below the renal artery
Anterior part segmental arteries :
1) Apical branch ( Superior branch )
2) Anterior Superior branch
3) Anterior inferior branch
4) Caudal branch ( Inferior branch )
Branch of posterior branch of the renal artery
Posterior segmental artery
The accessory renal arteries arise from ………………..
Abdominal aorta
How does the renal accessory arteries enter the kidneys ?
Hilum OR one of the two poles of the kidneys
What is the internal structure of the kidney :
1) Renal Cortex > Outer ( O with O )
2) Renal Medulla > Inner ( double n = m )
About Renal Medulla :
It consists of Renal Pyramids which project into minor calyces as Renal papillae that end in area cribrosa
About renal pyramids : ( 4 points )
1) Conical in Shape
2) (10-18) in number
3) their Bases are directed outward; toward renal cortex
4)their apexes are directed inward ; toward the renal sinus
About renal papillae : ( 2 points )
1) formed from The apices of renal pyramids
2) Contain the opening of Papillary ducts
Define area cribrosa :
The area where all the papillary ducts openings are recieved
Each Minor calyx receives …………….. papillae
1-3
Meaning that : if the minor calyx receives one renal papillae ; it is connected to one renal pyramid
And if it is connected to two or more renal papillae ; then it is connected to two or three renal pyramids since one renal papilla indicates one renal pyramids
Define the renal cortex :
It surrounds the renal medulla and forms renal columns
Define Renal Columns :
Other name : Columns of Bertin
Cortical tissue that extends between Renal pyramids
Define Juxtamedullary Cortex :
Part of cortex close to the Medulla
Venous drainage of the kidneys :
Left and right renal veins
Renal veins run …………………….. the renal arteries AND end in ……………………. .
In front of , IVC
Renal lymphatic drainage :
Para-aortic lymph nodes
Define the ureters :
Muscular tube that transports urine from the kidneys to urinary bladders
Ureters and peritoneum :
Retroperitoneal organ
Ureters length :
25 cm
Parts of the ureter :
1) pelvis of the ureter : continues superiorly with the renal pelvis
2) abdominal part : lies in the abdomen
3) Pelvic part : lies in the lesser pelvis
Pelvis of the ureter lies …………………………………………… .
Partly inside the renal sinus and partly outside the renal sinus
ureteric pelvis course ?
1) Condensation of 2-3 major calyces
2) Tapering as passing inferomedially
3) Continues with the abdominal part of ureter at the ureteropelvic junction ( pelviureteric junction )
Abdominal ureter course :
1) runs vertically downward
2) At the pelvic brim , A) Crosses the beginning of external iliac artery B)Continue with the pelvic part of the ureter
Abdominal Right ureter anterior relations : ( Covering and Crossing )
1) it’s upper part covered by second part of duodenum
2) Crossed by : 1) Right colic vessels 2) terminal part of ileum 3) Testicular vessels or ovarian vessels
Left abdominal Ureter relations : Crossing only
1) left colic vessels
2) left testicular or ovarian vessels
Posterior relations of the ureters :
Psoas major muscle
Pelvic ureter course :
1) Crosses the pelvic inlet and enters the pelvic cavity
2) Run downward on the pelvic wall to the level of Ishcial spine
3) Turns forward and medically on the floor of the pelvis to join the base of urinary baldder
4) The ureter passes obliquely within the wall of the bladder before opening into it ( Intramural part of the ureter )
Function of intramural part of ureters :
Act as a valve to prevent reverse flow of urine toward the kidneys
Pelvic part of ureters Relations in males :
1) Descends in front of the internal iliac artery and lies on obturator internus muscle
2) Crossed by vas deferens
Pelvic part of ureters relations in females :
1) Descends in front of the internal iliac artery and lies on obturator internus muscle
2) lies behind ovaries on the lateral wall of the pelvis
3) on the floor of the pelvis ; it runs in the root of the broad ligament and crossed by the uterine artery
Ureteric sites of constructions :
1) Pelviureteric junction
2) Pelvic brim ( the ureter crosses the artery )
3) Where the ureter enters the wall of the bladder
Constriction sites are where …………………………….. may be formed
Kidney stones
Arterial supply and venous drainage of ureters :
Upper part : Renal arteries and renal vein
Middle part : abdominal aorta , testicular or ovarian arteries , common iliac artery and their accompanying veins
Lower part : internal iliac artery and the vein
Lymphatic drainage of ureters :
Para-aortic lymph nodes , iliac nodes
Nerve supply of ureters :
Sympathetic and parasympathetic sources
Site of urinary bladder :
In the pelvic cavity , posterior to the pubic symphysis
Changes of bladder site during the course of life :
After birth ; it lies completely in the abdominal cavity and as the pelvis enlarges , it descends gradually into the lesser pelvis
The bladder when empty and full ;
When empty ; it is situated in the pelvic cavity behind the pubic symphysis and when full , it extends superiorly into the abdominal cavity.
Urinary bladder capacity :
(700-800) mL
Structure of the bladder:
Apex , base (Posterior surface ) , neck , superior surface , two inferolateral surfaces
Apex of the bladder :
It is directed forward toward the upper border of symphysis pubis
Median umbilical ligament extends :
From apex of the bladder to umbilicus
The two ureters enter the bladder at ……………….. .
Each of the upper corners of the base
Base of bladder’s posterior relation in males :
= Structures that separate the bladder from the rectum
1) Upper part of base related to rectovesical pouch
2) lower part is related to seminal vesicles and two vasa deferentia
Base of bladder’s posterior relation in females
It is related to vagina
Superior surface of the bladder relation in females :
1) Anterior 2/3 of the surface : covered by peritoneum AND related to uterus ( separated from it by uterovesical pouch )
2) Posterior 1/3 of surface : Not covered by peritoneum AND related to supravaginal part of the cervix
Superior surface of the bladder relation in males :
Completely covered by peritoneum AND related to Sigmoid colon and coils of ileum
Inferolateral surface of the bladder relation in both sexes :
No peritoneal relations AND related to retropubic pad of fat
Neck of bladder characteristics :
1) the most inferior part of bladder
2) the most fixed part of the bladder
3) it surrounds the origin of urethra at the internal urethral orifice
4) In males, it is surrounded by the base of the prostate
Why is the neck of bladder the most fixed part of bladder ?
Because it is anchored to its position by Pubovesical ligament in females OR puboprostatic ligament in males which connect the neck and pelvic part of urethra to the pubis bone
Describe the bladder interior :
The mucosal lining on the base of the bladder is smooth and firmly attached to the underlying smooth muscle coat of the wall ( Trigone of the bladder ) unlike elsewhere in the bladder where the mucosa is folded and loosely attached to the wall
About trigone of the bladder :
1) Base of trigone is directed upward and is formed by a muscular ridge (interureteric ridge) which extends between the two ureteric orifices.
2) Its superior angles correspond to the two ureteric orifices
3) Its inferior angle is formed by the internal urethral orifice.
Function of trigone of bladder :
The interureteric ridge forms a guide during the introduction of catheter into the ureter.
Arterial supply and venous drainage of bladder in females :
Arterial supply :
1) Superior vesical artery.
2) vaginal artery
Venous Drainage:
through the vesical plexus which drains into
the internal iliac veins.
Arterial supply and venous drainage of bladder in males :
Arterial supply :
1) Superior vesical artery.
2) inferior vesical artery
Venous Drainage:
through the vesical plexus which drains into
the internal iliac veins.
Lymphatic drainage of the bladder
Into the iliac lymph nodes
Nerve Supply of the Urinary Bladder:
Sympathetic fibers : are derived from L1&2 segments of the spinal cord.
Parasympathetic fibers : by the pelvic splanchnic nerve.
Define Male urethra :
A common canal for passage of urine and semen to outside the body
Sympathetic and parasympathetic effect on the bladder:
The sympathetic nerves inhibit contraction of the detrusor muscle of the bladder wall and stimulate closure of the sphincter vesicae.
The parasympathetic nerves stimulate contraction of the detrusor muscle of the bladder wall and relax of the sphincter vesicae.
Bony pelvis is composed of :
1) Hip bone forms anterior and lateral walls
2) Sacrum and coccyx form the posterior walls
The pelvis divided into two parts :
1) Greater or false pelvis
2) Lesser or true pelvis
Greater pelvis lies ………………………………..
Above the level of the pelvic brim (Pelvic inlet).
Lesser pelvis lies …………………………..
Below the pelvic brim
What is the pelvic orientation ?
The pelvic inlet is tilted to face anteriorly; the bodies of the pubic bones and the pubic arch are positioned in a nearly horizontal plane facing the ground
Anatomy of the lesser pelvis :
The true pelvis is cylindrical cavity and has an inlet, a wall, and an outlet.
Anatomy of the wall of pelvis :
In front and below: Pubic symphysis, bodies of the 2 pubic bones and the 2 pubic rami.
Behind and above: Concave pelvic surface of thesacrum & coccyx.
On each side: Pelvic surfaces of the ischium and ilium
Define pelvic inlet :
It is the circular opening between the abdominal cavity and the pelvic cavity through which the structures traverse between the abdomen and pelvic cavity
Boundaries of Pelvic inlet :
Posteriorly: Promontory &alae of the sacrum.
Anteriorly and on each side: Pubic symphysis,Pubic crest, pectineal line & arcuate line of the ilium.
Diameters of the inlet :
Antero– posterior (true conjugate) diameter:
From the midpoint of the sacral promontory to the upper border of the symphysis pubis.
Transverse diameter:
Between farthest points of the arcuate line
What is Diagonal conjugate diameter ?
extending from the lower border of the symphysis pubis to the midpoint of the sacral promontory , It measures (12.5 cm) in the females
Boundaries of pelvic outlet :
Posteriorly: Apex of the coccyx.
Anterior & anterolateral: Lower border of the symphysis pubis& pubic arch.
On each side &posterolateral: Ischial tuberosity, sacrotuberous ligament
Diameters of the outlet :
Antero-posterior diameter:
It extends from apex of coccyx to the lower border of the symphysis pubis.
Transverse diameter:
It extends between the two ischial tuberosity. assessed clinically by measuring the distance between the ischial tuberosities
What are the Ligaments of the pelvic wall?
1)Sacrotuberous ligament: Fan shape attached to ischial tuberosity and to lateral margin of sacrum, coccyx.
2) Sacrospinous ligament: Triangular in shape attached to lower part of lateral margin of sacrum &to tip of ischial spine.
