Anatomy Flashcards
What is the urinary tract?
the anatomical structures that urine passes through from its production to it’s excretion
What are the parts to the urinary tract?
Kidneys
Ureters
Bladder
urethra
What do the following parts of the urinary tract do: Kidneys: Ureter: Bladder: Urethra:
Kidneys: Produces urine
Ureter: Drains urine to the bladder
Bladder: stores and voids urine
Urethra: excretes urine
How does the urethra differ in men from women?
It is much longer
It also excretes semen.
In which three body regions does the urinary tract lie
Abdomen
pelvis
perineum
Which parts of the urinary tract lie in the abdomen?
Kidneys
Proximal ureter
Which parts of the urinary tract lie in the pelvis
Distal ureter
Bladder
Proximal urethra
Which parts of the urinary tract lie in the Perineum
distal urethra
Where is the boundary between the abdominal and pelvic regions?
the iliac crest/L4.
What happens at L4 vertebra?
The aorta bifurcates into the common iliac arteries.
the boundary between the upper and lower urinary tract is ____
L4 vertebra
The kidneys are intraperitoneal organs - true/false
False - they are retroperitoneal
The right kidney lies lateral to which structure
The inferior vena cava
The left kidney lies lateral to which structure
The abdominal aorta
What surface of the kidney is in contact with the peritoneum?
Anterior
What muscle(s) lie(s) posterior to the kidney? what are the functions of these?
posterior abdominal wall and postural muscles - they provide protection for the kidney
What structures bound the anterior border of the kidney - list from superficial to deep.
Visceral peritoneum paranephric fat Deep renal fascia perinephric fat (extends the whole way around) Renal capsule.
What is the renal capsule?
Another layer of very tough fascia which surrounds the whole kidney.
Where does the renal hilum lie?
the renal hilum lies on the medial aspect of the kidney
the renal hilum contains three structures; name them
The renal artery, renal vein and the ureter.
the renal artery and vein are branches of the ____ & ____ respectively
Abdominal aorta and IVC
The anterolateral abdominal wall muscles are the _______, _______ and _________
External oblique
Internal oblique
Transversus abdominus
The kidneys lie anterior to ______ _______muscle and lateral to ______ ______ muscle.
The kidneys lie anterior to quadrates lumborum muscle and lateral to psoas major muscle.
At what vertebral level do the kidneys lie?
Right kidney - L1-L3
Left kidney - T12-L1
Why is there a difference in the height of the left and right kidneys?
The liver is large and forces the right kidney down.
Which ribs are posteriorly related to the kidneys?
11 + 12 (floating ribs)
Why may the floating ribs cause danger to the kidneys?
they may contuse or lacerate the kidney if they fracture.
What should a normal kidney feel like on palpation?
it should be about 12cm long, 6cm wide, smooth, regular, well defined and firm to feel.
What structures is the right kidney related to?
Liver Hepatorenal recess 2nd part of duodenum Ascending colon right colonic flexure
Why is the hepatorenal recess important when lying supine?
It is the deepest part of the abdominal cavity when lying spin and so there is a tendency for fluid, if present to collect in the HR recess.
What structures is the left kidney related to?
the stomach
the tail of the pancreas
the hilum of the spleen
the splenic vessels
What is the arterial supply/venous drainage of the kidney?
Renal arteries/renal veins
the renal arteries lie anterior to the renal veins - true/false
False - lie posterior
The common iliac arteries lie anterior to the common iliac veins - true/false
True
Name all of the branches which contribute blood supply to the ureter
Renal artery, abdominal aorta, common iliac artery, internal iliac artery and vesicle artery.
What nodes drain the kidneys?
Lumbar nodes gathered around the abdominal aorta and inferior vena cava
The lymph from the ureters drain to which nodes?
Lumbar nodes, located around the AA and the IVC, iliac nodes located around the common, internal and external iliac vessels.
What are the two layers of a kidney?
Cortex
Medulla.
How many pyramids are located in the human medulla?
27
5000 nephron are contained in each medullary pyramid - true/false
False - 50,000
All the nephron are angled so as to point toward the pyramidal apex - true/false
true - this is why the medulla in a kidney is striped
Name the parts of the nephron
glomerulus, proximal convoluted tubule, loop of henlé, distal convoluted tubule, collecting duct
The collecting ducts coalesce to form a _______
Minor calyx
A number of minor calyces coalesce to form a _____
Major calyx
all major calyces join to make _____
the renal pelvis
the pelvis is much wider/narrower than the ureter
Wider
Name the three areas where constriction of the ureter can occur
pelviureteric junction
Pelvic brim-crosses the anterior aspect of the common iliac artery
The ureteric orifice of the bladder
What are renal calculi
Renal stones
Caused by hardening of calcium salts in the minor/major calyces.
The urinary tract responds to a constriction, internal or external by what mechanism?
Peristaltic wave contractions to try to dislodge the blockage.
Obstruction in the ureter or calyx causes _______ which if left untreated progresses to _______
Unlilater obstruction and progressing to unilateral kidney failure
Obstruction in the bladder causes _______ which if left untreated progresses to _______
Either unilateral or bilateral obstruction which if left untreated can lead to unilateral or bilateral failure
Obstruction in the urethra causes _______ which if left untreated progresses to _______
Bilateral obstruction and bilateral kidney failure if left untreated.
urine production will continue in obstruction until what occurs?
Until pressure in urinary tract exceeds filtration pressure in the glomerulus causing kidney failure.
What forms the pelvic floor?
The pelvic floor is made of a series of muscles called the pelvic diaphragm
What muscle is involved in the pelvic diaphragm?
Levator Ani
Where does levator ani originate and insert?
Anterior sacrum
Pubic Bone
What passes through the holes in the pelvic diaphragm?
Distal parts of the GI, the urinary tract and the reproductive tracts
Which part of the urinary tract is contained within the perineum?
The distal urethra
The ureters pass over which blood vessel to enter the pelvis?
The common iliac arteries OR the bifurcation between the internal and external iliac arteries.
Describe the route the ureters run when in the pelvic cavity
They run laterally along the walls of the pelvis until they reach the ischial tuberosity and then turn medially to enter the posterior of the bladder.
The route of the ureter in the pelvis is entirely retroperitoneal - true/false
False - it is entirely sub peritoneal.
The ureters run into the ureteric orifices of the bladder in an _______ ________ direction
Inferomedial
There is a circle of muscle which, when contracted, prevents urine flowing back into the ureters. Name this muscle and what else is it a part of?
the detrusor muscle
it is the main muscular component of the bladder walls.
Name the invagination of peritoneum found in both males and females.
The rectovesicle pouch.
What is the most inferior part of the peritoneal cavity in males?
The most inferior part is the rectovesicle pouch.
There is a structure in females that is not present in males, the eponymous name for which is the pouch of Douglas. Give its anatomical name and describe it.
It is the rectouterine pouch and is an invagination of the peritoneum to give a pouch between the rectum and the uterus.
What is the pouch between the uterus and bladder called?
The vesiculo-uterine pouch (imagine that!)
In the anatomical position, the most inferior part of the female peritoneal cavity is the rectovesicle pouch - true/false
False - the most inferior part of the female peritoneal cavity in the anatomical position is the rectouterine pouch (of Douglas).
Which structure lies very closely to the ureter in the female body? Which is the ureter?
the suspensory ligament of the ovary - the medial structure is the ureter.
the ureter runs inferior/superior to the uterine tubes and the uterine artery in females
Inferior - think of water under the bridge
In males the ureter runs inferior to the ejaculatory duct - true/false
False - it runs inferior to the vas deferens.
What artery are most of the arteries in the pelvis arising from?
The internal iliac artery
What vein are most of the veins in the pelvis draining toward?
the internal iliac vein
Branches of the internal iliac that are common to males and females include:
The vesicular artery (bladder)
Middle rectal artery (rectum)
branches of the internal iliac artery present in females only include:
The vaginal artery (vagina)
the uterine arteries (uterus)
branches of the internal iliac artery present in males only include:
The prostatic arteries (prostate)
What is the trigone?
A triangle of smoother tissue present in the bladder, the corners of which are formed by the ureteric orifices (posteriorly) and the internal urethral orifice (inferiorly)
The muscle forming the main bulk of the bladder is the ____________
Detrusor muscle
The detrusor muscle prevents retrograde ejaculation in men; how?
it encircles the internal urethral orifice and contracts during ejaculation to close the orifice and prevent ejaculation into the bladder.
What is the most anterior organ in the pelvis?
the bladder
When empty where does the bladder lie?
Against the posterior aspect of the pubic bone
In the female the uterus normally lies superior/inferior to the bladder and in a flexed/anteflexed position.
the uterus lies superior to the bladder and is in a mainly ante flexed position
What separates the uterus and the bladder?
uterovesicle pouch
The weight of the uterus is borne by the rectum - true/false
False - it is borne by the bladder (this why a pregnant lady needs to pee more?)
What lies inferior to the bladder in the male?
The prostate gland
What lies posterior to the bladder in both males and females?
The rectum.
An empty bladder lies completely in the _______. However when full the bladder may extend into the _______. The peritoneum covers (larger/smaller/same) amount of the bladder when full.
An empty bladder lies completely in the pelvis. However when full the bladder may extend into the abdomen. The peritoneum covers same amount of the bladder when full.
What are the two methods of urinary catheterisation?
Urethral
Suprapubic; needle catheterisation through the anterior abdominal wall so as to miss the peritoneal cavity.
The levator ani muscle in the female lies just superior/inferior to the external urethral sphincter and so can form a sphincter as well.
Superior
Approximately what length is the female urethra? What length is a male urethra? How do they compare/
Female - 4cm
Male - 20cm
Male is much larger
What are the two parts to the urethra in males>
Prostatic (passing through prostate)
Spongy (passing through corpus spongiosum)
Give the route of sperm after it is produced
Produced in testicle
Stored in epididymis
Passed into vas deferens (which runs in spermatic cord)
Spermatic chord runs through the inguinal canal including the deep and superficial inguinal rings.
runs posterior to the bladder. Seminal gland ducts join to give ejaculatory duct. Joins the prostatic urethra.
Where did the testicle develop embryologically?
The posterior abdominal wall
Where are the testicular artery/vein/lymphatics/vas deferens running?
Through the inguinal canal in the spermatic chord.
the testicle is surrounded by a peritoneal like structure - name it
the tunica vaginalis
What is excess fluid in the tunica vaginalis called?
Hydrocele.
Why are the testicles at risk of torsion?
they are very mobile and get all of their supply from the spermatic cord via the epididymis. they can end up twisting and cutting off the venous/arterial and lymphatic supply.
Where does the testicular artery arise from?
the abdominal aorta (think of its embryological origins in the abdomen).
What is the difference between the right and left testicular veins?
The right drains directly into the IVC where the left goes via the left renal vein.
If you cut a cross section of the testicle you will see lots of little structures called ________. they are packed very tightly but if carefully unravelled will be _________ long. they are responsible for the production of _________
Seminiferous tubules
Meters long
Sperm
The vas deferens cannot be felt in dissection - it is a very soft structure - true/false
False - very tough structure - can be felt
Where do the seminal vesicles lie?
the posterior of the bladder
There are ___ orifices on the prostatic urethra
3
the 3 orifices on the prostatic urethra allow the insertion of _________ & _________
the prostatic gland ducts and the ejaculatory duct.
What is the root of the penis attached to?
the ischial tuberosity
The erectile tissue in the penis is the _______
Corpus cavernosum (2x posteriorly) Corpus spongiosum (1 x anteriorly)
The right and left corpus cavernosum conduct what structures within them
the deep arteries of the penis
What is the glans of the penis?
the most superior part in the anatomical (erect) position and the widest part of the penis.
What is the body of the penis
Everything between the root and the glans
Where does blood supply to the penis come from?
The internal iliac artery.
What branches of the internal iliac supply the penis?
The internal pudendal artery gives off the deep arteries of the penis.
The blood supply to the scrotum is from two arteries; name them
internal pudendal
Branches of the external iliac artery
Lymph from the scrotum and most of the penis drains to the _____ and from the testis drains into the ______
superficial inguinal nodes
Lumbar nodes around the abdominal aorta.
Which motor nerves (Somatic/autonomic) cause ureteric peristalsis?
Autonomic
Which nerves (somatic/autonomic) cause contraction of the detrusor and internal urethral sphincter (in men)?
Autonomic
Which nerves (somatic/autonomic) cause contraction of the external urethral sphincter and levator ani?
Somatic motor
Pain from the kidneys/ureters/bladder/proximal urethra are supplied by somatic sensory fibres - true/false
False - supplied by visceral afferent fibres - remember viscera means organ…
The distal urethra pain sense is supplied from the somatic sensory fibres - true/false
True
What are the 5 types of nerve?
Somatic sensory Visceral sensory Somatic motor Parasympathetic motor Sympathetic motor
There are ____ pairs of cranial and _____ pairs of spinal nerves
12 cranial
31 spinal
The 12 cranial and 31 spinal nerves are the only means by which autonomic nerves can enter the CNS; sensory nerves can enter via other routes - true/false
False - these 43 nerve pairs are the ONLY way ANY nerve can access the CNS.
Each nerve that enters a cranial nerve or spinal nerve is carried the same distance within it - true/false
False - they will all differ.
Somatic motor nerves and sensory nerves are carried the whole way from origin to destination within the cranial and spinal nerves - true/false
True
Sympathetic and parasympathetic and visceral afferent nerves travel from origin to destination within the cranial/spinal nerves - true/false
False - limited portions to enter and exit the CNS.
Sympathetic nerve fibres only exit the CNS between which vertebral levels
T1-L2 (thoracolumbar outflow)
other than the head, the sympathetic nerves reach the smooth muscle/glands of the body wall in the _____(cranial/spinal) nerves
Spinal - trick question - no cranial nerve has a sympathetic fibre in it - be wary of this.
other than the head, the sympathetic nerves reach the smooth muscle/glands of structures other than the body wall in the _____ nerves
Splanchnic nerves
Spinal nerves therefore contain three nerve fibres to innervate the body wall - name them.
Somatic motor
Somatic sensory
Sympathetic
To reach the kidney ureter and bladder, the sympathetic fibres leave the spinal cord at which level?
T10 - L2.
To reach the kidney, ureter & bladder the sympathetic fibres enter the sympathetic chain unilaterally/bilaterally and do/do not synapse. they leave the sympathetic chain in the ________ nerve
enter the sympathetic chain bilaterally and do not synapse, leaving the sympathetic chain in the abdomino-pelvic splanchnic nerves.
What do the sympathetic fibres in the abdomino-pelvic splanchnic nerves synapse with? Where are these contained?
Abdominal sympathetic ganglia contained around the abdominal aorta
What happens after the sympathetic nerves synapse with the abdominal sympathetic ganglia?
they leave the ganglia and pass onto the surface of the artery supplying the structure they are running to and form periarterial plexuses
What other nerve fibres (not including sympathetic) are present in periarterial plexuses?
parasympathetic and visceral afferent fibres.
The parasympathetic fibres in the body arise from ______
Cranial nerves III/VII/IX/X
Sacral spinal nerves
(the Cranio-Sacral outflow)
Parasympathetic fibres do/do not innervate the smooth muscle and glands of the body wall
do not
the pelvic organs and hindgut receive their parasympathetic supply from the ______
pelvic splanchnic nerves
Parasympathetic fibres are carried (very briefly/entirely) by the sacral nerves
Very briefly then they exit again.
Parasympathetic nerves which innervate the kidneys and ureter are carried in the _____ while those that innervate the bladder are carried by the ______.
Innervate kidneys and ureter - vagus
Innervate bladder - pelvic splanchnic nerves
Somatic motor fibres run to the kidneys/ureter/bladder in the sacral spinal outflow - true/false
False - this is a sort of a trick question as they don’t supply any of these organs - somatic goes to the body wall (soma).
Where in the renal tract do somatic motor fibres run to?
distal urethra and the external urethral sphincter/levator ani muscle
Parasympathetic fibres from the vagus nerve control the contraction of the bladder, true or false?
False - parasympathetic fibres do control contraction of the bladder but they do this through the splanchnic nerves, not the vagus.
What three types of fibres control the urethral sphincter(s)?
parasympathetic, sympathetic and somatic motor
The sympathetic and parasympathetic fibres control the internal/external urethral sphincters - explain what they cause
Internal (males only). During ejaculation, the sympathetic fibres stimulate the internal sphincter to contract to prevent retrograde ejaculation. during urination the parasympathetic fibres cause inhibition of the sphincter to allow micturition.
Somatic motor fibres within the ______ nerve stimulate the internal/external urethral sphincter
Pudendal nerve
External
Somatic fibres within the _______________ stimulate levator ani to contract.
Nerve to levator ani (imagine that - what a surprise)
Pain from the kidney is usually felt in the ______
posterior flank (loin) on the ipsilateral side
Pain from the bladder is usually felt in the ______
Midline suprapubic region
Pain from a calculus obstructing the ureter is usually felt in the ______
Loin radiating to the groin on the ipsilateral side
Pain from the distal urethra is usually felt in the _____
Localised pain
Perineum
Visceral afferent fibres to the kidneys run alongside (para)sympathetic nerves to the spinal cord and enter between ______ & ______
Sympathetic
T11-L1
Visceral afferent fibres to the ureters run alongside (para)sympathetic nerves to the spinal cord and enter between ______ & ______
Sympathetic nerves
T11-L2
Visceral afferent fibres to the superior part of the bladder run alongside (para)sympathetic nerves to the spinal cord and enter between ______ & ______
Sympathetic
T11-L2
Visceral afferent fibres to the rest of the bladder, not touching the peritoneum, run alongside (para)sympathetic nerves to the spinal cord and enter between ______ & ______
Parasympathetic nerves
S2-S4.
Visceral afferent fibres to the proximal urethra run alongside (para)sympathetic nerves to the spinal cord and enter between ______ & ______
parasympathetic
S2-S4
Somatic sensory fibres to the proximal urethra run in the _________ nerve to the spinal cord and enter between ______ & ______
Pudendal
S2-S4
Where do visceral afferent fibres from the testis join the spinal cord? They run alongside (para)sympathetic fibres
T10-11
Sympathetic
Testis pain can be localised to the scrotum or present as groin pain - true/false
True
There are three nerve fibres that control micturition. Name them.
visceral afferent fibres to the bladder
pudendal nerve - somatic motor
Pelvic splanchnic nerves - carry parasympathetic
What senses bladder filling?
Stretch receptors in the visceral afferent nerve fibres
What level in the vertebrae do bladder filling stretch receptors enter the spinal cord?
S2/3/4
When the stretch receptors are activated there is a reflex to to empty the bladder by the contraction of ______ and inhibition of _______
Contraction of detrusor
Inhibition of the internal urethral sphincter (men only)
The contraction of detrusor and inhibition of the internal urethral sphincter to micturate is facilitated by which nerve type (s)?
Detrusor - parasympathetic
Sphincter - inhibited by parasympathetic
What allows us control over our continence?
nerve fibres carry an inhibitory signal inferiorly to block this reflex
What region of the brain allows us control over our continence?
The cortex
We can also voluntarily contract two structure to prevent urination - name them. Which type of innervation supplies them?
External urethral sphincter
levator ani
Somatic motor
Which muscles contract to increase intra-abdominal pressure and increase urinary flow?
The anterolateral abdominal wall muscles
What are the anterolateral abdominal wall muscles?
external/internal oblique & transversus abdominus.
What do the lumbar and sacral plexuses supply?
they supply the perineum and the lower limbs.
Where do most of the named nerves in the sacral plexus originate?
Spinal cord - they are all spinal nerves
Which nerves of the sacral plexus arise from L2/3/4?
Femoral nerve
Obturator nerve
The sciatic nerve originates from L2-S1; true/false
False; L4-S3
Where does the femoral nerve run?
Inferior to inguinal ligament to the anterior compartment of the thigh
Where does the obturator nerve run?
Through the obturator foramen into the medial compartment of the thigh
Where does the sciatic nerve run>
Into the posterior compartment of the thigh through the gluteal region. splits into the common fibular and tibial nerves at the popliteal fossa.
Where does the superficial fibular nerve supply?
Lateral compartment of the leg
Where does the deep fibular nerve supply?
Anterior compartment of the leg
Where does the the tibial nerve supply?
Posterior compartment of the leg and intrinsic foot muscles
