Anatomy Flashcards
What 4 major structures make up the urinary tract?
Kidney
Ureter
Bladder
Urethra
What are the two parts to the urinary tract?
Upper, containing the kidneys and ureters
Lower, containing the bladder and urethra
What 3 body compartments does the urinary tract involve?
Abdomen
Pelvis
Peritoneum
What is the difference in a male and female urethra?
Female is shorter and more likely to get a lower tract UTI
Where in the abdomen do the kidneys lie?
Retroperitonally
What three structures make up the hila of the kidney?
Renal artery
Renal vein
Ureter
At what level does the upper urinary tract become the lower?
L4
At the iliac crest
What other major landmarks are at L4?
Umbilicus
Bifurcation of abdominal aorta into right and left iliac artery
At which vertebral level is the left kidney?
T12-L2
At which vertebral level is the right kidney?
L1-L3
Why is the right kidney more inferior?
Presence of liver pushes it down
Which muscles are in direct relation to the kidneys?
Psoas
Quadratus lumborum
What layers surround the kidney?
Visceral peritoneum Paranephric fat Renal fascia Perinephric fat Renal capsule
Which ribs are associated with the kidneys?
11 and 12.
Which region of the body do the kidneys lie?
Flank/lumbar
Where is the kidney clinically examined?
Posterior to 12th rib in the RUQ
What cavity, where water collects in the supine patient, does the kidney lie?
Hepatorenal recess
Describe the location of the renal veins
Anterior to renal arteries
Describe the location of the common iliac veins
POSTERIOR to the common iliac arteries
Where does the lymph from the ureters drain?
Iliac nodes
Lumbar nodes
Where does lymph from the kidneys drain?
Lumbar nodes alone
Describe an infra-renal AAA
Aneurysm is below the renal arteries
What is the difference in renal artery stenosis when in the presence of an infra-renal AAA and a supra-renal AAA?
An infra-renal may be caused by atherosclerosis
While a supra-renal likely to due to occlusion of the renal artery
How is an AAA treated?
Endovascular aneurysm repair
Name some common variations of the renal system
Bifid renal pelvis
Bifid ureter
What two layers makes up the kidney?
Outer cortex and an inner medulla with a capsule surrounding it
What structures are contained within the medulla?
Pyramid
What structures lie within the pyramid?
Nephrons
Name the constituents of the nephron
Glomerulus Proximal convuluted tubule Loop of Henle Distal convuluted tubule Collecting duct
Name the structures which are involved in urine drainage
Collecting ducts Minor calyx Major calyx Renal pelvis Ureter
What is the constriction at the ureter called?
Pelviureteric junction
What can gather at the pelviureteric junction?
Calculi
What makes up calculi?
Calcium salts
Why is calculi pain colicky?
Smooth muscle in ureter.
Increased peristalsis to remove obstruction
Wave like pain
What is hydronephrosis?
Back pressure not the calcyes compresses the nephrons causing painful stretching of the renal capsule leading to renal failure
What may be found on examination with a hydronephrosis?
Kidney enlargement
What is the true pelvis?
Pelvic inlet to pelvic floor
What separates the true pelvis from the false pelvis?
Pelvic rim/inlet
Which muscle can be said to separate the pelvic floor from the peritoneum?
Levator ani
What does levator ani do?
Constricts the rectum and bladder
Describe the travel of the ureters
From kidney they pass anterior to common iliacs and follow the wall of the true pelvis. Posterior to the bladder and enter into the trigone.
Which cavity is present in males, which is the most inferior part of the peritoneal cavity?
Rectovesicle pouch
Which two cavities are present in females?
Vesicouterine pouch
Rectouterine pouch
What structure lies immediately lateral to the ureter in females?
Suspensory ligament of the ovary
What connects the uterus to the perineum?
Round ligament of the uterus
Where does the ureter lie in relation to the uterine artery and the Vas Deferens?
Inferior to uterine tubes and uterine artery.
“Water under the bridge”
Where do all the arteries supplying the pelvis come from?
Internal iliac artery
What are the 3 orifices in the trigone?
2 ureteric orifices
1 internal urethral orifice
What is also present at the internal urethral orifice in males?
Internal urethral sphincter
Which muscle causes contractions of the bladder?
Detrusor muscle
How is urine reflux to the ureter prevented?
Contraction of the detrusor muscle around the ureteric orifices
Which pelvic organ is most anterior and sits deep to the pubic bone?
Bladder
What anatomical differences are present in a full and empty bladder?
Full bladder may enter into abdomen
What kind of muscle is the external urethral sphincter made of?
Skeletal
What is the difference in the male and female urethra?
Female is much shorter
Where is sperm produced?
Seminiferous tubules in the epididymis
What structure carries sperm into the ejaculatory duct?
Vas deferens
What structure is the vas deferens part of?
Spermatic cord
What else is held in the spermatic cord?
Testicular artery
Testicular vein
Vas deferens
Lymphatics
What two muscle groups are involved in penile erection?
Corpus spongisoum
Left and right corpus cavernosum
Where is semen added to sperm?
Seminal gland
When does the vas deferens become the prostatic urethra?
When enters the prostate gland.
What is the urethra called as it exits the external urethral meatus?
Spongy urethra
What structure does the testis sit in?
Tunica vaginalis
What are the two parts of the tunica vaginalis?
Parietal and visceral, with serous fluid inbetween
What is excess fluid between the parietal and visceral tunica vaginalis called?
Hydrocoele
What structure drains deoxygenated blood from the testis?
Pampiniform plexus
Where do the testicular veins drain to?
Left drains to left renal vein
Right drains directly to vena cava
Which structure allows glandular secretions from the prostate into the prostatic urethra?
Prostatic ducts
What are the two zones of the prostate and which is most clinically relevant?
Central
Peripheral.
Most cancers are peripheral.
Which penile muscle does the spongy urethra sit in?
Corpus spongiosum
What is the penile raphe?
On anterior surface
That line.
Scrotal raphe also exist.
What is the anatomically correct name for the foreskin?
Prepuce
What is the blood supply to the penis?
Both the deep arteries of the penis and internal pudendal artery. Internal iliac only.
What is the blood supply to the scrotum?
Internal pudendal and branches from external iliac
Where does lymph from the testis drain to?
Lumbar lymph nodes at abdominal aorta
Where does lymph from the penis drain to?
Superficial inguinal nodes
What do somatic sensory nerve fibres do?
Convey sensations from the body wall to the CNS
What do visceral afferent nerve fibres do?
Carry sensation from organs to the CNS
What do somatic motor nerves do?
Convey motor responses from the CNS to the soma
How are motor responses to the organs carried out?
Parasympathetic or sympathetic nerve fibres
On which cranial nerves are parasympathetic fibres carried?
3, 7, 9 and 10
Sacral nerve plexus
All the sensory nerves in the renal system are visceral afferents apart from what?
The urethra while in the perineum is a somatic sensory
What divides the urethra into pelvic and perineum?
Levator ani
What parts of the renal system are controlled by motor nerves i.e. sympathetic and parasympathetic?
Ureteric and bladder peristalsis.
Urethral sphincter control
Which parts of the renal system are controlled by somatic motor nerves?
External sphincter and levator ani
Which kinds of nerves are involved in urinary continence?
Motor nerves
Somatic motor
Visceral afferents
Which nerves control both the motor and sensory parts of the perineum and lower limbs?
Somatic sensory and somatic motor
Between which spinal cord levels can sympathetic nerve fibres leave the CNS?
T1-L2
Thoracolumbar outflow
Where does the sympathetic chain run?
From C1 to sacral plexus, adjacent to spinal cord
How do sympathetic nerve fibres reach the body wall?
Within spinal nerves
How do sympathetic nerve fibres reach the organs/muscles of the body?
Cardiopulmonary or abdominopelvic sphlanchnic nerves
Describe the route of the splanchnic nerves
They follow the arteries supplying the same structures
How does the spinal cord and the sympathetic nerve chain communicate?
Rami communicans
How many ganglia are there in the cervical region?
3
superior middle and inferior
How many ganglia are in the thoracic and lumbar regions?
One for each spinal cord level so 17
Where do sympathetic nerve fibres going to the kidneys, ureter and bladder travel to?
Leave spinal cord at T10-T12
Enter into bilateral sympathetic chain
Leave the sympathetic chain within the abdominopelvic splanchnic nerves.
Where do sympathetic nerve fibres going to the kidneys, ureter and bladder synapse?
Abdominal sympathetic ganglia, at the abdominal aorta
What is a periarterial plexus?
Collection of nerves on the outside of the arteries which are post synaptic
Where do the parasympathetic nerves supply?
NOT body wall
Smooth muscle/glands
How do the parasympathetic fibres reach the muscles of the hindgut and pelvic organs?
Pelvic splanchnic nerves
Which cranial nerve is the parasympathetic nerves which innervate the kidneys and ureter carried in?
CN X
Nerves going to which structure is carried within the pelvic splanchnic?
Bladder
Which spinal cord levels does the pelvic splanchnic nerve leave?
S2,3 and 4
Which part of the tract is involved with somatic motor nerves?
External urethral sphincter
Which named nerve controls the external urethral sphincter?
Pudendal
Which muscle is contracted in the bladder when stimulated by S2,3 and 4?
Detrusor muscle
When does the internal urethral sphincter contract?
In males only.
During ejaculation
Which nerves control levator ani?
S3 and S4.
What spinal nerves do the visceral afferents from the kidneys use?
T11-L1
What spinal nerves do the visceral afferents from the ureter use?
T11-L2
What is the division in visceral afferent fibres in the bladder?
Superior part, touching the peritoneum is by T11-L2
The rest, not touching the peritoneum, is by S2,3 and 4.
How do visceral afferents from the urethra get back to the CNS?
Run alongside parasympathetics and use S2,3 and 4.
Which nerve senses stretch in the bladder as it fills?
Visceral afferents
S2,3 and 4
What muscles are used during micturition?
Detrusor contracts
Internal urethral sphincter, external urethral sphincter and levator ani relax.
Where does the femoral nerve come from?
L2,3 and 4.
Anterior compartment of thigh
Where does the obturator nerve come from?
L2, 3 and 4
Medial compartment of thigh
Where does the sciatic nerve come from?
L4- S3
Posterior compartment of thigh via gluteals
What does the sciatic nerve split into?
Tibial nerve
Common fibular
What does the tibial nerve supply?
Posterior leg
Intrinsic muscles of foot
What does the common fibular divide into?
Superficial fibular- lateral leg
Deep fibular- anterior leg
What is the sural nerve?
Sensation to lateral foot
