Anatomy Flashcards
pathway of urine production
1 - Kidney (produces urine)
2 - the ureter (drains urine)
3 - the bladder (stores urine)
4 - the urethra (excretion of urine/semen in males)
what is contained in the upper urinary tract
the kidneys x2
the ureters x2
what is contained in the lower urinary tract
the bladder x 1
the urethra x1
what bifurcation happens at L4/umbilical
bifurcation of the abdominal aorta into the common iliac arteries
where is the anatomical division of the abdomen and pelvis
iliac crest and L4
where do the kidneys sit
retroperitoneal
R - is lateral to IVC
L - is lateral to aorta
level L2
what are the boundaries of the kidneys
Posterior - psoas major, quadratus lumborum
Anterior - visceral peritoneum, paranephric fat, renal fascia, perinephric fat, renal capsule
Medial - renal hilum
Lateral - anterolateral abdominal wall muscles (3 layers)
what is contain in the renal hilum
renal artery
renal vein
ureter
what muscles does a surgeon have to go through to reach the kidneys
external oblique
internal oblique
transversus abdominis
then quadrates lumborum
where exactly are the kidneys
anterior to quadratus lumborum & lateral to psoas major
what vertebral level does the right and left kidney sit at and why is there a difference
Left - T12 to L2
Right - L1 to L3
Right pushed down by the liver
what protects the kidneys but can also cause damage
Floating ribs 11 + 12
If they are fractured they can damage the kidneys
what regions are the kidneys in
L - Left flank/LUQ
R - Right flank/RUQ
which direction to the kidneys move on breathing
inspiration - move inferiorly
expiration - move superiorly
anatomical relationship (posterior) of the right kidney
Posterior to:
- the liver and hepatorenal recess
- the 2nd part of the duodenum
- ascending colon
- right colic flexure
anatomical relationship (posterior) of the left kidney
posterior to
- stomach
- tail of the pancreas
- hilum of the spleen
- splenic vessels
where do the renal veins lie in relation to the renal arteries
anteriorly
where do the common iliac veins lie in relation to the common iliac arteries
posteriorly
where does lymph from the kidneys drain to
lumbar nodes (located around the abdominal aorta and IVC)
where does lymph from the ureter drain to
Lumbar nodes and iliac nodes (located around common, internal and external iliac vessels)
what are the different types of AAA
infra-renal = below levels of renal arteries supra-renal = above but can extend past the levels of renal arteries
what does the kidney concept of
outer cortex and an inner medulla
each medulla contains 27 pyramids
each pyramid contains around 50,000 nephrons
how does urine drain from the kidney
1 - collecting ducts 2 - minor calyx 3 - major calyx 4 - renal pelvis 5 - ureter
where is there a constriction in the kidney and why
tubes gradually get bigger with the renal pelvis being the biggest
the ureter is much smaller
constriction at the pelviureteric junction:
where are the 3 sites of ureteric construction
1 - pelviureteric junction
2 - ureter crossing anterior aspect of the common iliac artery
3 - ureteric orifice (opening into one corner of the trigone on the floor of the bladder)
how do renal calculi (stones) form
form in the calyces
form from urine calcium salts
can obstruct urinary tract from within
Ix for renal calculi
can be seen on x-ray
what can cause ureteric obstruction
internal - renal calculus or blood clot
external - expanding mass e.g. tumour
what is the ureter composed of and how does this affects its response to obstruction
smooth muscle
increased peristalsis proximal to the site of the obstruction in an attempt to remove it/flush it into the bladder
what does a patient with ureter constriction complain of
colicky pain
consequences of urine tract obstruction
renal failure - as urine has to ‘back up’ to the kidney
what causes unilateral and bilateral kidney problems
unilateral - obstructions within calyces or ureter, problems with bladder
bilateral - problems with bladder, urethra obstructions
what does renal failure mean
means failure to adequately filter the blood to produce urine
what is hydronephrosis
water inside the kidney
how does renal failure happen
urine back pressure into the calyces compresses the nephrons within the medullary pyramids leading to renal failure
presentation of some with acute hydronephrosis
painful - due to stretching of the renal capsule
palpable unilateral kidney
where does the ureters pass
from the retroperitoneum through the false pelvis and into the true pelvis
what does the false pelvis consist of
from iliac crests to pelvic inlet
part of the abdominal cavity
what does the true pelvis/pelvic cavity consist of
pelvic inlet to pelvic floor
is the pelvic cavity
where is the bladder found
in the pelvic cavity
what are the pelvic floor muscles
levator ani (pelvic diaphragm)
where does the urethra pass
through pelvic floor into perineum
what is the pelvic diaphragm made of
levator ani
Coccygeus
where are the ureters in relation to the common iliac vessels
anterior
where do the ureters turn medially to enter the POSTERIOR aspect of the bladder
ischial spin
why do the ureters enter the posterior bladder in an inferomedial direction
helps prevent reflux of urine back into the ureters
what type of route do the ureters take
sub peritoneal
who has a pouch of Douglas
females
where is the vesico-uterine pouch found
between the bladder and uterus
what is the role of the round ligament of the uterus
attach uterus to the perineum via the inguinal canal
what are some important anatomical relations of the pelvic ureters
- runs inferiorly to the vas deferens
- runs inferiorly to uterine tube and the uterine artery
“water under the bridge”
what are most of the arteries entering the pelvis
branches from the internal iliac artery
what are the 3 openings of the bladder and what do they form
2 ureteric orifices and internal urethral orifice
form trigone - triangle shape on the internal aspect of the bladder
what muscle forms the bulk of the bladder wall
detrusor muscle
how does the detrusor muscle prevent reflux of urine
encircles the ureteric orifices which tighten when the bladder contracts
what differs in male bladders to females and why
neck of the male bladder, the detrusor muscle forms the internal urethral sphincter muscle
- prevents ejaculation of semen back into the bladder
important anatomical relations of the bladder
- is the most anterior organs in pelvis
- in females, uterus lies superior to the bladder
- in males, the prostate gland lies inferior to the bladder and the rectum posterior
what are the 2 routes of catheterising a patient’s bladder
urethral and suprapubic
what type of muscle surrounds the urethra
voluntary skeletal muscle
what should the scrotum contain at birth
testes
what is the spermatic cord
a collection of structures which support the functioning of the testis
what do the testes sit in inside the scrotum
within a sac called the tunica vaginalis
what is excess fluid within the tunica vaginalis called
hydrocele
where are the testis at risk of twisting
the testis and epididymis are attached to the spermatic cord superiorly and are quite mobile
what is contained within the spermatic cord and what are there functions
vas deferens - transports sperm
testicular artery - supplies oxygenated blood
pampiniform plexus - drains deoxygenated blood
what passes through the deep inguinal ring
testicular artery testicular vein vas deferens lymphatics nerves
where is the epididymis and vas deferens palpated
epididymis - posterior aspect of the testis
vas deferens - within the spermatic cord
pathway of sperm
testis»_space; epididymis»_space; vas deferens»_space; ejaculatory duct»_space; urethra
what part of male anatomy is in contact with the levator ani muscle
the prostate gland
what zone of the prostate gland is felt on PR examination and why
peripheral zone
- most prostate cancers arise here
what traits the spongy urethra and expands distally to form the glans in males
corpus spongiosum
what transports the arteries of the penis
corpus cavernosum
what happens during male erection
the 3 cylinders of erectile tissue become engorged with blood at arterial pressure
what is circumsicion
removal of the prepuce
what is the blood supply to the penis
branches of the internal pudendal artery
which is a branch of the internal iliac
what is the blood supply of the scrotum
internal pudendal
branch of the external iliac artery
lymph drainage from the scrotum and the penis
superficial inguinal lymph nodes
lymph drainage from the testis
lumbar nodes around the abdominal aorta
what are the 5 types of nerve fibres
Sensory-
somatic sensory
visceral afferent
Motor -
somatic motor
parasympathetic
sympathetic
what do somatic sensory do
sensations from the body wall (soma)
visceral afferent nerve fibres
sensations from our organs
somatic motor
motor responses to our body wall
parasymp + symp
motor response to our organs
why is it said that sympathetic nerve fibres have a thoracolumbar out flow
Sympathetic nerve fibres leave the CNS only within the spinal nerves between spinal cord levels T1-L2
how does most sympathetic fibres reach there organ
by ‘hitching a ride’ with the artery going to that organ
what are splanchnic nerves
they convey visceral efferent and afferent fibres to and from the viscera of the body cavities
how does sympathetic nerve fibres relate to splanchnic nerves
postsynaptic symp fibres destined for the heart/lungs/oesophagus pass through cardiopulmonary splanchnic nerves to reach there destination
presynaptic fibres for stomach/intestines pass through the abdominopelvic splanchnic nerves
how do sympathetic nerve fibres get to the kidneys, ureters and bladder
- leave the spinal cord between T10 - L2
- enter sympathetic chain (bilaterally) but do not synapse
- leave the sympathetic chain within abdominopelvic splanchnic nerves
- synapse at the abdominal sympathetic ganglia located around the abdominal aorta
- POSTsynaptic sympathetic nerve fibres pass from the ganglia onto the surface of the arteries which are heading towards the organs they need to innervate
what is the name given to the collection of nerve fibres found on the outside of the arteries
periarterial plexus
what CN are responsible for parasympathetic outflow
III
VII
IX
X
how do parasympathetic fibres reach the hindgut
via the pelvic splanchnic nerves
what nerves carries the parasympathetic fibres which innervate the kidneys and ureter
CN X - vagus nerve
what nerves carries parasympathetic nerve fibres which innervate the bladder
pelvic splanchnic nerves
- they leave the spinal nerves S2, S3, S4
where is pain from the kidney normal felt
in ‘loin’
posterior aspect of the flank region on the affected side
where is pain from the bladder felt
suprapubic region
where can pain from a calculus obstructing the ureter be felt
radiating from ‘loin to groin’ on affected side
posterior aspect of the flank region to groin
where is pain from the urethra felt
localised in the perineum
how do visceral afferent nerve fibres get from the kidneys and ureters to the CNS
run alongside sympathetic fibres back to the spinal cord
enter the spinal cord between T11 and L1 (+L2 for ureter) - these dermatomes are where patients feel pain
Ddx of loin pain
skin origin (e.g. herpes zoster) muscular vertebrae spinal nerve root compression lower lobe pneumonia
Ddx of groin pain
hernias (inguinal or femoral)
lymphadenopathy
testicular pathology
how do visceral afferent nerve fibres get from the BLADDER to the CNS
superior part of bladder
run alongside sympathetic fibres back to the spinal cord
enter at T11 - L2
rest of bladder (not touching the peritoneum)
run alongside the parasympathetic nerve fibres back to spinal cord levels S2,S3, S4
Ddx of suprapubic pain
hindgut organs, e.g. sigmoid diverticula
other single, midline pelvic organs whose superior aspect touches the peritoneum, e.g. uterus
How Do Visceral Afferent & Somatic Sensory Nerve Fibres get from the Urethra to the CNS?
VA - run alongside the parasympathetic nerve fibres back to spinal cords levels S2,S3,S4
SS - carried within pudendal nerve also back to spinal cord levels S2,S3,S4
Ddx of perineal pain
vaginal tear
anal canal fissure
perineal genital ulcers (e.g. herpes)
How Do Pain Fibres get from the Testis to the CNS
visceral afferents run alongside sympathetic fibres back to the spinal cord to levels T10-11
pain can also present localised to scrotum and/or groin (L1)
Ddx of scrotal pain
skin lesions
strangulated inguinal hernia
what nerves are important for controlling urine flow
nerves leaving at level S2-4
Visceral afferent fibres
Pudendal nerve
Pelvic splanchnic nerves
what is involved in the reflex to empty the bladder
detrusor muscle contracts and the internal sphincter relaxes (only in males)
what signals that the bladder is full
stretch receptors at the end of visceral afferent nerve fibres
what nerves arise from the sacral plexus
pudendal nerve
sciatic nerve
what nerves arises from the lumbar plexus
lateral cutaneous nerve of the thigh
femoral nerve
obturator nerve
