Anatomy Flashcards
1
Q
pathway of urine production
A
1 - Kidney (produces urine)
2 - the ureter (drains urine)
3 - the bladder (stores urine)
4 - the urethra (excretion of urine/semen in males)
2
Q
what is contained in the upper urinary tract
A
the kidneys x2
the ureters x2
3
Q
what is contained in the lower urinary tract
A
the bladder x 1
the urethra x1
4
Q
what bifurcation happens at L4/umbilical
A
bifurcation of the abdominal aorta into the common iliac arteries
5
Q
where is the anatomical division of the abdomen and pelvis
A
iliac crest and L4
6
Q
where do the kidneys sit
A
retroperitoneal
R - is lateral to IVC
L - is lateral to aorta
level L2
7
Q
what are the boundaries of the kidneys
A
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)
8
Q
what is contain in the renal hilum
A
renal artery
renal vein
ureter
9
Q
what muscles does a surgeon have to go through to reach the kidneys
A
external oblique
internal oblique
transversus abdominis
then quadrates lumborum
10
Q
where exactly are the kidneys
A
anterior to quadratus lumborum & lateral to psoas major
11
Q
what vertebral level does the right and left kidney sit at and why is there a difference
A
Left - T12 to L2
Right - L1 to L3
Right pushed down by the liver
12
Q
what protects the kidneys but can also cause damage
A
Floating ribs 11 + 12
If they are fractured they can damage the kidneys
13
Q
what regions are the kidneys in
A
L - Left flank/LUQ
R - Right flank/RUQ
14
Q
which direction to the kidneys move on breathing
A
inspiration - move inferiorly
expiration - move superiorly
15
Q
anatomical relationship (posterior) of the right kidney
A
Posterior to:
- the liver and hepatorenal recess
- the 2nd part of the duodenum
- ascending colon
- right colic flexure
16
Q
anatomical relationship (posterior) of the left kidney
A
posterior to
- stomach
- tail of the pancreas
- hilum of the spleen
- splenic vessels
17
Q
where do the renal veins lie in relation to the renal arteries
A
anteriorly
18
Q
where do the common iliac veins lie in relation to the common iliac arteries
A
posteriorly
19
Q
where does lymph from the kidneys drain to
A
lumbar nodes (located around the abdominal aorta and IVC)
20
Q
where does lymph from the ureter drain to
A
Lumbar nodes and iliac nodes (located around common, internal and external iliac vessels)
21
Q
what are the different types of AAA
A
infra-renal = below levels of renal arteries supra-renal = above but can extend past the levels of renal arteries
22
Q
what does the kidney concept of
A
outer cortex and an inner medulla
each medulla contains 27 pyramids
each pyramid contains around 50,000 nephrons
23
Q
how does urine drain from the kidney
A
1 - collecting ducts 2 - minor calyx 3 - major calyx 4 - renal pelvis 5 - ureter
24
Q
where is there a constriction in the kidney and why
A
tubes gradually get bigger with the renal pelvis being the biggest
the ureter is much smaller
constriction at the pelviureteric junction:
25
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)
26
how do renal calculi (stones) form
form in the calyces
form from urine calcium salts
can obstruct urinary tract from within
27
Ix for renal calculi
can be seen on x-ray
28
what can cause ureteric obstruction
internal - renal calculus or blood clot
| external - expanding mass e.g. tumour
29
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
30
what does a patient with ureter constriction complain of
colicky pain
31
consequences of urine tract obstruction
renal failure - as urine has to 'back up' to the kidney
32
what causes unilateral and bilateral kidney problems
unilateral - obstructions within calyces or ureter, problems with bladder
bilateral - problems with bladder, urethra obstructions
33
what does renal failure mean
means failure to adequately filter the blood to produce urine
34
what is hydronephrosis
water inside the kidney
35
how does renal failure happen
urine back pressure into the calyces compresses the nephrons within the medullary pyramids leading to renal failure
36
presentation of some with acute hydronephrosis
painful - due to stretching of the renal capsule
| palpable unilateral kidney
37
where does the ureters pass
from the retroperitoneum through the false pelvis and into the true pelvis
38
what does the false pelvis consist of
from iliac crests to pelvic inlet
| part of the abdominal cavity
39
what does the true pelvis/pelvic cavity consist of
pelvic inlet to pelvic floor
| is the pelvic cavity
40
where is the bladder found
in the pelvic cavity
41
what are the pelvic floor muscles
levator ani (pelvic diaphragm)
42
where does the urethra pass
through pelvic floor into perineum
43
what is the pelvic diaphragm made of
levator ani
| Coccygeus
44
where are the ureters in relation to the common iliac vessels
anterior
45
where do the ureters turn medially to enter the POSTERIOR aspect of the bladder
ischial spin
46
why do the ureters enter the posterior bladder in an inferomedial direction
helps prevent reflux of urine back into the ureters
47
what type of route do the ureters take
sub peritoneal
48
who has a pouch of Douglas
females
49
where is the vesico-uterine pouch found
between the bladder and uterus
50
what is the role of the round ligament of the uterus
attach uterus to the perineum via the inguinal canal
51
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"
52
what are most of the arteries entering the pelvis
branches from the internal iliac artery
53
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
54
what muscle forms the bulk of the bladder wall
detrusor muscle
55
how does the detrusor muscle prevent reflux of urine
encircles the ureteric orifices which tighten when the bladder contracts
56
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
57
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
58
what are the 2 routes of catheterising a patient's bladder
urethral and suprapubic
59
what type of muscle surrounds the urethra
voluntary skeletal muscle
60
what should the scrotum contain at birth
testes
61
what is the spermatic cord
a collection of structures which support the functioning of the testis
62
what do the testes sit in inside the scrotum
within a sac called the tunica vaginalis
63
what is excess fluid within the tunica vaginalis called
hydrocele
64
where are the testis at risk of twisting
the testis and epididymis are attached to the spermatic cord superiorly and are quite mobile
65
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
66
what passes through the deep inguinal ring
```
testicular artery
testicular vein
vas deferens
lymphatics
nerves
```
67
where is the epididymis and vas deferens palpated
epididymis - posterior aspect of the testis
| vas deferens - within the spermatic cord
68
pathway of sperm
testis >> epididymis >> vas deferens >> ejaculatory duct >> urethra
69
what part of male anatomy is in contact with the levator ani muscle
the prostate gland
70
what zone of the prostate gland is felt on PR examination and why
peripheral zone
| - most prostate cancers arise here
71
what traits the spongy urethra and expands distally to form the glans in males
corpus spongiosum
72
what transports the arteries of the penis
corpus cavernosum
73
what happens during male erection
the 3 cylinders of erectile tissue become engorged with blood at arterial pressure
74
what is circumsicion
removal of the prepuce
75
what is the blood supply to the penis
branches of the internal pudendal artery
| which is a branch of the internal iliac
76
what is the blood supply of the scrotum
internal pudendal
| branch of the external iliac artery
77
lymph drainage from the scrotum and the penis
superficial inguinal lymph nodes
78
lymph drainage from the testis
lumbar nodes around the abdominal aorta
79
what are the 5 types of nerve fibres
Sensory-
somatic sensory
visceral afferent
Motor -
somatic motor
parasympathetic
sympathetic
80
what do somatic sensory do
sensations from the body wall (soma)
81
visceral afferent nerve fibres
sensations from our organs
82
somatic motor
motor responses to our body wall
83
parasymp + symp
motor response to our organs
84
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
85
how does most sympathetic fibres reach there organ
by 'hitching a ride' with the artery going to that organ
86
what are splanchnic nerves
they convey visceral efferent and afferent fibres to and from the viscera of the body cavities
87
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
88
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
89
what is the name given to the collection of nerve fibres found on the outside of the arteries
periarterial plexus
90
what CN are responsible for parasympathetic outflow
III
VII
IX
X
91
how do parasympathetic fibres reach the hindgut
via the pelvic splanchnic nerves
92
what nerves carries the parasympathetic fibres which innervate the kidneys and ureter
CN X - vagus nerve
93
what nerves carries parasympathetic nerve fibres which innervate the bladder
pelvic splanchnic nerves
| - they leave the spinal nerves S2, S3, S4
94
where is pain from the kidney normal felt
in 'loin'
| posterior aspect of the flank region on the affected side
95
where is pain from the bladder felt
suprapubic region
96
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
97
where is pain from the urethra felt
localised in the perineum
98
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
99
Ddx of loin pain
```
skin origin (e.g. herpes zoster)
muscular
vertebrae
spinal nerve root compression
lower lobe pneumonia
```
100
Ddx of groin pain
hernias (inguinal or femoral)
lymphadenopathy
testicular pathology
101
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
102
Ddx of suprapubic pain
hindgut organs, e.g. sigmoid diverticula
| other single, midline pelvic organs whose superior aspect touches the peritoneum, e.g. uterus
103
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
104
Ddx of perineal pain
vaginal tear
anal canal fissure
perineal genital ulcers (e.g. herpes)
105
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)
106
Ddx of scrotal pain
skin lesions
| strangulated inguinal hernia
107
what nerves are important for controlling urine flow
nerves leaving at level S2-4
Visceral afferent fibres
Pudendal nerve
Pelvic splanchnic nerves
108
what is involved in the reflex to empty the bladder
detrusor muscle contracts and the internal sphincter relaxes (only in males)
109
what signals that the bladder is full
stretch receptors at the end of visceral afferent nerve fibres
110
what nerves arise from the sacral plexus
pudendal nerve
| sciatic nerve
111
what nerves arises from the lumbar plexus
lateral cutaneous nerve of the thigh
femoral nerve
obturator nerve
