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Renal SB > Anatomy > Flashcards

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)

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2
Q

what is contained in the upper urinary tract

A

the kidneys x2

the ureters x2

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3
Q

what is contained in the lower urinary tract

A

the bladder x 1

the urethra x1

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4
Q

what bifurcation happens at L4/umbilical

A

bifurcation of the abdominal aorta into the common iliac arteries

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5
Q

where is the anatomical division of the abdomen and pelvis

A

iliac crest and L4

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6
Q

where do the kidneys sit

A

retroperitoneal
R - is lateral to IVC
L - is lateral to aorta
level L2

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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)

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8
Q

what is contain in the renal hilum

A

renal artery
renal vein
ureter

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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

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10
Q

where exactly are the kidneys

A

anterior to quadratus lumborum & lateral to psoas major

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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

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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

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13
Q

what regions are the kidneys in

A

L - Left flank/LUQ

R - Right flank/RUQ

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14
Q

which direction to the kidneys move on breathing

A

inspiration - move inferiorly

expiration - move superiorly

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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
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16
Q

anatomical relationship (posterior) of the left kidney

A

posterior to

  • stomach
  • tail of the pancreas
  • hilum of the spleen
  • splenic vessels
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17
Q

where do the renal veins lie in relation to the renal arteries

A

anteriorly

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18
Q

where do the common iliac veins lie in relation to the common iliac arteries

A

posteriorly

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19
Q

where does lymph from the kidneys drain to

A

lumbar nodes (located around the abdominal aorta and IVC)

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20
Q

where does lymph from the ureter drain to

A

Lumbar nodes and iliac nodes (located around common, internal and external iliac vessels)

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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
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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

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23
Q

how does urine drain from the kidney

A 
1 - collecting ducts
2 - minor calyx
3 - major calyx
4 - renal pelvis
5 - ureter
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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:

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25
Q

where are the 3 sites of ureteric construction

A

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)

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26
Q

how do renal calculi (stones) form

A

form in the calyces
form from urine calcium salts
can obstruct urinary tract from within

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27
Q

Ix for renal calculi

A

can be seen on x-ray

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28
Q

what can cause ureteric obstruction

A

internal - renal calculus or blood clot

external - expanding mass e.g. tumour

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29
Q

what is the ureter composed of and how does this affects its response to obstruction

A

smooth muscle

increased peristalsis proximal to the site of the obstruction in an attempt to remove it/flush it into the bladder

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30
Q

what does a patient with ureter constriction complain of

A

colicky pain

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31
Q

consequences of urine tract obstruction

A

renal failure - as urine has to ‘back up’ to the kidney

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32
Q

what causes unilateral and bilateral kidney problems

A

unilateral - obstructions within calyces or ureter, problems with bladder

bilateral - problems with bladder, urethra obstructions

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33
Q

what does renal failure mean

A

means failure to adequately filter the blood to produce urine

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34
Q

what is hydronephrosis

A

water inside the kidney

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35
Q

how does renal failure happen

A

urine back pressure into the calyces compresses the nephrons within the medullary pyramids leading to renal failure

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36
Q

presentation of some with acute hydronephrosis

A

painful - due to stretching of the renal capsule

palpable unilateral kidney

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37
Q

where does the ureters pass

A

from the retroperitoneum through the false pelvis and into the true pelvis

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38
Q

what does the false pelvis consist of

A

from iliac crests to pelvic inlet

part of the abdominal cavity

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39
Q

what does the true pelvis/pelvic cavity consist of

A

pelvic inlet to pelvic floor

is the pelvic cavity

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40
Q

where is the bladder found

A

in the pelvic cavity

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41
Q

what are the pelvic floor muscles

A

levator ani (pelvic diaphragm)

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42
Q

where does the urethra pass

A

through pelvic floor into perineum

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43
Q

what is the pelvic diaphragm made of

A

levator ani

Coccygeus

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44
Q

where are the ureters in relation to the common iliac vessels

A

anterior

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45
Q

where do the ureters turn medially to enter the POSTERIOR aspect of the bladder

A

ischial spin

46
Q

why do the ureters enter the posterior bladder in an inferomedial direction

A

helps prevent reflux of urine back into the ureters

47
Q

what type of route do the ureters take

A

sub peritoneal

48
Q

who has a pouch of Douglas

A

females

49
Q

where is the vesico-uterine pouch found

A

between the bladder and uterus

50
Q

what is the role of the round ligament of the uterus

A

attach uterus to the perineum via the inguinal canal

51
Q

what are some important anatomical relations of the pelvic ureters

A
  • runs inferiorly to the vas deferens
  • runs inferiorly to uterine tube and the uterine artery
    “water under the bridge”
52
Q

what are most of the arteries entering the pelvis

A

branches from the internal iliac artery

53
Q

what are the 3 openings of the bladder and what do they form

A

2 ureteric orifices and internal urethral orifice

form trigone - triangle shape on the internal aspect of the bladder

54
Q

what muscle forms the bulk of the bladder wall

A

detrusor muscle

55
Q

how does the detrusor muscle prevent reflux of urine

A

encircles the ureteric orifices which tighten when the bladder contracts

56
Q

what differs in male bladders to females and why

A

neck of the male bladder, the detrusor muscle forms the internal urethral sphincter muscle
- prevents ejaculation of semen back into the bladder

57
Q

important anatomical relations of the bladder

A
  • 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
Q

what are the 2 routes of catheterising a patient’s bladder

A

urethral and suprapubic

59
Q

what type of muscle surrounds the urethra

A

voluntary skeletal muscle

60
Q

what should the scrotum contain at birth

A

testes

61
Q

what is the spermatic cord

A

a collection of structures which support the functioning of the testis

62
Q

what do the testes sit in inside the scrotum

A

within a sac called the tunica vaginalis

63
Q

what is excess fluid within the tunica vaginalis called

A

hydrocele

64
Q

where are the testis at risk of twisting

A

the testis and epididymis are attached to the spermatic cord superiorly and are quite mobile

65
Q

what is contained within the spermatic cord and what are there functions

A

vas deferens - transports sperm
testicular artery - supplies oxygenated blood
pampiniform plexus - drains deoxygenated blood

66
Q

what passes through the deep inguinal ring

A 
testicular artery
testicular vein 
vas deferens 
lymphatics 
nerves
67
Q

where is the epididymis and vas deferens palpated

A

epididymis - posterior aspect of the testis

vas deferens - within the spermatic cord

68
Q

pathway of sperm

A

testis&raquo_space; epididymis&raquo_space; vas deferens&raquo_space; ejaculatory duct&raquo_space; urethra

69
Q

what part of male anatomy is in contact with the levator ani muscle

A

the prostate gland

70
Q

what zone of the prostate gland is felt on PR examination and why

A

peripheral zone

- most prostate cancers arise here

71
Q

what traits the spongy urethra and expands distally to form the glans in males

A

corpus spongiosum

72
Q

what transports the arteries of the penis

A

corpus cavernosum

73
Q

what happens during male erection

A

the 3 cylinders of erectile tissue become engorged with blood at arterial pressure

74
Q

what is circumsicion

A

removal of the prepuce

75
Q

what is the blood supply to the penis

A

branches of the internal pudendal artery

which is a branch of the internal iliac

76
Q

what is the blood supply of the scrotum

A

internal pudendal

branch of the external iliac artery

77
Q

lymph drainage from the scrotum and the penis

A

superficial inguinal lymph nodes

78
Q

lymph drainage from the testis

A

lumbar nodes around the abdominal aorta

79
Q

what are the 5 types of nerve fibres

A

Sensory-
somatic sensory
visceral afferent

Motor -
somatic motor
parasympathetic
sympathetic

80
Q

what do somatic sensory do

A

sensations from the body wall (soma)

81
Q

visceral afferent nerve fibres

A

sensations from our organs

82
Q

somatic motor

A

motor responses to our body wall

83
Q

parasymp + symp

A

motor response to our organs

84
Q

why is it said that sympathetic nerve fibres have a thoracolumbar out flow

A

Sympathetic nerve fibres leave the CNS only within the spinal nerves between spinal cord levels T1-L2

85
Q

how does most sympathetic fibres reach there organ

A

by ‘hitching a ride’ with the artery going to that organ

86
Q

what are splanchnic nerves

A

they convey visceral efferent and afferent fibres to and from the viscera of the body cavities

87
Q

how does sympathetic nerve fibres relate to splanchnic nerves

A

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
Q

how do sympathetic nerve fibres get to the kidneys, ureters and bladder

A
  • 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
Q

what is the name given to the collection of nerve fibres found on the outside of the arteries

A

periarterial plexus

90
Q

what CN are responsible for parasympathetic outflow

A

III
VII
IX
X

91
Q

how do parasympathetic fibres reach the hindgut

A

via the pelvic splanchnic nerves

92
Q

what nerves carries the parasympathetic fibres which innervate the kidneys and ureter

A

CN X - vagus nerve

93
Q

what nerves carries parasympathetic nerve fibres which innervate the bladder

A

pelvic splanchnic nerves

- they leave the spinal nerves S2, S3, S4

94
Q

where is pain from the kidney normal felt

A

in ‘loin’

posterior aspect of the flank region on the affected side

95
Q

where is pain from the bladder felt

A

suprapubic region

96
Q

where can pain from a calculus obstructing the ureter be felt

A

radiating from ‘loin to groin’ on affected side

posterior aspect of the flank region to groin

97
Q

where is pain from the urethra felt

A

localised in the perineum

98
Q

how do visceral afferent nerve fibres get from the kidneys and ureters to the CNS

A

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
Q

Ddx of loin pain

A 
skin origin (e.g. herpes zoster)
muscular 
vertebrae 
spinal nerve root compression
lower lobe pneumonia
100
Q

Ddx of groin pain

A

hernias (inguinal or femoral)
lymphadenopathy
testicular pathology

101
Q

how do visceral afferent nerve fibres get from the BLADDER to the CNS

A

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
Q

Ddx of suprapubic pain

A

hindgut organs, e.g. sigmoid diverticula

other single, midline pelvic organs whose superior aspect touches the peritoneum, e.g. uterus

103
Q

How Do Visceral Afferent & Somatic Sensory Nerve Fibres get from the Urethra to the CNS?

A

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
Q

Ddx of perineal pain

A

vaginal tear
anal canal fissure
perineal genital ulcers (e.g. herpes)

105
Q

How Do Pain Fibres get from the Testis to the CNS

A

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
Q

Ddx of scrotal pain

A

skin lesions

strangulated inguinal hernia

107
Q

what nerves are important for controlling urine flow

A

nerves leaving at level S2-4
Visceral afferent fibres
Pudendal nerve
Pelvic splanchnic nerves

108
Q

what is involved in the reflex to empty the bladder

A

detrusor muscle contracts and the internal sphincter relaxes (only in males)

109
Q

what signals that the bladder is full

A

stretch receptors at the end of visceral afferent nerve fibres

110
Q

what nerves arise from the sacral plexus

A

pudendal nerve

sciatic nerve

111
Q

what nerves arises from the lumbar plexus

A

lateral cutaneous nerve of the thigh
femoral nerve
obturator nerve

Renal SB (15 decks)

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