Anatomy Flashcards
what makes up the upper urinary tract?
the kidneys and the ureters
what makes up the lower urinary tract?
bladder and urethra
where might an upper urinary tract infection spread to?
the kidneys
what does a lower urinary tract infection involve?
the urethra and the bladder
what part(s) of the urinary tract are in the abdomen?
kidneys and proximal ureters
where about in the abdomen are the kidneys located?
retroperitoneum
at what vertebral level does the abdomen become the pelvis?
L4
what anterior landmark shows the division between the abdomen and the pelvis?
the level of the hip bones
what parts of the urinary tract are in the pelvis?
the distal ureters, the bladder and the proximal urethra
where is the distal urethra found?
perineum
what else happens at the division between the abdomen and pelvis?
bifurcation of the abdominal aorta
what major vessel does the right kidney lie lateral to?
the IVC
what major vessel does the left kidney lie lateral to?
the aorta
why is the left renal vein longer than the right?
it has to cross over aorta to get to IVC which is to the right
following the renal capsule what are the other layers surrounding the kidney?
perinephric fat then renal (deep) fascia then paranephric fat then visceral peritoneum
what groups of muscles surround the kidney?
posterior abdo wall muscles
antero-lateral abdo wall muscles
muscles of the back
what are the 3 layers of the anterolateral abdo wall muscles?
external oblique, internal oblique, transversus abdominis
what muscle of the posterior abdo wall sits posterio-medial to the kidney?
quadratus lumborum
what muscle of the back sits medial to the kidney?
psoas major
what is the right kidney slightly lower than the left?
the liver
at what vertebral level does the right kidney sit?
L1-L3
at what vertebral level does the left kidney sit?
T12- L2
when can the floating ribs be a problem to the kidneys?
if they are fractured the sharp displaced ends may contuse or lacerate the kidney
what are the dimensions of a normal kidney?
- about 12cm long
- about 6cm wide
how should a regular kidney feel?
smooth, regular, firm
where do you palpate posteriorly when examining the kidney?
within the flank region just inferior to 12th rib
where do you palpate anteriorly when examining the kidney?
with the right/left upper quadrant
how do the kidneys move with breathing?
move inferiorly on inspiration then superiorly on expiration
what is the right kidney posterior to?
- liver and hepatorenal recess
- 2nd part of the duodenum
- ascending colon
- right colic flexure
what is the left kidney posterior to?
- the stomach
- the tail of the pancreas
- the hilum of the spleen and the splenic vessels
what is the hepatorenal recess part of?
the greater sac of the peritoneal cavity
where do the renal veins sit in relation to the renal arteries?
renal veins sit anterior to renal arteries
what arteries sit anterior to the common iliac veins?
the common iliac arteries
where does lymph from the kidneys drain to?
the lumbar nodes
where are the lumbar nodes located?
around the abdominal aorta and inferior vena cava
what is the ureteric arterial blood supply branches of?
- the renal artery
- the abdominal artery
- common iliac arteries
- internal iliac arteries
- vesical (bladder) artery
where does the lymph from the ureters drain?
to the lumbar nodes and iliac nodes
if there is both AAA and renal artery stenosis, what are the 2 possible reasons for this?
- the renal artery stenosis is combined with an infra-renal AAA (both caused by atherosclerosis)
- the renal artery stenosis is due to a suprarenal AAA
How can a suprarenal AAA cause renal artery stenosis?
occlusion of the proximal renal artery by the aneurysm
what is meant by the solitary kidney?
patient only has one kidney
reasons for a solitary kidney?
- agenesis
- nephrectomy (pathology)
- nephrectomy (donation)
what many pyramids does the medulla of the kidney contain?
27 pyramids
how many nephrons does each pyramid contain?
50,000 nephrons
what gives the pyramids their striped appearance?
regularly arranged nephrons
how are the nephrons arranged?
running axially towards the apex of each pyramid
main structures of a nephron from proximal to distal?
glomerulus, proximal convuluted tube, loop of Henle, distal convuluted tube, collecting duct
where does the collecting duct drain to?
through the pyramid to drain the modified filtrate into the minor calyx
how does urine drain from the kidney?
nephrons collecting duct to minor calyx to major calyx to renal pelvis to the ureter
what is the constriction called where the wider renal pelvis becomes the narrower ureter?
the pelviureteric junction
what are the 3 anatomical sites of ureteric constriction?
- pelviureteric junction
- ureter crossing the anterior aspect of the common iliac artery
- ureteric orifice
what is the ureteric orifice?
opening into one corner of the trigone on the floor of the bladder
what do renal calculi result from?
from urine calcium salts
what can a ureteric constriction be due to?
interal obstruction eg impacted renal calculus or blood clot or external compression eg a tumour
what is the ureters response to obstruction?
increase peristalsis
how is renal failure defined?
failure to adequately filter the blood to produce urine
what is hydronephrosis?
water in the kidney
what affect does urine back pressure in the calyces have?
compresses the nephrons within the medullary pyramids leading to renal failure
why is acute hydronephrosis painful?
causes painful stretching of the renal capsule
where is the false pelvis?
from the iliac crests to the pelvic inlet
where is the true pelvis?
pelvic inlet to pelvic floor
where is the bladder found?
in the pelvic cavity
where does the urethra end up when it passes through the pelvic floor?
the perineum
what forms the pelvic floor?
the pelvic diaphragm
what is the levator ani muscle part of?
the pelvic diaphragm
what passes through the openings in the pelvic floor?
distal parts of alimentary, renal and reproductive tracts
what do the ureters pass anterior to, to enter the pelvis?
the common iliac vessels
what do the ureters do at the level of the ischial spine?
they turn medially to enter the posterior aspect of the bladder
in which direction to the ureters enter the bladder and why is this relevant?
enter the posterior bladder wall in an inferomedial direction - helps prevent reflux of urine back into ureter when the bladder contracts
in the anatomical position, what is the most inferior part of the male peritoneal cavity?
the rectovesicle pouch
what forms the roof over the pelvic organs?
the inferior part of parietal peritoneum
where does the pelvic diaphragm extend from?
from the sacrum to the pubis
what is the most inferior part of the female peritoneal cavity in the anatomical position?
rectouterine pouch (of douglas)
what is the vesico-uterine pouch?
pouch between the bladder and the uterus
what does the round ligament of the uterus do?
attaches uterus to the perineum via the inguinal canal
where is the suspensory ligament of the ovary in relation to the ureter?
suspensory ligament of the ovary is lateral to ureter
where does the ureter run in relation to the vas deferens?
ureter runs inferiorly to vas deferens
where is the uterine tubes and artery in relation to the ureter?
ureter runs inferiorly to the uterine tubes and uterine artery
arteries entering the pelvis are mainly branches from which artery?
internal iliac artery
where do pelvic veins drain to?
internal iliac vein
where do the prostatic arteries often branch from?
the vesical arteries
what forms the triangle shape on the internal aspect of the bladder known as the trigone?
the 2 ureteric orifices and the internal urethral orifice
where are the ureteric orrifices?
in the base (posterior aspect) of bladder
where is the internal urethral orifice?
on inferior aspect “floor” of bladder
where does the prostate lie in relation to the bladder?
prostate lies inferior to the bladder
what is the muscle that forms the main bulk of the bladder wall called?
detrusor muscle
what do the detrusor muscle fibres encircle?
the ureteric orifices
what does the detrusor muscle fibres do when the bladder contracts and what does this help prevent?
the tighten - helps prevent reflux of urine superiorly into the ureter
around the neck of the male bladder, what does the detrusor muscle form?
the internal urethral sphincter muscle
what does the internal urethral sphincter muscle do during ejaculation and why?
it contracts to prevent retrograde ejaculation of semen back into the bladder
why is most of the weight of the uterus borne of the bladder in females?
the body of the uterus usually lies superior to the bladder
what is the uterus separated from the bladder by?
the uterovesical pouch
where does an empty bladder lie and where does the peritoneum cover?
an empty bladder lies within the pelvis, peritoneum covers only its superior surface
where can a full bladder extend to and where does the peritoneum cover?
can extend out of the pelvis, peritoneum still only covers superior surface
what are the 2 ways to catheterise a patient?
- urethral catheterisation
2. suprapubic catheterisation
how is a suprapubic catheterisation acheived?
through anterior abdo wall and avoiding peritoneal cavity
approximately how long is the female urethra?
4cm long
how does the levator ani muscle act as a sphincter on the urethra?
urethra must pass through it to reach the exterior of the body
is the external urethral sphincter voluntary or involuntary?
voluntary
approximately how long is the male urethra?
20cm
what is the spongy urethra within?
within corpus spongiosum
when would suprapubic catheterisation be used instead of urethral catheterisation?
would only be used in urethral obstruction
where do the testes begin to develop embryologically?
posterior abdomen
what does the teste travel down to get to the scrotum?
inguinal canal
what is contained within the spermatic cord?
testicular artery, testicular vein, vas deferens, lymphatics, nerves
what are the 2 different types of nerves found in the spermatic cord and what do they innervate?
- autonomic for smooth muscle of vas
- and somatic for cremaster muscle
what is the name of the sac that the testis sit within?
tunica vaginalis
what is the epididymis covered by?
visceral tunica vaginalis
what is the appendix testis?
an embryological remnant - no function
what problem can the appendix testis cause?
can twist - torsion of appendix testis
what is excess fluid within the tunica vaginalis known as?
a hydrocele
what puts the testes at risk of twisting (torsion of spermatic cord)?
the testis and epididymis are attached to the spermatic cord superiorly and are quite mobile within the scrotum
what drains de-oxygenated blood from the testis?
the pampiniform venous plexus
what supplies the testis with oxygenated blood?
testicular artery `
where is the epididymis palpated?
at posterior aspect of the testis
where is the epididymis’ proximal end (the head) located?
at the posterior aspect of the superior pole of the testis
where is the vas deferens palpated?
within the spermatic cord, superior to the testes within the scrotum
what does the vas deferens feel like?
a thick piece of string
where does the vas deferens begin?
begins at inferior pole of the testis
where does the right testicular vein drain to?
directly into IVC
where does the left testicular vein drain to?
drains to left renal vein then to IVC
the vas deferens passes superiorly within the spermatic cord to where?
the deep inguinal ring
once the vas deferens is at the deep inguinal ring, what does it do?
turns medially into the pelvis
what muscle is the posterior aspect of the prostate gland in contact with?
the levator ani muscle
function of the prostatic ducts?
drains the glandular secretions from the prostate into the prostatic urethra
what joins to make the opening of the ejaculatory duct?
combined duct of vas deferens and the duct from the seminal gland
what zone of the prostate is felt on a digital rectal examination?
peripheral zone of the prostate
from which zone of the prostate do most malignancies arise?
the peripheral zone
what transmits the deep arteries of the penis?
the (right and left) corpus cavernosum
where is the corpus cavernosums?
posterior penis
what does the corpus spongiosum transmit?
spongy urethra
what does the corpus spongiosum expand distally to form?
to form the glans
what is the root of the penis attached to?
laterally attached to ischium of pelvis
what happens to the 3 cylinders of erectile tissue during erection?
they become engorged with blood
what lies deep to the penile raphe?
spongy urethra within the corpus spongiosum
what is another name for foreskin?
prepuce
what is paraphimosis?
swelling of the glans
what can paraphimosis be due to?
retraction of the prepuce
what is the blood supply to the penis?
- deep arteries of the penis
- branches of internal pudental artery
what is internal pudental artery a branch of?
internal iliac artery
what is the blood supply to the scrotum?
- internal pudental
- branches of external iliac artery
where does lymph from the scrotum and most of the penis drain to?
superficial inguinal lymph nodes
what is the only part of the penis that lymph does not drain to the superficial inguinal nodes?
the glans
where does lymph from the testis drain to?
lumbar nodes
what does the normal renal system motor function nerves control?
- ureteric peristalsis
- bladder contraction
- urethral sphincter control
what part of the renal system does the lumbar and sacral plexus (motor and sensory) supply?
perineum (distal part of renal system)
what are the 5 types of nerve fibre?
- somatic sensory
- visceral afferent
- somatic motor
- parasympathetic and sympathetic nerve fibres
what does the somatic sensory nerve fibres relay/
sensations from the body wall (soma)
what does the visceral afferent nerve fibres convey?
sensations from our organs
what nerve fibres convey motor responses to our body wall?
somatic motor
what do parasympathetic and sympathetic nerve fibres stimulate?
smooth muscle, cardiac muscle or glands
what type of nerve fibre innervates the external sphincter and levator ani?
somatic motor
what fibre(s) convey pain from the urethra?
visceral afferent (in pelvis) and somatic sensory (in perineum)
what is the only means by which any type of nerve can comminucate with the CNS?
by being carried within the cranial nerves or spinal nerves
where do sympathetic nerve fibres leave the CNS?
only within the spinal nerves between spinal cord level T1-T12
what are the 2 groups of splanchnic nerves that the sympathetic fibres travel within to reach the smooth muscle/glans of the body?
- cardiopulmonary or abdominopelvic
how do sympathetic fibres supplying the head reach the head?
mainly by following (hitching a ride with) the arteries supplying the same structures
where does the sympathetic chains run from?
run the entire length of the vertebral column
what do the sympathetic nerves travel between?
the sympathetic chain and spinal nerves’ anterior rami
where do the sympathetic fibres supplying the renal system leave the spinal cord?
between levels T10 and L2
what do the sympathetic fibres leave the spinal cord within (bilaterally)?
within the abdominopelvic splanchnic nerves
while the sympathetic nerve fibres are in the abdominopelvic splanchnic nerves, are the pre or post - synaptic?
pre-synaptic
where do the sympathetic nerve fibres supplying the renal system synapse?
at the abdominal sympathetic ganglia
where is the abdominal sympathetic ganglia located?
around the central branches of abdominal aorta eg coeliac trunk, SMA and IMA
what do the post-synaptic sympathetic nerve fibres for the renal system do after synapsing?
pass onto the surface if the arteries which are heading towards the organs they need to innervate
what is the collection of nerve fibres found on the outside of the arteries known as?
a periarterial plexus
what other nerve fibres are part of the periarterial plexuses?
parasympathetic and visceral afferent nerve fibres
what are the 4 cranial nerves that contain parasympathetic nerve fibres?
CN III, VII, IX and X
what other nerves carry parasympathetic nerve fibres? (other than the 4 CNs)
sacral spinal nerves
what do parasympathetic nerves not innervate that the sympathetic do?
the smooth muscle/glands if the body wall
how do parasympathetic fibres reach the smooth muscle/glands of the head and body?
via cranial nerves
parasympathetic fibres reach the smooth muscle/glands of the hindgut and pelvic organs via what?
pelvic splanchnic nerves
what are the parasympathetic fibres leaving the sacral spinal nerves known as?
pelvic splanchnic nerves
what nerve carries the parasympathetic fibres to the kidneys and ureter?
within the vagus nerve
where are nerve fibres that supply the bladder carried within?
the pelvic splanchnic nerves
how does the vagus nerve enter the abdomen?
through oesophageal hiatus with the oesophagus
what spinal nerves make up the pelvic splanchnic nerves?
S2, S3, S4
what are the only parts of the renal system that somatic nerve fibres go to?
those within the perineum eg distal urethra and its sphincter and levator ani
what spinal nerve form the pudental nerve?
S2, 3 and 4
what part of the renal system does the pudental nerve supply?
external urethral sphincter
what stimulates the detrusor muscle to contract?
parasympathetic fibres (from S2, S3, S4) via pelvic splanchnic nerves
what type of fibres stimulate the internal urethral sphincter (in males) to contract and when does this happen?
sympathetic fibres, during ejaculation
what stimulates the external urethral sphincter muscle to contract?
somatic motor fibres within the pudental nerve
where is pain from the kidney itself felt?
posterior aspect of the flank region on affected side
where is pain often felt from a calculus obstructing the ureter?
radiating from the loin to groin on affected side
where is pain from the bladder usually felt?
in suprapubic region (midline)
where is pain from the perineal part of the urethra usually felt?
quite localised in the perineum
where do visceral afferents from the kidneys run?
alongside the sympathetic fibres back to the spinal cord
where do visceral afferents from the kidneys enter the spinal cord?
between T11 and L1
where do visceral afferents from the ureters enter the spinal cord ?
between T11 and L2
what do visceral afferents carrying pain from the part of the bladder which touches the peritoneum run alongside?
sympathetic fibres
at what level do the visceral afferents carrying pain from the part of the bladder which touches the peritoneum enter the spinal cord at?
T11-L2
where do visceral afferents from the rest of the bladder (not superior part) run alongside and where do they enter the spinal cord?
run alongside the parasympathetic nerve fibres back to spinal cord levels S2, S3, S4
where do visceral afferents from the proximal urethra run and to where?
alongside parasympathetic nerve fibres back to spinal cord levels S2, S3, S4
what type of nerve fibres carry pain sensation from the distal urethra and to where?
somatic sensory nerve fibres within the pudental nerve. back to spinal cord levels S2, S3, S4.
where do the visceral afferent fibres from the testis enter the spinal cord and what do they run alongside?
run alongside sympathetic fibres back to spinal cord to levels T10-11
where else can testis pain be felt due to their close relation with the scrotal wall?
localised to the scrotum and/or groin (L1 region)
nerve fibres entering and leaving spinal cord at what levels are key in control of micturition?
levels S2-S4
what senses the bladder being stretched?
visceral afferent nerve fibres
where does the pudental nerve arrise from?
the sacral plexus
what nerve roots of the sacral plexus does the sciatic nerve arise from?
L4-S3
what named nerved does the lumbar plexus give rise to?
- iliohypogastric
- ilioinguinal
- lateral cutaneous nerve of thigh
- genitofemoral nerve
- femoral nerve
- obturator nerve
nerve root(s) of iliohypogastric nerve?
L1
nerve root(s) of ilioinguinal nerve?
L1
nerve root(s) of lateral cutaneous nerve of thigh?
L2, L3
nerve root(s) of genitofemoral nerve?
L1, L2
nerve root(s) of femoral nerve?
L2-L4
nerve root(s) of obturator nerve?
L2-L4
what nerve supplies the lateral compartment of the leg?
superficial fibular
what nerve supplies the anterior compartment of the leg?
deep fibular
what nerve supplies the muscles of posterior compartment of leg and intrinsic muscles of the foot?
tibial nerve
what does the femoral nerve become inferior to the knee?
the saphenous nerve
what supplies sensation to plantar aspect of foot?
tibial nerve
what supplies sensation to the lateral aspect of the foot?
sural nerves
