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Renal > Anatomy > Flashcards

Anatomy Flashcards

1
Q

what makes up the upper urinary tract?

A

the kidneys and the ureters

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2
Q

what makes up the lower urinary tract?

A

bladder and urethra

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3
Q

where might an upper urinary tract infection spread to?

A

the kidneys

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4
Q

what does a lower urinary tract infection involve?

A

the urethra and the bladder

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5
Q

what part(s) of the urinary tract are in the abdomen?

A

kidneys and proximal ureters

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6
Q

where about in the abdomen are the kidneys located?

A

retroperitoneum

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7
Q

at what vertebral level does the abdomen become the pelvis?

A

L4

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8
Q

what anterior landmark shows the division between the abdomen and the pelvis?

A

the level of the hip bones

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9
Q

what parts of the urinary tract are in the pelvis?

A

the distal ureters, the bladder and the proximal urethra

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10
Q

where is the distal urethra found?

A

perineum

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11
Q

what else happens at the division between the abdomen and pelvis?

A

bifurcation of the abdominal aorta

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12
Q

what major vessel does the right kidney lie lateral to?

A

the IVC

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13
Q

what major vessel does the left kidney lie lateral to?

A

the aorta

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14
Q

why is the left renal vein longer than the right?

A

it has to cross over aorta to get to IVC which is to the right

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15
Q

following the renal capsule what are the other layers surrounding the kidney?

A

perinephric fat then renal (deep) fascia then paranephric fat then visceral peritoneum

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16
Q

what groups of muscles surround the kidney?

A

posterior abdo wall muscles
antero-lateral abdo wall muscles
muscles of the back

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17
Q

what are the 3 layers of the anterolateral abdo wall muscles?

A

external oblique, internal oblique, transversus abdominis

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18
Q

what muscle of the posterior abdo wall sits posterio-medial to the kidney?

A

quadratus lumborum

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19
Q

what muscle of the back sits medial to the kidney?

A

psoas major

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20
Q

what is the right kidney slightly lower than the left?

A

the liver

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21
Q

at what vertebral level does the right kidney sit?

A

L1-L3

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22
Q

at what vertebral level does the left kidney sit?

A

T12- L2

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23
Q

when can the floating ribs be a problem to the kidneys?

A

if they are fractured the sharp displaced ends may contuse or lacerate the kidney

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24
Q

what are the dimensions of a normal kidney?

A
  • about 12cm long

- about 6cm wide

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25
Q

how should a regular kidney feel?

A

smooth, regular, firm

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26
Q

where do you palpate posteriorly when examining the kidney?

A

within the flank region just inferior to 12th rib

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27
Q

where do you palpate anteriorly when examining the kidney?

A

with the right/left upper quadrant

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28
Q

how do the kidneys move with breathing?

A

move inferiorly on inspiration then superiorly on expiration

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29
Q

what is the right kidney posterior to?

A
  • liver and hepatorenal recess
  • 2nd part of the duodenum
  • ascending colon
  • right colic flexure
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30
Q

what is the left kidney posterior to?

A
  • the stomach
  • the tail of the pancreas
  • the hilum of the spleen and the splenic vessels
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31
Q

what is the hepatorenal recess part of?

A

the greater sac of the peritoneal cavity

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32
Q

where do the renal veins sit in relation to the renal arteries?

A

renal veins sit anterior to renal arteries

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33
Q

what arteries sit anterior to the common iliac veins?

A

the common iliac arteries

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34
Q

where does lymph from the kidneys drain to?

A

the lumbar nodes

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35
Q

where are the lumbar nodes located?

A

around the abdominal aorta and inferior vena cava

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36
Q

what is the ureteric arterial blood supply branches of?

A
  • the renal artery
  • the abdominal artery
  • common iliac arteries
  • internal iliac arteries
  • vesical (bladder) artery
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37
Q

where does the lymph from the ureters drain?

A

to the lumbar nodes and iliac nodes

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38
Q

if there is both AAA and renal artery stenosis, what are the 2 possible reasons for this?

A
  • 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
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39
Q

How can a suprarenal AAA cause renal artery stenosis?

A

occlusion of the proximal renal artery by the aneurysm

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40
Q

what is meant by the solitary kidney?

A

patient only has one kidney

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41
Q

reasons for a solitary kidney?

A
  • agenesis
  • nephrectomy (pathology)
  • nephrectomy (donation)
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42
Q

what many pyramids does the medulla of the kidney contain?

A

27 pyramids

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43
Q

how many nephrons does each pyramid contain?

A

50,000 nephrons

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44
Q

what gives the pyramids their striped appearance?

A

regularly arranged nephrons

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45
Q

how are the nephrons arranged?

A

running axially towards the apex of each pyramid

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46
Q

main structures of a nephron from proximal to distal?

A

glomerulus, proximal convuluted tube, loop of Henle, distal convuluted tube, collecting duct

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47
Q

where does the collecting duct drain to?

A

through the pyramid to drain the modified filtrate into the minor calyx

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48
Q

how does urine drain from the kidney?

A

nephrons collecting duct to minor calyx to major calyx to renal pelvis to the ureter

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49
Q

what is the constriction called where the wider renal pelvis becomes the narrower ureter?

A

the pelviureteric junction

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50
Q

what are the 3 anatomical sites of ureteric constriction?

A
  1. pelviureteric junction
  2. ureter crossing the anterior aspect of the common iliac artery
  3. ureteric orifice
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51
Q

what is the ureteric orifice?

A

opening into one corner of the trigone on the floor of the bladder

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52
Q

what do renal calculi result from?

A

from urine calcium salts

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53
Q

what can a ureteric constriction be due to?

A

interal obstruction eg impacted renal calculus or blood clot or external compression eg a tumour

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54
Q

what is the ureters response to obstruction?

A

increase peristalsis

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55
Q

how is renal failure defined?

A

failure to adequately filter the blood to produce urine

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56
Q

what is hydronephrosis?

A

water in the kidney

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57
Q

what affect does urine back pressure in the calyces have?

A

compresses the nephrons within the medullary pyramids leading to renal failure

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58
Q

why is acute hydronephrosis painful?

A

causes painful stretching of the renal capsule

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59
Q

where is the false pelvis?

A

from the iliac crests to the pelvic inlet

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60
Q

where is the true pelvis?

A

pelvic inlet to pelvic floor

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61
Q

where is the bladder found?

A

in the pelvic cavity

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62
Q

where does the urethra end up when it passes through the pelvic floor?

A

the perineum

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63
Q

what forms the pelvic floor?

A

the pelvic diaphragm

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64
Q

what is the levator ani muscle part of?

A

the pelvic diaphragm

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65
Q

what passes through the openings in the pelvic floor?

A

distal parts of alimentary, renal and reproductive tracts

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66
Q

what do the ureters pass anterior to, to enter the pelvis?

A

the common iliac vessels

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67
Q

what do the ureters do at the level of the ischial spine?

A

they turn medially to enter the posterior aspect of the bladder

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68
Q

in which direction to the ureters enter the bladder and why is this relevant?

A

enter the posterior bladder wall in an inferomedial direction - helps prevent reflux of urine back into ureter when the bladder contracts

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69
Q

in the anatomical position, what is the most inferior part of the male peritoneal cavity?

A

the rectovesicle pouch

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70
Q

what forms the roof over the pelvic organs?

A

the inferior part of parietal peritoneum

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71
Q

where does the pelvic diaphragm extend from?

A

from the sacrum to the pubis

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72
Q

what is the most inferior part of the female peritoneal cavity in the anatomical position?

A

rectouterine pouch (of douglas)

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73
Q

what is the vesico-uterine pouch?

A

pouch between the bladder and the uterus

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74
Q

what does the round ligament of the uterus do?

A

attaches uterus to the perineum via the inguinal canal

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75
Q

where is the suspensory ligament of the ovary in relation to the ureter?

A

suspensory ligament of the ovary is lateral to ureter

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76
Q

where does the ureter run in relation to the vas deferens?

A

ureter runs inferiorly to vas deferens

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77
Q

where is the uterine tubes and artery in relation to the ureter?

A

ureter runs inferiorly to the uterine tubes and uterine artery

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78
Q

arteries entering the pelvis are mainly branches from which artery?

A

internal iliac artery

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79
Q

where do pelvic veins drain to?

A

internal iliac vein

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80
Q

where do the prostatic arteries often branch from?

A

the vesical arteries

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81
Q

what forms the triangle shape on the internal aspect of the bladder known as the trigone?

A

the 2 ureteric orifices and the internal urethral orifice

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82
Q

where are the ureteric orrifices?

A

in the base (posterior aspect) of bladder

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83
Q

where is the internal urethral orifice?

A

on inferior aspect “floor” of bladder

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84
Q

where does the prostate lie in relation to the bladder?

A

prostate lies inferior to the bladder

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85
Q

what is the muscle that forms the main bulk of the bladder wall called?

A

detrusor muscle

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86
Q

what do the detrusor muscle fibres encircle?

A

the ureteric orifices

87
Q

what does the detrusor muscle fibres do when the bladder contracts and what does this help prevent?

A

the tighten - helps prevent reflux of urine superiorly into the ureter

88
Q

around the neck of the male bladder, what does the detrusor muscle form?

A

the internal urethral sphincter muscle

89
Q

what does the internal urethral sphincter muscle do during ejaculation and why?

A

it contracts to prevent retrograde ejaculation of semen back into the bladder

90
Q

why is most of the weight of the uterus borne of the bladder in females?

A

the body of the uterus usually lies superior to the bladder

91
Q

what is the uterus separated from the bladder by?

A

the uterovesical pouch

92
Q

where does an empty bladder lie and where does the peritoneum cover?

A

an empty bladder lies within the pelvis, peritoneum covers only its superior surface

93
Q

where can a full bladder extend to and where does the peritoneum cover?

A

can extend out of the pelvis, peritoneum still only covers superior surface

94
Q

what are the 2 ways to catheterise a patient?

A
  1. urethral catheterisation

2. suprapubic catheterisation

95
Q

how is a suprapubic catheterisation acheived?

A

through anterior abdo wall and avoiding peritoneal cavity

96
Q

approximately how long is the female urethra?

A

4cm long

97
Q

how does the levator ani muscle act as a sphincter on the urethra?

A

urethra must pass through it to reach the exterior of the body

98
Q

is the external urethral sphincter voluntary or involuntary?

A

voluntary

99
Q

approximately how long is the male urethra?

A

20cm

100
Q

what is the spongy urethra within?

A

within corpus spongiosum

101
Q

when would suprapubic catheterisation be used instead of urethral catheterisation?

A

would only be used in urethral obstruction

102
Q

where do the testes begin to develop embryologically?

A

posterior abdomen

103
Q

what does the teste travel down to get to the scrotum?

A

inguinal canal

104
Q

what is contained within the spermatic cord?

A

testicular artery, testicular vein, vas deferens, lymphatics, nerves

105
Q

what are the 2 different types of nerves found in the spermatic cord and what do they innervate?

A
  • autonomic for smooth muscle of vas

- and somatic for cremaster muscle

106
Q

what is the name of the sac that the testis sit within?

A

tunica vaginalis

107
Q

what is the epididymis covered by?

A

visceral tunica vaginalis

108
Q

what is the appendix testis?

A

an embryological remnant - no function

109
Q

what problem can the appendix testis cause?

A

can twist - torsion of appendix testis

110
Q

what is excess fluid within the tunica vaginalis known as?

A

a hydrocele

111
Q

what puts the testes at risk of twisting (torsion of spermatic cord)?

A

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

112
Q

what drains de-oxygenated blood from the testis?

A

the pampiniform venous plexus

113
Q

what supplies the testis with oxygenated blood?

A

testicular artery `

114
Q

where is the epididymis palpated?

A

at posterior aspect of the testis

115
Q

where is the epididymis’ proximal end (the head) located?

A

at the posterior aspect of the superior pole of the testis

116
Q

where is the vas deferens palpated?

A

within the spermatic cord, superior to the testes within the scrotum

117
Q

what does the vas deferens feel like?

A

a thick piece of string

118
Q

where does the vas deferens begin?

A

begins at inferior pole of the testis

119
Q

where does the right testicular vein drain to?

A

directly into IVC

120
Q

where does the left testicular vein drain to?

A

drains to left renal vein then to IVC

121
Q

the vas deferens passes superiorly within the spermatic cord to where?

A

the deep inguinal ring

122
Q

once the vas deferens is at the deep inguinal ring, what does it do?

A

turns medially into the pelvis

123
Q

what muscle is the posterior aspect of the prostate gland in contact with?

A

the levator ani muscle

124
Q

function of the prostatic ducts?

A

drains the glandular secretions from the prostate into the prostatic urethra

125
Q

what joins to make the opening of the ejaculatory duct?

A

combined duct of vas deferens and the duct from the seminal gland

126
Q

what zone of the prostate is felt on a digital rectal examination?

A

peripheral zone of the prostate

127
Q

from which zone of the prostate do most malignancies arise?

A

the peripheral zone

128
Q

what transmits the deep arteries of the penis?

A

the (right and left) corpus cavernosum

129
Q

where is the corpus cavernosums?

A

posterior penis

130
Q

what does the corpus spongiosum transmit?

A

spongy urethra

131
Q

what does the corpus spongiosum expand distally to form?

A

to form the glans

132
Q

what is the root of the penis attached to?

A

laterally attached to ischium of pelvis

133
Q

what happens to the 3 cylinders of erectile tissue during erection?

A

they become engorged with blood

134
Q

what lies deep to the penile raphe?

A

spongy urethra within the corpus spongiosum

135
Q

what is another name for foreskin?

A

prepuce

136
Q

what is paraphimosis?

A

swelling of the glans

137
Q

what can paraphimosis be due to?

A

retraction of the prepuce

138
Q

what is the blood supply to the penis?

A
  • deep arteries of the penis

- branches of internal pudental artery

139
Q

what is internal pudental artery a branch of?

A

internal iliac artery

140
Q

what is the blood supply to the scrotum?

A
  • internal pudental

- branches of external iliac artery

141
Q

where does lymph from the scrotum and most of the penis drain to?

A

superficial inguinal lymph nodes

142
Q

what is the only part of the penis that lymph does not drain to the superficial inguinal nodes?

A

the glans

143
Q

where does lymph from the testis drain to?

A

lumbar nodes

144
Q

what does the normal renal system motor function nerves control?

A
  • ureteric peristalsis
  • bladder contraction
  • urethral sphincter control
145
Q

what part of the renal system does the lumbar and sacral plexus (motor and sensory) supply?

A

perineum (distal part of renal system)

146
Q

what are the 5 types of nerve fibre?

A
  • somatic sensory
  • visceral afferent
  • somatic motor
  • parasympathetic and sympathetic nerve fibres
147
Q

what does the somatic sensory nerve fibres relay/

A

sensations from the body wall (soma)

148
Q

what does the visceral afferent nerve fibres convey?

A

sensations from our organs

149
Q

what nerve fibres convey motor responses to our body wall?

A

somatic motor

150
Q

what do parasympathetic and sympathetic nerve fibres stimulate?

A

smooth muscle, cardiac muscle or glands

151
Q

what type of nerve fibre innervates the external sphincter and levator ani?

A

somatic motor

152
Q

what fibre(s) convey pain from the urethra?

A

visceral afferent (in pelvis) and somatic sensory (in perineum)

153
Q

what is the only means by which any type of nerve can comminucate with the CNS?

A

by being carried within the cranial nerves or spinal nerves

154
Q

where do sympathetic nerve fibres leave the CNS?

A

only within the spinal nerves between spinal cord level T1-T12

155
Q

what are the 2 groups of splanchnic nerves that the sympathetic fibres travel within to reach the smooth muscle/glans of the body?

A
  • cardiopulmonary or abdominopelvic
156
Q

how do sympathetic fibres supplying the head reach the head?

A

mainly by following (hitching a ride with) the arteries supplying the same structures

157
Q

where does the sympathetic chains run from?

A

run the entire length of the vertebral column

158
Q

what do the sympathetic nerves travel between?

A

the sympathetic chain and spinal nerves’ anterior rami

159
Q

where do the sympathetic fibres supplying the renal system leave the spinal cord?

A

between levels T10 and L2

160
Q

what do the sympathetic fibres leave the spinal cord within (bilaterally)?

A

within the abdominopelvic splanchnic nerves

161
Q

while the sympathetic nerve fibres are in the abdominopelvic splanchnic nerves, are the pre or post - synaptic?

A

pre-synaptic

162
Q

where do the sympathetic nerve fibres supplying the renal system synapse?

A

at the abdominal sympathetic ganglia

163
Q

where is the abdominal sympathetic ganglia located?

A

around the central branches of abdominal aorta eg coeliac trunk, SMA and IMA

164
Q

what do the post-synaptic sympathetic nerve fibres for the renal system do after synapsing?

A

pass onto the surface if the arteries which are heading towards the organs they need to innervate

165
Q

what is the collection of nerve fibres found on the outside of the arteries known as?

A

a periarterial plexus

166
Q

what other nerve fibres are part of the periarterial plexuses?

A

parasympathetic and visceral afferent nerve fibres

167
Q

what are the 4 cranial nerves that contain parasympathetic nerve fibres?

A

CN III, VII, IX and X

168
Q

what other nerves carry parasympathetic nerve fibres? (other than the 4 CNs)

A

sacral spinal nerves

169
Q

what do parasympathetic nerves not innervate that the sympathetic do?

A

the smooth muscle/glands if the body wall

170
Q

how do parasympathetic fibres reach the smooth muscle/glands of the head and body?

A

via cranial nerves

171
Q

parasympathetic fibres reach the smooth muscle/glands of the hindgut and pelvic organs via what?

A

pelvic splanchnic nerves

172
Q

what are the parasympathetic fibres leaving the sacral spinal nerves known as?

A

pelvic splanchnic nerves

173
Q

what nerve carries the parasympathetic fibres to the kidneys and ureter?

A

within the vagus nerve

174
Q

where are nerve fibres that supply the bladder carried within?

A

the pelvic splanchnic nerves

175
Q

how does the vagus nerve enter the abdomen?

A

through oesophageal hiatus with the oesophagus

176
Q

what spinal nerves make up the pelvic splanchnic nerves?

A

S2, S3, S4

177
Q

what are the only parts of the renal system that somatic nerve fibres go to?

A

those within the perineum eg distal urethra and its sphincter and levator ani

178
Q

what spinal nerve form the pudental nerve?

A

S2, 3 and 4

179
Q

what part of the renal system does the pudental nerve supply?

A

external urethral sphincter

180
Q

what stimulates the detrusor muscle to contract?

A

parasympathetic fibres (from S2, S3, S4) via pelvic splanchnic nerves

181
Q

what type of fibres stimulate the internal urethral sphincter (in males) to contract and when does this happen?

A

sympathetic fibres, during ejaculation

182
Q

what stimulates the external urethral sphincter muscle to contract?

A

somatic motor fibres within the pudental nerve

183
Q

where is pain from the kidney itself felt?

A

posterior aspect of the flank region on affected side

184
Q

where is pain often felt from a calculus obstructing the ureter?

A

radiating from the loin to groin on affected side

185
Q

where is pain from the bladder usually felt?

A

in suprapubic region (midline)

186
Q

where is pain from the perineal part of the urethra usually felt?

A

quite localised in the perineum

187
Q

where do visceral afferents from the kidneys run?

A

alongside the sympathetic fibres back to the spinal cord

188
Q

where do visceral afferents from the kidneys enter the spinal cord?

A

between T11 and L1

189
Q

where do visceral afferents from the ureters enter the spinal cord ?

A

between T11 and L2

190
Q

what do visceral afferents carrying pain from the part of the bladder which touches the peritoneum run alongside?

A

sympathetic fibres

191
Q

at what level do the visceral afferents carrying pain from the part of the bladder which touches the peritoneum enter the spinal cord at?

A

T11-L2

192
Q

where do visceral afferents from the rest of the bladder (not superior part) run alongside and where do they enter the spinal cord?

A

run alongside the parasympathetic nerve fibres back to spinal cord levels S2, S3, S4

193
Q

where do visceral afferents from the proximal urethra run and to where?

A

alongside parasympathetic nerve fibres back to spinal cord levels S2, S3, S4

194
Q

what type of nerve fibres carry pain sensation from the distal urethra and to where?

A

somatic sensory nerve fibres within the pudental nerve. back to spinal cord levels S2, S3, S4.

195
Q

where do the visceral afferent fibres from the testis enter the spinal cord and what do they run alongside?

A

run alongside sympathetic fibres back to spinal cord to levels T10-11

196
Q

where else can testis pain be felt due to their close relation with the scrotal wall?

A

localised to the scrotum and/or groin (L1 region)

197
Q

nerve fibres entering and leaving spinal cord at what levels are key in control of micturition?

A

levels S2-S4

198
Q

what senses the bladder being stretched?

A

visceral afferent nerve fibres

199
Q

where does the pudental nerve arrise from?

A

the sacral plexus

200
Q

what nerve roots of the sacral plexus does the sciatic nerve arise from?

A

L4-S3

201
Q

what named nerved does the lumbar plexus give rise to?

A
  • iliohypogastric
  • ilioinguinal
  • lateral cutaneous nerve of thigh
  • genitofemoral nerve
  • femoral nerve
  • obturator nerve
202
Q

nerve root(s) of iliohypogastric nerve?

A

L1

203
Q

nerve root(s) of ilioinguinal nerve?

A

L1

204
Q

nerve root(s) of lateral cutaneous nerve of thigh?

A

L2, L3

205
Q

nerve root(s) of genitofemoral nerve?

A

L1, L2

206
Q

nerve root(s) of femoral nerve?

A

L2-L4

207
Q

nerve root(s) of obturator nerve?

A

L2-L4

208
Q

what nerve supplies the lateral compartment of the leg?

A

superficial fibular

209
Q

what nerve supplies the anterior compartment of the leg?

A

deep fibular

210
Q

what nerve supplies the muscles of posterior compartment of leg and intrinsic muscles of the foot?

A

tibial nerve

211
Q

what does the femoral nerve become inferior to the knee?

A

the saphenous nerve

212
Q

what supplies sensation to plantar aspect of foot?

A

tibial nerve

213
Q

what supplies sensation to the lateral aspect of the foot?

A

sural nerves

Renal (10 decks)

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