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Year 2 - Renal (DP) > Anatomy > Flashcards

Anatomy Flashcards

1
Q

What parts of the urinary tract are in the retroperitoneum?

A

Kidneys

Proximal ureters

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2
Q

What parts of the urinary tract are in the pelvis?

A

Distal ureters
Bladder
Proximal urethra

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3
Q

What part of the urinary tract is in the perineum?

A

Distal urethra

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4
Q

What is the kidney enclosed in (from superficial to deep)?

A

(Visceral peritoneum)

  • Paranephric fat
  • Renal/Deep fascia
  • Perinephric fat
  • Renal capsule
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5
Q

What muscles surround the kidney?

A 
Posterior abdominal walls:
     - Quadratus lumborum
Anterolateral abdominal wall:
     - Obliques
     - Transverse abdominis
Back
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6
Q

What muscle is the kidney anterior to?

A

Quadratus lumborum

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7
Q

What muscle is the kidney lateral to?

A

Psoas major

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8
Q

What vertebral levels is the right kidney at?

A

L1-L3

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9
Q

What vertebral levels is the left kidney at?

A

T12-L2

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10
Q

What ribs protect the kidneys?

A

11 + 12

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11
Q

What effects can rib fractures have on the kidneys?

A

Contusion and Laceration

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12
Q

What are the dimensions of a normal kidney?

A

Length ~12cm

Width ~6cm

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13
Q

How does a usual kidney feel?

A

Smooth
Regular
Firm

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14
Q

What does the right kidney lie posterior to?

A

Liver
2nd part of duodenum
Ascending colon
Right colic flexure

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15
Q

What sac does the hepatorenal recess lie in?

A

Greater sac

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16
Q

What does the left kidney lie posterior to?

A

Stomach
Tail of pancreas
Hilum of spleen
Splenic vessels

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17
Q

Which is more anterior, the renal arteries or veins?

A

Veins

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18
Q

Which is more anterior, common iliac arteries or veins?

A

Arteries

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19
Q

What lymph nodes does renal lymph flow to?

A

Lumbar nodes

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20
Q

Where are the lumbar lymph nodes?

A

Around abdominal aorta and IVC

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21
Q

Where does ureteric lymph flow to?

A

Lumbar and iliac nodes

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22
Q

Where are the iliac lymph nodes located?

A

Around the common, internal and external iliac vessels

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23
Q

Which of the following blood vessels doesn’t supply the ureter:

  • Renal artery
  • Abdominal artery
  • Common and iliac arteries
  • Superior mesenteric artery
  • Vesical artery
A

Superior mesenteric artery

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24
Q

What does the vesical artery supply?

A

Bladder

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25
Q

What tends to be the cause of an infra-renal AAA and renal artery stenosis?

A

Atherosclerosis

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26
Q

What tends to cause renal artery stenosis by occlusion?

A

Suprarenal AAA

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27
Q

What is the most common anatomical variation in the renal system? What is its incidence?

A

Bifid renal pelvis -> 1:10

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28
Q

What renal anatomical variation has an incidence of 1:25?

A

Bifid ureter and unilateral duplicated ureter

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29
Q

What are three less common anatomical variations of the renal and urinary systems? What are their incidences?

A

Horseshoe kidney -> 1:500
Retro-caval (behind IVC) ureter -> 1:1500
Ectopic pelvic kidney -> 1:2500

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30
Q

What can cause a solitary kidney?

A

Agenesis

Neophrectomy

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31
Q

How many pyramids are in each renal medulla?

A

27

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32
Q

Approximately how many nephrons are in each renal pyramid?

A

~50000

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33
Q

What direction do nephrons run? How does this make the pyramids appear?

A

Axially to the apex:

- Striped appearance

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34
Q

Where does the collecting duct drain the filtrate into?

A

Minor calyx

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35
Q

Where is the first constriction do urine flow and what does this junction indicate?

A

Pelviureteric junction:

- Renal pelvis becomes ureter

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36
Q

Where are the anatomical sites of ureteric constriction?

A
  1. Pelviureteric junction
  2. Ureter crossing anterior aspect of common iliac artery (often at the bifurcation)
  3. Ureteric orifice
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37
Q

Where does the ureter open into?

A

One corner of the trigone on the bladder floor

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38
Q

What imaging modalities can show renal calculi?

A 
X-rays
IV urogram (shows ureteric narrowing)
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39
Q

What compound makes up the majority of renal calculi?

A

Calcium oxalate

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40
Q

Where do ‘staghorn’ calculi tend to form?

A

Pelvis and major calyces

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41
Q

What can internally obstruct the ureter?

A

Impacted calculus

Blood clot

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42
Q

What can externally obstruct the ureter?

A

Expanding mass (eg. Tumour)

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43
Q

What muscle is in the walls of the ureter?

A

Smooth muscle

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44
Q

When the ureter is obstructed, what is its response?

A

Increased peristalsis proximal to obstruction:

- In waves -> ‘Colicky’ pain

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45
Q

What type of obstructions can cause a unilateral back pressure up to the kidney?

A

Ureteric blockage

Bladder blockage

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46
Q

What type of obstructions can cause a bilateral back pressure up to the kidney?

A

Bladder blockage

Urethra blockage

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47
Q

In ureteric obstruction, when will urine production stop?

A

When urinary tract pressure > Glomerular filtration pressure

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48
Q

How does hydronephrosis result in renal failure?

A

Urine backs up into calyces -> Nephrone compression -> Renal failure

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49
Q

What kidney, when enlarged, is easier to feel on palpation?

A

Right kidney

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50
Q

Where is the false pelvis?

A

From iliac crests to the pelvic inlet

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51
Q

What is the false pelvis a part of?

A

Abdominal cavity

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52
Q

Where is the true pelvis?

A

From pelvic inlet to the pelvic floor

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53
Q

What forms the pelvic floor?

A

Pelvic diaphragm (mainly levator ani)

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54
Q

What are the openings in the pelvic floor?

A

Distal parts of the following tracts:

 - GI
 - Renal
 - Reproductive
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55
Q

Where is the perineum?

A

Between pelvic floor and skin

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56
Q

Where do the ureters lie in relation to the common iliac vessels?

A

Anteriorly

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57
Q

Where do the ureters run along?

A

Lateral pelvic walls

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58
Q

Where do the ureters turn medially?

A

At the level of the ischial spine

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59
Q

On what surface of the bladder do the ureters enter?

A

Posterior aspect

60
Q

What direction do the ureters enter the bladder? What does this prevent?

A

Inferomedial:

- Prevents vesicouretal reflux upon bladder contraction

61
Q

What is the route the ureters take?

A

Sub-peritoneal

62
Q

In relation to the uterine tubes and uterine artery, where do the ureters lie?

A

Inferiorly (‘Water under the bridge’)

63
Q

In relation to the vas deferens, where do the ureters lie?

A

Inferiorly

64
Q

What forms the trigone?

A

2 ureteric orifices

1 internal urethral orifice

65
Q

Where does the prostate lie in relation to the bladder?

A

Inferiorly

66
Q

The detrusor muscle forms the main bulk of what?

A

Bladder walls

67
Q

The detrusor mucle has fibres which encircle the ureteric orifices. What function does this have?

A

Tighten on bladder contraction -> Prevents vesicouretal reflux

68
Q

What structure does the detrusor muscle form in men? What function does this have?

A

Internal urethral sphincter:

- Prevents retrograde ejaculation

69
Q

Where does the bladder lie when empty?

A

Just posterior to the pubic bone

70
Q

Where does the uterus lie in relation to the bladder?

71
Q

What position does the uterus lie?

A

Anteflexed

72
Q

What separates the uterus and the bladder?

A

Uterovesical pouch

73
Q

Where does the rectum lie in relation to the bladder?

74
Q

The peritoneum covers what surface of the bladder?

A

Superior surface

75
Q

What is the approximate length of the female urethra?

76
Q

What is the approximate length of the male urethra?

77
Q

What are the four parts of the male urethra from internal to external?

A 
Intramural/Preprostatic part
Prostatic part
Intermediate/Membranous part
Spongy part (In corpus spongiosum)
78
Q

Where do the testes originally lie?

A

Posterior abdomen

79
Q

What route do the testes take to reach the scrotum?

A

Move through inguinal canal to scrotum

80
Q

What is contained in the spermatic cord?

A 
Testicular artery and vein
Vas deferens
Lymphatics
Nerves:
     - ANS for vas deferens smooth muscle
     - Somatic for cremaster muscle
81
Q

What are the testicular veins part of?

A

Pampiniform plexus

82
Q

What sac do the testes lie in?

A

Tunica vaginalis

83
Q

What embryological remnant of the testes can become twisted?

A

Appendix testis

84
Q

What is a hydrocele?

A

Excess fluid in tunica vaginalis

85
Q

What can testicular torsion result in?

A

Disruption of blood supply:

 - Severe pain
 - Testicular torsion
86
Q

Where can the epididymis be palpated?

A

Posteriorly

87
Q

What part of the prostate is in contact with the levator ani?

88
Q

What do the prostatic drains do?

A

Allow glandular secretions to drain into the prostatic urethra

89
Q

What forms the ejaculatory duct?

A

Vas deferens and seminal gland duct

90
Q

What part of the prostate is felt on PR exam?

A

Peripheral zone

91
Q

What part of the prostate do most malignant cancers arise from?

A

Peripheral zone

92
Q

Where does the penis lie?

A

Within perineum

93
Q

What is the anatomical position of the penis?

94
Q

What is the structure of the corpus cavernosum and what does it do?

A

Paired posteriorly

Transmits deep penile arteries

95
Q

What does the spongy urethra lie deep to and what is this structure a continuation of?

A

Penile raphe:

- Continuation of the scrotal raphe

96
Q

What is the blood supply to the penis?

A

Deep arteries of the penis:

 - Branches of internal pudendal artery
           - > From internal iliac artery
97
Q

What is the blood supply to the scrotum?

A

Via internal pudendal

Via branches of the external iliac artery

98
Q

Where does lymph from the scrotum and penis (excluding the glans) drain to?

A

Superficial inguinal LNs (in groin superficial fascia)

99
Q

Where does lymph from the testes drain to?

A

Lumbar nodes (around abdominal aorta)

100
Q

What nerve fibres provide motor control for ureteric peristalsis and bladder contraction?

A

SNS and PSN

101
Q

What nerve fibres provide motor control to the urethral sphincters?

A

Internal sphincter:
- SNS and PNS
External sphincter (and levator ani):
- Somatic motor

102
Q

What nerve fibres carry renal system pain from the kidneys, ureters, bladder and testes?

A

Visceral afferents

103
Q

What nerve fibres carry renal system pain from the urethra?

A

Visceral afferents in the pelvis

Somatic sensory in the perineum

104
Q

Where do SNS nerve fibres leave the spinal cord?

A

In spinal nerves T1-L2

105
Q

How do SNS nerve fibres get to the body wall?

A

In spinal nerves

106
Q

What part of the body do SNS fibres not supply via spinal nerves? How do these fibres reach this body part?

A

Head:

- Follow arteries supplying same head structures

107
Q

How do SNS fibres supply muscles/glands of organs? What are the two main kinds of these nerves?

A

Splanchnic nerves:

 - Cardiopulmonary
 - Abdominopelvic
108
Q

The SNS nerves supply the renal and urinary system leave at what spinal levels?

109
Q

What route do SNS fibres take to reach the end organ?

A
  1. Leave spinal cord
  2. Enter bilateral sympathetic chains
  3. Leave chains in abdominopelvic splanchnic nerves
  4. Synapse at abdominal sympathetic ganglia around the abdominal aorta
  5. Post-synpatic fibres pass from ganglia onto surface of arteries (periarterial plexus)
110
Q

What do the periarterial plexuses contain?

A

SNS fibres
PNS fibres
Visceral afferent fibres

111
Q

Where do PNS fibres leave the CNS?

A 
Four CNs (III, VII, IX and X)
Sacral spinal nerves
112
Q

What do PNS fibres not supply?

A

Smooth muscles and glands of the body wall

113
Q

How do PNS fibres reach the hindgut and pelvic organs?

A

Via pelvic splanchnic nerves (carried in sacral spinal nerves only briefly)

114
Q

What parts of the renal and urinary system does the vagus nerve supply?

A

Kidney

Ureter

115
Q

What parts of the renal and urinary system do the pelvic splanchnic nerves innervate?

116
Q

What parts of the renal and urinary system do the somatic motor nerves supply?

A

Perineum:

 - Distal urethra
 - Urethral sphincter (external)
 - Levator ani
117
Q

What initiates and propagates ureteric peristalsis?

A

Uteric cells:

- Built in auto-rhymicity

118
Q

How does the bladder contract?

A

PNS fibres:

 - S2, S3 + S4
 - Via pelvic splanchnic nerves
           - > Stimulate detrusor to contract
119
Q

What controls the internal urethral sphincter (in males only)?

A

SNS -> Cause contraction during ejaculation

PNS -> Relax it to allow urination

120
Q

What stimulates the contraction of external urethral sphincter?

A

Somatic motor fibres:

- Within pudendal nerve (S2, S3 + S4)

121
Q

What stimulates the contraction of the levator ani?

A

Somatic motor fibres:

- Within nerve to levator ani (S3 + S4)

122
Q

Where is kidney pain typically felt?

123
Q

Where is ureteric pain typically felt?

A

‘Loin to groin’

124
Q

Where is bladder pain typically felt?

A

Suprapubic region (midline)

125
Q

Where is perineal urethra pain typically felt?

A

Localised perineum

126
Q

Where do visceral afferent nerves from the kidney enter the spinal cord?

127
Q

Where do visceral afferent nerves from the ureters enter the spinal cord?

128
Q

Visceral afferent nerves either run alongside SNS fibres or PNS fibres. From what parts of the bladder do they run alongside the above fibres?

A

Alongside SNS:
- Bladder touching peritoneum
Alongside PNS:
- From rest of bladder

129
Q

Where do visceral afferent nerves from the bladder touching the peritoneum enter the spinal cord? Where is this pain perceived?

A

T11-L2

Midline, suprapubic pain

130
Q

Where do visceral afferent nerves from the rest of the bladder enter the spinal cord?

131
Q

What fibres do visceral afferents from the proximal urethra run alongside and where do they enter the spinal cord?

A

PNS fibres

Enter between T2 + T4

132
Q

What fibres supply the rest of the urethra?

A

Somatic sensory

133
Q

The fibres that supply the rest of the urethra are contained in what nerve?

A

Pudendal nerve (S2-S4)

134
Q

What can cause localised perineal pain?

A

Vaginal tear
Anal canal fissure
Perineal genital ulcers (eg. Herpes)

135
Q

The visceral afferents leaving the testes are carried alongside what fibres and enter the spinal cord at what levels?

A

SNS fibres

T10-T11

136
Q

Due to the close relationship with the scrotal wall, where can testes pain be felt?

A

L1 region (scrotum)

137
Q

Nerves entering and leaving the spinal cord at what levels control micturition?

A

S2, S3 and S4

138
Q

What nerves fibres control micturition?

A 
PNS fibres (in pelvic splanchnic nerves)
Visceral afferents
Pudendal nerve (somatic motor)
139
Q

Put the following steps in the micturition reflex in order:

  • Detrusor muscle stimulation
  • Bladder fills
  • Stretch receptors in visceral afferent stimulated
  • Inhibition of internal urethral sphincter (males)
  • Bladder stretching
  • Relayed to spinal cord between S2-S4
A
  1. Bladder fills
  2. Bladder stretching
  3. Stretch receptors in visceral afferent stimulated
  4. Relayed to spinal cord between S2-S4
  5. Detrusor muscle stimulation
  6. Inhibition of internal urethral sphincter (males)
140
Q

How can the brain overide the micturition reflex?

A

APs from inhibitory nerves from cortex pass inferiorly

141
Q

How else can we voluntarily prevent micturition?

A

Contract external urethral sphincter and levator ani by crossing our legs

142
Q

When it is appropriate to urinate, what series of contractions and relaxations occur? What nerve fibres carry out these functions?

A
  1. Detrusor contracts (PNS)
  2. Internal urethral sphincter (PNS), external ureathral sphincter and levator ani relax (somatic motor)
  3. Anterolateral abdominal wall muscles contract (somatic motor)
  4. Intra-abdominal pressure increased
  5. Urine forces out of EUS (somatic motor)
143
Q

Which of the following nerves does not arise from the lumbar plexus:

  • Iliohypogastric (L1)
  • Ilioinguinal (L1)
  • Lateral cutaneous nerve of thigh (L2 + L3)
  • Genitofemoral (L1 + L2)
  • Femoral (L2-L4)
  • Medial cutaneous nerve of thigh (L2)
  • Obturator (L2-L4)
A

Medial cutaneous nerve of thigh (it is a branch of the femoral nerve)

144
Q

What does the femoral nerve lie under?

A

Inguinal ligament (into anterior thigh compartment)

145
Q

What compartment does the obturator nerve lie in?

A

Medial thigh compartment

146
Q

What does the femoral nerve become and what does this nerve supply?

A

Saphenous nerve:

- Anteromedial leg and ankle

Year 2 - Renal (DP) (15 decks)

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