Anatomy #7 (Urinary) Flashcards
Unrinary system (Overall)
Eliminate Cellular waste
- Waste goes to extracellar space –> needs to be eliminated
Kidney Funtion
- Remove Waste
- Blood Pressure
- Plasma Volume
- Detoxify Blood
- Ex. Ibeprofin is filtered by the Kidney vs. Aceptometaphoc is filtered by the Lver
- balance pH
- Maintain Homeostasis
Mixing Cold Medicine and Aceptometahin
Don’t want to mix because teh cold medictaion often has Acetometahin –> if you take both them you can be atking too much Acetometaphin
CHECK VIDEO
Understanding of Kidney’s over time
Our understanding of kidneys over time has changed the idea of death
Before - Kidney failure was a death sentance –> person always dies
- Kidney function was a marker of death
BUT this chnaged with dialysis = changed the idea of death
Urinary System
Uses 2 Kidneys + great vessels Acending Inferior Vena cava + Aorta behind the renal artery) + Renal arteries
Renal Arteries
Go to the kidney - each kidney gets 1 renla artery
Renal artery = comes off the aorta
- Renal aretry is very large - because the Kidney is very well profuseed (Kidney gets 1/3 of teh cardiac output at any given) time
Renal vein = infront of the renal artery
Uriter
Comes from the hylum –> go to behiind the peretineum at the base of the pelvice –> go to behind the bladder –> intersect and perferate the bowl
Function - Conduits for collecting urine
Image - white lines)
Vessels in the Kideny
Vessels go inot the hylum in Kideney (where eveyrthing goes in in)
Bladder location
Behind Pubic synthesis
Kidneys (overall)
Retroperiteneul
Location - Between the 12th thoracic and 3rd lumbar vertabra (Low in the body - Just above the hips)
Left is usually higher and longer
Prefix for Kidneys
Nephro and Renal –> both meaning having to do with the Kidneys
Kidney Transplanst
1950 = First successful Kidney transplant –> IMPORTANT because begore kidney failure meant the person would die (changed idea of death)
- Transplants are usually unilateral
- Can leave the old kidney in if it is not an issue
Around when Kidney trasnoplant was made - dialysis was also made (1940s)
No Kidney function = can’t maintain life (more delayed than brain but can’t stay alive) UNTIL dialysis and transplants
Where do you transplant in a new kidney
You usually put the new kidney into the abdominal pouch in the lower abdomen
Why:
1. The kidneys are very deep and you would have to get to the kidneys if you were to implant them where the old kidneys are
- It is safer to put the kidney in a place where you have access to the vessles (better to work with)
2. There is less space where the kidneys usally are
3. Surgeons often leave the old kidney in if it is not causing any issues
Dialysis
Overall: Does the filteration of the Kidney
Method for remving the blood –> blood goes to a machine with a serioes of fine filters –> Filters out the water of the blood –> Blood goes to the body
Need to make a fistula for dialysis –> expands the size of the vein = makes the vein easier to get into
- Alternative to fistula = put a port and a catherter –> stay as a port in the pateint to gte to the vessel
Done 2-3X per week for the rest of the person’s life
Use of dialysis
Done for pateints that are waiting for a kidney transplant or pateints that are not candidates for the trasnplates
New Form of dialysis
Peritenial Dialysis
Pump a diastele (fluid to pick up waste material) to periteneal cavity
Peritenium acts as a membrane to filter the waste - Waste will go through the peritenium to the peritenueal cavity by osmosis –> Fluid that you pumped in (Diastele) will pick up the waste –> Pump the diastel out and disgard it
- waste products being dumped into peritoneal cavity from vasculature in peritenium
Uses the memebrane in the body instead of membrane in machines
Can be done at home + lower infection rates
Right Kidney
Shorter and lower than the left Kidney –> due to the placement of the Liver
Liver is bigger on the right side = liver pushes the right kidney down
Movement of the Kidneys
Kidneys are not fixed to the posterior wall –> they are mobile
There is a fat pad around them = cushions the kidneys
Vessles tether the kidney to the body + the tightness of the packing of eveyrthing around the kdiney keeps them in
Gonadal veins
Image - thin blue lines - BOTH the gonadal veins –> supply and drain the testes + overies
- Right side goes to the left renal vein
- left side goes to the Inferior vena cava
- Red = gonald arteries - come off abdominal aorta
Big Mddle red thing = Artery coming off the Abdominal Aorta
Fat Around the Kidneys
Inside - Kidney –> renal capsul (like pia/viscera) –> Perirenal fat (thin inner layer of fat) –> Renal fassa –> Perrenal fat
- Kidneys - surounded by fat
Renal capsul = liek pia
Perirenal fat = Thin layer of Viseral fat
Renal fassa = Thin fossa outside the kidney (not strong ; wispy)
Perarenal Fat = fat that fills the space (blends into the structures aorund it)
- Viseral fat
- Creates cushion for kidneys
Image - also see the muscle of the back (behind the fat) + see the spinous process (black line in the middle at the bottom)
Viseral Fat
More dangerous form of fat to have
Dangerous to have too much
Improtant when people starve = lose the viseral fat = person becomes more vulnerable to injruy
Protection of the Kidney
Kidney is not well protected (not very deep in body)
Only protected by the fat + rib + muscle BUT the kidney is still vulnerable
Boxers (MMA)
See person kicking other guy – person being kicked likley had an injury to the kidney (especially because the kidney is NOT well protected)
Football players
NOT uncommon for football players to pee blood (espcially when the equipment was not well designed)
NOW they have kiney pads in equipments
Shape of the Kideney
10 cm long ; 5 cm wide ; 3 cm thick
Overall - Bean shape
- Can have a horse shoe kidney (kidney is conncted to the ismus) –> Kidney will usually still function normally
- Has 3 lobes fused together
- Inner borader = hylum = where the vessels come and go
Vessles going into kidneys
Kidneys get 20% of bodies blood flow = lots of blood go through kidneys = has important vessels
Left Kidney - artery comes in froy of vein (Left renal artery is infornt of vena cava) + vein is longer
Right Kidney - Vein sits in fornt of the artery ; artery is lonegr
BOTH
1. Right/Legt renal veins = drains blood from kidney (drain to IVC)
2. Right/left renla artery (com eoff the aorta) = going into kidey
.
Importance of kidney
Kidney is a viral organ
if it fails the effect is not as immediate as the effect of the heart of teh brain failing BUt it is still important
1/3 of CO goes to the kidney
Renal Vessels
Renal Vessels are large –> lots of blood goes through
Branch off the big Red = Superuor mesonteric - sits on top of the left renal
- left renal = lower than the right because transverses the aorta
- Left artery come in from of vein ; right side stays behind the vein
KNOW THE VESSLES
Challenge of Kidney Transplants
Kidney transplants are usually straight foward because the vasculature of the kidney is mapped
Surgeon needs to watch for the vessles hat go form the aorta to the kidney
Renal glands are usually spared during kidney transplants
- In renal vein?
Lack of colateral circulation = good for surgery –> if removing kdiney for transplant or removing neoplasm = staright foward in terms of controling bleeding/having to ligate vessels
- Liagte arerty first - don’t want blood going into organ if there is no way to exit THEN ligate the vein AND take care of uriter AND contend with vessels going to adrenal gland –> After the kidney is free to remove
- BUT bad for trauma because if have issue with ciruclation in kidnney then you can’t rely on blood coming from somewhere else
Super renal vein/Adrenal vein
Goes into left renal vein – if want to miantain the adrenal gland = they need to reconnect the super renal vein somewhere or be carful to take right renal vein dustal to tributea
Colateral Circulation in the Kidney
Kidney does NOT have colateral circulation
Blood goes into the kidney –> Blood does whatever it needs to do –> Blood leaves
- No Secondary circulation
- One artery goes to the right kidney and 1 artery goes to the left kidney ALSO only one vein for each kidney to drain it
Artery branches as it goes to the hylum (1 renal aretery comes off the aorta) –> goes to the different lobes
Super renal glands
Preserved if possible during kidney trasnplants
Function - make epinephrine (adrenaline)
- Epipens = give lots of epinephorne for anophilactic shock
Hilum
Where all the vessels come and go
Pelvis
Looks like venous tissue –> shaped like a pyrimad/funnel shaped
- Collection funnel that goes to uriter
- Collects urine
Smaller vessles in Kidney
Trainglar shape - Pyrimids
Lines going down deeper - interlobar vessles - first branches off the renal artery
- Atery branches to interlobar arteries
vessels ciruclating aorund = Arcuate arteries - arched vessles into lobes
- Archiate arteryes - arching from one inter lobar to another –> create archade of arteries
Interlobular Artery - arteries that go to filtering unit –> go to bomans capsuls
- Branches that come off and trun to vein and come back
Bomans Capsules
Capilary surroudning by Bomans - at the end of the interlobule artery
CHECK VIDEO
Max Bradle Image
Max Bradle made an image of the kidney - worte the anatomical part for a kidney bladder surgery
Discovered the profusion of the kdiney - have reason for vasculature
Found the Lobular branches split to posterior and anterior = can an avacsular plane on a mid-corconal section of the kiney
- Use this section to go to the pelvis/go to the kidney –> follow the plane to the pelvis and void any major bleeding
Called Brandles line (plan in kidney that is avacsular)
Layers inside the Kidney
Cortext (outter layer) –> Medula (deeper)
Cortext
Contains Lameli (dots in the cortext)
Function (of lameli) - Filtering Units
Image - outter pink area
Medula
Made up of pyrimd shaped tissue
- Collection functin of kidney happens in each pyrimid units - ultimatley have area where runine collects into pelvis and then goes t the uriter
Deeper part (darker part)
Medula = tubules
- Lobules of healey
- Fuction - collecting tubes that go down
- Pyrimids = linear straitions
Movment if urine in Kidney
Pee is Filterized –> goe sto Lameli –> goes to colecting tubes –> goes to apex of pyridmids –> Atria f pelvis –> Pelvis proper –> uriter
Papillae
Apex of the Pyrimid (apex to a chanel that will bring urine to the pelvis)
Have perefations = collecting tubules = urine drains from filtration –> goes to the atrium of the pelvis
- Pyrimids terminate at a point that coinside with barnch that goes to pelvis
Have papillae that face us and that go away from us
Pelvis
Arangment of pelvs is divoded into:
1. Less Calyx
2. Greater Calyx
Lesser Calyx
Right outsdie the papillae
- Come from pappilae
“Hallway” –> forst area urine arives
Greater Calyx
Minor calix go together (less calyx come togetehr to form greater)
Collection goes together
Function - Funnels urine to the uriter
Multiple Greater Calyxs will join together and form the pelvis
Glomerulus
Capilaries in the Kidney
Function - Blood is being filtered
Image - Mesh like vessles at the bottom = vessels going around collecting tube (have filtration)
Image - long string at bottom - medula (above that is in teh corext)
- Loop of Hendle = in medul
Top portion - Goes to calicles
Middle - Vessels go to medula + lop of henley (filter)
Bottom INterlic artery and vein - Go into lobular
See colecting tubules - empty into the papilae
- Loops of henly go into the phyrimds
- Glamerilae (filteratiin) occurs in the cortext
- Colecting tubule sgoes down and dumps into apex of pyrmids
- Interlobar and archeates and interlobular going to glamerlar units and then sending collecting units down to the papillae
Kidney Stones
Kidney stones can fil the lesser and greater calyces
- Stones can make a cast of the pelvis
- Stones can be staghorn = more painful –> stone forms in multiple directions
- Stones are caused by the cyrtsilization of phosphates and Ca2+ (possible dairy can precipitate them + can be herditary)
- Stones are painful (pain gets so bad it becomes indistiguishable)
Max Bradle + Kidney Stones
Bradle = documented the hsapes of different calicies/stones
- Can see the 3D of calyces or 3D of pelvis
- Shows how the layers buildup over time (see mineral buildup)
- Some have chnages in core (can have coagulated blood or can be broken into peices(
- See one that is thick (big) –> becomes thin (formed in the lumen of the uriter)
- See peliv shape or calicies shape
- He had to put back together some of the stones because they were taken out during surgery and were broken
How do you remove kidney stones
Some can be taken out by surgery or lithotripsy
Past - Had to break up the stones and then pee it out
-1800s - able to crush the stones + get the stone out one sitting
- Before surgery = kidney stones were fatal
NOW - break up the stone with sound wave or laser
- Laser - Put a catherter into the uriter –> image opacity of stones –> break up the stones + evacuate stone with bag or aspiration
Lithotripsy
Catherter goes into kidney –> breaks up the stones –> removes the stones
Uses sound to break up the kidney stone
Image #2 of Kidney stones
Kidney stone is in the Lower Calcicer
- Stent went up uritehra to bladder to uriter –> in stent see stone (went in to diagnose)
STORY - rini had a collegue who had kidney stones –> had to wait until it passes
Polycystic disease/Dysplasia
Overall - have many cysts on the kidney
Aterogenic
Don’t know cause
Can spread to the pancreus or the liver
Can be asymptomatic to a certain extent
- If one cyst gets big (filled with fluid) = could affect function of kidney because it pushes on the kidney
Uriters
Tube that runs posterior to peritenium –> goes into perenium
Thin walled
Sits front of pelvis?
Sits in soaze muscle (beefy muscle) –> goes in front of the iliac vessles
- Iliac vessles = branches of the aorta
Pretty long
Parastlisis in the Uriter
There is some parastalsis in the Uriter to get usrine to the bladder
- Have thin walled muscular tossie in the wall of the uriter
BUT urine mostly moves through pressure and gravity (urine moves slower)
Uriter + surgery
When surgeons do GI or whipple or kidnye surgery = they need to be carful if the uriter
Need to be carful becuase they could knick the uriter = urine goes to the peretineum = causes peritinitus
When they do surgery they will put a ribon on the uriter to keep eyes on it to make sure they do not knick it
Uriters + urine movment overall
Ureters are lined with mucousal epithelium and with longitidudal and circular musclar fibers
Urine is move from the kidneys to the bladder in peristalic waves
Bladder
Bladder = tucked below the pubic bone sytnthesis
In females - uterus is on top of the bladder
Pubic Bone
Pouches in Urinary System
- Markers on the right side of image - recto-uriter puch - can get infected (infection can settle there)
- Vesic Uteran pouch (Vesicouterine pouch) - between the uterus and the bladder - can get infceted (infection can settle there)
Hard to get AB the puches
Uterus location
Uterus = on top of the bladder (Folded red)
Eveyrthing in image = UNDER the peritenium
Urithera
Goes from the bladder to outside the body
- SHorter in females
Male Uritehra
Male uritehra is longer because travels the length of the penis
Distended bladder
Distended bladder in image is wrong ecause there should not be air in the bladder ; bladder should be distended from fluid
Bladder location
Right behind the pubic synthesis
Prostate
Under the big red crcle
- next to the pubic synthesis
Rectovesicular pouch = next to the big red circle
Under the bladder at base of abdominal cavity
Bladder
Bladder is covered by Rugi
- Rugi = increases the surface area + allow tissue to stretch out
When the bladder colapsases it is small but it can also extend and hold a lot of pee –> can do this becase the musclature is flexible + because of the surface
Perferations (circles in blue) = Uriters
Circle = Trigone –> has the perferations at the top –> uriters turn foward and go to the back of the bladder
- Tirgine is NOT covered with rugi
- Orifeces coming in = from the urtiers - urtiers come down –> go behind the bladder –> curve and go to the bladder
Junction between the uriters going into the bladder
Similar to the ileosecal junction - have mechnaical arangments –> when blader is empty it opens the orifes
When bladder is detsnded = increase angle of junctionn = closes off the urine from coming to pure into the bladder
When blader is ecacuaed = angle opens and urine can go into the bladder
Prostate cancer
Urithera goes through the prostate = enlragtments of the prostate affects the flow of fluid down
When older = have slow stream of urine –> have to pee at night (have to pee but can’t pee fully –> makes them have to pee more often)
- Swollen prostate can affect too
Trigone of the bladder
Rini Ilistartions + catheter
Two residents came from Patrich walshes lab
Catheters –> go to the uriter and then to the bladder
- Double walled to the urine can drain
- Put saline to blow up the baloon to hold the catheter in bladder
- In male - cathetehr goes through the prostate
- Put in people going under general anestia ; always make sure pateints can pee after surgery before they leave hospital
High incedince of infection after using catheter –> Residents were writting a paper about the infections and asked Rini to illustrate how the Foly catheteer goes in
Rini saw that there was a cuff of latex when you remove the saline –> caused the resindets to reqirte the paper and hypothesisze that when you pull catheter the slaine leavses a cuff = when remve the catherter = roushing up the mucosa of the urithra
- Recomended that you should keep 0.5 CC of slaine in = makes it round (no cuff) = no roughing
Rini + Catherter (VIDEO)
2 residnets came over who were working with Pat walsh –> asked rini to help with paper on increase infcetion rate with folly catheters
Foly catherter - has a double lumen
- Put up rutehrra to bladder
- Outter lmebn they put syline syrngge and inject and inflates a baloon = prevents catehr from being pulled out of the bladder
- Inner lumen - drains urine
Found - when use catherter there is high inciddenos of bladder infecton –> theory was that when put cater is pulled out that movement can intrduce bacteria –> asked rini to ilutsrate that
Rini saw that when yo pull slaine out it callapses the latex but leaves a little cuff (stcks to self and makes ridges) –> he told the resistdents –> said the cuff would be bad because it would rough up the mucousa
To get rid of cuff = when take saline out you add back in 1 CC of fluid to get rid of ridge and make a bolbus shape
End - they rewrote the paper
Patrcik Walsh
Perfected the technique of removing the prostate but keeping the bundle of nerves that goes to the penis (nerves run along the side of the prostate)
To do surergy = push the nerves to the side and can get just the prostate
Before = 90% impotence ; after Walsh = 40% impotence
Male urinary
Urithera is in 3 parts:
1. Prostatic - leads bladder and goes through the prostate
2. Mebranous - goes through the duct of the penis (goe sthrough muscuslar floor of the bottom of the pereneum)
3. Cavernous - goes through the penis itself
Male = muscular floor of perenium
- Sphricter for urithera
- Damage muscle = cuases incompetance
Sphicter for Urtehra
Male = muscular floor of perenium
- Sphricter for urithera (Acts as sphicter?)
- Damage muscle = cuases incompetance
Damage = more pronounced in women vecause child birth (stretches the mucles) = muscle is less effective
Pelvic floor in male = important band of mucles - help supprt contents of lower abdomenial cavity
- As age = candevelop urinary incotenace or decal incontence
- Anything that weakens floor (body weight or child birth) = can affect urthera and lead to incotenance
Female urithera
All one section
