Anatomy Flashcards
List the components of the urinary tract
The kidney - produces urine
The ureter - drains urine from kidney to bladder
The bladder - stores and voids urine
The urethra - excretes the urine
What structures are found in the upper urinary tract
Right and left kidneys
Right and left ureters
What structures are found in the lower urinary tract
The bladder
The urethra
Both unpaired midline structures
Where might an upper urinary tract infection spread to
The kidneys
Which structures are affected by a lower urinary tract infection
Bladder and urethra
Which parts of the urinary tract are found in the abdomen
Kidneys and proximal ureters
In retroperitoneum
Which parts of the urinary tract are found in the pelvis
Distal ureters
Bladder
Proximal urethra
Which parts of the urinary tract are found out in the perineum
Distal urethra
Which part of the kidney is in contact with the peritoneum
The anterior surface touches the visceral peritoneum
What is contained in the hilum of the kidney
Renal vein (anterior) Renal artery (middle) Ureter (posterior)
What surrounded the lateral part of the kidney
Abdominal wall muscles
External and internal obliques and the transversus abdominus
How can the abdominal muscles protect the kidney
Guarding can help protect them from trauma
List the layers that surround the front of the kidney (from outside in)
Visceral peroneum Paranephric fat Renal (deep) fascia Perinephric fat - liquid Renal capsule - more fascia
How can the renal capsule cause problems in pathology
Does not stretch so any swelling of the kidney causes pain
Describe the position of the following vessels on a CT - abdominal aorta, IVC, renal vein and artery
Aorta is on the patients left
IVC is anterior to this and over to the right
Renal artery comes off aorta
Vein goes to IVC
The kidneys lie anterior and lateral to which muscles
In front of quadratics lumborum
Lateral to psoas major
Which vertebral levels are the kidneys at
Left - T12-L2
Right - L1-3
Right is lower due to the liver
Which ribs protect the kidney
Floating ribs 11 and 12
They cover the posterior and lateral parts of the kidney
Rib fracture can do what to the kidneys
Cause laceration or bruising
In which quadrants are the kidneys found
Left upper and right upper
In which abdominal regions are the kidneys found
Left and right lumbar (flank)
How do you palpated the kidneys
Place hand on the back just below rib 12
Get patient to breathe in and palpate in upper quadrant
Describe the location of the right kidney in relation to other organs
Posterior to the liver, part of the duodenum, ascending colon and hepatic flexure
Describe the location of the left kidney in relation to other organs
It’s sits posterior to the stomach, tail of the pancreas, hilum of the spleen and the splenic vessels
What is the significance of the hepatorenal recess
When someone lies on their back, it becomes the deepest part of the peritoneal cavity
Any excess fluid will collect here
Where does lymph from the kidneys drain to
The lumbar nodes
At what level does the abdominal aorta bifurcate
Level of the umbilicus
Where does lymph from the ureters drain to
Lumbar nodes and the iliac nodes
Where do the renal veins sit in relation to the arteries
They sit in front of the arteries
What sits anteriorly - common iliac arteries or veins
The arteries, when the aorta bifurcated it becomes anterior to the veins
Describe the blood supply to the ureters
Supplied by branches of the renal artery, abdominal aorta, common iliac, internal iliac and vesical artery
Renal stenosis related to an infra-renal AAA is likely caused by what
Atherosclerosis
Renal stenosis related to a supra-renal AAA is likely caused by what
Occlusion of the renal artery by the AAA itself
What are the two different placements of AAA
Supra renal - occurs at the level of the renal arteries
Infra-renal - occurs below the renal arteries, just above the bifurcation of the abdominal aorta
List some common variations in the renal system
Bifid ureter
Retrocaval ureter - sits posterior to IVC
Ectopic kidney - in a weird place, may be due to transplant
Solitary kidney - may have not formed or been removed
Describe the composition of the kidney
Made up of cortex and medulla
The medulla contains renal pyramids
The medulla has a striated appearance due to collections of nephrons which make up the pyramids
Describe how urine drains from the kidney
Comes from the collecting duct of the nephrons into the minor calyx
Then into major calyx
Then into renal pelvis
Then into ureter
What is the pelviureteric junction
Anatomical site of constriction between the renal pelvis and ureter
The ureter is narrower than the pelvis
List the anatomical sites of uretic constriction
pelviureteric junction
Where the ureter crosses the common iliac artery
Ureteric orifice - when it opens into the floor of the bladder
what are renal calculi
Kidney stones
how do renal calculi form
From urine calcium salts
they then cause obstruction
What can cause a ureteric obstruction
Internal problem - stone or blood clot
External compression - tumour
What happens to the ureter when it becomes obstructed
The smooth muscles in the walls start contracting to try and clear the problem
This leads to colicky pain
what is the consequence of urinary tract obstruction
The urine backs up to the kidneys
This leads to lots of back pressure and eventually renal failure
What is hydronephrosis
Excess urine backing up in the kidney - swells
Very painful
Where is the false pelvis
Goes from iliac crests to pelvic inlet
Part of the abdominal cavity
Where is the true pelvis
Pelvic inlet to pelvic floor
Makes up the pelvic cavity
Describe the path of the ureter through the pelvis
Pass through the retroperitoneum - anterior to common iliac vessels
Through the false pelvis and into the true pelvis
- along lateral walls
At level of ischial spine it turns medially to enter the posterior aspect of the bladder
What is the main muscle that makes up the pelvic floor
Levator ani
What are the deepest parts of the pelvic cavity in men and women
In men - rectovesicle pouch (between bladder and rectum)
In women its the pouch of douglas (between uterus and rectum)
Any excess fluid will collect here when standing
Where does the ureter runs in relation to the uterine artery
Ureter runs inferiorly to the uterine artery
‘water under the bridge’
Where does the ureter runs in relation to the vas deferens
Runs inferiorly to the vas deferens
‘water under the bridge’
List arteries that branch off the internal iliac artery in women
vesicle arteries - to bladder
uterine artery
middle rectal artery
vaginal artey
List arteries that branch off the internal iliac artery in men
vesical arteries- to bladder
prostatic arteries - come from vesicle
middle rectal artery
What is the trigone of the bladder
Triangle shaped area found in the internal aspect of the bladder formed by the 3 orifices of the bladder
2 ureter entrances and the internal urethral orifice
Smooth part of the wall
What muscle is responsible for bladder contraction
the detrusor
What happens to the orifices when the detrusor contracts
The muscles surrounding them also contract to prevent reflux of urine
What is the function of the internal urethral sphincter muscle
Found in men only
Contracts during ejaculation to prevent semen entering the bladder
List the anatomical relations of the bladder in women
Uterus lies superior to it - separated by the uterovesical pouch
Cervix/vagina is posterior
It sits posterior to the pubic bone
List the anatomical relations of the bladder in men
It sits posterior to the pubic bone
Rectum is posterior to it
Prostate is inferior to it
What are the 2 routes of catherization
Urethral - more common
Suprapubic - through abdominal wall, must be done on full bladder
Describe the difference in position between the empty and full bladder
An empty bladder lies within the pelvis
A full bladder can extend out of the pelvis: its superior part lies superior to the pubic bone
Which surface of the bladder is covered by peritoneum
The superior surface only
What are the different named parts of the male urethra
Prostatic urethra - passes through prostate
Spongy urethra - passes through the corpus spongiosum of the penis
Is the external urethral sphincter voluntary or involuntary
Voluntary (hopefully)
Describe the path of sperm through the male reproductive tract
Produced in seminiferous tubules
Passes to epididymis - storage
Then up vas deferens
Joins with seminal glands to form the ejaculatory duct
Then connects to urethra, passes through prostate and out
What is found in the spermatic cord
Testicular artery, vein
Vas deferens
Lymphatic vessels
Nerves - autonomic and somatic
The testes should be in the scrotum by birth - true or false
True
What covers the testis within the scrotum
A sac called the tunica vaginalis
The testes push into it like the lungs do the pleura
Has a visceral and parietal section
What is hydrocele
Abnormal fluid in the tunica vaginalis
What is testicular torsion
Twisting of the spermatic cord
Can disrupt blood supply to the testes and leads to severe pain
Risk of necrosis
What drains blood from the testes
Pampinform venous plexus
Drains into the testicular vein
The right testicular vein drains into IVC whilst the left goes to the renal vein
What are the different zones of the prostate
Has a central zone with peripheral zones either side
Peripheral zones are what is felt on PR (cancer is most common here anyway)
List the different sections of erectile tissue in the penis
Right and left corpus cavernosum
Corpus spongiosum
All 3 engorge with blood to cause erection
Where does the root of the penis attach
The ischium
What is the blood supply to the penis
Deep arteries of the penis which are branches of the internal pudendal artery
This comes from the internal iliac
What is the blood supply to the scrotum
Internal pudendal artery (from internal iliac)
Branches from the external iliac artery
Where does lymph from the scrotum and penis (except glans) drain to
Superficial inguinal lymph nodes found in the superficial fascia in the groin
Where does lymph from the testis drain to
Lumbar nodes around the abdominal aorta
At what level does the left renal hilum lie
L1
At what level does the right renal hilum lie
L1/2
What aspects of the kidney is US good for looking at
Size Scarring Distension of the calyx Calculi Any abnormalities in structure
What is a pre-contrast CT used for
Good at showing calculi - stone search
What is a corticomedullary CT used for
Cortical enhancement
Inject iondine contrast and take image after 25-70 secs
What is a nephrographic CT
Take image 80-180 secs after contrast injected
Medulla and cortex are enhanced equally
What is an excretory CT
Take image 5-15 mins after contrast injection
Gives opacification of the renal collecting system and ureters
How can MRI be used to assess the kidney
shows lesions, allows for vascular assessment
Shows up most pathology
What is the most common type of imaging used for the bladder
US
Who has the longer urethra - men or women
Men
