Anatomy Flashcards
Describe the function of the 4 MAIN structures that urine passes through before it is excreted
Kidney = produces urine Ureter = drains urine Bladder = stores/voids urine Urethra = excretion of urine
What anatomical structures make up the Upper Urinary tract?
kidneys (right &left)
ureters (right & left)
What structures make up the Lower Urinary tract?
bladder
urethra
What structures of the urinary tract are retroperitoneal?
kidneys
proximal ureters
What parts of the urinary tract are found within the pelvis?
- distal ureters
- bladder
- proximal urethra
What urinary structure is found in the perineum?
the distal urethra
What structures make up the renal hilum (from anterior to posterior)?
Renal vein
Renal artery
Ureter
What muscle is found posterior to the kidneys?
Quadratus Lumborum
What muscle is found medial to the kidneys?
Psoas Major
What layers of muscle are found lateral to the kidney?
Transversus Abdominis
Internal Oblique
External Oblique
from kidney outwards
What structures occupy the space between the anterior surface of the kidney and the visceral peritoneum?
- Visceral peritoneum
- Paranephric fat
- Renal (deep) fascia
- Perinephric fat
- Renal capsule
What should be noted about the blood supply to and from the kidneys on a CT scan?
The aorta is found more posterior than the IVC
What vertebral level is the left kidney found at?
T12-L2
What vertebral level is the right kidney found at and why is this?
L1-L3
pushed down by liver
Fracture of what ribs can cause potential trauma to the kidneys?
11 or 12 (floating ribs)
sharp displaced ends may bruise/lacerate the kidney
What quadrant / region is the Left kidney found in?
LUQ
Left Lumbar Region
What quadrant / region is the Right kidney found in?
RUQ
Right Lumbar Region
How do you “Ballot” for the kidneys?
- Palpate posteriorly in the lumbar/flank region inferior to the 12th rib
- Palpate Anteriorly in the RUQ
- Ask patient to breathe in so that diaphragm and either liver or spleen descend and move kidney downwards so it can be felt
A non-smooth kidney indicates an abnormality. TRUE/FALSE?
TRUE
What structures is the Right Kidney posterior to?
- liver
- hepatorenal recess
- 2nd part of duodenum
- ascending colon
- right colic (hepatic) flexure
What structures is the Left Kidney posterior to?
- stomach
- tail of the pancreas
- hilum of the spleen
- splenic vessels
What is the significance of the hepatorenal recess?
Fluid collects here if patient is lying on their back
Are the renal veins or arteries anterior at the kidneys?
Veins are anterior
Are the veins or arteries anterior at the level of common iliac bifurcation?
Arteries are anterior
Where does lymph from the kidneys drain to?
lumbar lymph nodes
Where does lymph from the ureters drain to?
Proximal = lumbar Distal = iliac
Describe the relationship of a supra-renal AAA to the renal arteries?
Begins above the level of the renal arteries but can also extend below the renal arteries
Describe the relationship of an infra-renal AAA to the renal arteries?
Starts below the level of the renal arteries
How are AAAs repaired?
Endovascular Aneurysm Repair (EVAR)
If the renal arteries are stenosed in an Infra-renal AAA, this is usually due to the aneurysm itself. TRUE/FALSE?
FALSE
- usually due to atherosclerosis
- Stenosis in supra-renal AAAs are usually due to the aneurysm itself
In what ways can the renal system vary anatomically?
Bifid renal pelvis Bifid Ureter OR Unilateral duplicated ureter Retrocaval Ureter (behind IVC) Horseshoe Kidney Ectopic Pelvic Kidney
What are the possible reasons for a patient only presenting with one kidney?
- agenesis
- nephrectomy (pathology)
- nephrectomy (donation)
Where in the kidney are the nephrons found?
In the renal pyramids of the medulla
What structures does urine pass through from the nephrons to the urethra?
- nephrons (collecting duct)
- minor calyx
- major calyx
- renal pelvis
- ureter
What is the largest area for collection of urine?
Renal Pelvis
What anatomical constriction landmark is marked by the wider renal pelvis becoming the narrower ureter?
pelviureteric junction
What other 2 areas are considered anatomical sites of ureteric constriction?
ureter crossing over the common iliac artery (over pelvic ridge)
ureteric orifice (opening into trigone in the bladder)
What is the significance of anatomical sites of vasoconstriction?
If kidney stones form they can block flow at these sites due to the narrowings
Why does ureteric obstruction present with colicky pain? (comes and goes)
- increased peristalsis proximal to the site of the obstruction
- attempt to flush it into the bladder
- peristalsis comes in waves => colicky pain
An obstruction in the ureter causes a unilateral back pressure of urine. TRUE/FALSE?
TRUE
What type of back pressure is caused by an obstruction in the bladder?
unilateral or bilateral kidney problems
What type of back pressure do patients experience if their obstruction is in the urethra?
bilateral
When does back pressure cause reduced urine output?
When the pressure within the urinary tract exceeds the pressures favouring filtration at the glomerulus
What is the definition of renal failure?
failure to adequately filter the blood to produce urine
The renal capsule has the potential to stretch if the kidney swells. TRUE/FALSE?
FALSE
Layer of deep fascia and is very tense (doesnt stretch)
=> causes patients a lot of pain
What is considered the false pelvis?
from iliac crests to pelvic inlet
What does the true pelvis extend to?
pelvic inlet to pelvic floor
What is the main muscle of the pelvic floor and where does the pelvic floor extend between?
Levator Ani
between pubic symphysis and coccyx
What is meant by a sub-peritoneal structure?
Passes below the peritoneal cavity
In an upright male, what is the most inferior part of the peritoneal cavity where fluid will collect?
Rectovesicle pouch
In an upright female what is the most inferior part of the peritoneal cavity where fluid will collect?
Rectouterine pouch (of Douglas)
What does the ureter run inferiorly to in both a male and a female?
Female = inferior to uterine artery Male = inferior to vas deferens
The arteries into the pelvis branch from what iliac artery?
Internal Iliac
What arteries go to supply the bladder, uterus and vagina?
Vesical arteries
Uterine arteries
Vaginal arteries
What arteries branch from the vesical arteries?
Prostatic arteries
What artery to the rectum is derived from the internal iliac artery?
Middle rectal artery
What 3 orifices form the trigone of the bladder?
2 ureteric orifices and the internal urethral orifice
What is the function of the the internal urethral sphincter muscle?
Contracts during ejaculation to prevent retrograde ejaculation of semen back into the bladder
What name is given to the normal position of the uterus and what takes most of its weight?
Anteflexed
Sits on top of bladder => this takes its weight
In what direction does the bladder expand when it fills?
Superiorly into abdominal cavity
What are the two methods of catheterisation?
urethral suprapubic (through anterior abdominal wall => avoiding peritoneal cavity)
The male urethra is much longer than the female urethra. TRUE/FALSE?
TRUE
What are the two parts of the male urethra and where are they found?
Spongy urethra (in corpus spongiosum) Prostatic urethra (through prostate)
The external urethral sphincter is INVOLUNTARY. TRUE/FALSE?
FALSE
the INTERNAL urethral sphincter is INVOLUNTARY
The EXTERNAL urethral sphincter in VOLUNTARY
Describe the course of the vas deferens
up through scrotum
into peritoneal cavity
behind bladder
Down through prostate (joins with seminal gland to form ejaculatory duct)
Then becomes prostatic, then spongy urethra
What structure moves with the testes when they descend into the scrotum?
Spermatic cord
What name is given to the “sac” that the testis sit inside when in the scrotum?
tunica vaginalis
visceral and parietal layer
Excess fluid in the tunica vaginalis is known as what?
hydrocele
What is contained within the spermatic cord?
vas deferens
testicular artery
pampiniform plexus
What is meant by testicular torsion?
- twisting of the spermatic cord
- disrupts the blood supply
Causes: - severe pain
- danger of testicular necrosis
What structures pass through the Deep Inguinal Ring to get into/out of the inguinal canal?
testicular artery testicular vein vas deferens lymphatics nerves
Where does the vas deferens begin?
The inferior pole of the testis
Where can the head of the epididymis be palpated?
The posterior aspect of the superior pole
What part of the prostate is palpated on PR examination?
- peripheral zone
- most prostate cancers (i.e. malignant) arise in the peripheral zone
In what cylinders of tissue are the deep arteries to the penis found?
right & left corpus cavernosum
What arteries do the deep arteries of the penis branch from?
the internal pudendal artery
from the internal iliac
What is the blood supply to the scrotum?
internal pudendal
AND branches from the EXTERNAL iliac artery
What structures of the male reproductive tract drain to the superficial inguinal lymph nodes?
Scrotum & most of the penis (not the glans)
Lymph from the testis drains to what group of lymph nodes?
lumbar nodes around the abdominal aorta