Anatomy Flashcards
where is urine produced
the kidneys
what is the role of the ureter
drains the urine from the kidneys to the bladder
what is the role of the bladder
stores and void the urine
what is the role of the urethra
excretion of urine (and semen in males)
what makes up the upper urinary tract
the kidneys and ureters
what makes up the lower urinary tract
the bladder and the urethra (both midline structures)
what parts of the urinary tract are in the abdomen (and where)
in the retro-peritoneum
the kidneys and proximal ureters
what parts of the urinary tract are in the pelvis
the distal ureters, the bladder and the proximal urethra
what parts of the urinary tract are within the peritoneum
the distal urethra
where are the kidneys
in abdominal cavity behind the peritoneum
enclosed within then renal fat/ fascia/ capsule
surrounded by skeletal muscles - anterior to quadratus lumborum, lateral to psoas major
lie lateral to the lower throacic/upper lumbar vertebral bodies
is the peritoneum in contact with the kidneys
yes the visceral peritoneum is touching the anterior surface of the kidneys
what is the role of the skeletal muscle surrounding the kidneys
guarding protects them from trauma
what muscles surround the kidneys
right anterolateral abdominal wall muscles- external oblique, internal oblique, transversus abdominis
posterior abdominal wall muscles- psoas major and left quadratus lumborum
muscles of the back
what is the hilum of the kidney
the ‘root’ were the renal artery and vein and the ureter attach to the kidney
what is the position of the contents of the hilum of the kidney
vein anterior, atery, ureter posterior
from the peritoneum what do you go through to get to the kidney
visceral peritoneum paranephric fat renal (deep fascia) perinephric fat (liquid that floats the kidneys) renal capsule (thick fascia) kidney
what is problematic about the renal capsule
as very thick fascia doesnt strectch well- if kidney were to expand in (e.g. hydronephrosis) then it would constrict the kidney and cause pain
is an axial ct of the abdomen where is the aorta and IVC
aorta is largest white circle on top of vertebral body (is slightly on the right)
IVC is superior and towards the left (not the smaller white hole next to the aorta- this is the crux of the diaphragm)
what vertebral level are the kidneys at IMPORTANT
right- L1-L3 (depressed by the liver)
left- T12-L2
where are the kidneys in relation to the ribs
floating ribs 11 and 12 are posterior to the kidneys (protect them but if they fracture can contuse (bruise) or lacerate the kidney)
which regions are the kidneys found in
upper R and L quadrants or the lumbar/ flank regions R and L
what is the normal finding when balloting a kidney
12cm long 6cm wide smooth regular firm
how do you ballot a kidney
palpate posteriorly within the right flank (inferior to 12th rib)
palpate anteriorly within the RUQ
as the patient breathes in the kidneys descend and can be trapped between the palpating hands
what happens to the kidneys during breathing
diaphragm in contact with both the liver and the spleen
during inspiration these are depressed so also depress the kidneys
what is the right kidney posterior to
the liver (and hepatorenal recess), the duodenum, ascending colon and right colic flexure (where the ascending becomes the transverse colon)
what is the left kidney posterior to
the stomach,
the tail of the pancreas, the hilum of the spleen, the splenic vessels
what is the hepatorenal recess
between the liver and the kidney- forms the deepest part of the greater sac of the peritoneal cavity when supine (lying down)
are the renal arteries anterior or posterior to the renal veins
veins are anterior, arteries posterior
which is anterior out of the iliac arteries and vein
iliac arteries are anterior to the common iliac veins
what does the renal artery arise from
the abdominal aorta
what does the renal vein drain to
IVC
where does the kidney lymph drain to
to the lumbar nodes (around the abdo aorta and IVC)
where does the abdo aorta birfucate
at the level of the umbilicus
what is the utereric blood supply
from lots of different branches (renal artery, aorta, common iliac, internal iliac, vesicle (bladder)
where does the lymph from the ureters drain to
has dual lymph drainage- the lumbar nodes and the iliac nodes
(iliac nodes located around the common, internal and external iliac vessels)
when associated with an abdominal aortic aneurysm, renal artery stenosis may be…
combined with an INFRA renal AAA (both cause by athersclerosis)
or due to a SUPRA renal AAA (caused by occlusion of the proximal renal artery by the aneurysm)
why might you have only one kidney
agenesis (failure to form)
nephrectomy (pathology/donation)
what are the types of anatomical variants in the kidneys
bifid renal pelvis bifid ureter and unilateral duplicated ureter retrocaval ureter (behind IVC) horseshoe ectopic pelvic kidney
describe the composition of the kidneys
outer cortex
inner medulla- make renal pyramids which contain regularly arranged nephrons giving striped appearance
how are the nephrons of the kidneys arranged
run axially towards the apex of each pyramid
how does urine drain from the kidneys
nephrons collecting duct minor calyx (where renal pyramids drain) (joint together to make) major calyx (join together to make) renal pelvis passes into ureter
ureter bigger or smaller than the renal pelvis
smaller- in kidneys urine drains through structures that get wider and wider until get to ureter at pelviureter junction where becomes narrow
problem for kidney stones
what is the pelviureteric junction
where the wider renal pelvis becomes the narrower ureter
where are the three anatomical sites of ureteric constriction
pelviureteric junction
ureter crossing the anterior aspect of the common iliac artery (often crosses the bifurcation) (where passes from abdo to plevis structure across bny rim)
ureteric orifice (opening into the corner of the trigone on the floor of the bladder)
what are renal calculi
stones that form from urine calcium salts and can obstruct the urinary tract
what is a stag horn calculus
one that lodges in renal pelvis and calyces
what can can uteric obstruction
internal obstruction (renal calculus/ blood clot)
external compression (tumour)
why is obstruction of the ureter painful
has smooth muscles in walls- increases peristalsis proximal to the site of obstruction in an attempt to remove the blockage and pass it into the bladder
peristalsis in wave colicky pain than comes and goes
what are the consequences of a urinary tract obstruction
cause urine to back up towards kidneys
if in calyces/ ureter =unilateral
if in bladder= uni/bilateral
if in urethra= bilateral
urine production will continue until the pressure within the UT exceeds the pressure favouring filtration at the glomerulus
what is renal failure
failure to adequately filter the blood to produce urine
what is a hydronephrosis
urine back pressure into the calyces compresses the nephrons within the meduallary pyramids leading to renal failure
causes enlargement of kidney (water in kidney)
why is acute hydronephritis pain
due to stretching of the renal capsule
what is the false pelvis
from the iliac crests to the pelvic inlet (is still part of the abdominal cavity)
what is the true pelvis
the pelvic cavity (from the pelvic inlet to the pelvic floor)
where is the bladder found
in the pelvic cavity
what is the pelvic floor muscle
levator ani
what does the ureter pass through to get to the perineum
levator ani
what separates the false and true pelvis
the pelvic rim (ridge of bone)
what is the pelvic diaphragm
the pelvic floor
what passes through the pelvic floor
distal parts of alimentary (GI), renal and reproductive tracts
what is the perineum
shallow compartment between the pelvic floor and skin
do ureters pass anterior or posterior to the common iliac vessels to enter the pelvis
anterior - then run anteriorly along the walls of the pelvis
how do the ureters enter the bladder and what is the relevance of this
at level of ischial spine they turn medially to enter the posterior aspect of the bladder (sub peritoneal root) in a inferomedial direction
helps present the reflux of urine back in to the ureters when the bladder contracts to void.
what is the retrovesicle pouch
in anatomical position is the most inferior part of the male peritoneal cavity
where does the ureter common cross the iliac
at its bifurcation (in females)
what is the pouch of douglas
the rectouterine pouch- the most inferior part of the female peritoneal cavity (when in anatomical position (standing)
what is the vesico-uterine pouch
between the bladder and the uterus
what is the round ligament of the uterus
attaches uterus to the perineum via the inguinal canal
does the ureter run superiorly or inferiorly to the uterine tubes and artery/ the vas deferens
runs inferiorly (water under the bridge) to both
where do the arteries in the pelvis mostly branch from
the internal iliacs
where do the veins of the pelvic drain to
the internal iliac vein
what are the main pelvic arteries in women
vesicle (bladder)
uterine
middle rectal
vaginal
what are the main pelvic arteries in men
vas deferens vesical arteries prostatic arteries (branches from the vesical arteries)
what does the common iliac branch into
external (becomes femoral) and internal iliac (supplies pelvic viscera)
what are the three orifices of the bladder and what do the form
2 ureteric orifices
internal urethral orifice
three form triangle shape on internal aspect of the bladder than has smooth surface= the trigone
where are the ureteric orficices
in the base (posterior aspect) of the bladder
where is the internal uretheral orifice
on inferior aspect ‘floor’ of the bladder
where is the prostate
inferior to the bladder
what surrounds the peritoneum
the vesicle peritoneum- makes it a sub peritoneal organ
what is the detrusor muscles and what is its function
contracts to bladder to void
encricles the ureteric orifices and constrict as bladder contracts- prevents reflux or urine
what is the internal urethral sphincter muscle
only in male bladder- at top of urethral orifice
formed from the detrusor muscle
constricts during ejaculation to prevent retrograde ejaculation of semen back into the bladder
what is the most anterior organ in the pelvis
the bladder- lies posterior to the pubic bone (when empty)
where is the body of the uterus in relation to the bladder
superior to it- in an anteflexed position, is separated from the bladder by the uterovesical pouch
most of uterus’ weight is borne by the bladder
where is the trigone
the posterior wall inferiorly (base and floor) of bladder
what is the position of an empty bladder
within the pelvis
peritoneum covers its superior surface only
what is the position of a full bladder
can extend out of the pelvis - its superior part lies lies superior to the pubic bone
peritoneum only covers its superior surface (same as empty)
what are the two catheterisation routes
urethral
suprapubic (only for full bladders)
how long is the female urethra
4cm long
what urethral sphincter is under voluntary control
external urethral sphincter
what other muscle can act as a sphincter for the urethra
the levator ani
how long is the male urethra
20cm
what separates the pelvis and the peritoneum
levator ani muscle
what is the prostatic urethra
the urethra as it passes through the prostate
what is the spongy urethra
the urethra as it passes through the corpus spongiosum (in penis)
where does urine leave the urinary tract in males
external urethral orifice (in meatus of penis)
what is the path of sperm
produced in seminiferous tubules in testes
stored in epididymis
vas deferens- goes through deep inguinal ring into inguinal canal into abdominal cavity
passes behind bladder
joins the seminal gland (where semen produced) to make ejaculatory duct
goes through prostate- joins with prostatic urethra
turns into spongy urethra
leaves via external urethral orifice
at birth where should the testes be
in the scrotum
what is the path of the testes
move from posterior abdomen, through inguinal canal to the scrotum
what does the spermatic cord contain
testicular artery, testicular vein (pampinoform plexus), vas deferens, lymphatic vessels draining testes, nerves- autonomic for smooth muscle of vas and somatic for cremaster muscle
in the scrotum what do the testes sit within
sac called a tunica vaginalis (fist in balloon- has parietal and visceral layer- testes never actually enter the sac)
what is a hydrocele
excess fluid within the tunica vaginalis
what is the paminiform plexus
plexus of veins which acts as venous drainage for the testes
what is torsion
twisting of the spermatic cord - disrupts the blood supply to the testes:
- severe pain
- danger of testicular necrosis
what are the gondal vessels
term for either the testicular/ ovarian arteries and veins
what does the left gonadal vein drain to
the left renal vein
what does the right gonadal vein drain to
the IVC
what do the gonadal veins arise from
the aorta
what passes through the deep inguinal ring
testicular artery, vein (pampiniform plexus drains into this), vas deferens, lymphatics and nerves
where does the vas deferens begin
at the inferior pole of the testes
where is the epidymis palpated
at the posterior aspect of the testes (its head (proximal end) is located at the posterior aspect of the superior pole of the testis)
where is the vas deferens palpated
within the spermatic cord, within the scrotym, superior to the testis
what are the prostatic ducts
through these glandular secretions drain from the prostate into the prostatic urethra
what is the ejaculatory duct
combined duct of the vas deferens and the duct of the seminal gland
how bid should the prostate be
size of a walnut
what part of prostate can you feel in a PR exam
peripheral zone (this is where most prostate cancer arise)
what ‘tubes’ make up the penis
right and left corpus cavernosum (posteriorly- transmit the deep arteries of the penis) corpus spongiosum (anteriorly- transmits the spongy urethera and expands distally to form the glans)
what happens during an erection
the 3 cylinder of erectile tissue becomes engorged with blood at arterial pressure
what is the root of the penis attached to
the ischium (bone) of pelvis
what is the blood supply of the penis
via the deep arteries of the penis- branches of the interbal pudendal artery (from internal iliac)
what is the blood supply to the scrotum
via the internal pudendal and branches from the external iliac artery
where does the lymph of the scrotum and penis (-glans) drain to
superficial inguinal lymph nodes found in the superficial fascia in the groin
where does the lymph from the testes drain to
lumbar nodes around the abdominal aorta
what motor function does the renal system have
ureteric peristalsis
bladder contraction
urethral sphincter control
what is urinary continence
the voluntary control of the elimination of urine from the bladder
what does the lumbar and sacral plexus supply
perineum, distal part of renal system and the lower limbs
what do somatic sensory nerve fibres do
carry sensations from the body wall to the CNS
what so visceral afferent nerve fibres do
convey sensation from our organs to the CNS
what do somatic motor nerve fibres do
motor response to are body wall from the CNS (e.g. stimulate skeletal muscle)
what are the types of visceral efferent nerve fibres
parasymathetic and sympathetic (both carry motor responses)
stimulate smooth muscle (involuntary, cardiac muscle or glands and organs
what controls ureteric peristalsis and bladder contraction
sympathetic/ parasympathetics
what controls urethral sphincter control
both visceral afferent (sympathetic and parasympathetic: internal sphincter as is within pelvis)
and somatic sensory/motor (external sphincter and levator ani as within perineum)
what senses pain from the kidneys,
and ureters
visceral afferent
what senses pain from the urethra
visceral afferent (in pelvis) and somatic sensory (in perineum)
what senses pain from the testis
visceral afferent (somatic sensory also as in perineum)
what controls urinaet continence
symp and parasympathetics
somatic motor
visceral afferent
what does the lumbar a sacral plexus provide
somatic sensory and somatic motor to the perineum and lower limbs
how many pairs of spinal nerves
31
how can a berve communicate with the CNS
by being carried by a cranial or spinal nerve (distance carried by this vary: somatic carried whole time, symp/para carried for limited portions)
what do spinal nerves carry
somatic motor
somatic sensory
sympathetic fibres (innervating the smooth muscle and glands of the body wall)
where and how do sympathetic nerves leave the CNS
within spinal nerves between T1 and L2 (thoracolumbar outflow)
how do sympathetic fibres reach the body wall
within spinal nerves
how do sympathetic nerves reach smooth muscle/ glands (bits other than body wall)
within splanchnic nerves (cardiopulmonary or abdominopelvic)
how do sympathetic nerves reach the muscle/ glands of the head
by following arteries which supply the same structures
how far down spine does the sympathetic chain go
the entire length of the vertebral column (hence able to convey sympathetic fibres into all 31 spinal nerves)
how do sympathetic nerve fibres get from the CNS to the kidneys, ureters and bladder
leave spinal cord between T10 and L2
enter sympathetic chains bilaterall but DO NOT synapse
leave sympathetic chains within abdominopelvic splanchnic nerves
synapse at the abdominal sympathetic ganglia (around the abdo aorta)
post synaptic fibres pass from the ganglia onto the surface of the arteries of target organs = periarterial plexus
what other nerves form periarterial plexuses
parasympathetic and visceral afferent fibres
where do parasympathetics leave the CNS
within 4 cranial nerves and the sacral spinal nerves (craniosacral outflow)
how do parasympathetics reach the smooth muscle/ glands of the body wall
they dont innervate these
how do parasympathetics reach the smooth muscle/ glands of the head and body
via cranial nerves
how do parasympathetic fibres reach the smooth muscles/ glands of the hindgut and pelvic organs
pelvic splanchnic nerves
how do parasympathetic nerve fibres get from the CNS to the kidneys, ureters and bladder
Parasympathetic nerve fibres which innervate the kidneys & ureter are carried within the vagus nerves (CNX)
Parasympathetic nerve fibres which innervate the bladder are carried within the pelvic splanchnic nerves (S2,3,4)
what spinal nerves are the pelvic splanchnic nerves in
S2,3,4
how do parasympathetic fibres reach specific organs
form periarterial plexuses
what parts of renal system are supplied by somatic motor nerve fibres
only those within perineum (body wall)- urethra and external uretheral sphincter and levator ani
where pain from the kidney felt
loin- posterior aspect of the flank region on affected side
where is pain from the bladder usually felt
suprapubic region (midline)
where is pain from the perineal urethra felt
localised within the perineum
where is pain from a calculus affecting the ureter felt
radiation from loin to groin on the affected side
how do visceral afferent nerve fibres get from the kidney to the CNS
run alongside sympathetic fibres to spinal cord
enter between T11 and L1 (why pain is felt in these dermatomes- e.g. posterior loin)
what are the differential diagnosis of loin pain
herpes zoster muscular (most common) vertebra spinal nerve root compression lower lobe pneumonia
how do visceral afferent nerve fibres get from the ureters to the CNS
run along side sympathetic fibres
enter spinal cord between T11 and T2
what are the differential diagnoses of groin pain (ureter pain)
hernias
lymphadenopathy
testicular pathology
how do visceral afferent nerve fibres get from the bladder to the CNS
(nerves that carry pain form superior bladder- touching peritoneum)
run alongside sympathetic fibres back to the spinal cord
they enter the spinal cord between levels T11 – L2
how do visceral afferent nerve fibres get from the bladder to the CNS
(nerves that carry pain form part not touching peritoneum)
travels back with PARAsympathetics to spinal cord S2,3,4
pain can refer to buttocks and gluteal region
what are the differentials for suprapubic pain
hindgut organs (sigmoid diverticulae) other organs e.g uterus
how do visceral afferent nerve fibres get from the proximal uretheras (in pelvis) to the CNS
along side parasympathetics to levels S2,3,4
how do somatic sensory nerve fibres get from the distal uretheras to the CNS
carried with the pudendal nerves to levels S2,3,4
causes well localised pain
what are the differentials for perineal pain
vaginal tear
anal canal fissure
perineal genital ulcers
how do pain fibres from the testes get to the CNS
visceral afferents run alongside sympathetic fibres back to the spinal cord to levels T10-11
pain from scrotum can be felt in localised pattern L1 region)
what are the differentials for scrotal pain
skin lesions
strangulated inguinal hernia
name the pain: dull, achy type pain in the loin (posterior flank)
pain from kidneys
name the pain: loin to groin pain
obstructed ureters
name the pain: dull, achy, suprapubic
bladder
name the pain: localised to peritoneum, sharp
urethera (distal)
name the pain: felt in scrotum, can radiate to the groin and anterior lower abdomen
testis
what nerves are carried in S2,3,4
visceral afferents, parasympathetics, somatic motor, sensory fibres
what is micturition
urine flow
how do you control urine flow
nerves S2-4
(carries visceral afferents)
pudendal (formed from S2,3,4)
pelvic splanchnic (carries parasympathic fibres which have left the CNS with S2,3,4)
what senses the stretch of the bladder
visceral afferent nerve fibres (relay this to CNS via S2,3,4)
what stops us peeing outselves
cerebral inhibition nerve fibres
what causes the detrusor muscle to contract
parasympathetics
what causes the internal uretheral sphincter to relax
parasympathetics
what cause the external urethral sphincter and levator ani to relax
somatic motor
what other muscle contract to help urination
anterolateral abdominal walls contract (somatic motor) to increase intra-abominal pressure
what part of spinal nerves can form plexuses
anterior rami
what makes up the lumbosacral plexus
the lumbar and the sacral plexus
what are the names nerves that emerge from plexuses
spinal nerves (most will contain somatic motor and sensory and sympathetics)
what does the pudendal nerve arise from
sacral plexus S2,3,4
what does the sciatic nerve arise from
from the sacral plexus (nerve roots L4-S3)
what does the lumbar plexus give rise to
iliohypogastric (L1) ilioinguinal (L1) lateral cutaneous nerve of thigh (L2,L3) genitofemoral nerve (L1,L2) femoral nerve (L2 – L4) obturator nerve(L2 – L4)
where does the femoral nerve travel
under inguinal ligament, into anterior compartment of the thigh
what is the path of the obturator nerve
passes through obturator foramen (pelvis) into medial compartment of thigh
what is the path of the sciatic nerve
into posterior compartment of thigh via the gluteal region
splits into tibial and common fibular nerves
what does the tibila muscle supply
posterior compartment of leg and the intrinsic muscles of the foot
what does the superficial fibular nerve supply
lateral compartment of leg
what does the deep fibular supply
anterior compartment of leg
what becomes the saphenous nerve
the femoral
what supplies sensation to the plantar aspect of the foot
tibial nerve
what supplies sensation to the lateral aspect of the foot
sural nerve
what supplies sensation to the first web space
deep fibular nerve
what supplies sensation to the dorsal foot
superficial fibular and saphenous nerve (from femoral)
what stimulates ureteric peristalsis
automatic action (auto rhymicity)
what controls bladder contraction
parasympathetics from S2,3,4 from pelvic splanchnic nerves stimulating detrusor
what causes the internal uretheral sphincter to contract (during ejaculation)
sympathetic stim
what causes the internal urethral sphincter to relax
parasympathetics (allows urine to flow)
what causes the external urethral sphincter to constrict
somatic motor fibres (S2,3,4) within the pudendal
what causes the levator ani to contract
somatic motor fibres (S3,4)
