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Renal > Anatomy > Flashcards

Anatomy Flashcards

1
Q

What are the four components of the urinary tract? Describe the function of each component.

A

The kidney- produces urine
The ureter- drains urine (from the kidney to the bladder)
The bladder- stores/ voids urine
The urethra- excretion of urine (and semen in males)

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2
Q

Describe the components of the upper and lower urinary tracts?

A

UPPER:
the 2 kidneys and 2 ureters

LOWER:
the bladder and urethra

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3
Q

Where is each component of the urinary tract located?

A

Kidneys and the proximal ureters in the abdomen specifically the retro peritoneum
Distal ureters, bladder and proximal urethra in the pelvis
The distal urethra in the perineum

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4
Q

Name 4 retroperitoneal structures?

A

1) Kidneys
2) Adrenal glands
3) Pancreas
4) Ascending and Descending Colon

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5
Q

Name 5 intraperitoneal structures?

A

1) Caecum, sigmoid and transverse colon
2) Liver and gall bladder
3) Stomach
4) Spleen
5) 1st part of duodenum, ileum and jejunum

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6
Q

What are the three structures of the renal hilum?

A

The renal artery, vein and ureter

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7
Q

Location of the adrenal glands?

A

Sit superiorly and medially on the superior pole of the kidney

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8
Q

The kidneys lie anterior to ________ & lateral to _________

A

quadratus lumborum

psoas major

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9
Q

What vertebral level do the two kidneys lie at? Why is it different on either side?

A

due to the size of the liver the right kidney lies at a slightly inferior vertebral level (L1 - L3 vertebrae) than the left kidney (T12 - L2 vertebrae)

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10
Q

The kidneys move ___1__ on inspiration and __2__ on expiration

A

1) inferiorly

2) superiorly

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11
Q

The kidneys are supplied with blood by the ________ which branch off the abdominal aorta at level ______ The renal arteries lie ______ to the renal veins

A

renal arteries
L1/2
posterior

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12
Q

Describe lymphatic drainage of the kidneys?

A

the lymph from the kidneys drains to the lumbar nodes (located around the abdominal aorta and inferior vena cava)

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13
Q

The ureter blood supply is from branches from five places which are?

A

the renal artery, the abdominal aorta, the common iliac artery, the internal iliac artery, the vesical (bladder) artery

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14
Q

Describe lymphatic drainage of the ureter?

A

the lymph from the ureters drains to the lumbar nodes & the iliac nodes (the latter located around the common, internal & external iliac vessels)

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15
Q

Each kidney consists of ______1________

The renal medulla is split up into a number of sections known as _____2______

A

1) an outer cortex and an inner medulla

2) renal pyramids

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16
Q

What gives renal pyramids their striped appearance?

A

The regularly arranged nephrons

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17
Q

Describe the pathway of urine draining from within the kidney?

A 
Nephron collecting duct
Minor calyx
Major calyx
Renal pelvis
Ureter

Each tube gets wider until there is a constriction at the pelviuretic junction as the ureter is narrower than the renal pelvis

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18
Q

Each kidney is enclosed in a ________

A

fibrous capsule

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19
Q

At what level is the renal hilum?

A

L1

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20
Q

What is the perineum?

A

Shallow compartment between the pelvic floor and skin

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21
Q

What forms the pelvic floor?

A

pelvic floor muscles > mainly the levator ani muscle

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22
Q

What are there openings in the pelvic floor for?

A

distal parts of alimentary, renal and reproductive tracts to pass through from pelvic cavity into the perineum

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23
Q

What type of muscle is levator ani? What 3 parts is it made up of?

A

Skeletal
Pubococcygeus
Iliococcygeus
Puborectalis

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24
Q

The levator ani muscle is supplied by what 2 nerves?

A

Nerve to levator ani and the pudendal nerve

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25
Q

Pudendeal nerve is made by coming together ______

A

S2,3 and 4 nerve roots

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26
Q

The ureters pass ___1____ to the common iliac vessels to enter the pelvis. They run ___2_____ along the lateral walls of the pelvis. At the level of the ischial spine, they turn ___3___ to enter the ___4____ aspect of the bladder

A

1) anterior
2) anteriorly
3) medially
4) posterior

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27
Q

The ureters enter the posterior bladder wall in an ____1_____ direction helps __________2_________

A

1) inferomedial

2) prevent reflux of urine back into the ureters when the bladder contracts

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28
Q

What forms the most inferior part of the male peritoneal cavity?

A

The rectovesical pouch

The pouch between the bladder at the front and the rectum at the back

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29
Q

What forms the most inferior part of the female peritoneal cavity?

A

The rectouterine pouch

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30
Q

The ureter runs inferiorly to the ____ in females

A

uterine tubes and arteries

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31
Q

The ureter runs inferiorly to the _____ in males

A

vas deferens

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32
Q

Describe the bladder trigone?

A

the 2 ureteric orifices (base posterior part of bladder) and the internal urethral orifice (inferior part of bladder) form the 3 corners of a triangle shape on the internal aspect of the bladder called the “trigone”

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33
Q

The muscle which forms the main bulk of the bladder wall is called the ______

A

detrusor muscle

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34
Q

Detrusor muscle fibres encircle the ureteric orifices, these fibres __1___ when the bladder contracts: another mechanism to _____2_______

A

1) tighten

2) prevent reflux of urine superiorly into the ureter

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35
Q

What is the most anterior organ in the pelvis?

A

The bladder

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36
Q

In the female, the body of the uterus usually lies ___1____ to the bladder in an ____2_____, it is separated from the bladder by the ____3_______. As a result ___________4_____________

A

1) superior
2) ante-flexed (ie the uterus is above but behind the bladder it kind of curves over the top)
3) uterovesical pouch
4) most of the weight of the uterus is borne by the bladder

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37
Q

In the male, the prostate gland lies ___1____ to the bladder and the ____2____ to the rectum

A

1) inferior

2) anterior

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38
Q

Describe an empty bladder vs a full bladder?

A

an empty bladder lies within the pelvis
peritoneum covers its superior surface only

a full bladder can extend out of the pelvis: its superior part lies superior to the pubic bone
peritoneum still only covers its superior surface

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39
Q

2 routes of catheterising a patient?

A

urethral (more common) & suprapubic (through anterior abdominal wall & avoiding peritoneal cavity)

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40
Q

The female urethra is approximately ____ long

A

4cm

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41
Q

During embryological and fetal development the testes move from their original position __________________

A

in the posterior abdomen, through the inguinal canal to the scrotum

42
Q

Describe the spermatic cord and what it contains?

A

Contains vas deferens which transports sperm
Testicular artery which supplies the testes with oxygenated blood
The pampiniform venous plexus which drains deoxygenated blood from the testes

43
Q

Inside the scrotum, the testis sit within a sac called the ____________

A

tunica vaginalis

44
Q

Where is sperm produced?

A

In the seminiferous tubules located within the testes

45
Q

Sperm are produced in _____1_____, the sperm then pass to ____2____, then into ____3____, the __4___ then becomes _____5______

A 
1 seminiferous tubules
2 rete testis
3 head of epididymis
4 epididymis
5 vas deferens
46
Q

Describe the route of sperm once it leaves the testes?

A

From the testes the sperm passes into the epididymis into the vas deferens which passes superiorly within the spermatic cord to the deep inguinal ring. At the deep inguinal ring the vas deferens turns medially into the pelvis. The vas deferens joins with the duct of the seminal vesicle to form the ejaculatory duct which opens into the prostatic urethra. The prostatic urethra also contains prostatic ducts through which the glandular secretions from the prostate drain into the prostatic urethra.

47
Q

What are the components of semen?

A

Sperm, prostatic fluid and seminal fluid

48
Q

The root of the penis is laterally attached to what bone of the pelvis?

A

Ischium

49
Q

Describe the 3 cylinders of erectile tissue in males?

A

the corpora cavernosa which are two cylinders lying side by side on the dorsal side and corpus spongiosum, a single cylinder on the ventral side (the underside of penis when not erect) which contains the urethra

50
Q

What happens to the erectile tissues during erection?

A

become engorged with blood at arterial pressure during

51
Q

Blood supply to the penis is via_____1_______ branches of the _______2_________

A

1) the deep arteries of the penis

2) internal pudendal artery (from the internal iliac)

52
Q

Blood supply to the scrotum is via the __________________

A

internal pudendal and branches from the external iliac artery

53
Q

Lymph from the scrotum & most of the penis (not the glans) drains to __________________________

A

the superficial inguinal lymph nodes found in the superficial fascia in the groin

54
Q

Lymph from the testis drains to _________________

A

drains to the lumbar nodes around the abdominal aorta

55
Q

The male urethra is approximately ________

A

20 cm

56
Q

Describe the 5 modalities of nerve fibres

A

somatic sensory – sensory for body wall
Somatic motor – motor to body wall muscles
Visceral afferent – sensory for organs
Parasympathetic – motor to organs, smooth muscle and glands
Sympathetic - motor to organs, smooth muscle and glands

57
Q

Normal ureteric peristalsis and bladder contraction is controlled by what nerve modalities?

A

Parasympathetic and sympathetic

58
Q

Describe the nerve modalities controlling urethral sphincter control?

A

Internal sphincter - parasympathetic and sympathetic

External sphincter and levator ani- somatic motor

59
Q

What nerve modalities conveys renal system pain? This includes the kidneys, ureter, bladder, urethra and testes.

A

Visceral afferents

Note the part of urethra in the perineum and parts of the testes will be somatic sensory

60
Q

The only means by which any type of nerve fibre can communicate with the central nervous system is by being carried within _______________

A

cranial nerves or spinal nerves

61
Q

How does it differ how somatic vs autonomic system uses cranial and spinal nerves?

A

Somatic motor and sensory are carried the entire length, from origin to destination, within these
Sympathetic and parasymapthetic and visceral afferents use them for limited portions to get in and out of CNS

62
Q

Sympathetic nerve fibres leave the CNS only within the spinal nerves between spinal cord levels _____

A

T1-L2

Thoracolumbar output!

63
Q

Sympathetic fibres reach the smooth muscle/glands of the body wall (other than the head) _____1_______

They reach the smooth muscle/glands of the body (other than the body wall) within nerves called ______2________

They reach the smooth muscle/glands of the head mainly by following _______3_____________

A

1) within the spinal nerves
2) splanchnic nerves – cardiopulmonary or abdominopelvic
3) (“hitching a ride with”) the arteries which supply the same structures

64
Q

Sympathetics leave the spinal cord at ___1___ but the sympathetic chain runs ___2_____ hence sympathetic fibres _____3______

A

1) T1-L2
2) entire length of spinal column
3) can be conveyed into all 31 pairs of spinal nerves

65
Q

Overview of how sympathetic nerve fibres get from the CNS to the kidneys, ureter and bladder?

A

Leave the spinal cord approx. between levels T10 and L2
Enter the sympathetic chains (bilaterally) but do not synapse
Leave the sympathetic chains within abdominopelvic splanchnic nerves
Synapse at the abdominal sympathetic ganglia which are located around the abdominal aorta
Postsynaptic sympathetic nerve fibres pass from the ganglia onto the surface of the arteries which are heading towards the organs they need to innervate.
The collection of nerve fibres found on the outside of the arteries is called a “periarterial plexus” (note other nerve fibre types also take part in these plexuses)

66
Q

Sympathetic nerve fibres for the kidneys bladder and ureter leave the spinal cord approximately between _____

A

T10 and L2

67
Q

Sympathetic nerve fibres for the kidneys bladder and ureter enter the sympathetic chains but ___1___ and leave the sympathetic chains within ____2_____

A

1) do not synapse

2) abdominopelvic splanchnic nerves

68
Q

Sympathetic nerve fibres for the kidneys ureter and bladder synapse at ______

A

abdominal sympathetic ganglia (located around the abdominal aorta)

69
Q

Parasympathetic nerve fibres leave the CNS only ______

A

within 4 cranial nerves (3,7,9 and 10) and in sacral spinal nerves
craniosacral outflow!

70
Q

Parasympathetic fibres _____1____ the smooth muscle/glands of the body wall

Parasympathetic fibres reach the smooth muscle/glands of the head and body via ___2_____

Specifically, parasympathetic fibres reach the smooth muscle/glands of the hindgut and pelvic organs via ____3______

A

1) do not innervate
2) cranial nerves
3) sacral spinal then pelvic splanchnic nerves

71
Q

Parasympathetic nerve fibres which innervate the kidneys & ureter are carried within ___________

A

the vagus nerves (CNX)

72
Q

Parasympathetic nerve fibres which innervate the bladder are carried within ______________

A

the pelvic splanchnic nerves (S2,3,4)

73
Q

Parasympathetics from both vagus and sacral spinal nerves reach organs via ______________

A

periarterial plexus, just like sympathetics.

74
Q

Describe and explain what parts of the renal system somatic fibres innervate?

A

the only parts of the renal system that somatic fibres go to are those within the perineum, e.g the urethra (distal to the pelvic floor) and its sphincter (external urethral sphincter and levator ani)

75
Q

Describe where and how pain from the kidney will be felt?

A

pain from the kidney itself is felt in the “loin”: posterior aspect of the flank region, on the affected side
Dull, achy type of pain (visceral)

76
Q

Describe where and how pain from the ureter will be felt?

A

Pain can be perceived anywhere along T11- L2 (as visceral afferents run alongside the sympathetic fibres)
If obstruction colicky pain that comes and goes
Loin to groin pain

77
Q

Describe where and how pain from the bladder will be felt?

A

Top part of bladder in contact with peritoneum travel with sympathetics back to T11-L so pain is felt in suprapubic region. Lower part of bladder travel with parasympathetics back to S2,3,4 (can sometimes result in referred pain to buttocks and gluteal region)

Pain tends to be dull achy suprapubic pain however.

78
Q

Describe where and how pain from the urethra will be felt?

A

visceral afferents from the proximal urethra (i.e. above the levator ani and in the pelvis) run alongside the parasympathetic nerve fibres back to spinal cords levels S2,S3,S4 so this pain is non-specific visceral pain.
somatic sensory nerve fibres from the remaining urethra are carried within the pudendal nerve also back to spinal cord levels S2,S3,S4. Pain from this part of the urethra will present as a localised pain within the perineum.

79
Q

Describe where and how pain from the testes will be felt?

A

due to its embryological descent, visceral afferents run alongside sympathetic fibres back to the spinal cord to levels T10-11
however, due to its close relationship to the scrotal wall (body wall), pain from the testis can also present localised to the scrotum and/or groin (L1 region)

in summary: Pain from testes referred to lower abdomen due to visceral afferents accompanying sympathetics back to T10-11. Pain from scrotum (body wall structure) is felt in a well localised pattern.

80
Q

The nerve fibres entering and leaving spinal cord levels ______ are key in the control of micturition. These contain _____________ fibres which are all important

A 
S2-4
Visceral afferents
Parasympathetics 
Somatic Motor
Somatic sensory
81
Q

Describe how urinary continence is achieved

A

As the bladder fills, this is sensed by stretch receptors at the end of visceral afferent nerve fibres
This information is relayed to the CNS via S2,S3,S4 spinal cord levels
There is a reflex at this point to empty the bladder by stimulation of the detrusor muscle and inhibition of the internal sphincter muscle
However in those infants who have been “potty trained” along with children and adults, the brain overrides this reflex; action potentials within inhibitory nerve fibres from the cortex pass inferiorly and inhibit this reflex. We can also voluntarily contract the external sphincter and levator ani muscles.

Once it is appropriate to micturate:
The cerebral inhibition of this reflex is lifted and there is a co-ordinated contraction/relaxation of various muscles:
The detrusor muscle contracts (parasympathetic)
The internal urethral sphincter (parasympathetic), external urethral sphincter and levator ani muscles relax (somatic motor)
The anterolateral abdominal wall muscles contract to increase intra-abdominal pressure and force urine out of the external urethral orifice (somatic motor nerve fibres)

82
Q

Describe nerves associated with ureteric peristalsis?

A

thought to be an automatic action initiated and propagated by ureteric cells which have their own in-built auto-rhymicity (akin to the GI tract muscle cells) rather than being directed by the sympathetic/parasympathetic nerve fibres

83
Q

Describe nerves associated with bladder contraction?

A

parasympathetic fibres (from S2,S3,S4 via the pelvic splanchnic nerves) stimulate the detrusor muscle to contract

84
Q

Describe nerves associated with the urethral sphincters and levator ani muscle?

A

sympathetic fibres stimulate the internal urethral sphincter muscle to contract (this occurs during ejaculation)
parasympathetic fibres inhibit (relax) the internal urethral sphincter muscle to allow urine to flow through the urethra
somatic motor fibres within the pudendal nerve - S2,S3,S4 - stimulate the external urethral sphincter muscle to contract
somatic motor fibres within the nerve to levator ani (S3,S4) stimulate the levator ani muscle to contract

85
Q

The filling of the bladder is sensed by _____1____ and relayed to the CNS by ___2____ causing a reflex which __3____ This can be overridden voluntarily by ___4_____

A

1) visceral afferents
2) S2,3 and 4
3) empty the bladder by stimulation of the detrusor muscle and inhibition of the internal sphincter muscle
4) the brain and then can also voluntarily contract the external urethral sphincter and the levator ani muscle

86
Q

What type of fibres stimulate contraction of the internal urethral sphincter and why?

A

ONLY IN MALES
Sympathetic fibres contract the sphincter during ejaculation to prevent reflux of semen into the male bladder during ejaculation

87
Q

What type of fibres stimulate relaxation of the internal urethral sphincter and why?

A

parasympathetic fibres reflexively inhibit (relax) the internal urethral sphincter muscle to allow urine to flow through the urethra

88
Q

What type of fibres stimulate the external urethral sphincter muscle to contract?

A

somatic motor fibres within the pudendal nerve - S2,S3,S4

89
Q

What type of fibres stimulate the levator ani muscle to contract?

A

somatic fibres within the nerve to levator ani (S2,3 and 4)

90
Q

Describe what happens during micturition and the nerve fibres associated with this?

A

The detrusor muscle contracts (parasympathetic)
The internal urethral sphincter (parasympathetic), external urethral sphincter and levator ani muscles relax (somatic motor)
The anterolateral abdominal wall muscles contract to increase intra-abdominal pressure and force urine out of the external urethral orifice (somatic motor nerve fibres)

91
Q

Name two important nerves that arise from the sacral plexus?

A

The sciatic nerve

The pudendal nerve

92
Q

The sciatic nerve arises from the ____1________. This is an extremely important nerve which innervates _________2____________

A

1) sacral plexus (nerve roots L4-S3)

2) a large number of muscles and skin in the lower limb

93
Q

The pudendal nerve arises from the _________________

A

the pudendal nerve is formed from S2,S3,S4

94
Q

The lumbar plexus gives rise to named nerves that supply the lower limb which are __________

A 
iliohypogastric (L1)
ilioinguinal (L1)
lateral cutaneous nerve of thigh (L2,L3)
genitofemoral nerve (L1,L2)
femoral nerve (L2 – L4)
obturator nerve(L2 – L4)
95
Q

The femoral nerve arises from the ________ nerve roots ______ travels ________ and supplies ________

A

lumbar plexus
L2-4
under the inguinal ligament
anterior compartment of the thigh

96
Q

The obturator nerve arises from the ________ nerve roots _______ and passes through the __________ to supply the ___________

A

lumbar plexus
L2-4
obturator foramen
medial compartment of the thigh

97
Q

The sciatic nerve arises from the _______ nerve roots _______ and passes into the __________

It divides into the ______________
The common fibular nerve divides again into the ________

A 
sacral plexus
L4-S3
posterior compartment of thigh via the gluteal region 
tibial and common fibular nerve
superficial and deep fibular nerve
98
Q

Describe the true pelvis vs the false pelvis

A

the false pelvis
from iliac crests to pelvic inlet
part of the abdominal cavity

the true pelvis (pelvic cavity)
pelvic inlet to pelvic floor

99
Q

Medullary pyramids have a round apex called a ___1__ which drains into ___2___

A

1) papilla

2) minor calyx

100
Q

What are the three parts of the male urethra?

A

prostatic urethra, membranous urethra, and spongy (or penile) urethra

Renal (19 decks)

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