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My Renal > Anatomy > Flashcards

Anatomy Flashcards

1
Q

What is the urinary tract?

A

all the structures urine passes through from production to excretion

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2
Q

What are the main parts of the urinary tract?

A
  • kidneys make urine
  • ureter drains urine
  • bladder stores/voids urine
  • urethra excretes urine
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3
Q

Where do user urinary tract infections spread?

A

to the kidneys

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4
Q

Where do lower urinary tract infections spread?

A

to the urethra and bladder

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5
Q

Where are the kidneys?

A

in the retroperitoneum

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6
Q

Where are the ureters and bladder?

A

proximal ureters- abdomen
distal ureters- pelvis
bladder- pelvis

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7
Q

Where is the urethra?

A

proximal- pelvis

distal- perineum

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8
Q

What surrounds the kidneys?

A
  • posterior to their own visceral peritoneum
  • enclosed within renal fat
  • surrounded by skeletal muscles
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9
Q

What skeletal muscles are the kidneys surrounded by?

A
  • posterior abdominal wall
  • muscles of back
  • antero-lateral abdominal wall (eg external and internal oblique and transverses abdominis)
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10
Q

What can protect the kidney from trauma?

A

muscle guarding

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11
Q

What is the exact kidney position?

A
  • anterior to the quadrates lumbrum
  • lateral to the psoas major
  • lateral to the vertebral bodies
  • posterior if the floating ribs
  • kidneys are in the L/RUQ
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12
Q

What vertebral bodies do each of the kidneys sit lateral to?

A
  • right= L1-3

- left= T12-L2

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13
Q

What direction do the kidneys move on breathing?

A
  • inferiorly on inspiration

- superiorly on expiration

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14
Q

Where is the hepatorenal recess?

A

between the right kidney and the liver

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15
Q

What is the location of the renal veins compared to the renal arteries?

A

veins are anterior to the arteries

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16
Q

Where does the lymph from the renal system go?

A
  • from the kidneys to the lumbar nodes

- from the ureters to the lumbar and iliac nodes

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17
Q

What is the ureteric arterial blood supply?

A

branches of the renal artery, AA, common iliac, internal iliac and vesical artery

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18
Q

What are the two possibilities for renal artery stenosis?

A
  • combined with infra-renal AAA as both as caused by atherosclerosis
  • due to suprarenal AAA as there is occlusion of the proximal renal artery by aneurysm
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19
Q

What are the main parts of the kidney?

A
  • cortex
  • medulla
  • pyramid
  • capsule
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20
Q

What is the passage of urine?

A

nephron’s collecting duct –> minor calyx –> major calyx –> renal pelvis –> ureter

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21
Q

Where does the passage of urine tube get wider or narrower from collecting duct to ureter?

A

gets wider until constriction at the pelviureteric junction

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22
Q

Where are the other contractions in the path of urine?

A
  • where ureter crosses the anterior of the common iliac artery
  • ureteric orifice (opens into one corner of the trigone on bladder floor)
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23
Q

What are renal stones?

A

renal calculi are formed from urine calcium salts and can obstruct the urinary tract from within

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24
Q

What are the main ways of ureteric obstruction?

A
  • internal obstruction from calculus or clot

- external obstruction from compression eg tumour

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25
Q

What is the response to ureteric obstruction?

A

increased peristalsis proximally so colicky pain

there will be back pressure of the urine

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26
Q

What is renal failure?

A

failure to adequately filter the blood to produce urine

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27
Q

What is hydronephrosis?

A

painful stretching of renal capsule as urine back pressure compresses nephrons so there is renal failure

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28
Q

What is the ureter path?

A
  • from retroperitoneum through false pelvis into the true pelvis
  • through pelvic floor
  • into perineum
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29
Q

What does the pelvic floor do?

A

(made of pelvic diaphragm called levator ani)

separates the pelvic cavity and perineum

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30
Q

Where do the ureters run?

A
  • completely sub-peritoneal
  • turn medially at the level of the ischial spine to enter the posterior bladder
  • enter badder wall in an inferomedial direction
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31
Q

Why do the ureters enter the bladder in the way they do?

A

inferomedially to prevent reflux during bladder contraction

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32
Q

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

A

rectovesicle pouch

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33
Q

What attaches the uterus to the perineum?

A

the round ligament via the inguinal canal

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34
Q

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

A

rectouterine pouch of Douglas

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35
Q

What is the difference in the ureter path in males and females?

A
  • males the ureter runs inferiorly to the vas deferens

- females the ureter runs inferiorly to the uterine tubes and uterine artery

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36
Q

What are the majority of arteries entering the pelvis?

A

branches from the internal iliac artery

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37
Q

What makes up the three points of the trigone?

A

the two superior are the ureteric orifices

the one inferior is the internal urethral orifice

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38
Q

What does the detrusor muscle do?

A
  • bulk of the bladder wall
  • encircles the ureteric orifices to prevent reflex of urine
  • forms the internal urethral sphincter muscle which contracts during ejaculation to stop semen going into the bladder
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39
Q

Where does the bladder sit?

A

the most anteriorly (the uterus in females is above and behind it)

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40
Q

How does the fullness of the bladder change its location?

A
  • empty bladder lies in the pelvis

- full bladder extends our of the pelvis above pubic bone

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41
Q

What covers the surface of the bladder?

A

the peritoneum only ever covers the superior surface

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42
Q

What is the length of the urethra?

A

female is 4cm

male is 20cm

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43
Q

What are the

A

prostatic
membranous
penile/spongy

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44
Q

Where do the testis develop?

A

next to the kidneys and descend through the inguinal canal to the scrotum

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45
Q

Where do the testis sit in the scrotum?

A

in a sac called the tunica vaginalis (like a fist in a balloon)

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46
Q

What is a hydrocele?

A

excess fluid in the tunica vaginalis of the testes

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47
Q

What is included in the spermatic cord?

A
  • vas deferens= transports sperm
  • testicular artery= supplies oxygenated blood to testis
  • pampiniform plexus= drain gin deoxygenated blood from testis
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48
Q

What does twisting of the spermatic cord cause?

A

severe pain and danger of testicular necrosis

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49
Q

What is in the deep inguinal ring?

A
  • testicular artery and vein (pampiniform plexus drains into this)
  • vas deferens
  • lymphatics
  • nerves
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50
Q

What are the palpable structures in the testis?

A
  • vas deferens begins at the inferior pole of the testis and can be palpated superiorly to the testis
  • epididymus can be palpated posteriorly to the testis
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51
Q

What is the path of sperm?

A
  • sperm develops in the seminiferous tubules of testes
  • epididymus
  • vas deferens
  • through abdominal wall in inguinal canal to pelvic cavity
  • connects with seminal gland to become ejauclatory duct
  • R and L with prostate gland drain into urethra
  • opens at external urethral meatus
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52
Q

Where is the prostate gland?

A
  • inferior to bladder
  • walnut sized gland around the prostatic urethra
  • inferiorly is the levator ani
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53
Q

What part of the prostate is felt on palpation PR?

A

the peripheral zone which is where cancers arise usually

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54
Q

What is the root of the penis attached to?

A

the ischium of the pelvis

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55
Q

What are the parts of the penis inside?

A
  • right and left corpus cavernous transmit the deep arteries of the pelvis
  • corpus spongiosum transmits the spongy urethra and expands distally to from the glans
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56
Q

What happens to the three penile cylinders during erection?

A

they become engorged with blood at arterial pressure

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57
Q

What is the penis blood supply?

A
  • deep arteries of the penis

- branches of the internal pudendal artery (from internal iliac)

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58
Q

What is the scrotal blood supply?

A
  • internal pudendal

- external iliac branches

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59
Q

Where does lymph from the scrotum and the penis (not glans) go?

A

drains to superficial inguinal lymph nodes in groin superficial fascia

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60
Q

Where does the lymph from the testis go?

A

drains to the lumbar nodes around the abdominal aorta

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61
Q

What is the sensory supply to the body wall?

A

to CNS by somatic sensory nerve fibres

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62
Q

What is the sensory supply to the organs?

A

to CNS by visceral afferent nerve fibres

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63
Q

What is the motor supply to the body wall?

A

conveyed from CNS by somatic motor nerve fibres and stimulate skeletal muscles to contract

64
Q

What is the motor supply to the organs?

A

from CNS by nerve fibres called sympathetics and parasympathetics

65
Q

What is the general rule for sensory supply to the pelvis and perineum?

A
  • pelvis is visceral afferent

- perineum is somatic sensory

66
Q

What does ureteric peristalsis and bladder contraction?

A

sympathetic and parasympathetic

67
Q

What does urethral spinster control?

A
  • sympathetic and parasympathetic (internal sphincter)

- somatic motor (external sphincter and levator ani)

68
Q

What does renal system sensory pain?

A

visceral afferent (but urethra in perineum is somatic sensory)

69
Q

Where do sympathetic nerve fibres leave the CNS and how do they get to where they need to be?

A

between T1-L2

  • reach body wall within spinal nerves
  • reach smooth muscle/glands of body within splanchnic nerves
  • reach head by hitching a ride on arteries
70
Q

What do spinal nerves contain?

A

somatic motor and sensory fibres and sympathetic fibres for smooth muscle and glands of body wall

71
Q

How do the sympathetic nerves get to the renal system?

A
  • leave spinal cord at T10-L2
  • enter and then leave the sympathetic chains via abdominopelvic splanchnic nerves
  • synapse at abdominal sympathetic ganglia around the AA
  • postsynaptic fibres run along arteries in periarterial plexuses along with parasympathetic and visceral afferent fibres
72
Q

How do the parasympathetic fibres get to the renal system?

A
  • leave CNS by 3,7,9+10 and sacral nerves
  • reach the handout and pelvic organs via pelvic splanchnic nerves
  • from kidney to ureters= CNX
  • to bladder= S2-4
  • they then use peri-arterial plexuses to move back
73
Q

Where do the somatic fibres go to in the renal system?

A

the perineum so the urethra end, its sphincter and levator ani

74
Q

Where does kidney pain get felt?

A

posterior flank on affected side as a dull/achy pain

75
Q

Where does pain from calculus in ureter get felt?

A

radiated from loin to groin of affected side

76
Q

Where does bladder pain get felt?

A

midline suprapubic which is a dull/achy pain

77
Q

Where does perineal urethra pain get felt?

A

localised to the perineum and is a sharp pain

78
Q

Where does testis pain get felt?

A

in scrotum and can radiate to groin and anterior lower abdomen

79
Q

How do visceral afferents go back to the CNS from the kidneys?

A

with sympathetics back to T11-L1 (with a common differential of muscular pain)

80
Q

How do visceral afferents go back to the CNS from the ureters?

A

to T11-L2

81
Q

How do visceral afferents go back to the CNS from the bladder?

A
  • touching the peritoneum: with sympathetics to T11-L2

- rest of the bladder: with parasympathetics back to S2-4

82
Q

How do the visceral afferents from the proximal urethra get back to the CNS?

A

with the parasympathetics back to S2-4

83
Q

How do the somatic sensory fibres from the distal urethra go back to the CNS?

A

within pudendal nerve to S2-4

84
Q

How do visceral afferents from the testis get back to the CNS?

A

with sympathetics to T10-11 (pain can also present localised to the scrotum due to the close relationship with the scrotal/body wall)

85
Q

What do S2-4 nerves carry?

A

visceral afferents, parasympathetics, somatic motor and somatic sensory so they control urine flow

86
Q

What is the first part of the urination reflex (needing to pee part)?

A
  • bladder fills and visceral afferents detect this
  • relayed to the CNS by S2-4
  • reflex to empty bladder by detrusor stimulation and internal sphincter inhibition (in males)
  • brain overrides this reflex
87
Q

What is the second part of the urination reflex (peeing part)?

A
  • detrusor contracts (P)
  • internal urethral sphincter (P), external urethral sphincter + levator ani (somatic motor) relax
  • anterolateral abode wall muscles contract to increase intra-abdominal pressure and force urine out (somatic motor)
88
Q

What nerves arise from the sacral plexus?

A
  • pudendal from S2-4

- sciatic from L4-S3

89
Q

How is ureteric peristalsis regulated?

A

auto-regulated by ureteric cells

90
Q

How is bladder contraction done?

A

parasympathetic fibres S2-4

91
Q

In males, what controls the internal urethral sphincter?

A
  • sympathetic to contract during ejaculation

- parasympathetic to relax for urinating

92
Q

How is the external urethral sphincter operated?

A

somatic motor with S2-4 for contraction

93
Q

How is the levator ani operated?

A

somatic motor within nerve to levator ani (S3-4) for contraction

94
Q

Why does the left kidney lie higher than the right?

A

the right is below the liver

95
Q

What level is the hilum at?

A
  • left is at L1

- right is at L1/L2

96
Q

What is in the renal hilum?

A
  • renal pelvis is posterior
  • renal artery is middle
  • renal vein is anterior
  • lymphatics
  • nerves
  • renal sinus fat
97
Q

Why is the left renal vein longer than the right?

A

it passes across the aorta anteriorly to join the right sided IVC

98
Q

What are the strengths of US for imaging the kidney?

A
  • renal size
  • cortical scarring
  • doppler
  • distension of pelvicalyceal system
  • calculi
  • detection of renal abnormalities
  • cheap
99
Q

What are the weaknesses of US for imaging the kidneys?

A
  • user dependent!
  • limited characterisation of focal lesions
  • no licensed contrast medium (micro-bubble contrast only licensed for hepatic US use)
100
Q

What are the strengths of CT for imaging the kidney?

A
  • quick
  • multi-phasic assessment of kidney
  • vascular assessment
  • characterises most pathologies
  • high spatial resolution
  • multiplanar imaging possible
101
Q

What are the weaknesses of CT for imaging the kidneys?

A
  • high dose ionising radiation

- contrast induced nephropathy

102
Q

What is seen on CT pre-contrast in the kidney?

A

calculi best

103
Q

What is seen 25-70s after contrast has been injected on CT?

A

cortical enhancement (corticomedullary)

104
Q

What is seen 80-180s after contrast has been injected on CT?

A

renal medulla and cortex equally (nephrographic)

105
Q

What is seen 5-15m after contrast has been given on CT?

A

opacification of the renal collecting system and ureters

106
Q

What is contrast induced nephropathy?

A
  • impairment of renal function occurs within 3 days following contrast
  • rise in serum creatinine and urea
107
Q

What are the risk factors for contrast induced nephropathy?

A
  • renal impairment - +/- diabetes mellitus
  • dehydration
  • congestive heart failure
  • LV ejection fraction < 40%
  • acute MI (within 24 hours)
    nephrotoxic drugs
108
Q

What are the strengths of MRI for kidney imaging?

A
  • excellent tissue contrast resolution
  • renal lesion characterisation
  • vascular assessment
  • characterises most pathologies
109
Q

What are the weaknesses for MRI for kidney imaging?

A
  • lengthy acquisition

- nephrogenic systemic fibrosis

110
Q

Where are the three anatomical locations where the ureters narrow in diameter?

A
  • pelviureteric junction (PUJ)
  • ureter enters the pelvis and crosses over the common iliac artery bifurcation
  • vesicoureteric junction (VUJ) as ureter enters bladder
111
Q

Where does the ureter enter the pelvis?

A

at bifurcation of common iliac artery

112
Q

What is the CT urogram used for?

A

assessing the collecting system, ureters and bladder

113
Q

What is the commonest imaging for the bladder?

A

US with a full bladder

114
Q

What is the best imaging for a tear in the bladder wall?

A

cystography to see leak

115
Q

What can CT urogram for the bladder by used for?

A
  • visualising the whole collecting system

- nodal and metastatic disease staging

116
Q

What is the gold standard for local staging of bladder wall tumours?

A

MRI

117
Q

What is urethrogram used for?

A

strictures, trauma and diverticula in the urethra

118
Q

What is US used for in genital imaging?

A
  • testes/scrotum
  • uterus and ovaries
  • prostate biopsies
119
Q

What is hysterosalphinogram used for?

A
  • infertility and tubal patency

- uterine abnormalities

120
Q

What is MRI used for in genital imaging?

A
  • prostate cancer local staging

- abnormalities not seen properly on US

121
Q

What do the kidneys reabsorb?

A
  • fluid
  • salt
  • glucose
  • amino acids
  • urea
122
Q

What is in the glomerular filtrate?

A

blood without RBCs and large plasma proteins

123
Q

What is reabsorbed into the blood in the PCT?

A

glucose, amino acids, salt, water, (phosphate, sulphate and lactate)

124
Q

What is secreted in to the nephron in the PCT?

A

H+, hippurates, neurotransmitters, bile pigments, uric acid, drugs and toxins

125
Q

What is the difference between transcellular and paracellular reabsorption?

A
  • transcellular: reabsorption across the cell layer that makes up the wall of the nephron
  • paracellular: varies upon how tight/leaky the nephron is
126
Q

What does secondary active transport need?

A

uses sodium ion gradient to move substances

127
Q

Where is Na+ reabsorbed into blood?

A

everywhere except the descending loop of Henle

128
Q

How is salt reabsorbed in the PCT?

A
  • Na+ comes into the cell with glucose or with amino acids or through a H+ exchange
  • Na+ then goes out of cell by K+ exchange
  • H20 and moves down osmotic cell in same direction as Na+
  • Cl- is reabsorbed passively through the paracellular route due to electrochemical gradient
129
Q

How is glucose absorbed in the PCT?

A
  • cotransport of Na+ and glucose into cell
  • facilitated diffusion of glucose out of cell
  • K+Na+ pump makes the Na+ gradient by pumping it out
  • water moves by osmosis
130
Q

Where is all the glucose that is filtered from the blood reabsorbed?

A

PCT

131
Q

What happens in the ascending limp of the loop of Henle?

A
  • no H20 reabsorption
  • Na+ and Cl- reabsorption
    there is decreasing concentration as you go up the limb
132
Q

What happens in the descending limp of the loop of Henle?

A
  • no NaCl reabsorption
  • highly permeable to H2O
    there is increasing concentration as you go down the limb
133
Q

Where is the highest and lowest osmolarity in the nephron?

A

high osmolarity in the medulla

low osmolarity in the cortex

134
Q

What substance also contributes to the concentration gradient in the loop of Henle?

A

urea adds solute to the interstitial fluid

135
Q

What is normal urine output?

A

1ml/min (can be 0.3-25ml/min depending on ADH)

136
Q

What adaptation does the vasa recta have to maintain gradient?

A

countercurrent exchange system to maintain gradient but passive exchange so the solute is not washed away

137
Q

What action does ADH have on the collecting duct?

A

increases water reabsorption

138
Q

What action does aldosterone have on the collecting duct?

A

increases Na+ reabsorption and increases H+/K+ secretion

139
Q

What actions do ANH and PTH have on the collecting duct?

A 
ANH= decrease in Na+ reabsorption 
PTH= increase in Ca2+ reabsorption and decrease in PO42- reabsorption
140
Q

What happens in the early DCT?

A

Na+K+2Cl- for NaCl reabsorption

141
Q

What happens in the late DCT?

A
  • Ca2+ reabsorption and H+ secretion

- Na+ and K+ reabsorption depending on aldosterone

142
Q

What is the permeability of the late collecting duct?

A

low ion permeability and a permeability to water dependent on ADH

143
Q

What detects dehydration?

A

hypothalamic osmoreceptors detect dehydration

ADH is made in hypothalamus and secreted from posterior pituitary

144
Q

What does ADH do?

A
  • vasopressin binds to receptor and ATP is made into cAMP
  • aquaporins are inserted into the membrane
  • more water is reabsorbed
145
Q

What change does ADH bring about in the urine?

A
  • high ADH= hypertonic urine, small volume of urine with high osmolality
  • low ADH= hypotonic urine, large volume of urine with low osmolarity
146
Q

What happens if the collecting duct goes into the medulla?

A

water is lost and fluid becomes concentrated (!if there is little ADH there are no aquaporins so cells of DCT and collecting duct are impermeable to water)

147
Q

What happens to ADH when there is hypovolaemia or hypotension?

A

activation of left atrial volume receptors (stretch receptors) so increase in ADH

148
Q

What extrinsic substances change ADH levels?

A

nicotine stimulates ADH

alcohol inhibits ADH

149
Q

What and how does aldosterone have an action?

A
  • secreted by adrenal cortex
  • in response to high K or low Na or activation of renin
  • slow acting
  • causes Na reabsorption and K secretion
  • INCREASE in BP
150
Q

What does an increase in [K+] stimulate?

A

directly stimulates adrenal cortex so there is K+ secretion

151
Q

What does a decrease in [Na+] stimulate?

A

indirectly stimulates secretion of aldosterone by juxtaglomerular apparatus

152
Q

What causes renin to be released from granular cells?

A
  • decreased BP in afferent arteriole
  • macula dense cells sense decrease in NaCl
  • increased sympathetic activity due to low arterial BP
153
Q

How does aldosterone decrease sodium?

A
  • increases the number of basolateral NaK pumps and increases their activity to reabsorb more sodium
  • increases expression of apical Na so more Na into cells
154
Q

Why is a low sodium diet and a loop diuretic given in HF?

A
  • low CO and BP
  • high aldosterone
  • salt and water retention
155
Q

What hormone is secreted when the atrium is stretched due to high BP?

A

ANP which causes excretion of Na+ so water leaves and there is decreased plasma volume

My Renal (8 decks)

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