Anatomy

Question 1

what does the urinary tract consist of?

Answer 1

kidneys
ureters
bladder
urethra

Question 2

are the kidneys retroperitoneal?

Answer 2

yes

Question 3

what does retroperitoneal mean?

Answer 3

behind the peritoneum

Question 4

what are the kidneys enclosed within?

Answer 4

renal capsule
perinephric fat
deep fascia
paranephric fat
visceral peritoneum

Question 5

why does the right kidney lie inferior to the left?

Answer 5

size of the liver

Question 6

what vertebral level does the right kidney sit at?

Answer 6

L1-3

hilum at L1/2

Question 7

what vertebral level does the left kidney sit at?

Answer 7

T12-L2

hilum at L1

Question 8

which ribs protect the kidney?

Answer 8

floating ribs 11 and 12

Question 9

what do the floating ribs risk being so close to the kidneys?

Answer 9

lacerations

Question 10

what does the renal hilum consist of?

Answer 10

renal pelvis (posterior)
renal artery (middle)
renal vein (anterior)
lymphatics
nerves
renal sinus fat

Question 11

why is the left renal vein longer than the right?

Answer 11

passes the aorta anteriorly to join right-sided IVC

Question 12

why do the kidneys move inferior on inspiration?

Answer 12

liver and spleen touch the diaphragm superiorly and superior poles of the kidneys inferior

Question 13

where does lymph from the kidney’s drain to?

Answer 13

lumbar nodes

Question 14

where does lymph from the ureters drain to?

Answer 14

lumbar and iliac nodes

Question 15

two types of RAS associated with AAA

Answer 15

1. combined with infra-renal AAA

2. supra-renal AAA

Question 16

two layers of the kidney

Answer 16

outer cortex

inner medulla

Question 17

urine drainage pathway from the kidney

Answer 17

nephron collecting duct
minor calyx
major calyx
renal pelvis
ureter

Question 18

two types of ureteric obstruction

Answer 18

1. internal

2. external

Question 19

examples of internal ureteric obstructions

Answer 19

impacted calculus

blood clot

Question 20

examples of external ureteric obstructions

Answer 20

expanding mass

Question 21

sites of constriction in the ureters

Answer 21

1. pelvic-ureteric junction
2. ureter crosses common iliac artery bifurcation
3. ureteric orifice

Question 22

what is in the walls of the ureters?

Answer 22

smooth muscle

Question 23

what produces colicky pain with an obstruction in the ureters?

Answer 23

there is increased peristalsis by the smooth muscle in the walls of the ureter proximal to the obstruction in an attempt to remove it

Question 24

what is hydronephrosis?

Answer 24

swelling of the kidney due to urine backing up which can compress nephrons and lead to kidney failure with painful stretching of the renal capsule

Question 25

what direction do the ureters enter the posterior bladder wall?

Answer 25

inferomedially

Question 26

why do the ureters enter the posterior bladder wall inferomedially?

Answer 26

prevent reflux of urine when bladder contracts detrusor muscle also encircles the orifices and prevents reflux

Question 27

what forms the trigone?

Answer 27

two ureteric orifices | internal urethral orifice

Question 28

what is the trigone?

Answer 28

triangle shape on internal aspect of the bladder

Question 29

what is the muscle of the bladder wall called?

Answer 29

detrusor muscle

Question 30

what does the detrusor muscle form around the urethra?

Answer 30

forms the internal urethral orifice which contracts during ejaculation

Question 31

describe embryological development of the testes?

Answer 31

move from posterior abdomen through inguinal canal to the scrotum

Question 32

what does the spermatic cord consist of?

Answer 32

``` testicular artery testicular vein vas deferens lymphatic vessels nerves ```

Question 33

what do the testes sit within?

Answer 33

tunica vaginalis

Question 34

what is a hydrocele?

Answer 34

excess fluid in the tunica vaginalis

Question 35

three motor functions of the renal system

Answer 35

1. ureteric peristalsis 2. bladder contraction 3. urethral sphincter control

Question 36

what produces ureteric peristalsis?

Answer 36

autonomic action initiated by ureteric cells which have auto-rhythmicity

Question 37

what produces bladder contraction?

Answer 37

parasympathetics stimulates detrusor muscle to contract

Question 38

what are the five types of nerve fibre?

Answer 38

1. somatic sensory 2. visceral afferents 3. somatic motor 4. sympathetic 5. parasympathetic

Question 39

role of somatic sensory nerve fibres?

Answer 39

sensations from body wall (soma)

Question 40

role of visceral afferent nerve fibres?

Answer 40

sensations from organs

Question 41

role of somatic motor nerve fibres

Answer 41

motor response to body wall (muscles)

Question 42

role of sympathetic and parasympathetic fibres

Answer 42

responses to organs

Question 43

how do sympathetic fibres reach the kidneys, ureters and bladder?

Answer 43

leave the spinal cord at T10-12 and enter sympathetic chains bilaterally leave within abdominopelvic splanchnic nerves synapsing with abdominal sympathetic ganglia at abdominal aorta reach organ via periarterial plexus

Question 44

how do parasympathetics innervate the kidney and ureter?

Answer 44

vagus nerve

Question 45

what parasympathetic innervates the bladder?

Answer 45

pelvic splanchnic nerves

Question 46

describe the mechanism behind urinary continence

Answer 46

- bladder filling is sensed by stretch receptors of visceral afferents - enter CNS via S2-4 - reflex is to empty bladder by stimulation of detrusor and inhibition of internal sphincter - brain overrides and APs in inhibitory nerves arrive - voluntary contraction of external sphincter and levator ani

Question 47

nerves that arise from the sacral plexus

Answer 47

``` pudendal (S2,3,4) sciatic (L4-S3) femoral (L2-4) obturator (L2-4) iliohypogastric ilioinguinal lateral cutaneous nerve of the thigh genitofemoral ```