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Renal > Anatomy > Flashcards

Anatomy Flashcards

1
Q

The urinary tract consists of what?

A
  • the anatomical structures through which urine passes from its production to its excretion (removal from the body)
  • the kidney; produces urine
  • the ureter; drains urine from kidney to bladder
  • the bladder; stores / voids urine
  • the urethra; excretion of the urine
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2
Q

What does the upper urinary tract consist of?

A
  • the kidneys (right and left)

- the ureters (right and left)

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3
Q

What does the lower urinary tract consists of?

A
  • the bladder (unpaired midline structure)

- the urethra (unpaired midline structure)

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4
Q

An upper urinary tract infection may spread where?

A

May spread to the kidneys

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5
Q

A lower urinary tract infection involves what?

A

The urethra and bladder

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6
Q

Where is the urinary tract found?

A

The abdomen;

  • in the retroperitoneum
  • kidneys
  • the proximal ureters

The pelvis;

  • the distal ureters
  • the bladder
  • the proximal urethra

The perineum;
- the distal urethra

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7
Q

What is found lateral to the kidney?

A
  • most laterally we have layers of muscles

- - anterolaterally is the abdominal wall muscles (external oblique, internal oblique, transversus abdominus)

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8
Q

What is found medial to the kidney?

A
  • hilum of the kidney / root of kidney
  • most anterior at the root is the renal vein
  • immediately behind that is the renal artery
  • inferiorly is the ureter
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9
Q

What is found anterior to the kidney?

A
  • immediately surrounding the kidney is the renal capsule
  • then perinephric fat
  • then renal / deep fascia of the kidney
  • then another layer of fat which is paranephric fat
  • then finally the visceral peritoneum
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10
Q

What is the renal capsule?

A

A tough fibrous tissue that closely encapsulates the kidney all the way around its surface

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11
Q

What is the perinephric and paranephric fat?

A
  • perinephric; liqudiy fatty area immediately surrounding the renal capsule
  • paranephric; further away from the kidney
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12
Q

What is found posterior to the kidney?

A
  • posterior abdominal wall muscles
  • most posterior is quadratus lumborum
  • posteromedial is psoas major (immediately behind kidney)
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13
Q

Where are the kidneys located?

A
  • posterior to their own visceral peritoneum
  • enclosed within the renal fat / fascia / capsule
  • surrounded by skeletal muscles; muscles of the posterior abdominal wall, muscles of the antero-lateral abdominal wall, muscles of the back
  • muscle guarding can protect the kidney from trauma
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14
Q

The kidneys lie?
A) anterior to
B) lateral to

A

A) anterior to quadratus lumborum

B) lateral to psoas major, also lateral to the lower thoracic / upper lumbar vertebral bodies

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15
Q

Why might the right kidney be found lower than the left kidney?

A
  • due to the size of the liver
  • L1-L3 for the right kidney
  • T12-L2 for the left kidney
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16
Q

Describe ‘balloting’ the kidneys

A
  • palpate posteriorly within the flank just inferior to the 12th rib
  • palpate anteriorly within the RUG
  • the liver and spleen lie in contact with the diaphragm superior and the superior poles of the kidneys inferiorly
  • so the kidneys move inferiorly on inspiration then superiorly on expiration
  • as the patient breathes in the kidneys descend and may be trapped for examination between the palpating hands
  • a normal kidney is 12cm long, 6 cm wide, smooth, regular and firm
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17
Q

Name the anatomical relationships of the right kidney

A
  • posterior to the liver (and hepatorenal recess), the 2nd part of the duodenum, the ascending colon and right colic flexure
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18
Q

Name the anatomical relationships of the left kidney

A
  • posterior to the stomach, the tail of the pancreas, the hilum of the spleen and the splenic vessels
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19
Q

What is the most dependent part of the greater sac of the peritoneal cavity in the supine patient?

A

Hepatorenal recess

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20
Q

What lies anterior tot he renal arteries?

A

Renal veins

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21
Q

The common iliac arteries are anterior to what?

A

The common iliac veins

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22
Q

The lymph from the kidneys drain to where?

A

The lumbar nodes (located around the abdominal aorta and inferior vena cava)

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23
Q

Where does the abdominal aorta bifurcate?

A

At the level of the umbilicus

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24
Q

What is the arterial ureteric blood supply?

A

Branches from;

  • the renal artery
  • the abdominal aorta
  • the common iliac artery
  • the internal iliac artery
  • the vesical (bladder) artery
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25
Q

The lymph from the ureters drains to where?

A
  • the lumbar nodes and the iliac nodes (the latter located around the common, internal and external iliac vessels)
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26
Q

Name examples of the anatomical variation in the renal system?

A
  • bifid renal pelvis, forking of the renal pelvis
  • bifid ureter
  • retrocaval ureter
  • horseshoe kidney
  • ectopic kidney down in the pelvis
  • solitary kidney
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27
Q

The human medulla contains what?

A

Renal pyramids

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28
Q

Each pyramid contains what?

A

Around 50,000 nephrons

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29
Q

What gives the pyramids their striated appearance?

A

The regularly arranged nephrons (running axially towards the apex of each pyramid)

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30
Q

How does the urine drain from the kidney?

A
  • nephrons collecting duct
  • minor calyx
  • major calyx
  • renal pelvis
  • ureter
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31
Q

The diameter of urine drainage ‘tubes’ is increasing until?

A
  • until a constriction at the pelviureteric junction

- the wider renal pelvis becomes the narrower ureter

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32
Q

What is the first constriction site within the renal system?

A

The pelviureteric junction

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33
Q

Name the anatomical sites of ureteric constriction

A
  • pelivureteric junction
  • ureter crossing anterior aspect of the common iliac artery (often crosses the bifurcation)
  • ureteric orifice (opening into one corner of the trigone on the floor of the bladder)
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34
Q

Renal calculi can form from what?

A
  • urine calcium salts and obstruct the urinary tract from within
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35
Q

A ureteric obstruction can occur as a result of what?

A
  • internal obstruction; an impacted renal calculus or a blood clot
  • external compression; an expanding mass (e.g. a tumour)
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36
Q

How does the ureter respond to obsturction?

A
  • it has smooth muscle in its walls so will respond similarly to the the GI tract
  • increase peristalsis proximal to the site of the obstruction in an attempt to remove it (flush it into bladder)
  • as peristalsis comes in waves, a patient with ureteric obstruction tends to experience paint that is colicky in nature
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37
Q

What are the consequences of urinary tract obstruction?

A
  • obstructions cause urine to back up in the tract toward the kidneys
  • obstructions within the calyces or ureter cause unilateral back pressure of urine
  • obstructions within the bladder may cause unilateral or bilateral kidney problems
  • obstructiosn to the urethra cause bilateral kidney problems
  • urine production will continue until the pressure within the urinary tract exceeds the pressures favouring filtration at the glomerulus
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38
Q

What is renal failure?

A

Means failure to adequately filter the blood to produce urine

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39
Q

What is hydronephrosis?

A
  • water inside the kidney
  • urine back pressure into the calyces compresses the nephrons within the medullary pyramids leading to renal failure
  • acute hydronephrosis causes painful stretching of the renal capsule
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40
Q

The ureters pass from the retroperitoneum to where?

A
  • through the false pelvis and into the true pelvis
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41
Q

What is the false pelvis?

A
  • from iliac crests to pelvis inlet

- part of the abdominal caivty

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42
Q

What is the true pelvis?

A

Pelvic inlet to the pelvic floor

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43
Q

Where is the bladder found?

A

In the pelvic cavity

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44
Q

Name the pelvic floor muscle

A
  • levator ani

- (pelvic diaphragm)

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45
Q

The pelvic floor is formed by what?

A
  • the bowel shaped pelvic diaphragm

- made up of muscles including levator ani

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46
Q

What are the openings in the pelvic floor for?

A
  • distal parts of alimentary, renal and reproductive tracts to pass through
  • from pelvic cavity into peritoneum
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47
Q

What is the perineum?

A

The shallow compartment between pelvic floor and skin

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48
Q

What passes anteriorly to the common iliac vessels to enter the pelvis?

A

The pelvic ureters

49
Q

Describe the route of the pelvic ureters

A
  • anterior to common iliac vessels to enter pelvis
  • run anteriorly (along the lateral wall of the pelvis)
  • at the level of the ischial spine, they turn medially to enter the posterior aspect of the bladder
  • this route is completely sub peritoneal
  • the ureters enter the posterior bladder wall in an inferomedial direction
50
Q

Why do the ureters enter the bladder wall in an inferomedial direction?

A

Helps prevent reflux of urine back into the ureters when the bladder contracts

51
Q

The ureter runs inferiorly to what in males and females?

A

Males;
- inferiorly to the vas deferens

Females;
- inferiorly to the uterine tubes and the uterine artery

52
Q

The arteries entering the pelvis are mainly branches from what?

A

The internal iliac artery

53
Q

What forms the 3 corners of the trigone?

A
  • 2 ureteric orifices

- Internal urethral orifice

54
Q

What lies inferior to the bladder in the male?

A

The prostate gland

55
Q

What are the ureteric orifices?

A

The opening through which the bladder will receive urine from ureters

56
Q

What is the name of the opening of from the bladder to the urethra?

A

The internal urethral orifice

57
Q

Which muscle forms the main bulk of the bladder wall?

A

The detrusor muscle

58
Q

The destrusor muscle fibres encircle what and why?

A
  • encircle the ureteric orifices
  • these fibres tighten when the bladder contracts; another mechanism to prevent reflux of urine superiorly into the ureter
59
Q

Around the neck of the bladder in the male, the detrusor muscle forms what?

A
  • the internal urethral sphincter muscle

- contract during ejaculation to prevent retrograde ejaculation of semen back into the bladder

60
Q

What is the most anterior organ in the pelvis?

A

The bladder

- lying posterior the the pubic bone when empty

61
Q

Describe the relationship between the bladder and the uterus

A
  • the body of the uterus usually lies superior to the bladder in an anteflexed position
  • it is separated from the bladder by the uterovesical pouch
  • as a result, most of the weight of the uterus is borne by the bladder
62
Q

The peritoneum covers what surface of the bladder?

A

The superior surface only

63
Q

A full bladder can extend out where?

A
  • out of the pelvis
  • its superior part lies superior to the pubic bone
  • peritoneum still only covers its superior surface
64
Q

Name the 2 routes of catheterisation

A
  • urethral (more common)

- suprapubic (through anterior abdominal wall and avoiding peritoneal cavity

65
Q

The female urethra is approx how long?

A

Approx 4cm long

66
Q

The male urethra is approx how long?

A

Approx 20cm long

67
Q

Sperm is produced where?

A

Seminiferous tubules of the testes within the scrotum

68
Q

Sperm is stored where?

A

Epididymis

69
Q

Describe the route of sperm

A
  • testes within scrotum
  • epididymis
  • pass into vas deferns
  • will then pass within spermatic cord through the abdominal wall
  • then tracks posterior to the bladder where it will join in the seminal gland
  • then it passes into ejaculatory duct
  • then into prostate gland to join prostatic urethra
  • semen and sperm then pass from prostatic urethra to spongy urethra
  • then exits via the external urethral orifice
70
Q

At birth, the scrotum should contain what?

A

The testes

71
Q

What is the spermatic cord?

A

A collection of structures which support the functioning of the testis (testicular artery, testicular vein, vas deferens, lymphatic vessels draining the testis, nerves)

72
Q

Inside the scrotum, the testes sit within a sac called what?

A

Tunica vaginalis

73
Q

Excess fluid within the tunica vaginalis is called what?

A

A hydrocele

74
Q

What is the function of the pampiniform venous plexus?

A

To drain deoxygenated blood from the testis

75
Q

The testicular arteries arise from where?

A

The abdominal artery

76
Q

Where do the left and right testicular veins drain?

A
  • right; drains directly back to the IVC

- left; drains back to the left renal vein

77
Q

Where is the epididymis palpated?

A
  • at the posterior aspect of the testis
  • its proximal end (the head) is located at the posterior aspect of the superior pole of the testis
  • the vas deferens is palpated within the spermatic cord; within the scrotum, superior to the testis
78
Q

What is the function of the prostatic ducts?

A

Through which the glandular secretions from the prostate drain into the prostatic urethra

79
Q

Describe the size and position of the prostate gland

A
  • approx ‘walnut sized’
  • surrounds the prostatic urethra
  • its inferior aspect is in contact with the levator ani muscles
  • opening is in the core of the prostatic urethra
80
Q

The prostate consists of what and what are these?

A
  • zones
  • the peripheral zone is the part of the prostate that is felt on digital rectal examination (most cancers arise here)
  • central zone
81
Q

The root of the penis is connected to what?

A

The ischium

82
Q

Describe the blood supply to the penis

A
  • via the deep arteries of the penis

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

83
Q

Describe the blood supply to the scrotum

A
  • via the internal pudendal

- branches from the external iliac artery

84
Q

Describe the lymph drainage of the penis

A
  • lymph from the scrotum and most of the penis (not the glans) drains to the superficial inguinal lymph nodes found in the superficial fascia in the groin
  • lymph from the testis drains to the lumbar nodes around the abdominal aorta
85
Q

Sensations from the body wall (soma) i.e. our external environment are conveyed to the CNS by what?

A

Somatic sensory nerve fibres

86
Q

Sensations from our organs i.e. our internal environment are conveyed to the CNS by what?

A

The visceral afferent nerve fibres

87
Q

Motor responses to our body wall are conveyed from the CNS by what?

A

Somatic motor nerve fibres and stimulate skeletal muscles to contract

88
Q

Motor responses to our organs are conveyed from the CNS by what?

A
  • sympathetic

- parasympathetic nerve fibres

89
Q

Ureteric peristalsis and bladder contraction is controlled by what nerve domains?-

A

Sympathetic / parasympathetic

90
Q

Urethral sphincter control is controlled by what nerve domains?

A
  • Somatic motor (external sphincter and levator ani )

- sympathetic / parasympatehtic (internal sphincter)

91
Q

Renal system pain is controlled by what nerve domains?

A

Visceral afferents

somatic sensory in perineum

92
Q

The voluntary control of the elimination of urine from the bladder is controlled by what nerve domain?

A
  • sympathetic / parasympathetic
  • somatic motor
  • visceral afferent
93
Q

Lumbar and sacral plexus (motor and sensory) is controlled by what nerve domain?

A
  • somatic sensory

- somatic motor

94
Q

Sympathetic fibres reach the smooth muscle / glands of the body wall within what?

A

Spinal nerves

95
Q

Sympathetic fibres reach the smooth muscles / gland of the body (other than body wall) within what?

A

Splanchic nerve (cardiopulmonary or abdominopelvic)

96
Q

Describe the route of the presynaptic sympathetic nerve fibres 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 splanchic nerves
  • synapse at the abdominal sympathetic ganglia which are located around the abdominal aorta
97
Q

Describe the route of the post synaptic sympathetic nerve fibres to the kidney, ureters and bladder

A
  • 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’
  • other nerve fibre types also take part in such plexuses are parasympathetic and visceral afferent nerve fibres (as they are all going to / coming from the same organs)
98
Q

Pelvic splanchic nerves are what modality?

A

Exclusive to the parasymapthetic system and are relayed to the organs of the pelvis

99
Q

Parasympathetic nerve fibres which innervate the kidneys and ureter are carried within what?

A

The vagus nerves

100
Q

Parasympathetic nerve fibres which innervate the bladder are carried within what?

A

The pelvic splanchic nerves

101
Q

How do somatic motor nerve fibres get from the CNS to the kidneys, ureters and bladder?

A
  • the dont go to any of these structures

- only somatic fibres go to body wall structures

102
Q

Pain from the kidney is felt where?

A
  • in the loin

- posterior aspect of the flank region, on the affected side

103
Q

Pain from the bladder is felt where?

A

Is usually felt in the suprapubic region (midline)

104
Q

Pain from the perineal part of the urethra is felt where?

A

Quite localised in the perineum

105
Q

Pain from a calculus obstructing the ureter can be felt where?

A

Radiating from loin to groin on the affected side

106
Q

Visceral afferents from the kidneys run along what to enter the spinal cord where?

A
  • run alongside sympathetic fibres

- enter the spinal cord approx between level T11 and L1

107
Q

Name differential diagnoses of loin pain

A
  • skin origin (e.g. herpes zoster)
  • muscular
  • vertebrae
  • spinal nerve root compression
  • lower lobe pneumonia
108
Q

Visceral afferents from the ureters run alongside what and enter the spinal cord where?

A
  • run alongside sympathetic fibres

- enter the spinal cord between T11 and L2

109
Q

Name differentials of groin pain

A
  • hernia (inguinal or femoral)
  • lymphadenopathy
  • testicular pathology
110
Q

Visceral afferents from the bladder run alongside what and enter the spinal cord where?

A
  • visceral afferents carrying pain from that part of the bladder which touches the peritoneum run alongside sympathetic fibres
  • enter the spinal cord between levels T11-L2
  • visceral afferents from the rest of the bladder (that not touching the peritoneum) run alongside the parasympathetic nerve fibres back to the spinal cord levels S2,S3, S4
111
Q

Name the differential diagnosis of suprapubic pain

A
  • hindgut organs e.g. sigmoid diverticula

- other single, midline organs whose superior aspect touches the peritoneum e.g. uterus

112
Q

How do visceral afferent and somatic sensory nerve fibres get from the urethra to the CNS?

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 the spinal cord levels S2,S3 ,S4
  • somatic sensory nerve fibres from the remaining urethra are carried within the pudendal nerve also back to spinal cord levels S2,S3,S4
113
Q

Name differential diagnoses of perineal pain

A
  • vaginal tear
  • anal canal fissure
  • perineal genital ulcers (e.g. herpes)
114
Q

How do pain fibres get from the testis to the CNS?

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)
115
Q

Name differential diagnoses of scrotal pain

A
  • skin lesions

- strangulated inguinal hernia

116
Q

How do we control micturition (urine flow)?

A
  • the nerve fibres entering and leaving the spinal cord levels S2-S4 are key in the control of micturition
  • visceral afferent fibres
  • pelvic splanchic nerves (carrying parasympathetic fibres that have left the CNS with S2,3,4)
  • pudendal nerve; S2,3,4 but this nerve carries somatic sensory and motor nerve fibres
117
Q

As the bladder fills, it is sensed by what?

A

Stretch receptors at the end of visceral afferent nerve fibres, this is relayed to the CNS via S2,S3,S4 spinal cord levels

118
Q

What happens once t is appropriate to micturate?

A
  • the cerebral inhibition of the 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)
119
Q

The pudendal nerve arises from where?

A

From the sacral plexus

Renal (7 decks)

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