Anatomy and embryology Flashcards
What is the appearance of the adrenal gland with an ipsilateral renal agenesis?
Linear as opposed to the inverted Y shape
What is the arterial supply of the adrenal gland?
3 main feeding arteries
1 - superior adrenal (off of inferior phrenic)
2 - middle adrenal (off of aorta)
3 - Inferior adrenal (off of renal)
What is the venous drainage of the adrenal gland?
Single adrenal vein entering the posterior IVC (right) or inferior phrenic (left)
What marks the junction between cortex and medulla?
The arcuate artery at the base of each pyramid
What is a column of bertin?
Column of cortical tissue that may descend between the pyramids in the kidney
What is the intrarenal collecting system
Minor calyces, infundibulum, and renal pelvis
What is Gerotas fascia?
The encasing perirenal fascia (ant and post)
What are the boundaries of the anterior pararenal space? What are its contents?
Posterior portion of peritoneal cavity to anterior layer of Gerotas fascia
Pancreas, 2nd-4th portions of duodenum, ascending and descending colon, hepatic and splenic arteries
What are the contents of the perirenal space?
Kidney, adrenal gland, proximal ureter
What are the boundaries of the posterior pararenal space? What are its contents?
posterior layer of perirenal fascia and psoas/lumborus fascia
No contents, just fat
What are the 4 potential spaces of the pelvic extraperitoneal space?
1 - space of retzius (btw bladder and symphisis pubis)
2 - retrovesicular space
3 - perirectal space
4 - presacral space
What is the minor/major infundibulum?
The drainage from minor to major calyx (minor) and from major calyx to renal pelvis (major)
What is the relationship of the ureter to the common/external iliac artery?
It will run anterior to the vessel
How long do the ureters course submucosally and where do they terminate?
2 cm
terminate at the lateral margin of the trigone
What is the narrowest part of the ureter?
UVJ
What are the 3 layers of the ureter?
mucosa
muscular
adventitial
What is the mucosal epithelium made of in the ureter?
Transitional epithelium
continuous with renal pelvis proximally and bladder distally
What is the arterial supply of the ureter, specifically the distal portion?
Prox - renal arteries (pelvis as well)
Mid - aorta, lumbar, gonadal, iliac
Distal - inferior vesical artery
What are the 4 layers of the bladder
Detrusor muscle
Lamina propria
Submucosa
Mucosa
What are the 3 layers of the detrusor muscle
Inner longitudinal
Mid circular
Outer longitudinal
What is the trigone?
The meeting point of the three bladder muscle layers
What is the main blood supply to the bladder? Where do these arise from?
Sup/Mid/Inf vesicular arteries
Arise from hypogastric arteries
The male urethra has an anterior and posterior portion - name the 2 segments in each
Post - prostatic, membranous
Ant - bulbous, penile
Where does the prostatic urethra end?
Superior aspect of urogenital diaphragm
What is the verumontanum? What is the utricle?
Verumontanum - mound of swelling of a longitudinal smooth muscle just proximal to the membranous urethra, near site of seminal vesicle entry
Utricle - small depression in the verumontanum the arises and projects posteriorly
Where do the ejaculatory ducts enter the urethra?
Post - prostatic portion just at the distal verumontanum
At what point does the prostatic mucosa change from transitional epithelium to stratified squamous?
At the membranous portion
Which portion of the urethra is narrowest? What are the margins?
Membranous
Prox - distal verumontanum
Dist - tip of the cone of the bulbous urethra
What are the margins of the bulbous urethra?
Inf aspect of urogenital diaphragm
Penoscrotal junction angle
What is the fossa navicularis?
The distal 2 cm of the penile urethra that is slightly dilated
What are the glands of littre?
Small mucus secreting submucosal glands in the bulbous and superior aspect of the penile urethra
Secrete mucus during sexual stimulation
Where do the cowpers ducts enter?
Into the proximal or midbulbous urethra
Where are cowpers glands in relation to the urethra
along the membranous portion
What is “Cobbs collar”, or the musculus compressor nuda?
A small striated musculotendinous sling of teh bulbocavernosus muscle at the proximal bulbous urethra
What are the three sphincters involved in continence of urine?
Internal urethral sphincter
Intrinsic sphincter
External sphincter
What is the primary muscle of passive urinary continence?
Circular internal urethral sphincter
Which sphincter is damaged during prostatectomy? Which one takes over?
Internal is damaged, intrinsic takes over
Where is the internal sphincter? Where is the intrinsic sphincter?
Internal - around the bladder neck
Intrinsic - below the verumontanum and surrounding the membranous urethra
Where is the external sphincter? What is its function?
Lies peripheral to the intrinsic sphincter and functions in active urinary incontinence
Dilated rete testes indicate what?
Vasectomy, epididymitis history
What is the hydatid of morgagni?
Vestigial remnant of the mullerian duct - “appendix teste”
tiny oval sessile body at upper ends of testes adjacent to head of epidydimis
Is the vas deferens ciliateD?
Only near the testicular portion
Where do the ejaculatory ducts empty
distal verunmontanum
What are the two components of the ejaculatory duct?
Ampulla of the vas deferens
Excretory duct of the seminal vesicles
What are the 4 zones of the prostate?
Anterior
Transitional
Central
Peripheral
What is the anterior zone of the prostate?
anterior to urethra, fibrous tissue
Where does BPH occur?
Transitional zone
Where is the transitional zone of the prostate?
Midprostatic urethra
Where do most prostatic carcinomas and infections occur?
Peripheral zone
What are the two anchors of the prostate? What separates it from the rectum?
1 - puboprostatic ligaments, extends from the posterior aspect of the pubis to the prostatic capsule
2 - apex is embedded in the muscle fibers of the external sphincter
Denonvilliers fascia
What is the normal ovarian volume in a premenopausal woman? Postmenopausal?
Pre - 5-20cm3
Post- 2-10 cm3
What is the graafian follice?
A dominant follicle that develops during the proliferative phase, usually >2cm
What is responsible for the “physiologic fluid” in the cul de sac
Mid cycle rupture of a dominant follicle
What is the life cycle of a dominant follicle?
Grows, then ruptures at mid cycle releasing fluid. Will then undergo vascularization and becomes the corpus luteum. This then secretes progesterone to prepare the endothelium for implantation
What is the blood supply to the ovary?
Ovarian artery off aorta
Adnexal branch off uterine artery
Where do the ovarian veins drain?
Left - ipsilateral renal vein
Right - IVC
What are the 3 segments of the fallopian tube?
Isthmus - narrow medial third
Ampulla - intermediate dilated portion
Infundibulum - fimbriated opening adjacent to ovary
What is the junctional zone of the uterus?
Innermost layer of myometrium
What are the MR characteristics of the endometrium? Junctional zone? Myometrium?
Endo - T2 hyperintense
JZ - T2 T2 hypointense
Myometrium - T2 hyperintense
In the premenopausal woman in the first half of the cycle, what are the 3 layers of endometrium on US?
Inner hyperechoic - coated walls of uterine cavity
Hypoechoic - functional layer
Outer basal layer - hyperechoic
What are the three phases and there approximate age of gestation in kidney development?
Pronephros - 3 weeks
Mesonephros - >3 weeks
Metanephros - 5th week
What are the remnants of the mesonephric duct in adults?
Male - vas deferens, seminal vesicles, ejaculatory ducts
Female - vestigial
Its also known as the wolffian duct
What does the metanephric blastema form into? What does the ureteral bud form into?
MB - nephrons
UB - ureter, renal pelvis, calyces, collecting ducts
When/how do the kidneys migrate into their adult positions?
4-8 weeks
Migrate cephalad and rotate 90 degrees around its longitudinal axis
How many renal lobes are present during gestation? When do they assimilate? What does failure of assimilation lead to?
14, 7 anterior and 7 posterior separated by a fibrous longitudinal groove
Assimilate at 28 weeks
Failure to join results in grooved cortical contour known as persistent fetal lobulation
What is a hypertrophied column of bertin?
When the cortex fuses in the embryo, the associated medulla in that lobe will abut the adjacent medulla, with little fusion. There will be columns of cortical tissue between adjacent medullary lobes, and some of them have a bulbous appearance and slight mass effect on the calyces - known as the column of bertin
What are the 4 stages of lower urogenital tract formation?
1 - formation of the cloaca
2 - separation of the cloaca into ventral and dorsal portions
3 - development into bladder, allantois, urogenital sinus
4 - development of ventral and vesicourethral portions of bladder, division of urogenital sinus into pelvic and phallic portions
What are the remnants of the mullerian duct in the male?
prostatic utricle in verumontanum, appendix testes
What do the mullerian ducts form in the female?
fallopian tubes, uterus, cervix, uppervagina, proximal urethra
What does the pelvic portion of the urogenital sinus form in the male? female?
Male - prostatic urethra, membranous urethra, distal prostate gland, UGD
Female - distal urethra, vestibule
What does the phallic portion of the urogenital sinus form in the male? female?
Male - bulbous and penile urethra, cowpers glands, glands of littre, corpus cavernosa and spongiosum
Female - clitoris, labia, hymen
How is the sex determined? When is it determined embryologically and anatomocally?
Undifferentiated gonads contain a cortex and medulla
Males - cortex regresses and sex cords form the rete testes and seminiferous tubules in medulla
Females - cortex develops follicles around vascular stromal core
6th week, by 12 weeks its anatomically
What are the embryonic origins of the following:
adrenal glands
kidney
collecting ducts/calyces/renal pelvis/ureter
bladder
mesoderm/ectoderm
metanephric blastema
ureteral bud from mesonephric duct
vesicourethral canal
What are the embryologic origins of the following:
Proximal posterior urethra
Distal posterior urethra/membranous urethra/anterior urethra
Prostate
Seminal vesicle
Ejaculatory duct/vas deferens/epididymis
Testis
Vesicourethral canal Urogenital sinus Urethral buds Mesonephric duct buds Mesonephric duct Genital ridge
What are the embryologic origins of the following:
Ovary
Uterus/fallopian tubes, upper vagina
Genital ridge
Mullerian duct
