Anatomy of Renal Tract Flashcards
What is the urethra?
Tube from bladder to external environment
What vertebral level are the kidneys?
T12 - L3
What is found on the superior surface of the left kidney?
Spleen
Kidney forms renal impression on spleen
Where does the abdominal aorta bifurcate?
L4
What are the crura of the diaphragm?
Attachments of diaphragm to lumbar vertebrae (right and left crus)
Why are the psoas major and the iliacus muscle considered together? What are they called together?
Similar function and same attachment –> attach to the femur
Iliopsoas
Where does the iliacus reside?
In the iliac fossa
What is the action of the quadratus lumborum?
Antagonist to rectus abdominis –> extension of the trunk
rectus abdominis acts in flexion of trunk
What nerve emerges from the lumbar plexus just underneath the 12th rib?
Subcostal nerve
What nerve emerges below the subcostal nerve (often as a common stalk)?
Common stalk splits into iliohypogastric (superior) and ilioinguinal (inferior) nerve
Where does the subcostal nerve, iliohypogastric and ilioinguinal nerve trace round to?
Anterior aspect, supplies the muscles of the posterior wall as well, skin and parietal peritoneum
Describe the route of the ilioinguinal nerve
As it transverses towards the anterior aspect, it goes between the transversus abdominis muscle and the internal oblique
As it travels round, it enters the inguinal canal (but doesn’t enter through the deep ring)
Goes towards genital region and supplies some of the skin
What nerve sits on top of the psoas major muscle?
Genitofemoral nerve –> splits into femoral and genital nerve
Describe the route of the genital branch
Passes through deep inguinal ring, through canal, out the superficial ring
What does the femoral branch supply?
Supplies skin of thigh around femur
What happens as the testes move through the inguinal canal? What does this mean for the genital branch?
Take a layer of fascia with them
Genital branch therefore has layer of fascia around it
Does the ilioinguinal nerve have layer of fascia around it?
No (even though it enters canal)
What happens at the renal papilla?
All the collecting ducts containing little bits of urine meet together (tip of renal pyramids)
What does each renal papilla open out into?
Minor calyx (2 or 3 minor calyces join together to form a major calyces)
What do the major calyces join to make?
Renal pelvis
What does the renal pelvis narrow to form?
Ureter, going towards bladder
Describe the ureter?
- Muscular tube
- Retroperitoneal
- Narrow lumen
- Has constrictions
What are the 3 constrictions of the ureter?
- Ureteropelvic junction: where renal pelvis narrows to form ureter
- Pelvic inlet: as ureter goes down towards bladder, it passes over iliac vessels and is constricted
- Entrance to bladder: angle changes as ureter enters bladder
What is purpose of entrance to bladder constriction of ureter?
Stops urine going back up ureter
What are kidney stones?
Some solutes can become crystallised to form stones
These stones can then become blocked at the 3 constrictions in the ureter
In males as the ureter passes towards the bladder, what structure is it crossed by?
Ductus (vas) deferens
What is the vas deferens?
Tube within spermatic cord that is transporting sperm from testes towards urethra
What does the vas deferens empty into?
Part of the urethra
Where does the prostate gland in a male sit?
Just underneath the bladder (so urethra has to pas through prostate gland)
In females as the ureter passes towards the bladder, what structure is it crossed by?
Uterine artery
Remember: water travels under the bridge (ureter passes underneath uterine artery)
What is a pyelogram?
A form of imaging of the renal pelvis and ureter.
Intravenous pyelogram – In which a contrast solution is introduced through a vein into the circulatory system
How are kidney stones removed?
- Surgery
- Lithotripsy (fire ultrasound waves to break them up and pass them out naturally)
How are kidney stones removed?
- Surgery
- Lithotripsy (fire ultrasound waves to break them up and pass them out naturally)
The peritoneum, as it approaches the pelvis, covers the superior aspect of pelvic organs (bladder, uterus, rectum).
As the overlying peritoneum passes over these organs, and delves between them, what is formed?
Peritoneal pouches
Male:
- Vesicorectal pouch (between bladder and rectum)
Female:
- Vesicouterine pouch (between the bladder and uterus)
- Rectouterine / uterorectal pouch (between uterus and rectum)
Why are peritoneal pouches clinically important?
During infection, especially in females, pouches are a common site for accumulation of free fluid or pus
If fluid during infection resides in utero-rectal pouch, how is it removed?
Transvaginal approach
What is the muscle of the bladder called?
Detrusor muscle
Describe the inner surface of the bladder?
2 parts:
- Upper: rugae (folds)
- Lower: trigone (smooth)
What is the trigone of the bladder?
Smooth triangular region of internal bladder –> different from rest of muscular bladder as does not contract
At lateral edges of the trigone is where ureters empty into
What are the 4 parts of the male urethra?
- Pre-prostatic
- Prostatic
- Intermediate
- Spongy
Where is the pre-prostatic part of the male urethra?
Opening of bladder to form urethra
Where is the prostatic part of the urethra?
When urethra gets to prostate
Where is the spongy part of the urethra?
Penile part
What is the posterior fornix?
Large recess behind the cervix, close to the rectouterine pouch
What is located behind the female urethra?
Vagina and posterior fornix
Is the male or female urethra longer?
Male
How is the length of the female urethra clinically important?
Shorter therefore increased risk of infection –> bacteria have to travel shorter distance
What are complications of prostate hyperplasia?
Can begin to squeeze on walls of urethra and bladder
- Impedes urination by distorting prostatic urethra
- Urine can be trapped in prostatic urethra (feel you need to wee all the time)
- Dysuria (painful or difficult urination)
- Nocturia (waking up in night to wee)
- Urgency
What is the best way to clinically examine the prostate?
Through the rectum
What is the best way to resect prostate?
TURP –> transurethral resection procedure
- Endoscopically remove prostate
Why do women struggle to control urination after childbirth?
Urethral sphincters fewer and less organised in females
In males, what are the urethral sphincters?
- Internal urethral sphincter
2. External urethral sphincter
What is function of internal urethral sphincter in males?
Stops sperm from going back into bladder
Under autonomic control
What nervous system controls bladder filling?
Sympathetic
What happens when bladder is filling?
Must contract external and internal urethral sphincter but relax muscular bag
What nervous system controls bladder emptying?
Parasympathetic –> parasympathetic fibres contract detrusor muscle and relaxes internal urethral sphincter
What control is the external urethral sphincter under?
Somatic (voluntary) –> ables you to control when you urinate
Pudendal Nerve
