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IMED3002 > Anatomy of the ureters > Flashcards

Anatomy of the ureters Flashcards

1
Q

How long is the ureter?

A

35 - 30 cm

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2
Q

How does the ureter propel urine towards the bladder?

A

Peristalsis

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3
Q

At what spinal level does the ureter arise?

A

Continuous with renal pelvis at L2

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4
Q

Is the ureter intra or retroperitoneal?

A

Retroperitoneal

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5
Q

How is the ureter located using the surface anatomy?

A

Ureter is a straight line 5 cm from the midsaggital plane extending from the L2 vertebra to the posterior superior iliac spine.

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6
Q

Where is the abdominal part of the ureter located?

A

From renal pelvis to bifurcation of common iliac artery

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7
Q

Where is the pelvic part of the ureter located?

A

Pelvic brim to posterior base of urinary bladder

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8
Q

What joint is located near the bifurcation of the common iliac artery?

A

The Sacroiliac joint

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9
Q

Ureter descends along medial border of the ________

A

Psoas major

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10
Q

What structures are located anteriorly to the right ureter?

A

Right testicular/ovarian vessels

Right colic/ileocolic vessels

Root of the mesentery

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11
Q

What structures are located posteriorly to the right ureter?

A

Tips of the transverse processes of the L2 - L5 vertebrae

Right genital femoral N

Right psoas muscle

Bifurcation of right common iliac artery

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12
Q

What structures lie anterior to the left ureter?

A

Left colic vessels

Left sigmoid vessels

Left testicular/ovarian vessels

Root of sigmoid mesocolon

Sigmoid colon

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13
Q

What structures lie posterior to the left ureter?

A

Tips of transverse processes

Left genital femoral nerve

Left psoas muscle

Bifurcation of left common iliac artery

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14
Q

Where do the ureters run at the pelvic brim?

A

Along the lateral pelvic wall parallel to the anterior margin of the greater sciatic notch.

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15
Q

Which direction do the ureters curve when they are opposite the ischial spine?

A

Anteromedially (they curve this direction superiorly to the levator ani)

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16
Q

How are the ductus deferans and the ureters positioned relative to each other?

A

Terminal part of the ureter enters the bladder anteriorly to the point where the ductus deferans enters the seminal vesicle

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17
Q

What structure does the ureter pass above before entering the urinary bladder?

A

The seminal vesicle

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18
Q

Which is more anterior the ureter or the ductus deferans?

A

The ureter

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19
Q

What is the path of the ductus deferens?

A

Passes through inguinal canal and attaches medially at the seminal vesicle

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20
Q

Where do the ovaries lie relative to the ureters?

A

Immediately anteriorly

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21
Q

How are the ovaries related to the ureters?

A

Ureter forms posterior wall of ovarian fossa in which the ovary lies

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22
Q

How do the ureters pass relative to the uterus?

A

The ureter passes laterally to the cervix before it attaches to the bladder then anteriorly to the anterior fornix of the vagina to attach to the nladder

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23
Q

What is the clinical significance of the pathway of the ureters relative to the uterus?

A

Damage to the ureters can occur during a hysterectomy

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24
Q

What structure lies posterior to the ureter at the entrance to the urinary bladder in males?

A

Rectovesical pouch

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25
Q

What structure lies posterior to the ureter at the entrance to the urinary bladder in females?

A

Anterior fornix of the vagina

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26
Q

What structures lie laterally to the ureter in males?

A

Anterior branches of the internal iliac artery (umbilical, superior and inferior vesical, and obturator artery)

Obturator Nerve

Obturator Fascia

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27
Q

What structures lie laterally to the ureter in females?

A

Anterior branches of the internal iliac artery

SUPERIOR VESICAL ARTERY

Obturator artery

Uterine artery

Obturator N

Obturator Fascia

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28
Q

What structures lie superior to the ureter in females?

A

Broad ligament

Uterine artery

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29
Q

What angle do ureters enter the urinary bladder?

A

Posterosuperior angle of its base

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30
Q

What direction do the ureters enter the bladder?

A

inferomedially

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31
Q

Where is the seminal vesicle located?

A

posterior to the bladder

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32
Q

Where do the ductus deferens run relative to the ureters?

A

Anteriorly and then superiorly to where the ureters meet the bladder

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33
Q

Where are the constrictions of the ureter located?

A

junction between renal pelvis and ureter at level L2/L3

At the pelvic brim near the bifurcation of the common iliac artery

At the entrance into urinary bladder wall

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34
Q

How many constrictions does the ureter have?

A

3

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35
Q

At what spinal level does the renal artery arise?

A

L1/L2 (like the hilum of the kidney)

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36
Q

Where does the right renal artery run relative to the IVC?

A

Posteriorly

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37
Q

What structure does the left renal vein pass behind?

A

The superior mesenteric artery

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38
Q

How much blood do the kidneys need?

A

They require 21% of CO

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39
Q

Do renal arteries have anastomoses?

A

No they are end arteries

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40
Q

What is the pathway of blood from heart to the glomerulus and back?

A

Heart -> Aorta -> renal artery -> Segmental artery -> Interlobular artery -> Arcuate artery -> Afferent arteriole -> Glomerulus -> Efferent arteriole -> peritubular artery and vasa recta -> Interlobular vein +arcuate vein ->arcuate vein ->Interlobular vein -> Renal vein -> IVC -> Heart

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41
Q

What are the divisions of the renal artery?

A

Divides into anterior and posterior divisions just before the hilum.

Anterior division divides into 4 segments

Posterior division continues to a segment on its own.

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42
Q

What are the anterior division’s segments?

A

Superior

Anterior superior

Anterior inferior

Inferior

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43
Q

What are the posterior divisions?

A

Posterior segment

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44
Q

What does the blood supply of the abdominal ureter consist of?

A

Renal artery

Gonadal artery

Suprarenal artery

Vessels from posterior abdominal wall

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45
Q

What supplies the pelvic part of the ureter?

A

Common iliac vessels

Internal iliac vessels

Inferior vesical vessels

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46
Q

What lymphatics drain kidneys?

A

Lymphatics from kidneys follow renal veins and drain into:

Right and Left lumbar lymph nodes

Caval lymph nodes

Aortic lymph nodes

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47
Q

What lymphatics do ureters drain into?

A

Para aortic lymph nodes

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48
Q

What lymph nodes drain superior portion of pelvic part of ureters?

A

external iliac lymph nodes

49
Q

What lymph nodes drain superior portion of pelvic part of ureters?

A

internal iliac lymph nodes

50
Q

Where do kidneys get their nerve supply?

A

Efferent fibres from renal nerve plexus

51
Q

What is the renal nerve plexus composed of?

A

Sympathetic and parasympathetic nerve fibers

52
Q

Where are the sympathetic nerve fibers that innervate the kidneys from?

A

T10 - L1 via abdominopelvic splanchnic nerve

53
Q

Where are parasympathetic nerve fibers derived from?

A

Both vagus nerves

54
Q

Where do visceral afferents from the kidneys go?

A

Visceral afferents follow sympathetic fibers retrograde to dorsal root ganglia and spinal cord segments (T11 - L2)

55
Q

Where do visceral afferents from the ureters go?

A

Ureter sympathetic innervation follows pelvic splanchnic nerves to dorsal root ganglia and spinal cord segments (T10 - L2)

Ureters are primarily above pelvic pain line

56
Q

Where is the visceral efferent innervation beneath the pelvic pain line from?

A

S2 - S4 and they follow parasympathetic pelvic nerve

57
Q

Where do kidneys get their parasympathetic innervation?

A

Vagus nerves

58
Q

Where do ureters get their parasympathetic innervation?

A

S2 - S4 splanchnic nerves

59
Q

What are stones that accumulate in calices or ureters?

A

calculi

60
Q

What do calculi do that causes pain to people?

A

They can block passages and cause swelling and hydronephrosis which results in what is known as ureteric colic

61
Q

Where is ureteric colic referred to?

A

Can be referred to lumbar or inguinal region

62
Q

What is the functional unit of kidney called?

A

Uriniferous tubule which consists of nephron, collecting tubule and collecting duct

63
Q

What are the contents of the renal corpuscle?

A

Glomerulus capillaries

Visceral epithelium (podocytes)

Parietal epithelium (bowman’s capsule)

64
Q

How many nephrons does the typical kidney have?

A

1.25 million

65
Q

What percentage of nephrons are cortical nephrons?

A

85%

66
Q

Where are cortical nephrons located?

A

Right beneath renal capsule

67
Q

What percentage of nephrons are medullary nephrons?

A

15% of nephrons

68
Q

Where are juxtamedullary nephrons located?

A

Close to renal medulla and have long loops of henle.

69
Q

What do juxtamedullary nephrons do?

A

Contribute to kidney’s ability to concentrate urine

70
Q

Which nephrons have longer loops of henle?

A

Juxtamedullary nephrons

71
Q

What are the components of the renal tubule?

A

Proximal and distal convoluted tubule

Loop of henle

72
Q

What is the role of the nephron?

A

Filter blood

Concentrate urine

Reabsorb nutrients and water

73
Q

What are the 2 poles of the renal corpuscle?

A

Vascular pole

Urinary pole

74
Q

What are the 2 layers of the bowman’s capsule?

A

Parietal layer

Visceral layer

75
Q

What epithelium does the parietal layer of the bowman’s capsule contain?

A

Simple squamous epithelium

76
Q

What cells constitute the visceral layer of the bowman’s capsule?

A

Podocytes envelope capillary tuft

77
Q

What is the capsular space and what is its function?

A

Capsular space is the space between bowman’s capsule and glomerulus which receives filtered liquid filtered through capillary wall and visceral layer.

78
Q

What are the 3 layers of filtration membrane in the renal glomerulus?

A

Fenestrations of endothelial cells of glomerular capillaries

Combined basement membrane

Filtration slits between foot processes of podocytes

79
Q

What structural aspect of podocytes makes them so important?

A

They have foot processes which embrace the capillaries and create small sieve like openings

80
Q

What are the types of processes that podocytes have?

A

Primary processes which are not in contact with basement membrane

Secondary processes that embrace the capillaries

Filtration slits which are spaces within interdigitation of secondary processes

81
Q

What is the juxtaglomerular apparatus?

A

Area of specialized contact between afferent arteriole and the distal straight tubule

82
Q

What are the 3 types of cells in the juxtaglomerular apparatus?

A

Juxtaglomerular granular cells

Macula densa cells

Extraglomerular mesangial cells

83
Q

What are juxtaglomerular granular cells?

A

Modiifed smooth muscle cells in afferent arteriole that are responsible for renin release

84
Q

What are macula densa cells?

A

Modified epithelial cells of distal straight tubule which contacts the vascular end of renal corpuscle and these cells signal renin release.

85
Q

What are extraglomerular mesangial cells?

A

Cells located at vascular pole that clear excess debris and trapped residue from basement membrane and they are both phagocytic and contractile.

86
Q

What are the 2 capillary beds associated with nephrons?

A

Glomeruli and vasa recta

87
Q

Where does the afferent arteriole come from?

A

Interlobular artery

88
Q

Where does the efferent arteriole go to?

A

The peritubular capillaries (or vasa recta)

89
Q

Where do peritubular capillaries drain into?

A

Interlobular veins

90
Q

Where do the vasa recta occur?

A

juxtamedullary nephrons

91
Q

Do cortical nephrons have vasa recta?

A

Nope

92
Q

What kind of exchange is there between ascending and descending loop of henle?

A

Countercurrent exchange of water and solutes

93
Q

What are the alternating regions of the renal cortex?

A

Cortical labrynth which consists of glomeruli and convoluted tubules

Medullary rays which consist of radially directed straight tubules of nephrons and collecting ducts

94
Q

What lines the proximal convoluted tubule?

A

Cuboid epithelium

95
Q

How many cells on proximal convoluted cross section?

A

3 - 4 cells

96
Q

What is a feature of the cytoplasm of proximal convoluted tubules? Why?

A

It is strongly acidophilic because they have lots of mitochondria

97
Q

What structures are unique to the proximal tubules?

A

The brush border surface with lots of microvilli

98
Q

What type of epithelium does the distal convoluted tubule have?

A

Cuboidal epithelium

99
Q

How are cells of the DCT different to the PCT?

A

DCT cells have less microvilli and a flatter surface.

Wider lumen

5 - 8 nuclei in cross section instead of 3 - 4

100
Q

What are the 2 parts of the loop of henle?

A

Descending thick & thin limb

Ascending thick & thin limb

101
Q

What is the difference between thick and thin limbs?

A

Thick epithelium is cuboidal

Thin epithelium is squamous

102
Q

What is the collecting/connecting tubule?

A

Tubular structure that is continuous with the nephron

103
Q

What is the function of the collecting/connecting tubule?

A

Remaining filtrated is moved through to the collecting duct

104
Q

What is the collecting duct?

A

Duct that collects urine from several nephrons and filters it through to the minor calyx

105
Q

What tissue type do collecting ducts have?

A

In the cortex they are lined by simple cuboidal epithelium and at the apex by simple columnar epithelium

106
Q

What are the types of cells in collecting ducts?

A

Principal cells with sparse short microvilli

Intercalated cells with abundant microvilli

107
Q

What happens to principal cells as they approach the renal papillae?

A

They lengthen

108
Q

What happens to intercalated cells as they approach the renal papillae?

A

They diminish in numbers

109
Q

What are renal papillae?

A

The location where the pyramids meet the minor calices

110
Q

Are intercalated discs dark or light staining?

A

Dark staining

111
Q

What shape is the lumen of the ureter?

A

Star shaped

112
Q

What are the layers of the ureter?

A

Lumen

Mucosa

Muscularis propria

Adventitia

113
Q

What are the parts of the mucosa of the ureter made up of?

A

Epithelium: transitional epithelium (aka urothelium)

Lamina propria

114
Q

What layers are not present in the ureter?

A

Muscularis mucosa

Submucosa

115
Q

What are the 2 layers of smooth muscles in ureters and where are they located?

A

Inner longitudinal and outer circular layer

They are located in the muscularis propria

116
Q

How is the lower third of the ureter different to the rest of the ureter?

A

Lower third contains an additional longitudinal smooth muscle layer

117
Q

What are the components of the adventitia of the ureter?

A

Dense irregular connective tissue containing blood vessels, lymphatic vessels and nerves

118
Q

What is special about transitional epithelium?

A

It can contract and expand according to what is required

IMED3002 (46 decks)

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