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MD3002 - Renal > Anatomy of the Urinary System > Flashcards

Anatomy of the Urinary System Flashcards

1
Q

What are the main functions of the urinary system?

A
  • Regulation of fluid balance
  • Regulation of electrolyte concentration
  • Production of renin
  • Removal of end-products pf protein metabolism and drug metabolism
  • Re-absorption of glucose and amino acid
  • Stabilisation of blood pH
  • Production of erythropoietin
  • Vitamin D metabolism
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2
Q

Where are the kidneys located with regards to the periotneum?

A

retroperitoneal

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3
Q

Where are the kidneys located?

A

On the posterior abdominal wall, below the diaphragm

Kept in place by the renal vessels and renal fascia

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4
Q

What is the surface projection of the kidneys?

A

Between upper borders of T12 and L3 vertebrae

Deep to last 2 ribs

Right kidney is 1cm inferior due to liver

May descend 1-2cm with deep inspiration

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5
Q

What keep the kidneys in place?

A

Renal vessels and renal fascia keep the kidneys in place

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6
Q

What are the kidneys encapsulated by? (from inside out)

A
  • Fibrous capsule
  • Perirenal (perinephric) fat
    • Fills renal sinus as well
  • Renal facia
    • Covers suprarenal gland as well
  • Pararenal fat
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7
Q
A

green = fibrous capsule

blue = perirenal fat

red = renal fascia

black = pararenal fat

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8
Q

What is observed in a cross section along the long axis of the kidney?

A
  • Renal cortex
  • Renal medulla
    • Renal pyramids: x8-10
    • Renal papilla: project into minor calyx
    • Renal columns of Bertin: extensions of the cortex around pyramids
  • Renal sinus, filled with perirenal fat
  • Hilum (A®P; VAAAPA)
    • Renal Vein
    • Renal Arteries
    • Penal Pelvis
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9
Q

What is a nephron? And what is its functions?

A
  • The functional unit of the kidney
    • Ultrafiltration
    • Reabsorption
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10
Q

What does a nephron consist of?

A
  • Renal corpuscle
    • Glomerulus
    • Bowman’s capsule
  • Proximal convoluted tubule
  • Loop of Henlé
  • Distal convoluted
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11
Q
A

red = proximal convoluted tubule

green = loop of Henlé

blue = distal convoluted tubule

black = renal corpuscle

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12
Q

Where do the renal arteries originate?

A
  • From aorta at L1/2
  • Posterior to renal veins
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13
Q

Where do the renal veins drain into?

A

inferior vena cava (behind superior mesenteric)

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14
Q

What are the branches that come of the renal artery?

A
  • Segmental artery
  • Interlobar artery
  • Arcuate artery
  • Interlobular artery
  • Afferent arterioles
  • Glomerule
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15
Q

How many segmental arteries does each kidney have ?

A

5

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16
Q

What do lobar arteries arise from?

A

Lobar arteries arise from each segmental artery (1 for each renal pyramid)

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17
Q

What do lobar arteries give off before enerting the renal substance?

A

Before entering the renal substance, each lobar artery gives off 2 or 3 interlobar arteries

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18
Q

Where do interlobar arteries run?

A

The interlobar arteries run towards the cortex on each side of the pyramids

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19
Q

What occurs At the junction of the cortex and medulla

A

the interlobar arteries give off the arcuate arteries that arch over the bases of the pyramids

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20
Q

What do the arcuate arteries give off?

A

give off several interlobular arteries that ascend in the cortex

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21
Q

Where do afferent arterioles arise from?

A

(they give blood directly to the renal corpuscle) arise as branches of the interlobular arteries

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22
Q

What is the lymphatic drainage of the kidney?

A

Lymph drainage to lateral aortic (lumbar) lymph nodes

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23
Q

What is the SNS supplty of the kidney?

A

T11-L1 (lesser and least sphlanchnic)

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24
Q

Where is pain from the kidneys referred to?

A

Referred pain to the back and lumbar region (costovertebral angle) as well as loin to groin

25
Q

What can afferents from the avgus nerve cause?

A

nausea and vomiting assoicated with such pain

26
Q

How does filtrate progress from the collecting tubules to the ureter?

A
  • The filtrate coming from the collecting tubules empty through renal papillae into minor calyces
  • Minor calyces empty, in turn, into two or three major calyces
  • Renal pelvis is the upper dilated portion of the ureter where major calyces empty into
  • Renal pelvis fills most of the renal sinus and continues as the ureter
27
Q

What is the ureter and where does it begin?

A
  • Muscular tube that transports urine from kidney to bladder
  • Commence at the hilum
28
Q

Where is the ureter in regard to the peritoneum?

A

retroperitoneal

29
Q

Describe the length and width of the ureter

A

25-30cm long

1-10mm wide

Right ureter is 1cm shorter than left

30
Q

What is the abdominal course of the abdomen?

A

Anterior to psoas major and branches of the lumbar plexus

Cross the common iliac artery or its bifurcation

31
Q

What is the pelvic course of the ureter in females?

A
  • Cross the umbilical artery obturator vessels and nerve
  • Form the posterior border of ovarian fossa
  • Crossed by uterine artery
32
Q

What is the pelvic course of the ureter in males?

A
  • Cross, the umbilical artery, obturator vessels and nerve
  • Cross the ductus deferens
33
Q

What is the intramural ureter?

A
  • The ureters pass through the bladder wall obliquely creating a flap valve
    • Pressure of urine in the full bladder force the “valve” to close
    • Prevents urine returning into the ureter (ureteric reflux)
34
Q

What are the 3 main constrictions of the ureter?

A
  1. At renal pelvis-ureter junction
  2. When it crosses the iliac vessels at the pelvic inlet
  3. When it passes through the bladder wall
35
Q

What is the arterial supply of the ureter?

A

Multiple sources of arterial blood, with longitudinal anastomosis

36
Q

What is the venous drainage of the ureter?

A

Veins form a network around the ureter, mirror the arteries

37
Q

Where do the lymphatics of the ureter drain into?

A

Lymphatics drain to lateral aortic (lumbar), common and internal iliac lymph nodes

38
Q

What is the nervous innervation of the ureter and where is pain referred to?

A
  • Sympathetic from T10-L1; Parasympathetic from S2-4
    • From aortic, renal, and pelvic plexuses
  • Referred pain is mainly to loin, groin and scrotum or labia
39
Q

Where is the bladder located with regard to the peritoneum?

A

retroperitoneal

40
Q

What is the bladder and where is it located?

A
  • muscular sac
  • Temporary urine reservoir
  • Shape and position variable
  • Rests on the pelvic floor
    • Neck is held in position by puboprostatic ligament in males and the pubovesical ligament in females
  • Posterior to the pubis when empty (in adults)
    • Descend to true pelvis after ~6 years if age
    • Rises above pubis when full
41
Q

How much liquid can the bladder hold?

A

300-600mL (max ~1L)

42
Q

What are the common features of the bladder in males and females?

A
  • Apex
    • Median umbilical fold
  • Fundus
  • Body neck
43
Q

Describe the bladder in males

A
  • Between fundus and rectum in males are retrovesical septum [fascia], seminal vesicle and ampulla of ductus deferens
  • Reto-vesical pouch
  • Retropubic (prevesical) space of Retzius
    • Santorini’s venous plexus
44
Q

Describe the bladder in females

A
  • Related posteriorly to vagina and cervix
  • Related superiorly to body of the uterus
  • Vesico-uterine pouch
  • Retropubic (prevesical) space
45
Q

What is the bladder wall composed of?

A

Wall composed of 3 layers of smooth muscle and mucosa

Detrusor muscle

46
Q

What occurs towards the neck of the male bladder?

A
  • Toward the neck of the male bladder, middle layer of muscle condenses and forms the internal urethral sphincter
    • Involuntary
    • Contracts during ejaculation to prevent passage of semen into the bladder
47
Q

What is the trigone of the bladder?

A
  • Trigone of the bladder is the ~triangular area on the mucosa
    • Openings of the ureters
    • Urethral opening
48
Q

What are the 4 components of the male urethra?

A
  • Pre-prostatic (intramural) urethra
    • Surrounded by involuntary internal urethral sphincter
  • Prostatic urethra
  • Membranous urethra
    • Surrounded by voluntary external urethral sphincter
  • Spongy urethra
    • Openings of the ducts of mucus-secreting urethral glands (glands of Littré)
49
Q

Describe the female urethra

A
  • Internal urethral sphincter (bladder neck and proximal urethra) that is functional and not a distinct anatomical feature
  • External urethral sphincter of striated muscle (voluntary) at distal urethra
  • 4cm long and 6mm wide
  • Related to the anterior vaginal wall
50
Q

What does the female urethra open into?

A
  • Opens in vulva (external female genitalia) between vagina and clitoris
  • The ducts if the para-urethral glands (Skene’s glands) open on each side of the lateral margins of the urethra
51
Q

What is the arterial supply of the bladder and urethra?

A

branches of internal iliac artery (superior and inferior vesical, middle rectal); branches from arteries to adjacent structures (e.g. vaginal); internal pudendal

52
Q

What is the venous drainage of the bladder and urethra?

A

: vesical (and prostatic) plexuses converging on internal iliac veins; internal pudendal

53
Q

what us the lymphatic drainage of the bladder and urethra?

A

internal and external iliac nodes

54
Q

What facilitates tumour spread in the urethra and bladder?

A

from the prostate there are valveless venous communications (baston venous plexus) with the internal vertebral venous plexus that may facilitate tumour spread

55
Q

What is the nerve supply of the bladder and urethra?

A
  • From inferior hypogastric (pelvic) plexus
  • Parasympathetic from S2-4 via pelvic splanchnic nerves
    • Contract detrusor muscle
    • Relax internal urethral sphincter in males
  • Sympathetic from T11-L2
    • Contract internal urethral sphincter in males
  • Somatic motor pudendal nerve (S2-4) and its branches
    • Controls external urethral sphincter
56
Q

Describe the storage phase of micturition

A
  • Parasympathetic supply to detrusor muscle “switched off” in spinal cord to allow bladder to relax and fill
  • When the volume of urine reaches ~400-500ml
    • Stretch receptors are activated
    • Pain in lower abdomen and perineum
  • Afferents to the S2-4 spinal cord (reflex micturition centre) ® ”M” Centre in pons
  • Inhibition is lifted ® Preganglionic, parasympathetic neurons at S2-4 are stimulated
  • Preganglionic fibres synapse with postganglionic fibres
57
Q

Describe the voiding phase of micturition

A
  • Contraction of detrusor muscle by parasympathetic
  • Relaxation of external urethral sphincter by pudendal nerve (S2-4)
  • Contraction of abdominal wall
  • Sensation of urine in urethra maintains the reflex
58
Q

What are the other aspects of micturition?

A

· The walls of the ureters & bladder are essentially muscular

· Peristaltic waves propel urine down the ureter (hence the colicky pain of ureteric calculi) & the bladder fills by relaxation of its muscular wall (detrusor muscle)

· Bladder emptying is by muscular contraction (detrusor muscle), aided by raised intra-abdominal pressure, with the internal urethral sphincter at the proximal urethra opening

· The epithelial lining is transitional epithelium or urothelium that is urine-proof & allows distension

· The detrusor muscle is smooth & involuntary controlled by the autonomic & particularly the parasympathetic system

· However, the external urethral sphincter around the distal urethra is striated & under voluntary control

MD3002 - Renal (3 decks)

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