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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
What can afferents from the avgus nerve cause?
nausea and vomiting assoicated with such pain
26
How does filtrate progress from the collecting tubules to the ureter?
* 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
What is the ureter and where does it begin?
* Muscular tube that transports urine from kidney to bladder * Commence at the hilum
28
Where is the ureter in regard to the peritoneum?
retroperitoneal
29
Describe the length and width of the ureter
25-30cm long 1-10mm wide Right ureter is 1cm shorter than left
30
What is the abdominal course of the abdomen?
Anterior to psoas major and branches of the lumbar plexus Cross the common iliac artery or its bifurcation
31
What is the pelvic course of the ureter in females?
* Cross the umbilical artery obturator vessels and nerve * Form the posterior border of ovarian fossa * Crossed by uterine artery
32
What is the pelvic course of the ureter in males?
* Cross, the umbilical artery, obturator vessels and nerve * Cross the ductus deferens
33
What is the intramural ureter?
* 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
What are the 3 main constrictions of the ureter?
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
What is the arterial supply of the ureter?
Multiple sources of arterial blood, with longitudinal anastomosis
36
What is the venous drainage of the ureter?
Veins form a network around the ureter, mirror the arteries
37
Where do the lymphatics of the ureter drain into?
Lymphatics drain to lateral aortic (lumbar), common and internal iliac lymph nodes
38
What is the nervous innervation of the ureter and where is pain referred to?
* 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
Where is the bladder located with regard to the peritoneum?
retroperitoneal
40
What is the bladder and where is it located?
* 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
How much liquid can the bladder hold?
300-600mL (max ~1L)
42
What are the common features of the bladder in males and females?
* Apex * Median umbilical fold * Fundus * Body neck
43
Describe the bladder in males
* 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
Describe the bladder in females
* Related posteriorly to vagina and cervix * Related superiorly to body of the uterus * Vesico-uterine pouch * Retropubic (prevesical) space
45
What is the bladder wall composed of?
Wall composed of 3 layers of smooth muscle and mucosa Detrusor muscle
46
What occurs towards the neck of the male bladder?
* 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
What is the trigone of the bladder?
* Trigone of the bladder is the ~triangular area on the mucosa * Openings of the ureters * Urethral opening
48
What are the 4 components of the male urethra?
* 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
Describe the female urethra
* 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
What does the female urethra open into?
* 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
What is the arterial supply of the bladder and urethra?
branches of internal iliac artery (superior and inferior vesical, middle rectal); branches from arteries to adjacent structures (e.g. vaginal); internal pudendal
52
What is the venous drainage of the bladder and urethra?
: vesical (and prostatic) plexuses converging on internal iliac veins; internal pudendal
53
what us the lymphatic drainage of the bladder and urethra?
internal and external iliac nodes
54
What facilitates tumour spread in the urethra and bladder?
from the prostate there are valveless venous communications (baston venous plexus) with the internal vertebral venous plexus that may facilitate tumour spread
55
What is the nerve supply of the bladder and urethra?
* 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
Describe the storage phase of micturition
* 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
Describe the voiding phase of micturition
* 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
What are the other aspects of micturition?
· 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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