Anatomy of the urinary tract (Funk) Flashcards
what are the vertebral levels for the left kidney
TV11-LV2
what are the vertebral levels for the right kidney
TV12-LV3 (lower than left b/c of the large liver)
what are 4 functions of the kidney
filter blood
produce urine
hormone secretion (erythropoietin, renin)
calcitrol production
where is the kidney located
located on each side of the vertebral column between the parietal peritoneum and musculatuer of posterior abdominal wall and diaphragm in the paravertebral gutter
how is the kidney angled
inferior pole is more lateral than the superior pole
hilum faces anteromedially
what is the clinical significance of the right kidney located more inferiorly than the left
the right kidney is more easily palpated
what are the posterior anatomical relationships of the kidneys (7) (p 309 netters)
a. Diaphragm
b. Psoas major
c. Quadratus lumborum
d. Transversus abdominis
e. Subcostal n.
f. Iliohypogastric n.
g. Ilioinguinal n.
clinical correlation:
what cain pain upon extension of the thigh (against resistance) indicate?
can indicate abdominal infection
Because of the relationship of the psoas major to many viscera (kidneys, ureters, pancreas, appendix, cecum, sigmoid colon, etc) infection can spread from these organs to the psoas, producing pain upon stretch.
what are the anterior anatomical structures to the right kidney 4
a. Liver
b. Duodenum
c. Ascending colon
d. Hepatorenal recess
what are the anterior anatomical structures to the left kidney 5
a. Stomach
b. Spleen
c. Pancreas
d. Jejunum
e. Descending colon
what is the peritoneum. where is the kidney in relation to this
the serous membrane of the abdomen
line viscera
kidney lies posterior to this and is retroperitoneal
what is the function of fat and fascia around the kidney
protective function
keeps kidney anchored in place
what are the parts of renal fascia and where do they blend
anterior and posterior layers surrounding each kidney and suprarenal gland
layers blend medially with adventitia of renal vessels
what separates the kidney and suprarenal gland?
c. Although, the kidney and suprarenal gland are enclosed in the same layer of renal fascia, there is a septum that separates the two in their own compartments.
SO if there is a kidney infection that does not necessarily mean there is a superrenal gland infection
where is pararenal fat found
external to the renal fascia
where is perirenal fat found
between the kidney and the renal fascia
clinical correlation
what is nephrotosis and what is the cause of this?
dropped kidney
a. Caused by a deficiency in the fats and fasciae surround the kidney (often seen in late stages of starvation).
b. Kidney drops into pelvis
c. Many times asymptomatic
clinical correlation
how does nephrotosis present
Sometimes presents with acute pain in the flank region which radiates to the groin (typical referred pain associated with kidney/ureter).
why don’t perinephric abscesses spread to contralateral kidney?
because the renal fasciae attach tightly to the renal vessels at the renal hilum
why do perinephric abscesses spread inferiorly into the pelvis
the anterior and posterior layers of fasciae fuse delicately around the border of the kidney
what is the organization at the hilum (artery, vein, pelvis)
renal vein is the most anterior structure
renal artery is posterior and slightly superior to the vein
renal pelvis posterior and slightly inferior to vein
what are the external features of the kidney
hilum
renal capsule
renal sinus
what is the renal sinus
open space inside the kidney containing renal calyces, renal pelvis, vessels, nerves and lymphatics
what are the internal structures of the kidney
cortex
medulla
minor calyx
major calyx
what makes up the cortex
primarily contains nephrons
also contains medullary rays (projections of medullary tissue)
what makes up the medulla
primarily contains the collecting tubules organized into renal pyramids contains cortical columns (projections of cortical tissue) renal papilae (apex of the renal pyramid directed towards the renal sinus)
what do the minor calyx do
surround and drain the renal papillae
what are the major calyx
confluence of 2-3 minor calyces
what are the 3 features of renal entrapment syndrome KNOW
left renal vein hypertension (blood can’t get back to vena cava)
hematuria (increased pressure causes rupture of small vessels within the kidney)
testicular pain
-testicular vein is also draining back to the left renal vein so this will have HTN of this vein. Develop varicosities
(females will have ovarian pain, diffuse pelvic)
which renal artery is longer? where does this longer artery pass
right renal artery
passes posterior to the IVC
what does the renal artery divide into at the hilum
5 segmental arteries (end arteries)
what does the renal artery branch from and at what vertebral body level
branches from the aorta at the LV1/LV2 level
where do the renal veins course at the renal hilum (in relation to the artery)
course anterior to the renal artery
what do the renal veins drain into
IVC
which renal vein is longer
left
what drainage does the left renal vein receive
receives the left gonadal, left inferior phrenic, and left suprarenal vein before joining the IVC
under what artery does the left renal vein pass before it reaches the IVC
superior mesenteric artery
what is renal entrapment “nutcracker syndrome”
The left renal vein passes between SMA and aorta; can be compressed between these two vessels. May cause: hematuria, abdominal pain, left testicular pain (pelvic pain in females)
where does the sympathetic innervation to the kidney originate
T10-L1 (ventral horn)
what is the path of sympathetic innervation starting at the ventral horn to the kidneys
what is the efferent output and afferent output of sympathetics?
preganglionic fibers via lesser, least and lumbar splanchnic do not synapse in the spinal nerve but continue on and synapse with postganglionic cell bodies located in the aorticorenal and renal ganglia
this then distributes to the kidney via the renal plexus
efferent: mainly vasomotor –> causes vasoconstriction and controlling the amount of blood going into the kidney)
afferent: also carry pain fibers
in what nerve does parasympathetic innervation travel
vagus
what is the path of the parasympathetic nerves
preganglionic fibers travel with the vagus
postganglionic cells are within the walls of kidney
what is the efferent function of parasympathetic
afferent?
efferent: Likely motor to smooth muscle in walls of calyces (to cause contraction)
afferent: Carry primary stretch afferent fibers. (sensory)
Urine stretches stretch calyx info back with vagus motor component causes contraction of smooth muscle urine moved into the ureter
what are kidney stones
what do these cause
- Kidney stones are typically concretions of salts and inorganic material.
- These can accumulate in the kidney and pass into the ureter.
- They can cause a significant amount of pain which will refer “from loin to groin”.
where is the referred pain from the kidney
on the flank region and then radiating in to the groin
lets say at T11 spinal nerve there is pain fibers coming in from both viscera and body wall
if you get a kidney stone there are these afferent pain fibers from the kidney AND there are body wall pain fibers (both have cell bodies in this area)
ascending pain pathways will be activated and go to the brain.
The brain gets confused about pain coming from the kidney. the brain interprets this pain as coming from the body wall…. so you will feel pain coming from the body wall and this is referred pain
what is the first constriction site in the ureter
as the ureter passes over the inferior renal pole (abdominal part)
what is the second constriction site in the ureter
ureter crosses over external iliac vessels (pelvic part)
what is the third constriction site in the ureter
ureter traverses the bladder wall (intramural part)
what are the preganglionic fibers of the sympathetic NS for the upper ureters via what nerves
where are the postganglionic cell bodies
preganglionic fibers T10-T12 via lesser, least splanchnic nerve s
Postganglionic cell bodies located in the aorticorenal and renal ganglia; distribute via the renal plexus.
what are the efferent sympathetics
afferent?
Primarily vasomotor
*Also carry pain fibers
what are the efferents with parasympathetics ?
afferents?
of the upper and lower ureters
Motor to ureteral smooth muscle (peristalsis)
Carry primary stretch afferent fibers.
for the upper ureters what do the preganglionic fibers of the parasympathetic NS travel via
vagus nerve
where are the postganglionic cells of the parasympathetics of the upper and lower ureters
within the wall of the organ
what do the preganglionic fibers of the parasympathetic NS travel with for the lower ureters
pelvic splanchnic nerves (S2, S3, S4)
via what nerve do the sympathetic preganglionic fibers travel with and what cord levels of the lower ureters
where are the postganglionic cell bodies
Preganglionic fibers (L1-L2) via lumbar splanchnic nn. Postganglionic cell bodies located in various ganglia.
what is the function of the ureter
muscular tube which transports urine from kidney to urinary bladder
where is the ureter in relation to the peritoneum
retroperitoneal
where does the ureter course
- Course inferomedially along posterior abdominal body wall, descends over pelvic brim to enter pelvis, then along lateral pelvic wall to enter posterior bladder wall.
where is the ureter in relation to the psoas major and common iliac vessels
posterior
where is the ureter in relation to the gonadal vessels and colic vessels
anterior
what is the upper 1/3 of ureter arterial supply?
lymphatic drainage?
renal a/v
lumbar lymph nodes
what is the middle 1/3 of ureter arterial supply?
lymphatic drainage?
gonadal, aorta, common iliac aa/vv.
common iliac lymph nodes
what is the lower 1/3 of ureter arterial supply?
lymphatic drainage?
internal iliac a/v
common, external, internal iliac lymph nodes
what is the function of the urinary bladder
store urine
where is the apex of the urinary bladder
what attaches to the apex
posterior to pubic symphysis; attachment of median umbilical ligament
what does the neck (the inferior portion of bladder) of the urinary bladder surround
urethral orifice
what is significant about the base of the urinary bladder- what structure enter there
ureters enter
what lines the inside of the bladder
transitional epithelium
how many layers are in the detrusor muscle layer of the bladder
3 smooth muscle layers not well-organized
what surface of the bladder is covered with serosa.
what is the rest of the bladder have for outer layer
superior surface–> serosa
remainder of bladder –> adventitia
what is the trigone of the bladder
makes up the floor of the bladder
a. Triangular area between the ureteral orifices and internal urethral orifice.
b. Superior border marked by interureteric crest; inferior border marked by uvula.
what is the inner trigonal muscle layer an extension of?
outer layer?
c. Inner trigonal muscle is an extension of ureteric muscle.
d. Outer trigonal muscle is typical detrusor muscle
what are the supporting ligaments of the bladder (2)
- Lateral ligament of bladder (thickening of endopelvic fascia)
- Puboprostatic or pubovesicle ligament
what is cystocele
fallen bladder
what are the causes of cystocele
what are the symptoms of cystocele
Can result from a weakening of the pelvic diaphragm and/or ligaments which support the bladder.
The most common cause of a cystocele is childbirth; can also result from obesity, chronic constipation, or heavy lifting.
can cause urinary incontinence as well as incomplete emptying of the bladder
autonomic fibers to the urinary bladder distribute via what
inferior hypogastric plexus
what are the sympathetic cord levels of innervation to the urinary bladder and via what nerves.
where are the postganglionic cell bodies
T10-L2 via lumbar and sacral splanchnic nerves
b. Postganglionic cell bodies located in various ganglia.
where are the efferents of sympathetic inneration going to in the urinary bladder
afferents come from where on the bladder?
trigonal muscle
sphincter urethrea mm
vasomotor
afferents- pain from the superior surface of bladder
what do the preganglionic parasympathetic fibers travel via to the urinary bladder and where are the postganglionic cell bodies
pelvic splanchnic nerves
postganglionic bodies are in the wall of the organ
what does efferent parasympathetic innervation to the bladder do?
afferent input tell what?
c. Efferent: contraction of detrusor muscle; vasomotor.
d. Afferent: stretch; pain from non-peritonealized portions of bladder.
what is the function of the male urethra
passage of urine and sperm (18-22 cm)
what are the 4 portions of the urethra
- Intramural urethra - extends through neck of bladder
- Prostatic urethra – extends through prostate
- Membranous urethra
- Spongy (penile) urethra
what makes up the sphincter urethrae muscle and what does it regulate
composed of both skeletal muscle and smooth muscle
regulates urinary continence
what are the 2 associated glands of the urethra
bulbourethral glands
urethral (mucous secreting)
how long is the female urethra
4 cm
what are the glands in the female that are homologs of the prostate
paraurethral (Skene’s)
open near the external urethral orifice
what is the micturition process.
what happens as the bladder fills
where do these stretch neurons travel and with what nerves (and cord levels)
where do they go in the brain
what do the descending fibers that have been activated what nerves?
what do these activated nerves cause? (they inhibit and activate something
As the bladder fills, an increasing number of stretch receptors begin to fire. These stretch neurons travel to the spinal cord with the pelvic splanchnic nerves (S2,S3,S4). Ascending fibers then travel through the spinal cord to the brainstem micturition center.
Descending fibers from the brainstem then activate the motor (GVE-P) component of the pelvic splanchnic nerves (parasympathetic)
The pelvic splanchnic nn cause contraction of detrusor mm and emptying of the bladder.
Descending fibers also cause relaxation of the sphincter urethrae muscles (inhibiting both the sympathetically-innervated internal portion…..
and somatically innervated internal portion)
