Anatomy of Urological Surgery Flashcards
List the urological structures of the body.
1 - Kidneys.
2 - Adrenal glands.
3 - Bladder.
4 - Prostate.
5 - Pelvis.
6 - Penis.
7 - Testis.
8 - Abdominal walls (anterior and posterior).
Which layer of connective tissue encases the kidneys?
Gerota’s fascia.
List the structures that traverse the diaphragm.
1 - Aorta.
2 - Inferior vena cava.
3 - Azygos veins.
4 - Thoracic duct.
5 - Phrenic nerve.
What are the crura of the diaphragm?
Where are their attachments?
- The tendinous leg-like projections of the diaphragm that bind the diaphragm to the spine.
- The right crus attaches to the L3 vertebral body.
- The left crus attaches to the L2 vertebral body.
Through which opening of the diaphragm does the thoracic duct pass?
Which other structure pases through this opening?
Where in the diaphragm is this opening?
- The aortic hiatus.
- The aorta also passes through the aortic hiatus.
- The aortic hiatus is located posteriorly, near the spine.
Which structure traverses the diaphragm immediately anterior to the aorta?
What is the name of the opening in the diaphragm through which this structure passes?
- The oesophagus.
- It passes through the oesophageal hiatus.
Which nerves travel with the oesophagus through the oesophageal hiatus?
The anterior and posterior vagal trunks.
Through which area of the diaphragm does the inferior vena cava pass?
The central tendon of the diaphragm.
Which nerves innervate the diaphragm?
What are their roots?
- The left and right phrenic nerves.
- C3, 4 and 5.
What is the function of latissimus dorsi?
They contract the arms to lift the body upwards.
To which rib does the kidney have the closest relations?
The 12th rib.
Which layer of connective tissue encloses the muscles surrounding the kidney?
Lumbodorsal fascia.
Why might a patient with spinal tuberculosis (Pott’s spine) present with a lump in the groin?
Because pus from an abscess from the spine can flow through the lumbodorsal fascia into the femoral triangle.
Describe the organisation of layers of the anterior abdominal wall from deep to superficial.
Two layers of fascia:
1 - Camper’s fascia.
2 - Scarpa’s fascia.
Three layers of aponeuroses:
3 - External oblique.
4 - Internal oblique.
5 - Transversus abdominis.
Which hernias are the most common?
Inguinal hernias.
What is the evolutionary function of the inguinal canal?
List the contents of the inguinal canal in males and females.
What was the tradeoff?
- The testes function best at 33 degrees C, so they developed outside the body.
- In males, the inguinal canal serves as a passage for the spermatic cord and ilioinguinal nerve.
- In females, the inguinal canal serves as a passage for the round ligament of the uterus, ilioinguinal nerve and genitofemoral nerve.
- The tradeoff is that the canal, like most ring structures in the body, are susceptible to hernias.
List the layers of muscle bordering the posterior abdominal wall from deep to superficial.
1 - Psoas major.
2 - Quadratus lumborum.
3 - Latissimus dorsi and, at the same depth of the wall:
4 - Sacrospinalis.
List the layers of peritoneum.
1 - Parietal peritoneum.
2 - Visceral peritoneum.
What are the vertebral levels of the kidneys?
Why are the kidneys not at the same levels?
- The right kidney is between vertebral levels L1 and L3.
- The left kidney is between vertebral levels T12 and L3.
- The right kidney is lower because it is displaced by the liver superiorly.
What is situs inversus?
A congenital condition in which the major visceral organs are reversed.
What is dextrocardia?
A congenital condition in which the heart is rotated towards the right side of the chest rather than the left.
List the relations of the right kidney.
Superior:
1 - The right adrenal gland.
2 - The liver.
3 - The hepatorenal ligament.
Middle:
4 - 2nd part of the duodenum (descending).
5 - Colic flexure.
Inferior:
6 - Small intestine.
What is the hepatorenal ligament?
The ligament formed by the parietal peritoneum that attaches the kidney to the posterior liver.
List the relations of the left kidney.
Superior:
1 - Left adrenal gland.
2 - Tail of the pancreas.
3 - Splenorenal ligament.
Middle:
4 - Splenic flexure.
5 - Descending colon.
Inferior:
Small intestine.
What is the splenorenal ligament?
The ligament formed by the parietal peritoneum that attaches the kidney to the spleen.
What is the splenic flexure?
The bend between the transverse and descending colon.
What is the colic flexure?
The bend between the transverse and ascending colon.
On a transverse CT scan, how can the aorta be told apart from the vena cava?
The aorta is on the left whereas the vena cava is on the right (of the patient).
List the anatomical differences between the left and right blood supplies to the kidneys.
1 - The right renal vein is shorter than the left renal vein.
2 - The right renal vein receives blood directly from the right kidney and has no other branches, whereas the left renal vein has 3 other tributaries:
- Left gonadal vein.
- Left lumbar vein (there are other lumbar veins that branch directly from the vena cava).
- Left adrenal vein.
Why does the right gonadal vein join directly with the vena cava whereas the left gonadal vein joins with the left renal vein?
Because the aorta is on the left side of the vena cava, preventing the gonadal vein from joining with the vena cava on the left side.
What is a varicocele?
What causes it?
- An enlarged vein in the scrotum.
- It is caused by a distended left gonadal vein.
List the 3 anterior branches of the aorta.
1 - Coeliac trunk.
2 - Superior mesenteric artery.
3 - Inferior mesenteric artery.
How do testicular cancers spread to the lymph?
By rising through the left and right gonadal veins to the lymph nodes surrounding the great vessels.
