B10 Week 2 Flashcards by Sumaya L

How does urine form and travel?

Urine forms in the kidneys and collects in the renal pelvis. It travels down the ureters to be stored in the bladder and excreted via the urethra

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How does urine travel in the ureter?

Entry of urine into renal pelvis causes it to dilate. Induces pacemakers to produce action potential in ureter for peristaltic contractions to propel urine.

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What are the divisions of the ureter?

Renal pelvis
Abdominal
Pelvic
Intramural

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What are the natural ureteric constrictions?

Pelvi-ureteric junction
Bifurcation of common iliac artery
Vesico-ureteric junction

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What is the pelvic-ureteric junction?

Area where the renal pelvis joins to the ureter.

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What is the vesico-ureteric junction?

Area where ureter enters the bladder. Obstruction can occur here if the ureter is too short via Paquin’s law.

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What is the blood supply to the ureter?

Segmental based on the ureter level.RGCI

Renal pelvis level: renal artery
Abdominal level: gonadal artery (testicular/ovarian)
Pelvic level: common iliac artery
Intramural level: internal iliac artery

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What is the lymphatic drainage of the ureter?

Para-aortic lymph nodes

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What is the innervation to the ureter?

Ureteric plexus in T11-L2, derived from renal, aorticorenal and superior and inferior hypogastric plexus.
T11-L2 is the sympathetic innervation.
S2-S4 for parasympathetic innnervation.

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What is the sympathetic innervation of the ureter?

T11-L2

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What is the parasympathetic innervation to the ureter?

S2-S4

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How does urine enter bladder?

Enters the base of the bladder, partially covered by peritoneum.

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What are the features of the bladder?

Contains rugae in bladder wall in order to expand and avoid changes in internal pressure.

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What is the bladder trigone?

Triangular shaped region at the bladder base. It is formed by the openings of the ureter posteriorly in the bladder and the opening of the urethra.

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What are the features of the trigone?

It has a smooth surface due to its mesodermal origin, as well as being less mobile and more sensitive to pain. The rest of the bladder is endodermal origin.

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What is the lymphatic drainage of the bladder?

Para-aortic nodes and internal iliac nodes

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What affects sensation in the bladder?

Suppression of nerve impulses due to bladder being empty. Reduced pain sensation upon empty bladder.

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Parasympathetic innervation to the bladder

S2-S4
Stimulates the contraction of the detrusor muscle for bladder contraction. Inhibits the external urethral sphincter for micrutition.

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Sympathetic innervation to the bladder

T10-L2.
Inhibits impulses to detrusor muscle to allow relaxation and storage of urine in bladder. Stimulates the external sphincter to prevent micrutition.

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What is the innervation to the urethra?

Branches of the Inferior hypogastric plexus. This plexus is posterior to the urinary bladder:
Pudendal in females
Prostatic plexus in males

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Innervation to male urethra?

Sympathetic, parasympathetic and visceral is delivered by the prostate plexus, a branch of the inferior hypogastric plexus which also controls the urethral sphincters.

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What are the components of the male urethra?

Prostatic urethra: prostatic tissue surrounded by transitional epithelia

Membranous urethra: pseudostratified columnar epithelia and passes through the external urethral sphincter

Spongy urethra: surrounded by corpus spongiosum and transitions from pseudostratified columnar -> stratified squamous in glans penis

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What is the lymphatic drainage of male urethra?

Internal iliac and deep inguinal nodes

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What is the female urethra?

Much shorter than the male urethra and opens into a vestibule anterior to the vaginal opening.

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What is the composition of the female urethra?

3 coats Muscular coat: continuous with the detrusor muscle Erectile coat: Surrounded by corpus spongiosus Mucosal coat: Formed of stratified squamous epithelia which can produce mucus

What is the histology of the female urethra

Begins as transitional epithelia -> Pseudostratified columnar -> Stratified columnar ->Stratified squamous at external urethral orificie

What is the innervation of the female urethra?

Branch of the inferior hypogastric plexus -> pudendal nerve. This also controls the external urethral sphincter.

What is the lymphatic supply to the female urethra?

Internal and external iliac nodes.

What are the cells of the prostate?

Fibroblasts for supportive structure Glands for semen production Muscle cells for control of flow of ejaculation/urine

What is the largest zone of the prostate?

Peripheral zone where carcinomas are most likely to occur

What is the arterial supply to the prostate?

Inferior vesical artery

What is the venous drainage of the prostate?

Prostatic venous plexus into internal iliac vein

When does adenomatous prostatic growth occur?

Type of BPH where adenoma forms in the stromal/epithelial cells around age 30.

What drives Benign prostatic hyperplasia?

Aging increases levels of 5-alpha reductase for depletion of testosterone levels via catalysing: testosterone -> dihydrotestosterone or Testosterone -> Oestrogen

What drives prostatic cell growth?

Most potent is dihydrotestosterone. Oestrogen has a lesser effect.

Consequences of BPH issues?

Filling issues and Voiding issues

What are the filling issues?

Increased frequency and urgency of urination, dysuria and nocturia

Why does terminal dribbling occur?

Weakness of pelvic muscles surrounding urethra. -> occurs due to continuous straining of bowels, overweight, constant cough, prostate surgery.

Why does incomplete voiding occur?

Damage to the cauda equina that can also cause incontinence Pelvic splanchic nerve damage

What causes poor stream?

Overactive bladder which increases urge Enlarged prostate with compression of urine outflow

Why does decreased urination frequency occur?

Dehydration Shock Enlarged prostate- preventing urinary flow Expanding haematoma- prevents flow Tumour compression

Why does hesitancy of urination occur?

Enlarged prostate/prostate infection

What causes elevated PSA?

UTI Prostatitis Benign prostatic hyperplasia Prostate cancer

What is sensitivity?

Proportion of true positives that are identified. True positives/ True positives + false negatives

What is specificity?

Proportion of true negatives that are identified True negatives/ True negatives+ false positives

What is the ROC curve?

Plot of the true positive against the rate of false positives

Why is sensitivity important?

Important in patient diagnosis to avoid unneeded interventions or treatment that may cause harm

Symptoms of cystitis

Dysuria, polyuria and urge to urinate

Symptoms of pyelonephritis

Accompanies symptoms of cystitis with fever, flank pain, nausea and vomiting

Symptoms of cystitis in children

Fever, onset of urinary incontinence Infants will feed poorly, vomit, sleep more and show jaundice signs.

Symptoms of cystitis in elderly

Change in mental status such as confusion, fatigue and there may be incontinence.

Features of E.Coli

Baccili gram negative anaerobic bacteria commonly found as part of gut microbiome

How is E.Coli introduced into the urinary tract?

Wiping back to front after defaecation Anal intercourse Switching from anal to vaginal intercourse

Bacterial cause of UTI

E.Coli, Staphylcoccus saprophyticus, Proteus

Staphylcoccus saprophyticus

Gram positive bacteria found in the female genital tract. Increased risk of UTI with sexual activity when this is displaced into the urethra.

Proteus

Gram negative baccili bacterium found in soil and water. Once establishing UTI, commonly ascends up urinary tract to kidney

What is the diagnostic criteria for UTI?

Urinalysis for RBC, WBC, nitrites or leukocyte esterase Urine culture for bacterial cause

Treatment of UTI?

Antibiotics such as trimethoprim + sulfamethaxodaole

BPH risk factors

Increasing age, obesity, family history and inactivity. Driven by levels of dihydrotestosterone and oestrogen.

Consequences of BPH

Reduced urine flow which leads to: Bladder stones and bladder failure Urination issues with voiding and storage Urinary retention

Dietl's crisis

Episodic pain in the flank due to pelvi-ureteric obstruction

Testicular cancer pathology

Most commonly germ cell tumour. This is divided into seminomatous and non-seminomatous Lymphoma and secondary metastases

Prostate cancer pathology

Malignancy with glandular origin in the acinar or ductal epithelia which originates in the peripheral zone, lesser in the transitional zone and central zone.

Renal abscess

Caused by haematogenous spread of UTI

Orchitis

Inflammation of the testicles due to mumps virus