B5.077 Human Urinary System

Question 1

components of the urinary system

Answer 1

kidney x 2
ureter x 2
urinary bladder
urethra

Question 2

differences between male and female urinary systems

Answer 2

male: has prostate and longer ureter
female: shorter ureter and lies anterior to uterus and ovaries

Question 3

functions of the urinary system

Answer 3

waste excretion via liquid

Question 4

normal urine specs

Answer 4

0.4-2L daily
bladder volume = 300 - 400 mL
duration of urination = 21 +/- 13 s

Question 5

polyuria

Answer 5

> 2.5 L /day

Question 6

oilguria

Answer 6

0.1-0.4 L/day

Question 7

anuria

Answer 7

< 0.1 L/day

Question 8

overview of basic renal function

Answer 8

1. removal of waste products and drugs from the body
2. balance the body’s fluids
3. regulation of plasma ionic composition
4. regulation of plasma osmolarity
5. regulation of plasma volume
6. regulation of plasma hydrogen ion concentration (pH)
7. release of hormones (renin) to regulate BP
8. control production of RBCs
9. engaged in vit D activation

Question 9

what is a staghorn calculi

Answer 9

whole calix filled with kidney stone structure

need to be surgically removes

Question 10

epidemiology of kidney stones

Answer 10

occur in 1/10 people at some point in their life

exhibit “time effect” aka take about 10 years to develop

Question 11

what are kidney stones due to

Answer 11

increased excretion of stone forming components such as calcium, oxalate, urate, or cystine

Question 12

resolution of kidney stones

Answer 12

< 4 mm have 80% chance of spontaneous passage

> 8 mm have 20% chance of spontaneous passage, require additional treatment

Question 13

types of calcium stones and their prevalence

Answer 13

1. calcium oxalate 80%
2. calcium phosphate 5-10%
3. uric acid 5-10%
4. struvite 10-15%
5. cysteine 1-2%
6. xanthine (very rare)

Question 14

calcium oxalate findings

Answer 14

acidic urine

X ray +

Question 15

calcium phosphate findings

Answer 15

alkaline urine

x ray +

Question 16

uric acid findings

Answer 16

acidic urine

x ray -

Question 17

struvite findings

Answer 17

due to infection
infectious urine
x ray +

Question 18

cystine findings

Answer 18

genetic defect

x ray +

Question 19

xanthine findings

Answer 19

x ray -

Question 20

what is PKD

Answer 20

polycystic kidney disease
an inherited genetic disorder which causes clusters of cysts to develop primarily within kidneys
kidney enlargement and loss of function over time
cysts may also occur in liver, seminal vesicles, and pancreas

Question 21

type 1 PKD

Answer 21

autosomal dominant
PKD1 85%
PKD2 15%

Question 22

type 2 PKD

Answer 22

autosomal recessive
PKHD1 incidence 1:20,000
carrier 1:70

Question 23

examples of kidney tumors

Answer 23

1. renal cell carcinoma, 80-90%
2. transitional cell carcinoma 5-10%
3. renal sarcoma, <1%
4. wilms tumor, nephroblastoma
5. renal adenoma
6. oncocytoma
7. angiomyolipoma

Question 24

describe the structure of the ureter

Answer 24

muscular tube, 25-30 cm x 3-4 mm

layers: lumen, transitional cells, lamina propria, inner muscle (longitudinal), outer muscle (circular)

Question 25

muscle contraction in the ureter

Answer 25

occurs every 10-15 s

Question 26

prevalence of ureter duplication

Answer 26

0.8-0.9%

Question 27

discuss the ureter blood supply

Answer 27

receives blood from multiple arteries spanning from renal down to the vaginal during surgical resection, have to be careful about severing blood vessels

Question 28

physiologic narrowings of the ureter

Answer 28

1. uretopelvic junction (UPJ) 2. crossing over the iliac vessels 3. uretovesical junction (insertion into bladder wall) stones get stuck here

Question 29

what are some sources of UPJ obstruction

Answer 29

1. intrinsic (developmental problem in muscle) 2. ureteral hypoplasia 3. abnormal or high insertion of ureter into the renal pelvis (angular junction) 4. crossing lower-pole renal vessel (usually artery) 5. rotation of the kidney

Question 30

consequence of UPJ obstruction

Answer 30

hydronephrosis | occurs in 1:1500 live births

Question 31

what is important to know about the orientation of the bladder in females

Answer 31

right next to cervix | common site of cervical cancer metastasis

Question 32

what is the trigone

Answer 32

area of muscle between 2 ureteral openings and neck of bladder sensitive to bladder expansion

Question 33

neuronal control of sphincters

Answer 33

``` internal = involuntary external = voluntary ```

Question 34

layers on bladder histology

Answer 34

lumen, transitional epithelium, lamina propria, muscular layer, adventitia with fat

Question 35

why is the transitional epithelium of the bladder important

Answer 35

contains multinucleated umbrella cells which make glycans to seal the bladder surface blocks toxins from getting into deep tissue

Question 36

what is the most important layer of the bladder

Answer 36

muscular layer

Question 37

run through the micturition reflex

Answer 37

1. stretch receptors detect bladder filling and transmit afferent signals to spinal cord via pelvic nerve 2. signals return to bladder from S2 and S3 spinal cord segments via parasympathetic fibers in pelvic nerve 3. efferent signals excite detrusor muscles (contraction) 4. efferent signals relax internal urethral sphincter, urine is involuntarily voided if not inhibited by brain 5. for voluntary control, micturition center in pons receives signals from stretch receptors 6. if it is time to urinate, pons returns signals to spinal interneurons that excite detrusor and relax internal sphincter, urine is voided 7. if it is untimely to urinate, pons excites spinal interneurons that keep the external sphincter contracted to retain urine in bladder 8. later, pons ceases these signals and external sphincter relaxes

Question 38

hypogastric nerve function

Answer 38

sympathetic control of bladder muscle and internal sphincter relaxes bladder via NE contracts internal sphincter via NE

Question 39

pelvic nerve function

Answer 39

parasympathetic control of bladder muscle | contracts bladder via Ach

Question 40

pudendal nerve function

Answer 40

somatic control of external sphincter | contracts sphincter via Ach

Question 41

medical examinations of the urinary bladder

Answer 41

urinalysis cystoscopy urodynamic testing

Question 42

what is urodynamic testing

Answer 42

series of tests of urination, usually done in a doctors office urine flow, pressure, bladder capacity, and other measurements can help identify bladder problems

Question 43

components of a urodynamic test

Answer 43

``` post void residual volume multichannel cytometry uroflowmetry bladder neck EMG urethral pressure profilometry fluoroscopy of the bladder and bladder neck during voiding ```

Question 44

2 classes of urinary bladder tumors

Answer 44

papillary | nodular

Question 45

what is the prostate

Answer 45

walnut sized gland 7-16 grams secretes alkaline fluid in semen

Question 46

types of benign prostatic hyperplasia

Answer 46

basal < stromal < grandular basal = non nodular stromal = CD34+ fibroblast cells, nodular glandular = most common, nodular

Question 47

what is TURP

Answer 47

trans urethral resection of prostate treatment for BPH break off pieces of prostate and suck them out not done much anymore

Question 48

more common BPH surgery

Answer 48

laser vaporization of the prostate | less bleeding and fewer complications that TURP

Question 49

epidemiology of prostate cancer

Answer 49

1 in 9 men will develop it (lower than in past due to reduced screening and reduced false positives) 60% are over 65 1 in 41 will die from it

Question 50

treatment options for prostate cancer

Answer 50

1. surgery 2. radiotherapy 3. chemotherapy 4. hormone therapy 5. immunotherapy 6. targeted therapy

Question 51

posterior urethra

Answer 51

within body

Question 52

anterior urethra

Answer 52

outside of body

Question 53

urethral stricture

Answer 53

can happen in males | narrowing of the urethra resulting in difficulty passing urine through it

Question 54

what are hypospadias

Answer 54

urine exiting body at wrong place | requires surgery to reroute urine and enable standing urination, correct bend, and make penis look normal