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AB&SS 1 > C7: Urinary Tract > Flashcards

C7: Urinary Tract Flashcards

1
Q

which tissue do the kidneys arise from?

what are the 3 stages of development?

A

mesoderm

  • pronephros
  • mesonephros
  • metanephros
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2
Q

decribe the pronephros

when do they form

A
  • form early in the 4th wk of embryonic development

- non-functioning/rudimentary

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3
Q

decribe the mesonephros
when do they form?

what structure do they eventually become

A
  • form late in the 4th wk of embryonic development
  • function as interim kidneys

-eventually form the mesonephric duct (wolffian duct)

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4
Q

what does the mesonephric duct form in M and W?

when are ureters formed?

A

M: epididymis, vas deferens, ED
W: mullerian duct which forms the vagina and uterus

Form ureters for M and W @ 4 wks gestation

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5
Q

decribe the metanephros

when do they form and when do they start functioning

A
  • permanent kidneys

- form @ end of 5th wk… function @ ~8wks

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6
Q

when do they kidneys migrate from pelvis to abdo? wks

why does this occur?

A

12-15 wks

-due to rapid caudal growth (not really migration)

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7
Q

where does the bladder develop from?

which structure does it connect to in utero?

A

urogenital sinus

-connects to allantois

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8
Q

what does the allantois become?

where does it develop?

A

develops in yolk sac

-becomes urachus…. urachus becomes the median umbilical ligament
(urachus is the opening or pathway the bladder moves through to go from lower abdo to pelvis…. should seal off)

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9
Q

when does the bladder become a true pelvis organ?

A

after puberty

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10
Q

describe the location of the kidneys

A
  • retroperitoneal in the perirenal space
  • oblique to the paravertebral gutters
  • parallel to psoas
  • posterior and lateral to IVC and AO
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11
Q

describe the location of the poles of the kidney

A
  • upper poles are posterior and medial

- medial margins are more anterior than lateral margins

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12
Q

where do the ureters enter the bladder?

relationship to iliacs?

A
  • posterolateral aspect

- anteior to iliacs

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13
Q

where are the ureters the narrowest?

length?

A

UPJ… ~8mm
30cm length

(UVJ is ~2mm)

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14
Q

are ureters retroperitoneal?

A

yes

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15
Q

describe the location of the bladder

A

extraperitoneal

  • empty: true pelvis
  • full: into false pelvis

for M:
-superior to prostate

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16
Q

norm width and AP of adult kidney?

how different can the 2 kidneys be in length?

A

w: 4-5cm
AP: 3cm

1.5cm different (L usually longer)

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17
Q

list the protective layers of the kidney and describe them inner to outer

A
  1. fibrous capsule
  2. perirenal fat (adipose)
    - continous with renal sinus
  3. renal fascia (gerotas fascia)
    - anchors kidneys and adrenals to post. abdo wall
    - seperates perirenal space from pararenal space
  4. pararenal fat
    - outside gerotas fascia
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18
Q

what is ptosis

A

when kidney falls due to tear in fascia (renal fascia)

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19
Q

what is the kid parenchyma? what is it composed of?

A

functional tissue

-made of cortex and medulla

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20
Q

what is the renal cortex

describe its location, what tissue does it contain and what function does it carry out?

A
  • outer part below the real capsule
  • columns of Bertin project b/w the renal pyramids towards the sinus and each have their own interloper artery and vein
  • contains nephrons (functional units of kidney)
  • site of urine production
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21
Q

what is the renal medulla

A
  • inner part

- contains pyramids (8-18)

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22
Q

describe how the renal pyramids are positioned in the kidney

when are pyramids considered enlarged?

A

base directed towards the cortex and apex directed towards renal sinus

-when they’re thicker than cortex

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23
Q

what is the renal sinus?

which structures does it contain?

A
  • fatty central portion which is continuous with perirenal fat
  • contains calyces, renal pelvis, vessels and nerves
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24
Q

what are the functions of the minor and major calyces?

how many of each?

A

minor (8-18): receive urine from pyramids

major (2-3): join to form renal pelvis which leaves the sinus as the uereter

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25
Q

another term for the major calyces

A

infundibula

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26
Q

list the structures that enter and leave the renal hilum from anterior to posterior

A
  • Renal vein
  • renal artery
  • ureter
  • third branch of renal artery
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27
Q

what are the uerters? how do they transport urine

what are there 3 point of narrowing?

A

-muscular mucosal lined tubes that carry urine through peristalsis and gravity

  1. UPJ -ureteropelvic junction, where ureters insert into kid
  2. pelvic brim
  3. UVJ - ureterovesicular junction- entrance to bladder (narrowest point, where stones get lodged)
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28
Q

what are the folds within the bladder? how do they appear in empty vs full state

A

rugae

  • empty: wrinkled
  • full: smooth
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29
Q

capacity of bladder?

what post void volume is non significant

A

300-500 ml

<100ml

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30
Q

what is the trigone?

wheres it located?

A
  • triangular area of b/w openings of ureters and urethra… doesnt change shape
  • located on base/posteior surface of bladder
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31
Q

what is the bladder neck?

does it change shape?

A

urethral orifice

…doesnt change shape

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32
Q

wheres the apex of the bladder located?
does it change shape?

which ligament attaches here?

A

the anterior and superior part of the bladder… yes changes shape

-median umbilical ligament

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33
Q

what are the 4 layers of the bladder wall?

A
  1. Mucosa
    + inner layer, contains the rugae
  2. Submucosa
    + connective tissue
  3. muscle
    + made of detrusor muscle
    +has 3 layers
    + forms sphincter muscles
  4. serosa
    + peritoneal covering
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34
Q

how thick should the bladder wall measure

A

full: 3mm AP
empty: 6mm AP

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35
Q

what is the urethra?

how is it different in M and W

A

membranous canal leaving the bladder at the trigone

W: canal pierces the urogenital diaphragm
M: longer and had 3 areas (prostatic, membranous, penile)

36
Q

where do the renal arteries branch off AO?

how does the RRA travel?

A
  • from the lateral aspect bell the level of the SMA

- posterior to IVC

37
Q

describe the divisions of the renal arteries

A
  • Renal arteries divide into several branches before entering the kidney… then…
  • The renal arteries divide into interlober arteries which travel b/w pyramids
  • Interlobar divide into arcuate arteries which are at the base of the pyramids
  • Arcuate A divid into interlobular arteries which travel into the renal cortex
  • Interlobular divide into afferent arterioles that carry blood to the glomerulus of the nephron
38
Q

what is the CMJ

what measurement is it a marker for?

A

corticomedullary junction- border b/w the cortex and medulla where the arcuate artery is located… will appear echogenic and pulsatile

-for measuring the cortical thickness

39
Q

how does the echogenicity of the kid cortex compare to liver?

how should pyramids be spaced in the kidney?

A

isoechoic to or slightly LESS echogenic to the liver (compare at same depth)

-equidistant

40
Q

when are the renal pelvis and infundibulum not seen on US?

A

if they are collapsed due to lack of hydration

41
Q

which structures can commonly be mistaken for the renal arteries?

A

crux of diaphragm

42
Q

how will kid cortex of neonates/infants appear on US

A
  • isoechoic or more echogenic than liver
  • thin compared to pyramids
  • lobular contour that goes away by 6yrs
43
Q

how will the size of kidney pyramids of neonates/infants appear on US

A

-larger than adults

44
Q

how will kid sinus of neonates/infants appear on US

A

indistinctive due to little fat

45
Q

how do kidneys sit in the abdo of children compared to adults?
when should children show adult kid patterns?

A

lower in the abdomen

-should show by 6 months

46
Q

do we often visualize ureters?

A

no, not unless dilated

47
Q

What’s the relationship of the R kid to the hepatic flexure and the diaphragm

A

Hepatic flexure is anterior to kidneys and diaphragm is posteriorto the kidney

48
Q

If the ureters are dilated, or if there’s hydronephrosis, what should you look for?

A

Jets in the bladder to see if its blocked

49
Q

If there’s a mass in the bladder, what should you check the kidneys for?

A

Hydronephrosis

50
Q

What is the modality of choice for evaluating the bladder?

A

Cystoscopy

51
Q

What waste does the kidney remove from the blood?

A

Metabolic waste- CO2, urea, Uris acid, creatine

52
Q

List the main functions of the kid

A

Removes metabolic waste
Balances H20 and electrolytes
Maintains blood pressure

53
Q

Where is the location of the nephron

A

Partially in the cortex and medulla

54
Q

What’s the main function of the nephron

A

Filters blood and produces urine

  • helps control blood concentration and volume
  • regulates pH
55
Q

What are the 2 types of nephrons

A

Juxtamedullary (deep)

Cortical (superficial)

56
Q

What are the 2 main parts of the nephron

A
  1. Renal Corpuscle
    - contains a network of capillaries (glomerulus)… and a membrane with filtration slits (Bowman’s capsule)
  2. Renal tubule
    - contains the proximal convoluted tubule, distal convoluted tubule, loop of henle and collecting duct
57
Q

How does the nephron filter the blood

A

Through osmosis and active transport

58
Q

Describe the route that blood takes to get to the nephron

A

Renal artery>interlobar artery> accurate artery> interlobular artery> afferent artery> Glomerulus

59
Q

What are the 3 processes involved in urine formation

A
  1. Glomerular filtration
  2. tubular reabsorption
  3. Tubular secretion
60
Q

Describe how glomerular filtration works

Where does it occur?

A
  • Afferent arterioles carry blood to the glomerulus, then an increased in BP forces H20 and dissolved substances through the membrane
  • this H20 and dissolved substances pass into the Bowman’s capsule its then called filtrate
  • then the filtrate passes through an opening in the Bowman’s into the renal tubule
61
Q

Do RBCs pass through the membrane and into the Bowman’s capsule?

A

No

62
Q

How do the RBCs leave the glomerulus?

A

Through the efferent arterioles

63
Q

What is filtrate composed of?

A

Blood plasma without protein

64
Q

Describe the process of tubular reabsorption

Where does it occur?

A
  • nutrients in the filtrate are reabsorbed back into blood

- reabsorption occurs via the peritubular capillaries at the PCT, ascending and descending loop of henle

65
Q

Describe the process of tubular secretion

Where does the path of the fluid travel?

A
  • waste is secreted into the DCT
  • controls blood pH

Urine> collection duct> pyramid> renal pyramid

66
Q

Where is the juxtaglomerula apparatus located?

Which how cells are located in the JA?

A

-At the point where the DCT, afferent and efferent arterioles come into contact

-granular cells (afferent arterioles)
And
-macular densa cells (DCT)

67
Q

Where are granular cells located? what do they release

Where are macular cells located? What do they inhibit

A

-Afferent arterioles
+release renin

-DCT
+ inhibit renin

68
Q

What’s the main function of the JA?

A

Regulate BP

69
Q

What’s the function of ADH? Where and when is it released

A
  • helps with water retention
  • released when the blood volume is low
  • secreted by the posterior pituitary
70
Q

What’s the function of Aldosterone? Where and when is it released

A
  • Acts on PCT to control the rate of sodium reabsorption (increases sodium levels)
  • released by adrenal cortex when there’s a decrease in blood volume
71
Q

Is aldosterone influenced by the renin-angiotensin system?

A

Yes

72
Q

What’s the function of renin? Where and when is it released

A
  • stimulates the production of angiotensin

- released by the JA in the kidneys when BP is lowered

73
Q

Angiotensin stimulates the release of what hormone>?

A

Aldosterone

74
Q

How much kidney function do you need to lose to see a change in blood test values?

A

60%

75
Q

What is a serum creatinine blood test?
When will values be elevated?

How is it related to glomerular filtration levels?

Where is it secreted?

A
  • increased values with renal failure, nephritis and obstruction
  • directly related
  • kidneys

+MORE sensitive than bun test

76
Q

What is a bun blood test

Is it as sensitive as serum creatinine

What do increased and decreased levels indicate?

A
  • blood urea nitrogen is the end product of protein metabolism that’s formed in the liver
  • value will reflect protein intake and renal excretory capacity
  • not as sensitive as serum creatinine
  • increased indicate renal dysfunction and dehydration and increased protein metabolism
  • decreased: hepatic damage, malnutrition, over hydration
77
Q

What is a serum electrolyte blood test?

What do increased and decreased levels indicate?

A

Checked for electrolyte levels in blood

Increased: acute renal failure, glomerulonephritis
Decreased: chronic and acute renal failure (depending on cause)

78
Q

What amount of RBCs in urine are abnormal?

When would levels be elevated?

A

Any amount (called hematuria)

-detected in inflammation, tumours, pyelonephritis, calculi

79
Q

What does WBCs in the urine indicate

A

Infection, inflammation and necrosis

80
Q

What is pyuria?

What does it indicate

A

Pus in the urine

Indicates infection

81
Q

What’s proteinuria, what amount is abnormal?

When would it be seen?

A

Protein in urine
Even trace amounts are abnormal

Seen in nephritis, polycystic disease, stones, carcinomas

82
Q

What does pH of the urine refer to?

What does it mean if urine is acidic or alkaline?

A

Strength of urine

Acidic: increased hydrogen ions
Alkaline: decreased ions

83
Q

What is specific gravity urine test?

When would you have low levels/

A

-measures kidneys ability to contracted urine

Low: renal failure and pyelonephritis
High: increased levels in decreased urine output (dehydration)

84
Q

What’s the upper limit of norm for a hypertrophied column of bertin?

A

> 3cm

85
Q

Is the blood still oxygenated when it passes through the efferent arterioles?

A

Yes

86
Q

When does the arterial blood in the kidney become deoxygenated?

A

As it passes through the peritubular capillaries

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