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Semester 4 > Case 8 > Flashcards

Case 8 Flashcards

1
Q

The ureters are continuous with the renal pelvis at what junction?

A

The ureteropelvic junction

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2
Q

What is the ureters’ relationship to the peritoneum?

A

It is retroperitoneal

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3
Q

The ureters descend on the medial aspect of what muscle?

A

psoas major

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4
Q

The ureters cross what as they pass through the pelvic brim?

A

The end of the common illiac arteries or the start of the external iliac arteries

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5
Q

What are the three points where the ureter are constricted?

A

The uretopelvic junction, where they cross the common iliac vessels at the pelvic brim and where the ureters enter the wall of the bladder.

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6
Q

What supplies blood flow to the upper portion of the ureters?

A

the renal arteries

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7
Q

What supplies blood flow to the middle portion of the ureters?

A

branches of the abdominal aorta, the testicular/ovarian arteries and the common iliac arteries

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8
Q

What supplies blood flow to the ureter in the pelvic cavity?

A

branches of the internal iliac arteries

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9
Q

What are the three layers of the ureters from innermost to outermost?

A

inner mucosa, central muscular layer and an outer connective tissue (adventitial) layer

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10
Q

What type of structure is the inner mucosa of the ureters made of?

A

an internal transitional epithelium with a surrounding lamina propria, which is thick and elastic

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11
Q

What is the arrangement of the muscle of the upper two thirds of the ureters?

A

It has two layers of smooth muscle, an inner longitudinal one and an outer circular one

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12
Q

What is the arrangement of the muscle of the bottom third of the ureters?

A

There are three layers of smooth muscle a central circular layer with two longitudinal inbetween

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13
Q

What is the most anterior element of the pelvic viscera?

A

The bladder

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14
Q

The bladder is shaped like a three sided pyramid describe its surface and how it lies within the body

A

It has an apex and a base, two inferolateral surfaces and asuperior surface

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15
Q

The apex of the bladder is directed to what anatomical feature? It is supported by which ligament? What does this attach it to?

A

The apex of the bladder is pointed toward the pubic symphysis. The apex of the bladder is attached to the umbilicus by the median umbilical ligament

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16
Q

The base of the bladder is posed in what direction?

A

posteroinferiorly

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17
Q

What is the trigone of the bladder?

A

The smooth triangular shaped area at the base of the bladder where the mucosal lining of the bladder is smooth and firmly attached to the muscle coat of the wall

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18
Q

The inerolateral sides of the bladder are cradled between what muscles?

A

The levator ani muscles of the pelvic diaphragm and the adjacent obturator internus muscles

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19
Q

The neck of the bladder is connected to the inferioposterior aspect of the the pubic bone by tough fibromuscular bands what are they called?

A

pubovesical ligament in wommen and puboprostatic ligaments in men

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20
Q

What happens to the transitional epithelium of the bladder under pressure?

A

It an stretch until it resembles squamous epithelium

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21
Q

How long is the female urethra?

A

4cm long

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22
Q

What does the female urethra pass through what does it open to at the end?

A

it passes through the pelvic floor inferiorly into the perineum then through the deep perineal pouch and perineal membrane then opens in the vestibule between the labia minora

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23
Q

What is the name of the two small para-urethral mucous glands that open onto the lateral margins of the external urethral orifice?

A

skene’s glands

24
Q

How long is the male urethra how many times does it bend throughout its course?

A

it is 20cm and bends twice

25
Q

What are the four parts of the urethra?

A

preprostatic, prostatic, membranous and spongy

26
Q

What is the role of the internal urethral sphincter?

A

it helps prevent retrograde movement of semen into the bladder during ejaculation

27
Q

How long is the preprostatic part of the urethra? What structure is it associated with?

A

It is 2cm long and associated with the internal urethral sphincter

28
Q

How long is the prostatic part of the urethra?

A

3-4cm long

29
Q

The lumen of the prostatic portion of the urethra is marked by which fold of mucosa? What are the notable features on this structure?

A

It is marked by the urethral crest, each side of this has a depression called the prostatic sinus, it also is enlarged either side midway along its length to form a circular elevation called the seminal colliculus

30
Q

What opens onto the semial colliculus?

A

the prostatic utricle/ the opening of the male ejaculatory duct

31
Q

What does the membranous part of the urethra pass through? What is it surrounded by in men and women?

A

It passed through the deep perineal pouch, it is surrounded by the external urethral sphincter

32
Q

Where do the bulbourethral glands open into the penis?

A

the bulb of the spongy urethra

33
Q

What type of epithelium is the urethral lining composed of?

A

stratified squamous epithelium the starts as transition at the next then becomes stratified columnar at the midpoint and stratified columnar at the end. The lamina propria is thick and elastic and its mucosa is folded in the folds are mucin secreting cells and the lumen is kept closed when not uniating

34
Q

What are the anatomical relations of the prostate?

A

it is inferior to the bladder, posterior to the pubic symphysis and anterior to the rectum

35
Q

What are the four divisions of the prostatic parenchyma?

A

peripheral, central transitional and the anterior fibromuscular stroma

36
Q

How much of the prostate is made up of the peripheral division?

A

70%

37
Q

How much of the prostate is made up of the central division?

A

25%

38
Q

How much of the prostate is made up of the transitional zones?

A

5%

39
Q

How much of the prostate is made up of the anterior fibromuscular stroma?

A

5%

40
Q

What is fibrinolysin? What is its role in semen?

A

It is a hydrolytic enzyme released in the prostate that liquefies coagulated semen allowing it to flow

41
Q

What coordinates the flow of urine to the bladder via the peristalsis of the ureters?

A

The micturition reflex

42
Q

What is the effect of bladder filling activating stretch receptors, what are the two consequences of this?

A

Afferent fibers in the pelvic nerves carry impulses to the sacral spinal cord increasing their activity. This both fascilitates parasympathetic motor neurons in the sacral spinal cord and stimulates interneurons that relay sensation via the thalamus and its projection fibers to the cortex making one aware of the fluid pressure in the bladder

43
Q

What nerve innervates the external urethral sphincter?

A

The pudendal

44
Q

Where it the micturation center that controls most of urination?

A

The pons

45
Q

Men over what age typically experience BPH? What ethnicity experiences it less?

A

over 60, it is less common in asian individuals

46
Q

What is the main hormone implicated in BPH?

A

dihydrotestosterone

47
Q

What enzyme present in prostate stromal cells converts testosterone to DHT?

A

type 2 5 alpha reductase

48
Q

What enzyme is present in the liver and skin can convert testosterone to DHT?

A

Type 1 5 alpha reductase

49
Q

What receptor is activated by DHT? What is the most important growth factor that is produced in greater numbers because of this?

A

nuclear androgen receptor (AR) is activated. THe most imporant growth factor is FGF-7

50
Q

Apart from FGF-7 what are three other important growth factors in BPH? What do they stimulate?

A

FGF-1 and FGF-2 and TGF-beta are important as they stimulate fibroblast proliferate

51
Q

Medical treatments for BPH involve the inhibition of what?

A

alpha1 adrenergic receptor and 5-alpha reductase

52
Q

What proportion of men over 80 will have a milignant foci in their prostatate?

A

80%

53
Q

Prostatic cancer accounts for what proportion of cancer in men?

A

7%

54
Q

Why are PSA tests so unreliable?

A

they can often give false positives and 20%of men with prostate cancer have normal PSA levels

55
Q

What is pyuria?

A

White blood cells in excreted urine

56
Q

The distribution of uretal pain is usually along what nerves?

A

T11-T12

57
Q

What is oliguria?

A

reduced urine volume

Semester 4 (10 decks)

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