Clinical Anatomy Of The Urinary System Flashcards
Describe the landmarks of an abdominal X-ray
Not all abdominal organs can be clearly identified on x-ray imaging
- Just like thoracic imaging, using a systematic approach will aid in in assessment of visible structures
- Assess the image quality
-Examine the bones and identify bones landmarks Rib 12 Vertebrae Pelvic bones -Iliac crest -Pelvic crest -Acetabulum
Bowel gas pattern
Soft tissue structures
What is a urteogram?
Ureters are not usually clearly visible with plain X-rays
Introducing a contrast material allows for visibility
Look for:
- narrowing of lumen
- Variations of pathways
- Duplication
What is the main demographic of urinary tract stones?
More common in men
Age range 20-60 years
Explain urinate tract stones
-Aggregates of calcium, phosphate, oxalate, urate and other soluble salts
Urine becomes saturated and a small change in pH can cause precipitation of these salts
Pain usually radiates from the infra-scapular region into the groin, may even radiate into the scrotum
There may be hematuria
Stones may also be caused by bacteria
What are the complications of urinary tract stones?
- infection
- urinary obstruction
- Renal failure
What causes pain from kidneys and ureters?
Pain from kidney stones, (pain from ureters mainly) is commonly reffered to the flanks, inguinal region, groin, scrotum/labia majora and/or upper thigh; the classic loin to groin type dustribution
Rationale:
Sympathetics are supplied from about T11-L2 (carries visceral afferents fibers going back to spinal cord )
Higher levels of these fibers will radiate near the UPJ
Lower levels near the UVJ
What causes reffered pain along kidney and ureters?
Ilioinguinal nerve- (skin over upper medial thigh, upper scrotal and labial areas)
Iliohypogastric nerve- (skin over the anterior abdominal muscles, pubic symphysis) or Subcostal nerves depending on the location of the kidney stone
What is the urinary bladder? Where is it found?
Muscular organ for collection for urine
Located just posterior to the pubic symphysis area
Contrast the bladder empty and full
Empty-4 sided pyramid; resides in true pelvis
Full- ovoid; protrudes anteriorly & superiorly into abdominal cavity
What is the blood supply of the urinary bladder?
Superior and inferior vesicle artery
What is the lymphatic drainage of the bladder?
Internal and external iliac nodes
What are the relationships if the urinary bladder?
The apex is attached to the umbilicus by the median umbilical fold (remnant if the uracus)
- The base is located posterioinferiorly.
- Ureters enter at the posterior superior edges
- Urethra exits inferiorly
What are the internal structures of the urinary bladder?
Bladder trigone
Detrusor muscle
Internal urethral sphincter
Sphincter urethrae(external sphincter)
What is the bladder trigone?
Smooth area of the bladder in the non-distended state-bounded by:
- Urethral orifices- open into the posterior lateral aspect of the bladder
-Urethra-commences at the neck of the bladder as the internal urethral orifices
What is the detrusor muscle?
- Smooth muscle of bladder wall
- Relaxes to allow filling
- Contracts to empty
- Autonomic innervation
What is the internal urethral sphincter?
- located at the neck of the bladder
- continuation of detrusor muscle
- autonomic innervation
What is the sphincter urethrae (external urethral sphincter)?
- located in deep perineal space
- skeletal muscle
- somatic innervation (pudendal nerve)
Explain ligamentius support of the bladder?
Condensations of tendinitis arch of pelvic fascia/loose connective tissue
- Pubovesicle (dudes) or pubrostatic (duddetes) ligaments
- Perineal membrane and associated muscles, levator ani of the pelvic floor
- Together they hold the neck of the bladder in place and help support /suspend
Explain the innervation of bladder
Dense autonomic plexus around the bladder
- Parasympathetic from S2-4 (pelvic splachni), then through the inferior hypo gastric to the bladder
- Sympathetic T10-12 (lesser and Least splachnic) and L1 & 2 (lumbar splachnics) reach the vesical plexus via hypogastric nerves (only to very superior aspect of bladder)
Visceral afferents for pain travels with the Sympathetic/parasympathetic nerves
Pudendal (S2-4) somatic motor to the external urethral sphincter
Where dies pain in the bladder refer from?
Pain from the bladder refers to the perineum (area between the vagina and anus in women and between the penis and scrotum in men)
May also involve an increase in urinary urge
Summarize innervation to the contractile parts of the urinary bladder
Detrusor muscle during mictruition
- sympathetic- relaxation
- parasympathetic- contraction
Internal urethral sphincter
- sympathetic- contract
- parasympathetic- relax
External urethral sphincter (pudendal nerve-somatic)
Explain the innervation of the bladder when there is a feeling of fullness
Stretch- visceral afferents accompanying parasympathetic (pelvic splachnic / sympathetics)/sympathetics
Explain the innervation of the (detrusor muscle) smooth muscle organs of the wall
Parasympathetics (pelvic splachnic)
What is the innervation of the internal sphincter (s moth muscle)?
sympathetics contracts parasympathetics rekaxes
What is external anal sphincter Innervated by?
Skeketal muscle- somatic efferent control (voluntary- oudedpndal nerve)
Explain urinary control in infants
Infants have no cortical control of the external sphincters organs of the voiding reflex(automatic voiding)
Conscious control of both of these are learned over time
Adults have cortical control of external sphincters and voiding reflex can be c8ntroled (continence of bladder and bowel)
Describe the urethra in females
- approx. 4cm In length
- external urethral orifice opens into vestibule of the vagina
Ascending UTI more common because:
-short urethra
- proximity to vagina and anus
- intercourse
Describe female urethral sphincters
Internal urethra sphincter
-under sympathetics- contracts
-under parasympathetic- relaxes
External urethral sphincters
Under somatic efferent-pudendal n.
Describe the make urethra
Prostatic urethra- situated within anterior half of prostate
Me,brownouts urethra-located within the deep perineal pouch - ass. With sphincter urethrae
Penile/spongy urethra- it’s proximal portion contains openings fir the bulbourethral glands
What is the use of urethral cathererization?
Insertion of a flexible tube through the urethra
In the male the shape of the urethra has 2 bends
- 1st bend is in the spongy urethra and can easily be manipulated
- 2nd bend is located at the membranous urethra and is fixed
If not inserted carefully the catheter may damage the bulb of penis- just deep to the first bed
What is a suprapubic catheterization ?
A urinary bladder catheterization inserted through the skin about 1 inch above the symphysis pubis
It is inserted under a general or local anesthetic
-Used for closed drainage and May be left in place of a time, sutured to the abdominal skin
What are the pros of suprapubic catheterization?
Lower incidence of urinary tract infection, ease of voiding of naturally when the catheter is clamped, and ease of ambukation
What are the cons of suprapubic catheterization?
Must initially be inserted through the abdominal wall by a physician and the insertion site must be cleaned daily using sterile technique if the patient is in the hospital
When inserting a catheter the penis…
Must be manipulated to “straighten out” the bends in the penile urethra
Outline changes in the pelvic floor during delivery
- Causes weakness of the pelvic muscles
- Muscle weakness in reduced support to pelvic organs
Explain stress incontinence of the urinary bladder
Pelvic floor and perineal muscles are important fir stability of pelvic organs and to maintain continence
External sphincters and pelvic floor muscles are voluntary muscles
Coughing and laughing increases the intra-abdominal muscles
Sphincters are weak and therefore doesn’t close of the urethra and urine leaks out
What is cystocele?
Prolapse of the bladder inti the vaginal canal
What are the common causes of cystocele?
- repetitive straining for bowel movements
- Constipation
- Chronic or violent coughing
- Heavy lifting
- Being overweight or obese
