CPR 41+42

Question 1

what are the 3 constrictions of the ureter?

Answer 1

1. ureteropelvic junction
2. crossing of the illiac Artery
3. ureterovesical junction

Question 2

water under the bridge; female?

Answer 2

the ureter is under the uterine artery and vein

Question 3

water under the bridge; male?

Answer 3

The ureter is under the ductus deferens

Question 4

urinary tract stones?

Answer 4

more common in males
20-60 years of age

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

stones may be caused by bacteria

complications:
infection, urinary obstruction, renal failure

Question 5

pain from kidney stones is referred where and why?

what nerves?

Answer 5

commonly referred to the flanks, inguinal area, upper thigh

sympathetics are supplied from T12-L2

Ilioinguinal N, Iliohypogastric N, subcostal N.

Question 6

blood and lymph supply of the bladder?

Answer 6

blood: superior and inferior vesicle artery
lymph: external iliac nodes

Question 7

relationship of bladder in female and male?

Answer 7

female:
bladder then uterus and then rectum (A to P)

male:
anterior to rectum and rectovessicle space

Question 8

Detrusor muscle of the bladder?

internal urethral sphincter?

sphincter urethrae?

Answer 8

Detrusor: 
SM of the bladder wall 
relaxes to allow filling 
contracts to empty 
autonomic innervation 

internal urethral:
located at the neck of the bladder
continuation of detrusor muscle
autonomic innervation

sphincter urethrae:
located in deep perineal space
skeletal muscle
somatic innervation (pudendal N)

Question 9

ligamentous support for males and females’, regarding the bladder?

Answer 9

male: puboprostatic
female: pubovesical

Question 10

innervation of the bladder? sympathetic versus parasympathetic

Answer 10

detrusor:
sym: relaxation
para: contraction (pelvic splanchnics)

internal urethral:

sym: contact
para: relax

external sphincter: 
Pudendal N (somatic) 

sensation of filling/ fullness = visceral afferents

Question 11

Who is more likely to get a UTI?

Answer 11

females; much shorter urethra

Question 12

parts of the male urethra?

Answer 12

prostatic: anterior half of the prostate
membranous: located within the deep perineal pouch

penile / spongy: proximal portion and has openings for the bulbourethral glands

Question 13

two types of catheterization?

Answer 13

urethral and suprapubic

Question 14

stress incontinence

Answer 14

weakness of the pelvic floor muscles and sphincters, thus urine can leak

Question 15

Cystocele

Answer 15

prolapse of the bladder into the vaginal canal

common causes: 
repetitive straining for bowel movements 
constipation 
chronic cough (violent) 
heavy lifting 
obesity

Question 16

renal transplant

Answer 16

transplant is placed and attached in the region of the iliac fossa

Question 17

nutcracker syndrome?

Answer 17

The compression of the left renal vein between
the superior mesenteric artery (SMA) and aorta.

symptoms:
pain (left flank, pelvis)
varicocele
hematuria

Question 18

histology of the renal cortex?

Answer 18

granular in appearance
contains most components of the nephron
goes between the medullary pyramids as renal columns

Question 19

histology of the renal medulla?

Answer 19

arranged in pyramids
projects into renal minor calyx
striated appearance

Question 20

medullary ray?
cortical labyrinth?
renal lobule?

Answer 20

medullary ray: pars recta
within the cortex
contains the straight tubules

cortical Labyrinth: pars convoluta
contains renal corpuscle and convoluted tubules

renal lobule:
medullary ray is in the middle and has the cortical labyrinth on both sides.

Question 21

blood supply of the kidney?

Answer 21

renal artery 
segmental A 
interlobar A
Arcuate A
Interlobular A
afferent arteriole 
glomerulus 
efferent arteriole

Question 22

efferent arteriole of the cortical and Juxtamedullary nephrons

Answer 22

cortical:
efferent arterioles forms peritubular capillary network

Jx:
efferent arterioles become vasa recta

vasa recta:
run parallel to LOH
countercurrent exchange on ions in the medulla

Question 23

what are the three different nephrons?

differences?

Answer 23

1. cortical
   short loops of henle
2. intermediate
   mid-cortical
3. Juxtamedullary
   long loops of henle (concentration of urine)

Question 24

components of the renal corpuscle?

function?

Answer 24

glomerulus: afferent of efferent arterioles are found at the vascular pole

bowman’s capsule: surrounds glomerulus

Mesangium: mesangial cells (intra-glomerular)

Question 25

parts of the bowman’s capsule?

Answer 25

visceral layer: inner layer
consists of podocytes (modified squamous cells)
invests glomerular capillaries

parietal layer: outer layer
simple squamous
continuous with PCT

urinary space: lies between the two layers
collects ultrafiltrate

Question 26

characteristics of the endothelium of glomerular capillaries?

Answer 26

numerous fenestrations
no diaphragms
produces NO and PGE

lots of aquaporin-1 receptors

Question 27

Glomerular basement membrane

Answer 27

fused basal lamina of endothelial cells and podocytes

made up of type 4 collagen and heparan sulphate

Question 28

Factors that affect filtration?

Answer 28

1. charge
   negative charged molecules are repelled since BM is negative
2. size
   larger molecules have more difficulty passing
3. shape

Question 29

Goodpasture’s syndrome?

Answer 29

IgG against the type 4 collagen of the basement membrane, thus glomerulonephritis

hematuria, proteinuria

Question 30

two types of mesangial cells?

function?

Answer 30

Lacis cells and extraglomerular mesangial cells

they are within the capsule

function:
phagocytosis of residue along with GBM
secretes ECM
secretion of IL-1, PE2, PDGF (inflammatory)

Question 31

histology of PCT?

function?

Answer 31

found in the cortex
simple cuboidal epithelium
large cells
brush border

function:
reabsorb glucose and amino acids, and polypeptides