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BPM1 Exam 5 - Cardiovascular, Pulmonary, and Renal 2 > CPR 61-62 - Urinary System and Development > Flashcards

CPR 61-62 - Urinary System and Development Flashcards

1
Q

Describe the relationships of the anterior surface of the right kidney.

A
  • Adrenal gland is covering the superior pole of kidney
  • Liver covers the middle third of kidney
  • Duodenum covers the medial quarter of kidney
  • Small intestine covers a small portion of the inferior pole of kidney
  • Colon covers the lateral half of the lower third of the kidney

Refer to image

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2
Q

Describe the relationships of the posterior surface of the right kidney.

A
  • Diaphragm is just posterior to the superior pole
  • Rib 12 is just posterior and inferior to the superior pole
  • The bottom two thirds and medial third is just anterior to the psoas major
  • The bottom two thirds and middle third is just anterior to the quadratus lumborum
  • The bottom two thirds and lateral third is just anterior to the transversus abdominis

Refer to Image

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3
Q

Describe the relationships of the anterior surface of the left kidney.

A
  • The adrenal gland, stomach, and tail of pancreas cover the medial upper quadrant of the left kidney
  • The spleen covers the lateral upper quadrant of the left kidney
  • The small intestine cover the medial lower quadrant of the left kidney
  • The colon covers the lateral lower quadrant of the left kidney

Refer to image

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4
Q

Describe the relationships of the posterior surface of the left kidney.

A
  • Rib 11 is just posterior to the apex of the kidney and rib 12 is just posterior and superior to the hilum of the kidney
  • The diaphragm is just posterior to the kidney between ribs 11 and 12
  • The lower half and medial third of the kidney is just anterior to the psoas major
  • The lower half and middle third of the kidney is just anterior to the quadratus lumborum
  • The lower half and lateral third of the kidney is just anterior to the transversus abdominus

Refer to image

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5
Q

At what vertebral levels are the kidneys and their hilums found?

A

Kidney span from T12-L3

Hilums are at the L1-L2 levels

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6
Q

List the contents of the hilum from anterior to posterior

A

Renal Vein

Renal Artery

Renal Pelvis

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7
Q

Name and describe the deepest renal covering.

A

Renal Capsule

Connective tissue closely adhered to the kidney that also enters the hilum and lines the renal sinus. It is continuous with the connective tissue forming the walls of the calyces and renal pelvis.

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8
Q

Name and describe the second deepest renal covering.

A

Perirenal (perinephric) Fat

A layer of fat enclosing the renal capsule and adrenal gland

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9
Q

Name and describe the third deepest renal covering.

A

Renal Fascia or Gerota’s Fascia

A membranous condensation of the extraperitoneal fascia that surrounds the perirenal fat.

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10
Q

Name and describe the most superior renal covering.

A

Pararenal fat

A layer of fat surrounding the Gerota’s fascia (renal fascia)

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11
Q

Why is the fat surrounding the kidney important?

A

The kidney has no ligaments surrounding it. The fat layers and their attachments help to maintain the position of the kidneys and renal arteries without compressing them too much.

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12
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13
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14
Q

What is the hepatorenal recess? Where is it located? Why is it significant?

A

A space found between the kidney and liver just superior to the right kidney and posterior to the liver. If there is fluid in the abdomen then it will accumulate in this space when the body is supine.

aka - Pouch of Morrison

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15
Q

What are renal columns?

A

Extensions of the cortex into the medulla

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16
Q

Describe the contents of the cortex and medulla of the kidney.

A

The cortex contains the renal corpuscles, convoluted tubules, the proximal part of the proximal straight tubule, the distal part of the thick ascending limb, the macula densa, the proximal part of the collecting duct, arcuate arteries, interlobular arteries, afferent/efferent arterioles, glomerular capillaries, peritubular capillaries, interlobular veins, and arcuate veins.

The medulla contains the distal part of the proximal straight tubule, thin descending and ascending limbs. the proximal part of the thick ascending limbs, the distal part of the collecting duct, the vasa recta, and a papilla that drains into a minor calyx

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17
Q

Describe what the renal pelvis is and its route.

A

The renal pelvis is a merger of the major calyces. The renal pelvis exits the hilum and narrows to form the ureter at the ureteropelvic junction (UPJ)

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18
Q

What is the renal sinus?

A

The renal sinus is a cavity within the kidney which is occupied by the renal pelvis, renal calyces, blood vessels, nerves and fat.

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19
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20
Q

What do you call a nephron plus a collecting duct?

A

A uriniferous tubule

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21
Q

Why isn’t a collecting duct considered to be part of a nephron?

A

Because several different nephrons drain into one collecting duct via a connecting tubule.

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22
Q

What is a minor calyx?

A

A merger of several collecting ducts at the renal papilla

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23
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24
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25
Q

Describe the path of blood flow from renal artery to renal vein.

A

renal artery - segmental artery - interlobar artery - arcuate artery - interlobular artery - afferent arteriole - glomerular capillary - efferent arteriole - peritubular capillaries and/or vasa recta - interlobular veins - arcuate veins - interlobar veins - segmental veins - renal vein

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26
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27
Q

Name the lymph nodes that the kidneys, ureters, and bladder drain to.

A

Kidney - left and right lumbar lymph nodes

Upper Ureter - kidney lymphatics or lumbar lymph nodes

Middle Ureter - common iliac lymph nodes

Lower Ureter - common, external, and internal iliac lymph nodes

Pelvic Ureter and Bladder - internal iliac lymph nodes

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28
Q

Name the plexus that innervates the kidneys and what that plexus consists of.

A

Renal Plexus consists of rami from:

  • Celiac ganglion and plexus
  • Aorticorenal ganglion
  • Least thoracic splanchnic nerves
  • 1st lumbar splanchnic nerve
  • Aortic plexus
  • Sympathetics from T11-L2
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29
Q

From where does the renal plexus enter the kidneys?

A

Usually around the renal arteries

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30
Q

What plexuses does the renal plexus give rise to?

A

The ureteric and gonadal plexuses

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31
Q

What is the function of the majority of renal nerves?

A

Vasomotor

some sensory

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32
Q

How do the efferent renal nerves get back to the CNS?

A

With the thoracic splanchnic nerves

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33
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34
Q

From which regions of the trilaminar disk does most of the urinary system develop?

A

Intermediate mesoderm and the urogenital sinus

35
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36
Q

What does the intermediate mesoderm give rise to? What will these structures become?

A

The urogenital ridge which consist of the nephrogenic cord and gonadal ridge.

The nephrogenic cord will give rise to urinary system components and the gonadal ridge will give rise to genital system components.

Refer to image

37
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38
Q

What are the developmental stages the nephrogenic cord will go through? Briefly describe the functional capacity of each phase.

A
  1. Pronephros - rudimentary non functional
  2. Mesonephros - functions briefly during early fetal development
  3. Metanephros - serves to form the permanent kidney
39
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40
Q

When/where does the pronephros appear, what does it do, when does it disappear?

A
  • At the beginning of week 4, 7-10 cell groups appear in the cervical region of the nephrogenic cord. This is the pronephros
  • These cells form vestigial excretory units called nephrotomes
  • The signals the nephrotomes secrete will stimulate the formation of the mesonephros
  • The pronephros will regress and disappear before the mesonephros is formed at the end of week 4
41
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42
Q

When/Where does the mesonephros appear? What does it do/become?

A
  • The mesonephros begins to appear in week 4 as the pronephros regresses
  • Excretory tubules appear first which lengthen to form an S-shaped loop that will acquire a tuft of blood vessels. These blood vessels will form primitive glomeruli and the S-shaped excretory tubules will form bowman’s capsule
  • The tubules will eventually joint the longitudinal collecting duct known as the mesonephric duct
  • Beginning around the middle of the 2nd month the cranial tubules will undergo degeneration while new ones form caudally.
  • By the end of the second month the majority of tubules will have disappeared and a large ovoid organ has developed on either side of the midline. Some tubules and the mesonephric duct will persist in males to develop gonadal organs

Refer to image

43
Q

How and when does the metanephros develop? What does it consist of?

A

The metanephros appears in the 5th week when the ureteric bud, which forms from the mesonephric duct near the cloaca, penetrates the metanephric blastema, which forms from mesenchymal tissue at the caudal portion of the nephrogenic cord.

The blind end of the ureteric bud is referred to as the diverticulum.

Refer to image.

44
Q

Describe how the ureters, renal pelvis, and calyces develop.

A

Ureters - develops from the stalk of the ureteric bud

Renal pelvis - when the ureteric bud first penetrates the metanephric blastema it dilates to form the primitive renal pelvis

Calyces - once in the metanephric blastema the diverticulum will split into two or three buds, these will form the major calyces. Each of those buds will then split into two or three buds to form the minor calyces.

Refer to image

45
Q

Describe how the collecting ducts develop.

A

The buds that split to form the minor calyces split again and extend into the metanephric blastema as straight collecting tubules. When the straight collecting tubules reach the periphery of the metanephric blastema they split one last time and arch to form arched collecting tubules.

Refer to image

46
Q

Describe how the nephron develops.

A

The straight and arched collecting tubules induce the formation of clusters of mesenchymal metanephric blastema cells called metanephric vesicles. These vesicles elongate to form S-shapte renal tubules that will become the Bowman’s capsule, PCT, loop of henle, and DCT. Capillaries will grow into the renal tubules and the proximal ends of the tubules will become invaginated by glomeruli. Eventually each renal tubule will contact and become continusous with the end of an arched collecting tubule to form a functional uriniferous tubule.

Refer to image

47
Q

Why is the fetal kidney lobulated with fissures on the surface? Why do these features disappear over time?

A

The splitting and intrustion of the ureteric bud into the metanephric blastema causes the outside of the blastema to appear lobulated with fissures. As the kidneys functionally mature after birth, the lobulations gradually disappear due to the growth of connective tissue, vasculature, and increasing size of nephrons. If this process fails then the kidney will show fetal lobulations.

48
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50
Q

Discuss renal ascent, rotation, and arterial supply.

A
  • Initially the hila face ventrally and receive branches from the common iliac arteries
  • As the caudal parts of the embryo grow away from the kidneys they come to lie higher in the abdomen.
  • During their “ascent” the kidneys rotate medially and receive blood from successively higher and higher branches from the aorta
  • Eventually the primordial caudal branches disappear leaving only the final renal arteries as blood supply
  • By week 9, the kidneys contact the suprarenal glands and reach their adult position
51
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52
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53
Q

What are accessory renal arteries? Describe their typical route and their clinical significance.

A

Accessory renal arteries are arteries that supply the kidneys and do not arise from renal arteries. They may arise from the aorta above or below the main renal artery (usually below) and they typically supply the lower pole of the kidney. Accessory arteries that do supply the lower pole typically cross over the ureter and can cause obstruction (hydronephrosis).

54
Q

What is an “end artery” and what are the renal “end arteries.” Why is this clinically significant?

A

An end artery (or terminal artery) is an artery that is the only supply of oxygenated blood to a portion of tissue. The renal end arteries are the renal segmental arteries. If any of them become blocked, injured, or ligated it will lead to ischemia of the supplied kidney segment.

55
Q

What does “agenesis” mean and what do we need to know about renal agenesis?

A

Agenesis is the failure of an organ to develop due to the absence of primordial tissue. Renal agenesis occurs when the ureteric bud degrades early or fails to form entirely. Unilateral renal agenesis is more common in boys, usually affects the left kidney, and is asymptomatic if the other kidney is normal. Bilateral renal agenesis leads to oligohydramnios (amniotic fluid deficiency) which causes pulmonary hypoplasia and the POTTER sequence appearance. It is incompatible with post-natal life.

56
Q

What do we need to know about supernumerary kidneys?

A
  • They are extra kidneys
  • They are very rare
  • They can either share a ureter (bifid ureter) with another kidney or have their own.
  • If the supernumeray kidney has its own ureter then there were probably two separate ureteric buds on that side
  • When there are separate ureters, one may have a fistulous opening into the urethra, vagina, or vestibule
57
Q

Facts we need to know about horseshoe kidney.

A
  • 1:500 births
  • Fusion of lower poles while still in pelvis
  • Ascent interrupted at the inferior mesenteric artery

Refer to image

58
Q

Describe the route of the ureters in males and females. Mention the sections where the ureter constricts.

A
  1. Starts at UPJ (first constriction)
  2. Travels inferiorly along the posterior abdominal wall in the retroperitoneal space and anterior to the psoas muscle
  3. Crosses the iliac vessels at the pelvic brim near the iliac artery bifurcation (second constriction)
  4. Crosses under the uterine artery & vein in females or under the gonadal artery & vein in males (water under the bridge)
  5. Finally passes through the wall of the urinary bladder at the UVJ (third constriction)

Refer to image

59
Q

What is the blood supply to the ureters?

A

Renal arteries

Abdominal aorta

Iliac arteries

60
Q

What is a bifid ureter and what causes it?

A

A bifid ureter is a ureter that is split into two at the kidney but merges back to one along its route to the bladder. It is caused by incomplete division of the ureteric bud.

Refer to image

61
Q

What is a crossed fused ectopic kidney?

A

This occurs when the left kidney fuses with the right kidney during development when they are still in the pelvis. They then both ascend together along the right kidney path. Both kidneys still have their own ureter. The left suprarenal gland has no kidney associated with it.

Refer to image

62
Q

Describe the location and appearance of the bladder when it is empty and full.

A
  • Always located just posterior to the pubic symphyses
  • When empty it resembles a 4 sided pyramid and it resides in the true pelvis
  • When full it is ovoid and it protrudes anteriorly and superiorly into the abdominal cavity
63
Q

Discuss the locations of the urinary bladder apex, base, and neck. Also discuss the attachments of the urinary bladder

A
  • The apex is anteriosuperior and it is attached to the umbilicus by the median umbilical fold/ligament (remnant of the uracus)
  • The base is posteriorinferior and the ureters enter at the two superior edges of the base
  • The neck is most inferior and is where the urethra exits inferiorly. It is held in place by the pubovesical ligament in females and the puboprostatic ligament in males
  • The rest of the bladder is held in place by condensations of the pelvic fascia/loose connective tissue

Refer to image

64
Q

Discuss the blood supply and lymphatic drainage of the urinary bladder.

A
  • Blood is supplied by the superior and inferior vesicle artery
  • Lymph is drained to the external iliac nodes
65
Q

Where is the median umbilical ligament located?

A

Within the fat-filled retropubic space which is an extra-peritoneal space located between the pubic symphysis and the urinary bladder posterior to the tranversalis fascia and anterior to the peritoneum

Refer to image

66
Q

List the relationships of the urinary bladder in females.

A
  1. Peritoneum superior
  2. Uterus superioposterior
  3. Vagina is posterioinferior
  4. Retropubic space is inferioanterior
  5. Pubic symphyses are anterior.

Refer to image

67
Q
A
68
Q

List the relationships of the urinary bladder in males

A
  1. Peritoneum superior
  2. Rectovesicle pouch posterior
  3. Prostate inferior
  4. Retropubic space inferioanterior
  5. Pubic symphyses anterior

Refer to image

69
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A
70
Q

List the three muscles of the urinary bladder. Mention their locations, actions, what type of muscle they are, and whether their innervation is autonomic or somatic.

A
  1. The detrusor muscle is the smooth muscle of the bladder wall. It relaxes to allow filling and contracts to empty. It receives autonomic innervation
  2. The internal uretral sphincter is located at the neck of the bladder and is a continuation of the detrusor muscle and is smooth muscle. It constricts to prevent emptying and relaxes to allow emptying. It receives autonomic innervation
  3. The spincter urethrae (external urethral spincter) is located in the perineal space inferior to the prostate. It is skeletal muscle that receives somatic innervation. Its actions are the same as the internal urethral spincter, except voluntary.

Refer to Image

71
Q

Describe how SNS and PSNS innervation affects the muscles of the bladder. Describe the route these nerves will follow.

A

Detrusor muscle - SNS relaxes and PSNS contracts

Internal Urethral Sphincter - SNS contracts and PSNS relaxes

External Urethral Sphincter - somatic innervation contracts

PSNS nerves arise from S2-S4 as part of the pelvic splanchnics. SNS nerves arise from T10-L2 as part of the lesser and least splanchnics, lumbar splanchnics, and hypogastric plexus.

72
Q

What nerve innervates the external urethral sphincter?

A

Pudendal nerve

73
Q

What nerves provide the sense of a full bladder and/or bladder pain? What route do they take back to the CNS? Where is bladder pain felt?

A

Visceral afferents accompanying the parasympathetics of the pelvic splanchnics

Pain from the bladder referes to the perineum and may also increase urinary frequency due to increased urinary urge

74
Q

Describe what the cloaca becomes, how it does this, and when this happens.

A

The cloaca will become the bladder, the prostatic & membranous portions of the male uretra, the entire female urethra, and the rectum. From weeks 4-7 the urorectal septum will divide the cloaca into an anterior portion, urogenital sinus, and a posterior portion, rectum. The upper portion of the urogenital sinus which is continuous with the allantois will give rise to the bladder. The middle portion of the urogenital sinus will give rise to the prostatic and membranous male urethra or the entire female urethra. The lower portion (phallic portion) of the urogenital sinus develops differently for each sex. Refer to image

75
Q

How do the ureters come to merge with the bladder? How does this association change througout development?

A

During development the caudal portion of the mesonephric ducts are absorbed into the wall of the urinary bladder and become the trigone. Consequently the ureters enter the bladder. As the kidneys “migrate” up the ureteric orfices are moved superiorly and posteriorly on the bladder.

76
Q

What does the perineal body develop from?

A

The urorectal septum

77
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78
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A
79
Q

Approximately how long is the female urethra and is it spongy or membranous?

A

It is about 4cm in length and is membranous

80
Q
A
81
Q

Describe the bends of the male urethra.

A

The first bend is in the spongy urethra and be easily manipulated. The second bond is located in the membranous urethra and is fixed

82
Q

What are the two types of bladder catheterization and their pros and cons?

A

Urethral Catheterization - catheter is fed into the bladder via the urethra. Pros: insertion/removal does not require an anesthetic and is relatively easy. Cons: higher incidence of UTI, can damage bulb of penis upon insertion, prevents natural voiding, makes ambulation difficult

Suprapubic Catheterization - catheter is inserted into the bladder through the skin about 1 inch above the pubic symphysis. Pros: lower incidence of UTI, allows for natural voiding, makes ambulation relatively easy. Cons: requires an anesthetic and physician to insert, insertion site must be cleaned daily.

83
Q
A

BPM1 Exam 5 - Cardiovascular, Pulmonary, and Renal 2 (16 decks)

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