Genitourinary System, Adrenals and Posterior Wall Flashcards
innervation of ureters
-renal and hypogastric nerve plexus
-males- testicular nerve plexus
-females- ovarian nerve plexus
-peristaltic movements of smooth muscle are stimulated by stretch receptors
-parasymp increase constriction -> peristaltic movement to move urine from kidneys to bladder
-symp decreases contraction
urinary system structures
-2 kidneys
-2 ureters
-1 urinary bladder
-1 urethra
kidneys
-located retroperitoneal space on posterior abdominal wall
-superior pole - deep to 11-12 ribs
-inferior pole- 1 fingers breadth superior to iliac crest
-right kidney lies slightly lower than left > due to liver and large right lobe
-each moves inferiorly with inspiration -> 2-3 cms
-each kidney contains:
-hilum
-renal pelvis
-major and minor calyces (minors make up major)
-renal capsule
-renal cortex
-renal medulla
function of kidneys
-1. excretion of waste products from proteins metabolism via filtration in nephrons
-2. returns nutrients and chemicals back into blood via reabsorption
-3. control water and electrolyte balance
-nephron- functional unit that filters and purifies blood
-1 mil nephrons in cortex of each kidney
-each nephron consists a renal corpuscle -> contains glomerulus, bowmans capsule, and renal tubule
hilum of kidney
-located on medial concave border
-entrance for blood vessels, lymph, nerves, ureters, into renal sinus
-transmits from anterior to posterior:
-renal vein
-renal artery (2 branches) -> branches after passing through hilum
-ureter
-lymph vessels
-sympathetic nerve fibers
renal sinus
-renal pelvis, calycies, vessels, nerves, lymphatics are embedded
-mostly fat inside
coverings of the kidney
-from outer to inner
-pararenal fat
-renal fascia
-perirenal fat
-fibrous capsule
-provide support and tether ureters and renal vessels
-holds everything in position on the posterior abdominal wall
fibrous capsule
-surrounds kidney and closely applied to surface
-innermost layer
perirenal fat
-covers fibrous capsule
-surrounds kidney and vessels
renal fascia
-collection of connective tissue
-encloses kidneys and suprarenal glands
-continuous with transversalis fascia and blends with vessel sheaths
-infection can spread to abdomen***
pararenal fat
-Large in quantity
-extraperitoneal fat of lumbar region
-posterior to kidneys
-outermost layer
renal cortex
-outer layer
-renal columns- goes between renal pyramids
-medullary rays- extend from bases of the renal pyramids (collecting duct of nephron)
-contain glomerulus, proximal and distal tubules
renal medulla
-renal pyramids
-each kidney has about 12 renal pyramids
-apex (renal papilla) and base -
-apex at the minor calyx
-contains collecting ducts and loops of henle
-gives rise to medullary rays- extensions of it into the renal cortex
renal pelvis
-minor calyces make up the major calyces
-major calyces drain into renal pelvis
-flattened extension of the proximal ureter
-apex is continuous with ureter
-receives 2-3 major calyx
renal columns
-passageway for the nerves and blood vessels
lobes of kidney
made up of pyramids and associated cortex
internal structures of the kidney
-renal cortex
-renal medulla
-minor/major calyces
-renal pelvis
arterial supply to kidney
-renal arteries (off aorta)- L1-L2
-Right renal artery is longer and passes posterior to IVC bc of placement where the aorta is
-renal arteries are anterior to renal pelvis
-renal arteries divides into 5 segmental arteries
-the 5 segmental arteries branch into lobar arteries- 1 lobar artery supplies each renal pyramid
-lobar arteries branch into 2-3 interlobar arteries- in the renal columns
-at the junction of the cortex and medulla interlobar arteries branch into…
-arcuate arteries- branch up to base of pyramids
-interlobular arteries- projecting up towards capsule -> supply cortex
-then goes to afferent arterioles -> glomerulus -> efferent arterioles -> venules -> veins -> renal vein
-each segmental artery supplies a segment of the kidney independently -> preserves
lobar artery
-end artery
-cut this and it cuts perfusion to everything distal
renal veins
-veins follow the arteries
-they unite to form the right and left renal veins
-anterior to renal arteries (use this to orient urself)
-longer left renal vein receives L suprarenal and gonadal veins and drains into IVC
-right receives tributaries from right kidney and drain into IVC
innervation of kidneys
-renal nerve plexus
-arise from lesser and least splanchnic nerves from sympathetic trunk
-(dont get caught up on this)
-mainly sympathetic innervation:
-regulate blood flow and pressure
-stimulate renin release
-stimulate sodium and water reabsorption
suprarenal glands**
-paired endocrine organs surrounded by renal fascia and lies on the superomedial aspect of the front of the kidney
-each consists of 2 distinct endocrine organs -> cortex and medulla
-cortex produces steroid hormones- aldosterone (Na, K, H2O), cortisol (glucose metabolism, immune), androgens (male sexual development)
-medulla produces epinephrine and norepinephrine
-arterial supply- superior suprarenal (inferior phrenic), middle suprarenal (aorta), inferior suprarenal (renal)
-venous drainage- suprarenal vein -> IVC (R) and renal vein (L)
-innervation: celiac plexus and splanchnic nerves
-mainly preganglionic sympathetic and synapse directly with cells of medulla
ureters
-muscular ducts
-25cm
-run inferior from apices of renal pelvis at the hila along lateral wall of the pelvis and pass over the pelvis brim at the bifurcation of the common iliac arteries
-smooth muscle -> peristaltic contraction to move urine
-carry urine from kidneys to bladder
-pass over pelvic brim
-empty into urinary bladder
-3 constrictions:
-renal pelvis meets the ureter
-at the pelvic brim- at bifurcation of common iliac arteries
-at junction with the bladder
blood supply of ureters
-arterial supply- proximal ureter- renal artery
-middle ureter- ovarian/testicular artery
-distal ureter- superior vesical artery
-all the arteries anastomose with each other along the wall of the ureter
-venous drainage:
-corresponds to arteries
-to IVC
-Left renal vein receives L ovarian / testicular vein -> ivc (right goes to IVC)
urinary bladder
-hollow viscus with muscular walls
-retroperitoneal
-anterior surface is covered with peritoneum
-tetrahedral shape when its empty
-varies in size, shape, and position depending on its contents
-500cc of urine
-empty bladder- pelvis-> tympanic
-full bladder- extends to suprapubic/hypogastric region -> dull
-temporary reservoir for urine
-located in pelvis directly posterior to pubic bones
-endopelvic fascia surrounds the bladder -> connective tissue layer between parietal and visceral layers of pelvic fascia
-retropubic space- between the pubic bones and bladder -> filled with fat and loose connective tissue
parts of bladder
-apex- most anterior
-fundus (base)- opposite apex; formed by the posterior wall, superior lateral border is formed by ureters, triangle shape
-body- majority of the bladder between apex and fundus, within, where urine collects
-neck
-internal orifice of urethra- where the urethra starts in the bladder
apex of bladder
-most anterior
-highly distensible
-embedded in extraperitoneal fat
-points to superior edge of pubic symphysis
-superior aspect covered by peritoneum
-connected to umbilicus via median umbilical ligament
neck of bladder
-where fundus and inferolateral surfaces meet
-lies inferiorly
-anchored by pelvic ligament and floor of bladder
-unchanged by amount of urine
-males- superior process of prostate -> support
-females- superior surface of urinogenital diaphragm -> not as supportive -> bladder prolapse
-males- held in position by puboprostatic ligament
-females- pubovesicula ligaments
-these ligaments are thickenings of pelvic fascia
interior of bladder
-walls of bladder are composed of detrusor muscle:
-smooth muscle
-3 layers of interlacing bundles
-covered with mucous membrane-> forms folds (rugae)
-folds flatten as bladder distends
-forms internal urethral orifice
-trigone- no folds -> smooth
-ureteric orifices, internal urethral orifice
trigone of bladder
-triangular area of mucous membrane at base of bladder firmly adhered to detrusor muscle -> no folds
-always smooth
-angles formed by- two ureteric orifices and one urethral orifice
-orifices are encircled by loops of detrusor muscle
-assist in preventing reflux of urine
-lacks rugae
blood supply of bladder
-arterial- superior and inferior vesicular artery (from internal iliac)
-venous- corresponds to arteries
-vesical venous plexus (males- prostatic venous plexus; females- vaginal venous plexus)
-drains into internal iliac vein -> Common iliac -> IVC
innervation of bladder
-inferior hypogastric plexus
-sympathetic fibers (L1-L2 lumbar ganglia):
-inhibit contraction of detrusor
-stimulates contraction of urethral sphincter
-parasympathetic fibers (splanchnic nerves from S2-S4):
-stimulates contraction of detrusor muscle
-inhibits action of urethral sphincter
male urethra
-8 inch muscular tube
-conveying urine from neck of bladder to external meatus on glans
-3 parts:
-prostatic
-intermediate (membranous)
-spongy penile
prostatic urethra
-passes through prostate
-1.2 inches
-widest and much dilatable portion of urethra
-structures:
-urethral crest- most prominent feature, longitudinal ridge in posterior wall
-prostatic sinus- groove on each side of urethral crest; where the prostatic ducts enter urethra
-prostatic utricle- slit like; junction of the reproductive tracts and urinary tracts -> where ejaculatory ducts enter urethra (where urinary and reproductive tract connect) **
intermediate(membranous) urethra
-lies within the urogenital diaphragm
-surrounded by external urethral sphincter
-shortest portion
-least dilatable
penile urethra
-6 inches
-surrounded by erectile tissue of bulb and corpus spongiosum
-bulbourethral glands open into penile urethra inferior to urogenital diaphragm
external meatus
-narrowest part
-fossa terminalis (navicular fossa)- dilated terminal end
female urethra
-1.5 inch muscular tube extending from bladder neck to external meatus
-opens into vestibule (about 1 inch below clit)
-anterior to vagina
-at sides of external meatus are -> small orifices of paraurethral glands
-urethra can be dilated easily
innervation of male urethra
-prostatic and intermediate (membranous):
-prostatic plexus (visceral afferent, symp and parasymp) -> extension of inferior hypogastric plexus
-spongy urethra:
-symp, lumbar splanchnic nerves
-parasymp- pelvic splanchnic nerves
-external sphincter has voluntary control via perineal branch of pudendal nerve
-dorsal nerve of penis (branch of pudendal) provides somatic innervation to spongy urethra (S2-S4)
female urethra innervation
-vesical nerve plexus- visceral afferent, symp and parasymp
-pudendal nerve- external sphincter (S2-S4)
kidney stone
-pain is T10-L2
-from lion to groin
-pts move around a lot (sitting still is uncomfortable)
-visceral afferent fibers conveying pain sensation to CNS
-pain caused by distention of lumen of ureter
-stone pressure -> increase lumen size -> renal colic
-pain can extend from lower lumber, inguinal region, external genitalia, inner thigh -> same T10-L2 innervation
-4ml can pass usually
-5ml cant
posterior abdominal wall
-psoas- covers a lot of the nerve innervations
-quadratus lumborum
-transversus abdominis
-psoas major
-psoas minor
-ilaous
-subcostal nerve- external oblique and skin of wall
-iliohypogastric ilioinguinal nerve- abdominal muscles and skin of pubic and inguinal regions
-lateral femoral cutaneous nerve- skin on anteriolateral thigh
-genitofemoral nerve
-femoral nerve- iliacus, flexors of hip, extensors of knee
-obturator nerve- adductor muscles
s2-4
