GU Anatomy Flashcards
Where do the kidneys sit in the abdominal cavity?
The kidneys are often a source of retroperitoneal bleeds. The adrenal/suprarenal glands sit on top of the kidneys.
Where do the kidneys sit?
Kidneys sit between vertebral levels T12 and L3 in the retroperitoneal space. The right kidney is pushed down lower due to the presence of the liver, so it is more prone to trauma
What is the vascular supply to the kidneys?
Abdominal aorta and IVC
The renal arteries supply the kidneys and branch off of the abdominal aorta and the renal veins drain the blood from the kidneys and into the IVC
What does perinephric fat stranding tell us on CT?
“Perinephric fat stranding” on CT scan
Fat that cushions and protects the fat posteriorly. Can see haziness or fat stranding present when there is infection or pathology going on in the kidneys. It can indicate things like pyelonephritis.
What are the two main portions of the adrenal glands?
Cortex and medulla. Different types of hormones are secreted from these different areas of the kidney
Also called the suprarenal glands
What is the flow of urine through the kidneys?
Cortex → medulla (papilla) → minor calyces → major calyces → renal pelvis → ureter
Where do nephrons sit?
In the renal pyramid
Describe the ureters of the kidneys
They are mostly retroperitoneal and continuous with renal calyx. We can give drugs to help dilate the ureter to relax the smooth muscle and allow the stone to pass through. An example of a drug like this is Tamsulosin (Flomax).
Where are the most likely locations for constrictions or obstruction?
These are the common areas where kidney stones get caught and can cause back up of urine into the kidneys
What does a kidney stone look like on imaging?
Stone light up bright on scans and it is very painful
What spinal nerves innervate pain with kidney stones?
Spinal cord levels: T11-L2
How does urine not flow back up to the kidneys?
Distension closes the ureters to prevent backflow
Bladder neck and urethra
Folds of muscle and smooth muscle to help the bladder to distend and grow in size.
Dysfunction of the ureters and distension of the valve that close the bladder, result in what condition?
Vesicoureteral reflux
What is the bladder neck?
Area close the urethra and at the bottom of the trigone
The triangular area of smooth muscle in the bladder, is known as what and how is it important clinically?
It is called the trigone. This is where infections tend to persist and this how some patients may constantly be geting UTIs
What is the muscle of the bladder?
detrusor muscle, which contracts during urination to push the urine out
Define the preprostatic urethra
Internal urethral sphincter. Its main function is to prevent retrograde movement of semen into the bladder after ejaculation
Define the prostatic urethra
Ducts from the prostate give the substances found in semen
What is the membranous urethra/deep perineal pouch
Bulbo-urethral glands and ducts- they secrete an alkaline substance into the urethra during ejaculation, because semen is very acidic and we want to prevent the tissue from being damaged and the sperm from being killed.
External urethral sphincter which is a voluntary sphincter
What is the spongy urethra?
It is surrounded by the Corpus spongiosium, which is essentially just erectile tissue
What are the structures of the male urinary system?
The urethra is shorter or longer in females?
Shorter. This is one of the reasons why women get UTIs much more frequently
When are the testes formed?
The testes are formed in the abdomen in utero and then they descend down toward the pelvic area through the inguinal canal
What is an indirect inguinal hernia?
It is lateral to the epigastric artery. The intestines herniate down into the scrotal sac through the inguinal canal. As they descend into the scrotal sac, they bring with them, nerves, vessels, drainage ducts, etc.
What is a direct inguinal hernia?
It is medial to the epigastric artery. Push directly through the abdominal wall.
What are the structures of the testes?
The covering of the testes and associated structures:
Spermatic cord covering testicular arteries and pampiniform venous plexus
Tunica vaginalis
Tunica albuginea
What is the main function of the spermatic cord and the pampiniform venous plexus?
a system of veins and arteries that supply the testes, they also work to absorb of the heat from the scrotum to cool the semen and sperm
What is the tunica vaginalis?
The spermatic cord comes down to form the tunica vaginalis. It is a sac of peritoneum to become the parietal and visceral layers
What is the tunica albuginea?
Encloses each testes and forms the tough outer covering and forms septa or partitions that come down.
What is the direction of sperm flow?
Seminiferous tubules → straight tubule → rate testis → efferent ductules → epididymis → ductus/vas deferens → ampulla (through prostate) → prostatic urethra
Where does spermatogenesis occur?
Seminiferous tubules, it undergoes a lot of levels of majurity to become mobile and gain the ability to fertilize an egg
What is the function of the testes?
The production of sperm
What is the function of the seminal vesicles?
Where the majority of the volume of semen is produced
What is the function of the vas derferens + seminal vesicle?
These are responsible for the ejaculatory duct. This is also the location of the ampulla.
What is the function of the prostate?
It is responsible for the volume of semen, the prostate specific antigen (PSA), and sperm activation
What is the function of the bulbourethral glands?
It is responsible for the pre-ejaculatory alkaline substance and urethral lubrication
What is a vasectomy?
Cutting and ligating ductus/vas deferens. This is nearly 100% effective form of birth control. There is still a need for repeat testing after surgery. They will need to attend their follow up
Where does the bulbourethral gland sit?
In the perineal tissue
What are the components of semen?
Milky-white mixture of sperm and accessory gland secretions
2-5 ml semen are ejaculated contianing 20-150 million sperm/ml
Protects and activates sperm, and facilitates sperm movement
Alkaline fluid neutralizes acidity of male urethra and female vagina and enhances motility
Contains prostaglandins that decrease viscosity of mucus in the cervix and stimulate reverse peristalsis in uterus.
Contains the hormone relaxin and other enzymes that enhance sperm motility
Can suppress female immune response
Antibiotic chemicals destroy some bacteria
What are the body/erectile structures of the penis?
The corpus cavernosa is in pink. This lends to the urethra staying open during an erection.
The the corpus spongiosum is in purple and surrounds the urethra. The corpus sponiosum extends distally to form the glans penis. They both are filled with vessels that fill and contribute to that rigidity during an erection.
What are the anchoring structures of the penis to pelvis?
The crura of the penis and the bulb of the penis which attach the corpus cavernosum to the pelvic wall.
What are the muscle of the penis?
Ischiocavernosus covers the crura.
Bulbosponious attaches the corpus spongiosum and covers the bulb.
These muscles constrict during an erection to help in maintaining it. This can be a big cause of ED if there is dysfunction within these muscle.
The muscles of the penis are innervated by what spinal nerves?
S2-S4 which is supplied by the pudendal nerve.
Sx of dysfunction may include dribbling of urine, a less than forceful ejaculatory contraction
Contraction of the Bulbosponious muscle causes what?
Outward pushing of the semen and it works to empty the urethra during urination. It will also compress just a little to help prevent venous drainage during an erection.
What are the ligaments of the penis?
Fundiform and Suspensory ligament
Provides support and maintains penile position during erection.
What is the fundiform ligament?
It comes down and around the penis. This is an extension of the fascia of the abdomen
What is the suspensory ligament?
Attaches to the pubic symphysis
What are the structures of the scrotum?
Dartos muscle minimizes heat loss, within the scrotal tissue and is the reason why the scrotum has the wrinkled look.
Cremaster muscle: absent cremaster reflux may indicate testicular torsion or neurological damage to L1-L2
The pampiniform plexus works to reduce heat loss as well.
Where is the cremaster muscle found?
Found within the spermatic cord and covers and goes upward through the spermatic cord and arises from the internal oblique muscle. Functions a lot to elevate the testes especially in cold temperatures
What is the cremaster reflex?
A cotton swab to the inner thigh and the testes will elevate or move upwards. The absence of this reflex can indicate testicular torsion or some type of neurological issue.
Why is the scrotal sac wrinkled?
It reduces surface area and minimize heat loss. The dartos muscle is the big contributor of this.
How do the dartos muscle and the cremaster muscle react in colder conditions?
They will contract to bring the scrotal sac and the testes closer to the body to maintain temperature. If this doesn’t function correctly, it can also lead to male infertility
What is the perineum?
Urogenital triangle
Anal triangle
What are the surface structures of the penis and other associated structures?
Glans penis w/ frenulum (inferior surface) and prepuce (foreskin)
Body/shaft of penis w/ midline raphe (extends midline into scrotum to form two pouches that house the testes)
Scrotum contains testes/epididymis
What is cryptorchidism?
It is the failure of the tests to make their normal descent.
It can cause sterility and increases risk of testicular cancer
Oftensurgery is usually performed during early childhood to rectify this problem
Define circumcision
It is the surgical removal of the foreskin.
In the US, 60% of males are circumcised, but only 15% in other parts of the world.
Studies show a reduction in penile cancer, STDs, UTIs, easier hygiene etc
What are some of the functions kidney?
Filters the blood and pass his waist as urea or uric acid as a product called urine. Helps maintain blood volume, electrolyte balance within our blood like potassium, sodium, and calcium. Helps maintain acid base balance
Is the kidney intro or retroperitoneal?
retro
How are the kidneys protected?
Fat and soft tissue structures, protected superiorly by floating ribs 11 and 12, some muscle as well
What displaces the kidney on the right side of the body? What structure is that closely at the left kidney?
The liver displaces the right kidney. The left kidney is in close proximity to the spleen
What is the name for the outermost tough fiber layer of the kidney?
renal capsule
Describe these structures
Describe these structures
Describe these structures
What is the functional unit of the kidney?
The nephron is a very small filtration piece that is found within different tissues of the kidney. The majority of the filtration process occurs in the cortex, but the drainage pathway is contained within the medullary tissue. The collection itself will be in the calyces, with one minor calyce collecting all the filtrate from a renal pyramid
What is the glomerulus and all its associated structures?
It is a capillary network where the actual filtration is going to occur. The efferent and inherent branching arterials come into and out of the glamorous. Bowmans capsule within the glamorous captures nutrients in a sack to be filtered through the rest of the kidney with the proximal convoluted tubule. Bowermans capsule surrounding the glomerulus and the PCT are located within the cortex of the kidney. The filtrate will then descend into the medullary tissue and into the loop of Henle.
What is the loop of Henle?
The loop of Henley has two different portions, and ascending limb that runs thin to thick and a descending limb that runs thick to thin. Following the loop of Henley, we are going to have a DCT, the filtrate is then filtered down into the collecting duct, Which will drain into a renal papilla and then into a minor calyce, towards a ureter
Where do the vessels that support kidney function branch off of the abdominal aorta?
L1
Which renal artery needs to pass posterior to the IVC?
The right renal artery
Which renal artery takes a more direct route and is therefore shorter?
The left renal artery
Which renal vein receives blood directly from the gonadal vein?
The left renal vein
What is the flow of urine from the urinary pelvis to the ureter with all the junctions?
Renal cortex → renal medulla and renal pyramid → renal papilla → minor calyx (about 20) → major calyx (2-5) → renal pelvis → URETEROPELVIC JUNCTION → ureter → urinary bladder
What is the significance of the renal pelvis?
It is located at the junction point of all the major calyces and will pass through the opening of the renal hilum. The renal sinuses will also drain into the renal hilum
Define these structures
Define these structures
Define these structures
What is the Detrusor muscle clinically significant?
It is a specialized type of smooth muscle only found in the bladder that allows the transitional epithelium to expand and contract and will help assist with gravity, when voiding the bladder
What is the clinical significance of the ureteric orifice?
It acts as a one-way valve or sphincter to prevent urine in fluid back up
Within the ureter is special smooth muscle that is capable of a wave like contraction known as?
Peristalsis, that helps propel urine from the kidney, all the way down to the urinary bladder
What are the three major points where blockage can occur in the ureter?
Junction of the renal pelvis with the ureter
The point where the ureter crosses over the pelvic inlet
The junction of the ureter with the urinary bladder
How would dysfunction at the junction of the renal pelvis with the ureter cause issues?
Closure would increase pressure in the kidney and shut it down and cause renal failure
How would dysfunction of the ureter as it crosses over the pelvic inlet occur?
Obstruction caused by enlargement of underlying issues or contrition due to other abdominal organs
How would dysfunction at the junction of the ureter with the urinary bladder cause an issue?
It would default where it doesn’t open and close properly to allow the urinary bladder to adequately fill and can back up and cause a massive defect
Where does the male urethra begin and end?
The male urethra begins at the internal urethral orifice and terminates at the external urethral orifice
What are the three main portions of the male urethra?
pre-prostatic urethra
Prostatic urethra
Membranous urethra
Describe the pre-prostatic urethra
Enclosed within the walls of the urinary bladder
Describe the prostatic urethra
The junction of the two sources of fluid (Urine from the bladder and semen from the ejaculatory duct). The internal urethral sphincter closes to prevent urine from exiting during ejaculation and to keep sperm from entering the bladder
Describe the membranous urethra
At the perineal membrane and it is enclosed proximity to the external urethral sphincter
What is the bulbourethral gland?
Produces the pre-ejaculate fluid in the sins or exits by the fourth portion of the urethra. This fluid also helps lubricate internal aspect of the urethra, during erection to avoid any tearing due to the stretching and lengthening process
What is the navicular fossa?
he wider part of the urethra just before it terminates at the external urethral orifice
What is the overall function of the urinary system?
Filter the blood and eliminate waste
Where do blood vessels, lymphatic vessels, and nerves enter and exit the kidney?
Renal hilum
What is the functional unit of the kidney?
Nephron
Where does glomerular filtration take place?
The renal corpuscle also known as Bowmans capsule
The bulbourethral Gland is positioned at the height of which subdivision of the male urethra?
Membranous urethra
The left renal artery is a direct branch of which vessel?
The abdominal aorta
What is the main function of the male reproductive system?
To produce hormones and germ cells for the reproduction of the organism
What structure is a part of the spermatic cord?
Vas deferens
Which organ produces the gamete from the male reproductive system?
Seminiferous tubules
Where do sperm mature and grow within the male reproductive system prior to ejaculation?
epididymis
Which structure is responsible for pre-ejaculate, the fluid that assist in lubricating the urethra during Erection?
Bolbo urethral gland
In anatomical position the corpus spongiosum is located on which surface of the shaft of the penis?
Anterior
What structure is cut during a vasectomy?
Vas deferens
What is the flow of semen and it’s associated structures?
Seminiferous tubules → efferent ductules → Epididymis→ ductus deferens→ Ejaculatory duct→ Prostatic urethra→ Membranous urethra→ Penile urethra
