Kidney/Ureter/Bladder

Question 1

Which of the following is true regarding renal anatomy?
The cranial pole of the left kidney lies within the renal fossa of the liver
The right kidney is more mobile than the left
The renal vein is located more ventrally than the renal artery
The kidney is surrounded by substantial fat in only obese animals

Answer 1

A right (renal fossa of caudate liver lobe)
B left >R
C TRUE
D always, even lean

Question 2

True or false: in 13% of canine and 10% of feline kidneys there are multiple renal arteries?

Answer 2

true

Question 3

What is the basic functional unit of the kidney?

Answer 3

nephron

Question 4

Which of the following is true regarding urine formation?
A Normal urine production in dogs and cats varies between 30-60ml/kg/day
B Glomerular filtrate is roughly 300mg/dL
C Filtrate goes from the glomerulus -> proximal convoluted tubule ->descending loop of Henle -> ascending loop of henle -> distal convoluted tubule ->collecting tubule -> papillary duct -> collecting system
D Glomerular filtration rate is roughly 40% of renal plasma flow

Answer 4

A (false, 20-45ml/kg/day) or (1-2 ml/kg/hr)
B (300mOs/L) UNIT
C true
D 20%

Question 5

Which is true?
A The kidneys receive 15% of the animal’s cardiac output
B The cortical blood flow is 4 mL/min/g tissue
C The outer medulla blood flow is 1.3 mL/min/g tissue
D The inner medulla blood flow is 5 mL/kg/min

Answer 5

A 25%
B true
C outer 0.7 ml/min/g
D inner 0.1 ml/min/g

Question 6

Which is true?
A Renal perfusion pressure is less than mean systemic pressure
B GFR is 30% of the renal blood flow
C GFR is determined by hydrostatic forces
D Anesthesia decreases autoregulation of the kidneys

Answer 6

A RPP = Mean systemic pressure
B 20%
C hydrostatic AND osmotic
D true

Question 7

Which is true?
A Medullary washout is due to increased medullary blood flow
B Concentrating ability of the kidney depends on the cortex
C Concentrating ability is increased by increased blood flow through the vasa recta, secondary to vasodilation, increased arterial pressure, or increased fluid volume.
D Osmolarity of the renal medullary interstitial fluid is ~300 mOs/L, whereas non-medullary interstitial fluid is ~1200-1400 mOs/L

Answer 7

A true
B medulla
C concentrating ability is decreased by increased blood flow
D medullary 1200-1400 mOs/L and non-medullary about 300mOm/L

Question 8

What molecule contributes to 40-50% of the renal medulla osmolarity?

Answer 8

urea

Question 9

Which of the following statements is true?
A There is no general guideline for the size of ureters in canines
B 30% of felines may have a left circumcaval ureter
C The blood supply to the ureter is from the ureteral artery and the ureteric br. Of the caudal vesicular artery
D The pitch of the m. fibers in the canine ureter is circular distally, becomes more oblique, and then almost longitudinal proximally

Answer 9

A 0.07 x length body of L2
B right
C true
D proximal circular, middle oblique, distal longitudinal

Question 10

Which of the following is false?
A Ureters have an outer adventitial layer, central muscular layer, and inner mucosal layer
B 3 plexes of vessels, nerves and lymphatics exist between the layers
C Canine ureters have been proven to have microvilli projecting into lumen
D Transitional epithelial exists in longitudinal folds when not distended

Answer 10

C (human ureters have microvilli- proven)

Question 11

Which of the following is false regarding the anatomy of the bladder?
A. The ventral median ligament connects the bladder to only the linea alba, and can be cut during cystotomy
B. The lateral bladder ligaments contain the distal portion of the ureters and umbilical artery
C. In male animals the deferent ducts pass dorsal to the bladder
D. There is no anatomically distinct internal sphincter at the vesicourethral junction

Answer 11

A Ventral median ligament connects to linea alba AND pelvic symphysis

D the detrusor muscle has oblique interdigitating m. fiber contiguous with smooth muscle of urethra

Question 12

Which of the following is false regarding bladder innervation?
A. Smooth muscle at the vesicourethral junction is maintained in a steady state of contraction by sympathetic stimulation via the hypogastric nerve
B. The hypogastric nerve is responsible for relaxation of the detrusor muscle and urine storage
C. Activation of stretch receptors by distension of the detrusor muscle results in parasympathetic activation and detrusor muscle contraction via the pudendal nerve
D. The parasympathetic innervation to the bladder originates in the sacral spinal cord from the segments S1-S3

Answer 12

A, B hypo –> symp –>storage
C FALSE pelvic nerve –> parasymp -> detrusor m. contraction
D S1-S3 –> pelvic n

Question 13

True/Flase: E. Voluntary control of micturition occurs via the pudendal nerve and direct cortical innervation of the pontine micturition center.

Answer 13

true

Question 14

True/False

Full-thickness defects of the bladder regain 100% of normal tissue strength in 21-28 days

Answer 14

false: 14-21 days

mucosal defects heal in 5 days

Question 15

The uretrhal mucosa layer is composed of ___________ epithelium proximally but becomes ________ _________ distally.

Answer 15

transitional–> stratified squamous

Question 16

What are the 3 branches of the internal pudendal A that supply branches to the urethra?

Answer 16

Prostatic, urethral, artery of the penis

Question 17

The smooth muscle is innervated by the ________ (parasympathetic) and ___________ (sympathetic)

Answer 17

pelvic
hypogastric
[Striated muscle supply exclusively by the pudendal (somatic efferent) nerve]

Question 18

True or false: positive-contrast retrograde urethrography is the imaging modality of choice for evaluation of urethral lesions?

Answer 18

true

Question 19

Which of the following is true?
A Mucosal continuity is a critical factor that influences urethral healing while extravasation of urine is not
B The urethral mucosa can regenerate within 5 days as long as a strip of the urethra remains intact
C Narrowing of the lumen has to exceed 60% for a patient to exhibit clinical signs of urethral stricture
D Hyperkalemia causes spiked T waves, shortened QRS and PR intervals, and shortened QT interval

Answer 19

C true
extravasation ALSO affects healing
strip intact –> 7 days for mucosa regeneration
spikes T waves, depressed R waves, PROLONGED QRS/PR/QT intervals –> atrial standstill–> wide QRS complexes

Question 20

When to treat for hyperkalemia?

Answer 20

significant ECG changes or serum K+ > 8 mEq/L

Question 21

Which of the following is true?
A Urinary diversion is recommended for 5-7 days following urethral anastomosis to minimize risk for stricture
B Suture in healthy bladder tissue is typically covered by epithelium within 5 days
C Evidence does not support successful use of Polyglactin 910 in urethral tissue
D Female dogs have more longitudinal smooth muscle and less striated urethral sphincter

Answer 21

A(3-5 days)
B true
C (Vicryl, false - there is anecdotal evidence)
D CATS have more smooth and less striated

Question 22

Which receptors are present in the detrusor muscle? the urethral smooth m?

Answer 22

detrusor = Beta r
urethral = alpha r

Question 23

What is the MOA of prazosin?

Answer 23

highly selective alpha1 R ANTagonist
stimulation at urethral sphincter smooth muscle
relax
Will cause secondary vasodilation

Question 24

what is the MOA of bethanechol?

Answer 24

parasympathomimetic
Muscarinic cholinomimetic
for detrusor atony (once the alpha antagonists have taken effect to relax internal urethral sphincter) so urine can be expressed

Question 25

what is the MOA of phenoxybenzamine

Answer 25

alpha-adrenergic antagonists to target the internal urethral sphincter (relax) especially with UMN bladder (less specific than prazosin)

Question 26

how is urine storage accomplished?

Answer 26

beta-mediated detrusor muscle relaxation,
alpha-mediated internal urethral sphincter tone,
cholinergic (nicotinic)-mediated external urethral tone

Question 27

what kind of muscle is the detrusor muscle

Answer 27

smooth muscle

Question 28

how is urination accomplished?

Answer 28

adrenergic input to the bladder is decreased, –> increased detrusor muscle activation and decreased internal urethral sphincter tone.
Cholinergic stimulation via the pelvic (parasympathetic) –> detrusor muscle contraction and pudendal nerves (skeletal innervation) –> external urethral sphincter relaxation

Question 29

How does diazepam help with urinary function?

Answer 29

Can relax external urethral sphincter (skeletal muscle)

Question 30

how does estrogen contribute to urinary function?

Answer 30

improve smooth muscle contractility and sensitivity to α-adrenergic stimulation, (combined therapy with α-adrenergics for USMI)

Question 31

MOA of phenylpropanolamine? when is it prescribed?

Answer 31

α-adrenergic agonist

used for USMI

Question 32

What is the complication rate cystostomy tubes

Answer 32

50%

Question 33

True/false: it appears to be the duration of the need for bladder expression or catheterization, rather than the method, that is independently associated with increased risk of bacterial infection

Answer 33

true

Question 34

what are renal replacement methods?

Answer 34

1. Transplants: immunosuppress
2. Peritoneal dialysis:
3. Intravenous hemodialysis (removes low molecular weight substances (<500DA) such as urea, creatinine, electrolytes)