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Urogenital Block > L3 - Anatomy of the kidneys, ureters, urinary bladder > Flashcards

L3 - Anatomy of the kidneys, ureters, urinary bladder Flashcards

1
Q

Retroperitoneal space location

A

Anatomical space in abdominal cavity located posterior to the parietal peritoneum

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2
Q

Structures in retroperitoneal space

A

S = Suprarenal glands

A = Aorta/IVC

D = Duodenum (second and third segments [some also include the fourth segment]

P = Pancreas (only head, neck, and body are retroperitoneal)

U = Ureters

C = Colon (only the ascending and descending colons, as transverse and sigmoid retain mesocolon)

K = Kidneys

E = Esophagus

R = Rectum

112 212 111

1) Kidneys
2) Ureters
3) Suprarenal glands
4) Muscles
5) Vessels arising from abdominal aorta
6) Spine and nerves (lumbar spinal nerves and autonomic nerves mostly)

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3
Q

Lymphatic drainage of posterior abdominal wall

A

1) Pre-aortic nodes (drains lymph from foregit to hindgut, liver, gallbladder, pancreas, spleen); efferent lymph forms intestinal trunk
2) Lateral aortic nodes (drains kidneys, suprarenal glands, testes, ovaries, uterus, deep vessels of abdominal wall, common illiac nodes); efferent lymphs form the right and left lumbar trunks

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4
Q

Kidney location

A
  • Retroperitoneal on the posterior abdominal wall
  • lies at the levels of T12 to L3
  • Right kidney lower than left kidney due to position of the liver
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5
Q

Kidney coverings

A

INNER (Cortex)—

1) Fibrous capsule
2) Perirenal/perinephric fat (surrounds kidneys and their vessels)
3) Renal Fascia
4) Pararenal/paranephric fat

OUTER————

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6
Q

Structures that hold kidneys in position

A

1) Fibrous capsule of the kidneys
2) Perirenal fat
3) Renal Fascia
4) Pararenal fat
5) collagen bundles (from renal fascia)
6) Renal vessels
7) Ureter

**NO LIGAMENTS

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7
Q

Renal sinus

A
  • Space within the kidneys
  • Consist of renal pelvis, renal calices (major calyx and minor calyx)
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8
Q

What is the renal hilum

A
  • the entrance to the renal sinus
  • Vessels, nerves, ureter enter and exit the renal sinus via the renal hilum
  • located at the level of transpyloric plane (~T12)
  • *** Order of vessels from anterior to posterior: renal vein, renal artery, ureter
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9
Q

Internal structures and layers of kidneys

A

INNERMOST

1) Renal Pelvis
2) Major calyx
3) Minor calyx
4) Renal Papillae
5) Renal Pyramid, renal columns
6) Renal Medulla
7) Renal Cortex

OUTERMOST

OUTERMOST

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10
Q

What is the renal pelvis

A
  • Flattened, funnel shaped expansion of the superior end of ureter
  • apex of renal pelvis continuous with ureter
  • receives two or three major calices
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11
Q

Major calyx

A
  • continuous with renal pelvis
  • devides into two or three minor calices
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12
Q

Definition of renal papillae

A

The apex of the renal pyramids, from which urine is excreted

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13
Q

Blood vasculature of the kidneys

A

ARTERIES

  • Left and Right Renal arteries arises from abdominal aorta to supply kidneys
  • Renal arteries arise at the level of IV disc between L1 and L2
  • Right renal artery longer than left renal artery (due to location of abdominal aorta on the left)
  • Each divides close to the hilum into five segmental arteries supplying renal segments

VEINS

  • Left and Right Renal veins drains into the Inferior Vena Cava
  • Drainage to IVC at level L2
  • Right renal vein longer than left renal vein (due to IVC’s location on the right)
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14
Q

Lymphatic drainage of kidneys

A
  • Renal lymphatic vessels follow the renal veins
  • Drains into the lateral aortic lymph nodes (para-aortic or lumbar)
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15
Q

Nerve supply of kidneys

A
  • Renal Nerve Plexus (both sympathetic and parasympathetic)
  • sympathetic: Renal sympathetic plexus (T12)
  • parasympathetic: Vagus Nerve (CNX)

(? different from Moore ?)

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16
Q

Location of Suprarenal Glands

A
  • Superomedial aspect/superior poles of the kidneys
  • Retroperitoneal on the posterior abdominal wall
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17
Q

Internal structure/layers of suprarenal glands

A

INNERMOST

1) Suprarenal medulla (developed from neural crest cells; releases catecholamines e.g. epinephrine and norepinephrine)
2) Suprarenal cortex (derived from mesoderm; releases corticosteroids and androgens)

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18
Q

Arteries of Suprarenal glands

A

Due to endocrine function of adrenal glands, abundant blood supply is necessary

  • Superior suprarenal arteries from inferior phrenic artery
  • Middle suprarenal arteries from abdominal aorta
  • Inferior suprarenal arteries from renal arteries
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19
Q

Veins of suprarenal glands

A
  • the shorter Right Suprarenal Vein drains into IVC
  • the longer Left Suprarenal Vein, joined by inferior phrenic vein, enters the left renal vein, then IVC
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20
Q

Lymphatic drainage of suprarenal glands

A

Lateral aortic (para-aortic or lumbar) lymph nodes

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21
Q

Nerve supply of suprarenal glands

A
  • Celiac plexus
  • Preganglionic fibers from Abdominopelvic splanchnic nerves (T5-T9)

(? different from Moore ?)

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22
Q

Ureter location

A
  • Begins at the renal pelvis (most posterior at the hilum) and ends at the urinary bladder
  • Retroperitoneal on the posterior abdominal wall
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23
Q

Physiological narrowings of ureter

A

1) Ureteropelvic junction (where renal pelvis joins the ureter)
2) where ureter crosses the pelvic brim/external iliac artery
3) Ureterovesical junction (where ureter pierces the urinary bladder wall)

** These 3 narrowings are potential sites for ureteric calculus obstruction

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24
Q

Anatomical relations of ureter in male

A

Ductus deferens lies anterior to the ureter

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25
Q

Anatomical relations of ureter in female

A
  • At the base of broad ligament and cardinal ligament, ureter passes below the Uterine artery
  • important when doing hysterectomy or abdominopelvic surgery where they are liable to ligation
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26
Q

Ureteric entry of bladder

A
  • Ureters obliquely insert into the bladder (angles of the trigone of the bladder), acting as a valve
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27
Q

Vasculature of ureter

A

Arteries

  • branches of abdominal aorta
  • renal arteries
  • gonadal arteries (i.e. testicular/ovarian artery)
  • iliac arteries
  • vesical arteries

Veins

  • renal veins
  • gonadal veins
  • iliac veins
  • vesival veins
28
Q

Lymphatic drainage of ureters

A

Lateral aortic (para-aortic or lumbar) lymph nodes

29
Q

Nerve supply of ureter

A

1) Renal plexus
2) Testicular plexus
3) Hypogastric plexus

30
Q

Reference of ureteric stone pain

A

Loin, scrotum, penis or labia majora

31
Q

Bones of pelvis girdle

A

3 bones:

1) Left hip/pelvic bone (fused from left ilium, ischium, pubic)
2) Right hip/pelvic bone (fused from right ilium, ischium, pubis)
3) Sacrum (fused from 5 sacral vertebrae)

32
Q

Hip bone structure

A
  • consist of three bones (superior to inferior): ilium, ischium, pubis
  • these bones unite by a triradiate cartilage, forming the acetabulum
  • the acetabulum is a cup-like depression that articulates with the head of femur
33
Q

Joints of pelvic girdle

A

1) Lumbosacral joint (lumbar vertebrae with sacrum)
2) Sacroiliac joints (sacrum with ilium)
3) Sacrococcygeal joint (posteriorly; sacrum with coccyx)
4) Pubic symphysis (anteriorly; left & right hip bones at pubis)

34
Q

Pelvic Inlet or Pelvic Brim components

A

(Posterior, lateral to anterior)

1) Promontory and Ala of Sacrum
2) A right and left Linea Terminalis:
a) Arcuate line (inner surface of ilium)
b) Pecten pubis/pectineal line (oblique ridge of superio-lateral pubis)
c) Pubic Crest

35
Q

Anterioposterior diameter of pelvic inlet

A
  • Measured by pelvimetry
  • from sacral promontroy to pubic crest
  • >11.5cm
36
Q

Pelvic outlet components

A

(Posterior, lateral to anterior)

1) Tip of coccyx
2) Inferior margin of sacrotuberous ligament
3) Ischial tuberosities (laterally)
4) Pubic arch

37
Q

Important ligaments that stabalizes pelvic bone

A

1) Sacrospinous ligament (Sacrum to ischial spine)
2) Sacrotuberous ligament (Sarum to ischial tuberosities)

38
Q

Muscular component of pelvic lateral wall

A

Obturator internus muscles

39
Q

Muscular component of pelvic posteo-lateral wall

A

Piriformis muscles

40
Q

Function of piriformis and obturator internus muscles

A

1) Forming the lateral pelvic wall
2) Lateral rotator of the hip joint

41
Q

Obturator canal

A

A deficiency in the obturator internus muscles and the obturator membrane, with the function of:

1) Allowing passage of obturator VAN to pass from pelvis to thign, supply the adductors on the medial quadrant of the leg

42
Q

Greater Pelvis/False pelvis boundary

A

Superiorly bounded by the pelvic girdles

Inferiorly bounded by the oblique plane of pelvic inlet

43
Q

Lesser pelvis/true pelvis boundary

A

Superiorly bounded by the oblique plane of pelvic inlet

Inferiorly bounded by the pelvic floor/pelvic diaphragm

44
Q

Key comparison of male and female pelves

A

(Male vs female)

Pelvic inlet: narroe vs wide

Pelvic outlet: smaller vs larger

Pubic arch/subpubic angle: Narrow (<70º) vs Wide (>80º)

Obturator foramen: round vs oval

Acetabulum: Large vs small

45
Q

Major arteries supplying true pelvis of women

A

6 Main arteries:

1,2) Paired Internal iliac arteries

3,4) Paired ovarian arteries

5) Median sacral artery
6) Superior rectal artery

46
Q

Major arteries supplying true pelvis of men

A

4 main arteries:

1,2) Paired Internal iliac arteries

3) Median sacral artery
4) Superior rectal artery

(** Testicular arteries do not enter true pelvis)

47
Q

Branches of internal illiac artery

A

Anterior division (7-8 branches)

1) Umbilical
2) Obturator
3) Superior vesical
4) Internal pudental (supplies perineum)
5) Inferior gluteal
6) Middle rectal

7♂) Inferior vesical (give rise to prostatic artery and artery to ductus deferens)

7♀) Vaginal

8♀) Uterine

Posterior division (3 branches)

1) Iliolumbar
2) Lateral sacral
3) Superior gluteal

48
Q

Autonomic Nervous structure of the true pelvis

A

Supplied by superior and inferior hypogastric plexes (T1-2, S2-4)

Pelvic Splanchnic Nerves

  • arises in the pelvis from spinal nerves S2-S4
  • conveys parasympathetic fibers to hypogastric plexus

Lumbar Splanchnic Nerves

  • arises from L1-2
  • supply sympathetic fibers to hypogastric plexus

Origin:

Coeliac plexus (T5-T11, CNX) —>

Superior Mesenteric plexus —>

Intermesenteric plexus (no vagal parasympathetic fibers; Lumbar splanchnic nerve L1 L2 from lumbar sympathetic trunk) —>

Inferior Mesenteric Plexus —>

Superior Hypogastric Plexus (lumbar splanchnic nerve)—>

Inferior Hypogastric Plexus (Sacral splanchnic nerve)

[[pelvic splanchnic nerves S2-4 run through to inferior mesenteric plexus]]

49
Q

Structures in the true pelvic cavity

A

1) Urinary Bladder
2) Rectum
3) Anal Canal
4) female repriductive organs (uterus, ovaries, fallopian tubes, vagina)
5) male reproductive organs (prostate, seminal vesicle, ductus deferens)
6) Nerves (mainly hypogastric plexes)
7) Veseels (mainly branches of internal iliac artery)
8) lymphatics

50
Q

Pelvic Floor

A

The pelvic floor is formed by a muscular structure known as the pelvic diaphragm (PD) which consist of:

1) Levator ani muscle

a) Puborectalis
b) Pubococcygeus
c) Iliococcygeus

2) Coccygeus muscle

51
Q

Pelvic Diaphragm nerve supply

A

1) Sacral nerve 4 and 5
2) Branches of pudendal nerve

52
Q

Action of pelvic disphargm

A

1) Supports and stablilizes the position of pelvic viscera
2) Act as a sphincter for anorectal junction and vagina

** Due to 1, damaged PD (e.g. women after parturition) would caused prolapsed of the pelvic viscera ie. pelvic organs (e.g. bladder, vagina, uterus, rectum) passing through into the perineum.

53
Q

Perineal body (location, clinical relevance)

A

Location: Between pelvic diaphragm and irogenital diaphragm; posterior to vagina/prostate

Clinical relevance: damage to perineal body will cause prolapse of pelvic viscera

54
Q

Peritoneal reflections (definition and examples)

A

Peritoneal reflections are infolding along the abdominal and pelvic cavities

a) Vesicouterine pouch (space between bladder and uterus in female)
b) Rectovesical pouch (space between bladder abd rectum in male)

55
Q

Urogenital diaphragm (components and points of interest

A

Components:

1) Deep transverse perineal muscles (DTPM)
2) Perineal membrane (over the muscles)
3) Sphincter urethrae

Notes:


1. DPTM is incomplete and not entirely transverse.


  1. sphincter urethrae may not exist and it could be part of the urethra within.
  2. perineal membrane plays a major part of the support
56
Q

Bladder wall layers

A

(internal to external)

1) Transitional epithelium (folded when relaxed, can be stretched)
2) Detrussor muscle (very thick)
3) outer serous peritoneal layer (superior surface only)

57
Q

Support of the bladder

A

1) Urogenital diaphragm
2) Pelvic fascia
3) Medial umbilical ligament (umbilical artery)
4) Median umbilical ligament (urachus)

58
Q

Trigone

A
  • A triangular area at base of bladder
  • between the internal urethral orifice and the two ureteric orifices
  • smooth in lining
  • most sensitive to pain and stretching
  • upper border marked by ureteric ridge/fold
59
Q

Ureteric ridge/fold location

A

between ureteric orifices on the urinary bladder

60
Q

Sphincter vesicae

A

Aka Internal urethral sphincter

  • Located at the neck of the urinary bladder
  • smooth muscles; supplied by ANS (involuntary)
  • fixed by pubovesical ligament (female) and puboprostatic ligament (male)
61
Q

Sphincter urethrae

A
  • aka External urethral sphincter
  • Skeletal muscles; under voluntary control by somatic nervous system
62
Q

Anatomical relationships of urinary bladder

A

Anterior: Pubic symphysis

Posterior: Uterus (female); Rectum (male)

63
Q

Vasculature of urinary bladder

A

Arterial Supply:

1) Superior vescial artery (from internal illiac artery)
2) Inferior vesical artery (male) / vaginal artery (female)

Venous drainage:

Vesical venous plexus -> prostatic venous plexus -> internal iliac vein

64
Q

Lymph drainage of urinary bladder

A

internal and external iliac nodes

65
Q

Nerve supply of urinary bladder

A

ANS: Hypogastric plexus (T1-2, S2-4)

66
Q

Transurethral cytoscopy

A

an invasive procedure that will allow you to view the internal features of the bladder, prostate, urethra, ureters and extract ureteral stone or perform other surgical procedures.

67
Q

Suprapubic Aspiration

A

Distended bladder rises above the symphysis pubis and lifts the peritoneum away from the anterior abdominal wall. A needle can be punctured above the symphysis pubis to drain the bladder.

Urogenital Block (39 decks)

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