lecture 1: The Kidney and Urinary Tract

Question 1

where is the position of the kidneys`?

Answer 1

• The kidneys are retroperitoneal in the upper abdomen. - The right kidney is usually lower than the left. - Superior pole of right kidney lies on 11th ICS while that of the left sits at the 11th rib. - BOTH hilum lie at the level of L1

Question 2

which nerves supply the kidney?

Answer 2

The nerves (posterior) that supply the kidneys include: o 11th intercostal and sub-costal nerves. o Iliohypogastric nerve. o Ilioinguinal nerve.

Question 3

what muscles are related to the kidney?

Answer 3

The muscles that are related to the kidneys include: o The diaphragm. o Transversus abdominus. o Quadratus lumborum. o Psoas Major.

Question 4

what is present anterior to the kidney?

Answer 4

The right: liver, hepatic flexure and hilus lie BEHIND the 2nd part of the duodenum. ▪ The left: stomach, pancreas, spleen and splenic flexure.

Question 5

what is the blood supply to the kidney?

Answer 5

• The left renal vein is longer than the right. - The left renal artery is shorter than the right.

Question 6

what is the organisation of the kidneys?

Answer 6

• The cortex is granular-looking due to random organisation. - The medulla is striated coming down to an apex due to the radial arrangement of the tubules - Each lobe (of the multi-lobed kidney) drains through its OWN papilla and calyx - Each pyramid also receives its own blood supply and ureter branch.

Question 7

*******draw and label a diagram of the kidney ****

Answer 7

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Question 8

how are the ureters positioned?

Answer 8

• the ureters run vertically downwards in the lumbar transverse processes’ plane -they also run anteromedially into the bladder - the ureters run anterior to the bifurcation of the common iliac arteries -

Question 9

which vessels do the ureters take supplies from?

Answer 9

the ureters take supplies from all of the major vessels in the abdomen - renal arterial branch - A testicular or ovarian arterial branch. - Small direct braches of the aorta itself. - External and internal iliac arterial branches

Question 10

where are the sites of constrictions of the ureter?

Answer 10

1st – Ureteropelvic junction. o 2nd – Pelvic inlet. o 3rd – Entrance to bladder

Question 11

what might happen at the constrictions of the ureter?

Answer 11

(sites of kidney stone blocks):

Question 12

how is urine carried?

Answer 12

via peristalsis through a muscle coat

Question 13

how does the ureter open to the bladder? what does this prevent?

Answer 13

• Urine is transported by peristalsis by smooth muscle walls - Urine is transported by peristalsis by smooth muscle walls

Question 14

what is the structure of the bladder?

Answer 14

• pelvic organ - triangular pyramid with the apex pointing anteriorly and the base pointing posteriorly - lined by the urothelium

Question 15

what is the urothelium?

Answer 15

• A 3-layered epithelium with a slow cell turnover. - Large luminal cells form a specialised low-permeability luminal membrane.

Question 16

*********look and label a diagram of a ureter?

Answer 16

*********

Question 17

*********look and label a diagram of a bladder?

Answer 17

*********

Question 18

what happens when the bladder swells?

Answer 18

As ureter runs obliquely in, as the bladder swells (due to corrugated internal membrane), - the ureters are pushed back and function as a self shutting valve

Question 19

*********what are the two types of urinary sphincters?

Answer 19

• Sphincter vesicae – Internal sphincter (smooth) - Sphincter urethrae – External sphincter (striated).

Question 20

what is the nature of he internal sphincter?

Answer 20

At neck of bladder. ▪ REFLEX action – to bladder wall tension. • Initiated by 300-400ml. ▪ Controlled PNS

Question 21

what is the nature of the external sphincter?

Answer 21

In perineum. ▪ VOLUNTARY action – inhibition of nerves. ▪ Tone maintained by somatic pudendal nerves. • S2, S3, S4.

Question 22

how close are the sphincters in women and men?

Answer 22

In women, these sphincters are VERY close. ▪ In men, these sphincters are further apart.

Question 23

what is the differences between the reflex control and voluntary control of releasing the bladder?

Answer 23

******* look at diagram

Question 24

urethra of a female?

Answer 24

• The women’s urethra is very short and so not very significant ( lots of UTIs) - no right angle between the urethra and bladder

Question 25

urethra of a male?

Answer 25

• Men have their urethra organised in 7 areas: - 2 right angles between the urethra and bladder so harder to put in a catheter

Question 26

how does the lymph drainage work?

Answer 26

Lymph drainage follows the arterial system. internal iliac, common iliac, root of gonadal arteries, inferior mesenteries, superior mesenteries

Question 27

what are the 7 parts of the male urethra?

Answer 27

Internal urethral orifice – ( bladder neck, bladder outlet.) o Prostatic urethra. o Membranous urethra. o Bulbar urethra. o Penile urethra. o Navicular fossa. o External urethral meatus. in prague men buy prostitutes named emily

Question 28

why are UTIS more common in women?

Answer 28

• the environment is warm and moist so bacteria will thrive - the urethra is very short