Lecture 17-18 Urinary System Flashcards by Cindy Liu

What are the functions of the kidney?

Exocrine: Selective excretion of water and a range of organic and inorganic substances - urine
Endocrine: erythropoietin, 1, 25-hydroxycholecalciferol derived vitamin D, renin

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What is the kidney embedded in?

Perineal fat which is in turn embeded in fibrous renal fascia

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What is the position of the right kidney in relation to the left kidney?

The right kidney is about 1cm lower and more lateral than the left

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Are the superior or inferior poles closer to the midline?

Superior

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What are the five structural features of the kidney?

Poles - upper and lower
Surfaces - anterior and posterior
Borders - medial with hilum and lateral
Hilum
Sinus

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What are the arrangements of the vessels in the hilum from anterior to posterior?

Vein, artery, ureter (also nerves and lymph vessels)

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What is the internal structure of the kidney? or What is the path of the collecting duct in the kidney

Cortex –> Medulla –> Pyramid –> Papilla –> minor calyx (7-13) –> major calyx (2-3) –> pelvis

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What are the calices and pelvis lined with?

Mucosa with an extensible epithelium called transitional epithelium and a smooth muscle wall

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What are the anterior relations of the right kidney? (5)

Suprarenal, liver, duodenum, right colic flexure, small intestine

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What are the anterior relations of the left kidney? (6)

Suprarenal, spleen, stomach, jejunum, left colic flexure, pancreas

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What are posterior relations to both kidneys? (6)

Diaphragm, psoas major and minor, quadratus lumborum, medial and lateral arcuate ligaments

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Where may accessory arteries arise from?

Above or below main artery, coeliac, superior mesenteric or common iliac arteries

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Where do the renal veins drain into?

IVC

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The left renal vein is normally anterior to the aorta true or false?

True

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What does the left renal vein receive blood from?

Left gonadal and left suprarenal veins

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Where do the renal nerves arise from?

Renal plexus, which arises from the coeliac plexus

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Where does the renal plexus travel on?

Renal artery

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The kidney cannot function adequately without nerves true or false?

False

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What does the renal plexus consist of?

Sympathetic fibres (from thoracic splanchnic) - vasomotor and also supply upper ureter
Parasympathetic fibres (from vagus) - supply smooth muscle of wall of calices, pelvis and ureters
Sensory (from phrenics)

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What is the function of the ureters

Urine transport through peristalsis

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The ureters are retroperitoneal true of false?

True

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How doe the ureters travel?

Vertically from the transpyloric plane, across psoas and around the wall of lesser pelvis to the level of pubic tubercles where they enter the base of the bladder

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What are the relations of the ureter

Anterior to psoas and lumbar transverse processes
Males: crossed by ductus deferens
Females: travels between ovary and internal iliac artery

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What is the ureter

A muscular tube

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The ureter is occasionally duplicated true or false?

True

What are the three constrictions of the ureter

1. Junction of renal pelvis with ureter 2. Pelvic brim 3. Junction with bladder

What are the three regions that pain from extensive distention can be referred to?

Groin, labia and testis

Where do the arteries and veins from the ureters come from?

Adjacent vessels (small and numerous from them)

Where does the autonomic innervation of the ureters arise from?

Aortic, renal, superior hypogastric and inferior hypogastric plexuses.

The ureter nerves are essential for peristalsis true or false?

False, they more moderate it

Which certain areas of modified smooth muscles can act as pacemakers for the ureter peristalsis?

Calices, pelvis, upper ureter

The ureter only has autonomic innervation true or false?

False, it also has vasomotor

What is the function of the bladder?

Storage of urine

Where does the bladder sit?

In the anteroinferior lesser pelvis and extends into the abdomen when full

What are the surfaces of the bladder?

Superior Apex Two inferolateral surfaces Base/fundus and neck

Which surface of the bladder is covered with peritoneum?

Superior

Where does the apex of the bladder get directed?

Anterosuperiorly into the median umbilical ligament (urachus)

What are the inferolateral surfaces of the bladder located in?

Retropubic fat

In males, what is the neck of the bladder in contact with?

The base of the prostate

What are the superior relations of the bladder?

Small intestine, sigmoid colon, uterus in female

What are the posterior relations to the bladder in the male? (4)

Seminal vesicles, ampulla, rectovesicular pouch, rectum

What are the posterior relations to the bladder in the female? (3)

Uterovesicular pouch, cervix and upper vagina

The mucosa of the bladder walls is folded when the bladder is full of urine, true or false?

False

Where is the mucosa always smooth in the bladder?

At the trigone

What is the trigone marked by?

Base of bladder marked by openings of the ureter and urethra

What is the bladder wall made of?

Transitional epithelium on interlacing smooth detrussor muscle

The muscle bundles of the trigone are small compared to elsewhere and continue into the ureters and urethra true or false?

True

What sphincters are at the opening of the urethra?

Internal and external sphincters

What is the internal sphincter composed of in males?

Smooth muscle in the bladder neck which forms a complete collar extending into the prepostatic urethra

How is the internal urinary sphincter supplied?

With sympathetic fibres

What does contraction of the internal sphincter do during ejaculation?

Prevent retrograde flow of semen into the bladder

The internal sphincter is important for urinary continence true or false?

False, external sphincter is likely to be more important

What is the internal sphincter in females composed of?

Smooth muscle that is oblique at the neck and extends obliquely into the upper urethra

What is the external sphincter comprised of?

Ring of striated muscle

What muscles besides the external sphincter play an important role in female continence?

Pelvic floor muscles

What occurs to the muscles during urination?

The sphincter relaxes and the detrussor contracts.

What is urination triggered by?

Stretch receptors in the bladder wall

What are the blood vessels of the bladder?

Vesicular arteries from the internal iliac artery | Vesicular veins drain to internal iliac veins

What type of innervation occurs in the bladder wall?

Sensory - relay information about the stretch of the bladder wall as the bladder fills Parasympathetic - sensory input can cause parasympathetic fibres to respond by causing contraction of detrussor and inhibition of the sphincter Sympathetic - relatively sparse in bladder wall , vasomotor and can inhibit detrussor

How is the male bladder neck innervated?

Sympathetic fibres are numerous, they contract the (internal) sphincter as the bladder fills and especially during ejaculation and also in the walls of accessory organs of the male reproductive tract

How is the female bladder neck innervated

Fewer sympathetic fibres in the neck of the bladder and comparatively more parasympathetic fibres

How long is the female urethra?

4cm

What is the lining of the urethra?

Mucosal lining and smooth muscle

What is the urethral position in females

It crosses the perineal membrane anteroinferiorly to open anterior to the vaginal orifice.

The suprarenals are exocrine organs true or false?

False

Where are the suprarenals located? (3)

On the superior pole of each kidney, within the renal fascia but separated from the kidney by fibrous septum

What shape are the right and left suprarenals?

Triangular and semilunar

What are the relations of the right suprarenal

Posterior to the IVC and right hepatic lobe | Anterior to the diaphragm

What are the relations of the left suprarenal

Posterior to the stomach, pancreas and splenic artery | Anterior to the diaphragm

What are the medial borders of both suprarenals closely related to?

Coeliac ganglia that lie between the coeliac trunk and suprarenals

What is the macro structure of the suprarenals?

Capsule, cortex and medulla

What are the three layers of the cortex and what do they produce? (outer to inner)

Zona glomerulosa - mineralcorticoids Zona reticularis Zona fasciulata - both produce glucocorticoids and sex hormones

What does the medulla of the suprarenals produce?

Adrenaline and noradrenaline in response to preganglionic sympathetic nerves

What are the three pairs of arteries that supply the suprarenals and their origins?

Superior - inferior phrenic artery Middle - abdominal aorta Inferior - renal artery

How are the arteries arranged on the suprarenals?

Spread out over the capsule to form fine branches

What is the venous drainage of the suprarenals?

A single suprarenal vein emerging from the hilus which drains to the IVC on teh right and the renal vein on the left

What is the innervation of the suprarenals?

Mostly preganglionic sympathetic fibres from the sympathetic trunk and coeliac ganglion which synapse on medullary cells

What is the surface anatomy for the upper poles of the kidney?

Right - deep to 11th rib/at level of body of T11 | Left - at level of 11th intercostal space

What is the surface anatomy of the lower pole?

Approximately the level of the body of L3

What is the surface anatomy for the apex of the bladder?

Umbilical at the level of the upper margin of the pubic symphysis

What is the anatomical position of the ureters?

They cross the transverse process of L3, midpoint of the sacroiliac joint and enter the bladder at the level of the pubic tubercle