Lecture 17-18 Urinary System Flashcards
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
What is the kidney embedded in?
Perineal fat which is in turn embeded in fibrous renal fascia
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
Are the superior or inferior poles closer to the midline?
Superior
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
What are the arrangements of the vessels in the hilum from anterior to posterior?
Vein, artery, ureter (also nerves and lymph vessels)
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
What are the calices and pelvis lined with?
Mucosa with an extensible epithelium called transitional epithelium and a smooth muscle wall
What are the anterior relations of the right kidney? (5)
Suprarenal, liver, duodenum, right colic flexure, small intestine
What are the anterior relations of the left kidney? (6)
Suprarenal, spleen, stomach, jejunum, left colic flexure, pancreas
What are posterior relations to both kidneys? (6)
Diaphragm, psoas major and minor, quadratus lumborum, medial and lateral arcuate ligaments
Where may accessory arteries arise from?
Above or below main artery, coeliac, superior mesenteric or common iliac arteries
Where do the renal veins drain into?
IVC
The left renal vein is normally anterior to the aorta true or false?
True
What does the left renal vein receive blood from?
Left gonadal and left suprarenal veins
Where do the renal nerves arise from?
Renal plexus, which arises from the coeliac plexus
Where does the renal plexus travel on?
Renal artery
The kidney cannot function adequately without nerves true or false?
False
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)
What is the function of the ureters
Urine transport through peristalsis
The ureters are retroperitoneal true of false?
True
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
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
What is the ureter
A muscular tube
The ureter is occasionally duplicated true or false?
True
What are the three constrictions of the ureter
- Junction of renal pelvis with ureter
- Pelvic brim
- 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