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GU > Lecture 2: Kidneys, Ureter, Bladder and Posterior Abdominal Wall > Flashcards

Lecture 2: Kidneys, Ureter, Bladder and Posterior Abdominal Wall Flashcards

1
Q

Quadratus Lumborum O: I: Innervation?

A

O: Iliac Crest I: 12th rib and L1-4 Transverse processes Innervation: T12, L1-L4 (anterior rami)

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2
Q

Iliacus O: I: Action: Innervation:

A

O: iliac fossa I: Lesser Trochanter (join psoas to form common tendon) Action: Hip flexion Innervation: Femoral Nerve (L2-4)

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3
Q

Psoas Major O: I: Action: Innervation:

A

O: T12, L1-L5 I: Lesser Trochanter Action: Raise body from supine position, bend trunk laterally, flex hip joint Innervation: Lumbar plexus (L1-3)

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4
Q

The Renal Artery comes off _______ at level ____

A

The Renal Artery comes off para-aortically at level L1

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5
Q

The Testicular Artery comes off at level ____

A

The Testicular Artery comes off at level L2

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6
Q

How many Veins and arteries supply and drain the posterior abdominal wal

A

5x Lumbar Veins 5x Lumbar arteries

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7
Q

Where do the aorta and IVC bifurcate?

A

Aorta: @L4 IVC: @L5

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8
Q

Flow diagram of the Urinary System? These are all ________

A

Kidney> Ureter > Bladder > Urethra These are all ‘retroperitoneal’

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9
Q

What sits atop each kidney?

A

‘Suprarenal Glands’ NOT part of urinary system, involved in dealing with adrenaline. Also infraperitoneal

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10
Q

Where do the kidneys (+ suprarenal glands) sit within the abdominal cavity. Where does the ureters exit each kidney?

A

above ‘psoas major’ and ‘quadratus lumborum’ Ureters exit at L1 (transpyloric plane)

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11
Q

Each kidney sits behind and below what rib?

A

RK: rib 12 (lower due to liver) LK: rib 11 & 12

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12
Q

The Kidneys have a smooth ____________. Each Hilum contains __________ and branches of the _________, (also lymphatics and ANS). The kidneys can be divided into ______ and _______________.

A

The Kidneys have a smooth outer capsule. Each Hilum contains Renal veins and branches of the Renal arteries, (also lymphatics and ANS). The kidneys can be divided into upper and lower poles.

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13
Q

Are the ureters/renal pelvis posterior or anterior to the renal vessels?

A

Posterior.

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14
Q

Draw and label the kidney - internal overview structure (page 31)

A

….

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15
Q

Right Kidney Relations Anterior: Posterior:

A

A: suprarenal gland, liver, 2* duodenum, hepatic flexure of colon P: diaphragm, psoas, quad. lumborum, transversus abdominis, rib 12, subcostal nerve

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16
Q

Left Kidney Relations Anterior: Posterior:

A

A: Suprarenal gland, spleen, stomach, pancreas, jejunum, splenic flexure of colon. P: diaphragm, psoas, quad. lumborum, transversus abdominis, rib 11 & 12, subcostal nerve

17
Q

Renal veins and arteries are at level ____, the ____ is slightly lower then the _____. Veins are ______ to arteries.

A

Renal veins and arteries are at level L1 (come off para-aortically), the RHS is slightly lower then the LHS. Veins are anterior to arteries.

18
Q

Before entering the kidneys renal arteries branch into?

A

anterior and posterior branches > Segmental branches

19
Q

Which renal artery is longest. The right renal artery runs _____ to the IVC

A

The right renal artery is longest and runs posterior to the IVC

20
Q

Which renal vein is longest and by how much? The left renal vein runs _____

A

Left Renal artery is 3x longer. It runs anterior to aorta, under SMA and posterior to splenic vein/body of pancreas. *R. renal vein runs posterior to 2* duodenum

21
Q

What is the nervous innervation of the kidneys? S: PS: Referred pain =

A

‘Renal Plexus’ S: complicated PS: Vagus Referred Pain = flank pain

22
Q

Renal lymph?

A

Para-aortic nodes @L1

23
Q

What are the ureters? Explain their journey

A

25cm SM tubes that propel urine from the kidneys via contractions (+ filtration pressure) Exit Kidney @L1, extend vertically down from hilus on surface of psoas muscle. Roughly in-line w transverse processes of lumbar spine, Cross bifurcation of common iliac artery (@ant sacro-iliac joint) Passes lateral wall of pelvis to ischial spine Enters bladder on inferior surface at the trigone.

24
Q

The 3 constrictions of the Ureters are? Why are these sites important?

A

Junction of ‘ureters & renal pelvis’ (Pelvi-ureteric junction PUJ) Where ureters cross the ‘Pelvic brim’ As they enter ‘bladder wall’ This is most common areas of renal calcium obstruction

25
Q

Draw the Ureter Blood, nerve and lymph diagram

A
26
Q

How is it that the bladder doesn’t fall? When it fills where does it move? What is it made of?

A

Has a partial peritoneum covering that is ‘stuck’ against pubic bones’

When it fills it rises into the suprapubic region

  • Transitional epithelium and rugae
  • SM coat (Detrusor muscle)
  • ** SM spincter at neck of cladder (sphincter vesicae)
27
Q

What is the trigone?

A
  • Triangular smooth area at the base of the bladder, mucous membrane with no rugae.
  • Ureters enter and urethra exits at the points of the triangle
  • In between uteric openings is known as the inter-ureteric crest
28
Q

Blood and Nerve supply of the Bladder?

A

Arterial: Superior (x2) and inferior vesical arteries from each side
-off of anterior branch of internal iliac a.

Venous: Vesical Plexus (drain to internal iliac v. )

Nervous: ANS inferior hypogastric plexus
S= sacral splanchnic nerves S2-4
PS= pelvic splanchnic

Pain is referred to the suprapubic region (L1/2)

29
Q

Male vs female urethra?

A

Female: bladder ⇒ through deep and superficial Perineal pouches

Male: 4 distinct regions

  1. Pre-prostatic
  2. Prostatic (widest part- many ducts emptying in)
  3. Membranous (thinnest part- through deep perineal pouh)
  4. Spongy (through corpus spongiosum)
30
Q

Lymphatics of the ureter, bladder and urethra?

A

Ureter drains to:

  • Lumbar
  • common/external/internal iliac

Bladder drains to:

  • Internal iliac nodes

Urethra

  • internal iliac nodes
31
Q

Label this diagram

A

..

32
Q

Course of Iliohypogastric and Ilioinguinal nerves

A

BOTH L1!

  • Emerge at lateral border of psoas
  • Run obliquely over Q.lumborum (hypo superior to inguinal)
  • Pierce Transversus Abdominis
  • Ilioinguinal will pierce int. oblique to enter inuinal canal and accompany spermatic cord throguh SF inguinal cord
33
Q

Sensory and motor control of Iliohypogastric and Ilioinguinal

A

iliohypogastric;
Sensory: Lateral gluteal & Pubic skin
Motor: transverse abdominis & Internal oblique

Ilioinguinal;
Sensory: skin of medial thigh + roots of penis/scrotum or mons pubis/labia
Motor: transversus Abdominis & internal Oblique

34
Q

Genitofemoral Nerve.
Level:
Branches:
Sensory:
Motor:

Course:

A

Level: L1 and L2
Branches: Genital and femoral
Sensory: scrotum or mons pubis, skin of upper anterior thigh
Motor: Cremasteric muscle

Course:

  • Emerges throguh and runs atop psoas
  • Genital branch will enter spermatic cord to innervate Cremaster muscle and give sensory to genital skin
  • Femoral branch passes under inguinal lig to thigh
35
Q

Lateral Femoral Cutaneous n.
Levels:
Sensory:
Course:

A

Levels: L2 & L3
Sensory: Skin on Anterior & lateral thigh

Course:

  • Emerges from lateral border of Psoas
  • Descends obliquely across surface of Iliacus
  • Passes under inguinal lig. (at lateral extremity near attachment to ASIS)
36
Q

Bernhardt-Roth Syndrome

A

-Numbness of outer thigh due compression of the lat. femoral cut. nerve as it passes under the inguinal lig.

Many causes (eg; seat belts, exercise, tight clothing)

37
Q

Femoral Nerve

Levels:
Sensory:
Motor:
Course:

A

Levels: L2-4 (largest)
Sensory: skin on anterior thigh and medial leg
Motor: Pectineus, iliacus and ant compartment of thigh

Course:

  • Emerges from lower lateral border of Psoas
  • Runs between iliacus and Psoas
  • Passes under inguinal lig. to thigh
38
Q

Obturator Nerve

Levels:
Sensory:
Motor:
Course:

A

Levels: L2-4
Sensory: skin on medial thigh
Motor: obturator externus and medial comp. of thigh

Course:

  • emerges from lower MEDIAL border of psoas
  • passes behind common iliac art. then lateral to internal iliac and ureters
  • Runs along along walls of pelvis cavity exit via the obturator foraen (through obturator canal)

GU (28 decks)

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