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Anatomy (MPAS) > Lecture 20: anatomy of the renal system and male reproductive organs > Flashcards

Lecture 20: anatomy of the renal system and male reproductive organs Flashcards

1
Q

What covers the retroperitoneal structures of the abdomen?

A

The posterior parietal peritoneum

See figure

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2
Q

Paired branches of the abdominal aorta

A

Inferior phrenic

Suprarenal

Renal

Lumbar

Ovarian/testicular

Common iliac

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3
Q

Unpaired branches of abdominal aorta

A

1) Celiac trunk
2) Superior mesenteric
3) Inferior mesenteric
4) Median sacral

See figure

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4
Q

Venous drainage of abdomen

A

Veins follow arteries and collect in vena cava

Except venous drainage from digestive tract and spleen : portal vein

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5
Q

Where do the lymph nodes in the retroperitoneal space collect lymph from?

A

Lymph collects in the cysterna chill, just inferior to the diaphragm

It then ascends into the thoracic duct, which empties into the left venous angle

See figure

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6
Q

What is the importance of the lymph system in the retroperitoneal space?

A

Lymphatic disease

Cancer staging

Lipids from digestion are transported by the lymph

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7
Q

What are the 3 sources of blood supply to the adrenal (suprarenal) glands?

A

1) Inferior phrenic arteries
2) Abdominal aorta
3) Renal arteries

See figure

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8
Q

What does the cortex of the adrenal gland produce?

A

Glucocorticoids (cortisol)

Mineralocorticoids (aldosterone)

Weak androgens (dehydroepi-androsterone)

See figure

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9
Q

What does the medulla of the adrenal gland produce?

A

Catecholamines (adrenaline/epinephrine and some noradrenaline/norepinephrine)

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10
Q

What is the only source of androgens in females?

A

The cortex of the adrenal glands

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11
Q

What are the urinary organs?

A

Kidney

Ureter

Bladder

Urethra

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12
Q

What structures are in the hilum of the kidney?

A

Renal artery (s)

Renal vein

Ureter

See figure

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13
Q

How to know if you’re looking at the anterior or the posterior side of a kidney?

A

Posterior side has the connection to the ureter

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14
Q

What protects the kidney?

A

Renal fascia and fat capsule

See figure

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15
Q

Where are the openings of the capsule surrounding the kidneys?

A

Open medially (blood vessels) and caudally (ureter)

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16
Q

What is the significance of the proximity of the kidney to the nerves of the lumbar plexus?

A

Diseases of the kidney may cause pain in the groin (ilioinguinal nerve)

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17
Q

Functions of the kidney

A

Blood filtration (glomerulus)

Reabsorption

Excretion

Production and secretion of renin, erythropoietin (EPO) and 1,25-(OH)2 vitamin D3

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18
Q

Function of the renal pelvis

A

Collects urine from the renal papillae and connects to the ureter

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19
Q

Significance of EPO in renal failure

A

Patients with renal failure are anemic over time

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20
Q

Longitudinal cross section of the kidney - parts

A

See figure

Renal papillae

Major calyx

Renal cortex

Renal pyramid

Renal column

Minor calyx

Renal pelvis

Renal hilum

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21
Q

Structure and location of the ureter?

A

Retroperitoneal muscular tube of 20-30 cm of length

3 layers of smooth muscle facilitate peristalsis

Crosses iliac vessels anteriorly

Enters urinary bladder at the trigone

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22
Q

Trajectory of ureter in men vs women

A

In men: lateral and inferior to ductus deference, joins bladder superior to seminal vesicles

In women: crosses beneath the uterine artery - water under the bridge

see figure

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23
Q

Importance of location of ureter in women

A

Crosses beneath the uterine artery

Uterine artery is ligated in hysterectomy.

Need to be careful not to ligate ureter!!

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24
Q

Where are the three constrictions of the ureter?

A

1) Exit from the hilum
2) Crossing of iliac blood vessels and pelvic brim
3) Entrance into bladder

See figure

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25
Q

Location of urethra in men vs women

A

Women: urethra is tightly connected to the anterior wall of the vagina

Men: Prostate surrounds proximal urethra

See figure

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26
Q

Male urethra

A

Urethra in neck of bladder

Prostatic urethra

Intermediate (membranous) urethra

Spongy (penile) urethra

Navicular fossa

See figures

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27
Q

What is the membranous part of the male urethra sensitive to?

A

Injury during insertion of urethra catheter

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28
Q

What is the widest part of the male urethra?

A

Prostatic

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29
Q

What does the prostatic male urethra contain?

A

Openings of the ejaculatory ducts and of the prostatic ductules

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30
Q

Pathology of prostatic male urethra

A

Benign prostatic hypertrophy (BPH)

Prostatic urethra can become obstructed by proliferating tissue

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31
Q

Where is the spongy part of the male urethra located?

A

Within the corpus spongiosum of the penis

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32
Q

How long is the female urethra?

A

Shorter than male urethra, only 4 cm long

33
Q

Location of the external urethral orifice in females

A

In the vestibule

Anterior to the vaginal orifice

34
Q

How are the female urethra and the vagina connected?

A

Through connective tissue

Pass together through pelvic diaphragm, perineal membrane and external urethral sphincter

35
Q

Parts of the urinary bladder

A

Ureter

Detrusor muscle

Internal urethral sphincter

External urethral sphincter (inurogenital diaphragm)

Membranous urethra

Prostatic urethra

See figure

36
Q

SNS and PSNS control of bladder

A

PSNS stimulates detrusor muscle

SNS stimulates external urethral sphincter

37
Q

What happens to location of bladder when it is full? Clinical significance?

A

Extends and rises up to 10 cm above pubic symphysis

Pushes bladder’s peritoneal lining further toward umbilicus

Surgical access superior to the pubic symphysis is possible without opening the peritoneal cavity

See figure

38
Q

What is the space of retzius?

A

Space between bladder and os pubis

See figure

39
Q

What covers the top of the bladder fundus and apex?

A

Parietal peritoneum

40
Q

Where is the safest spot for a catheter?

A

The median and paramedic suprapubic area of the anterior abdominal wall

Does not contain vital blood vessels or nerves

See figure

41
Q

Ultrasound with urinary bladder and catheter

A

Catheter needs to be clamped to allow filling of the bladder to investigate polyps, tumours or signs of cystitis

See figure

42
Q

What are the male reproductive organs outside the pelvis?

A

Testis - male gonad, production of testosterone and spermatozoa

Epididymis - maturation and storage of spermatozoa

Vas deferens - transportation of spermatozoa

Bulbourethral glands - lubrication, accessory sex gland

Penis - copulation

43
Q

What are the male reproductive organs within the pelvis?

A

Vas deferens

Prostate gland

Seminal vesicles

44
Q

What are the accessory sex glands?

A

Prostate gland

Seminal vesicles

Form the liquid component of ejaculate

45
Q

What is the role of the testis?

A

produces spermatozoa (tubuli seminiferi)

produces testosterone (Leydig cells)

46
Q

What ensheathe the testis and epididymis?

A

Tunica vaginalis testis

47
Q

Where are the testis located?

A

In the scrotum: extraperitoneal

48
Q

Blood and lymph vessels of the testis? Drainage?

A

Testicular arteries derive from the abdominal aorta and traverse the inguinal canal

Left testicular vein drains into left renal vein, right one into inferior vena cava

Lymph vessels travel along testicular vessels to drain into pre-aortic lymph nodes (lumbar nodes)

49
Q

What are the male reproductive organs in the pelvis? Location?

A

Seminal vesicle

Prostate

Vas deferens

Located beneath the peritoneal lining (extraperitoneal), subperitoneal

50
Q

Structure and location of vas deferens

A

Long muscular tube

Connects epididymis to ejaculatory duct

Traverses the inguinal canal

Enlarges to ampulla behind the bladder

Joins seminal vesicle for the ejaculatory duct

51
Q

What is the largest accessory gland of the male reproductive system? Size?

A

Prostate

3 x 4 x 2 cm (chestnut size)

52
Q

Location of prostate

A

Between bladder and perineal membrane

53
Q

Where do the prostate’s ducts open?

A

Prostatic part of male urethra

54
Q

What is the prostate embedded inside?

A

A fibromuscular stroma

Contains smooth muscle

55
Q

How much of the ejaculate volume is composed of prostatic secretions?

A

20-30% of ejaculate volume

56
Q

Prostatic secretion characteristics

A

Acidic (pH 6.4)

Serous

Milky

57
Q

Content of prostatic secretions

A

immunoglobulins

acidic phosphatase

proteases

fibrinolytic enzymes

zinc

prostaglandins

citrate (acidic pH!)

spermin (polyamine associated with nucleic acids. Initially thought to only be in semen, but now found in other tissues)

58
Q

Why are the testis located outside the abdomen?

A

Temperature control is important for sperm production

Risk of developing testicular cancer increases in undescended testis

59
Q

What nerves supply the deep arteries of the penis? Importance? Location?

A

PSNS nerves (pelvic sphlanchnic nerves S2-S4)

Essential for penile affection

Course lateral to the rectum and the prostate

60
Q

What structures join to form the ejaculatory duct?

A

The seminal vesicle

Ampulla of vas deferens

Ejaculatory duct then enters urethra

61
Q

Where does the arterial supply of the prostate originate from?

A

Inferior vesical artery

See figure

62
Q

Venous drainage of prostate

A

Prostate veins drain into the vesicoprostatic plexus which drains into the internal iliac vein.

63
Q

Parts of penis

A

Glans

Body

Root

See picture

64
Q

What are the roots of the penis covered by?

A

Scrota raphae

65
Q

What does the penis contain?

A

2 corpora cavernosa (contain arterial blood)

1 corpus spongiosum surrounding the urethra (contains venous blood, softer, contains urethra)

66
Q

What is the scrotum?

A

Pouch of skin and muscle (cremaster muscle)

Homologous to the labia major in women

67
Q

What does the scrotum contain?

A

Testis

Epididymis

Blood vessels

68
Q

Arteries of penis

A

All arteries are branches of the internal pudendal artery

69
Q

Veins of penis

A

Deep dorsal vein drains blood from corpora cavernosa into the prostatic venous plexus

70
Q

Corpora cavernosa and corpus spongiosum in erection

A

Both corpora cavernosa lie within a common tunica albuginea: erection is facilitated by fast influx of
arterial blood into the cavernous spaces (deep penile artery)

The corpus spongiosum is a separate erectile body embedding the urethra.

See figure

71
Q

What are the corpus cavernous formed by?

A

Both crura of the penile root converge anteriorly to form the corpora cavernousa

72
Q

What is the corpus spongiosum formed by?

A

The bulb of the penis continues anteriorly to form the corpus spongiosum and the glans penis

73
Q

What events occur during penile erection

A

Parasympathetic stimulation (S2-S4) via pelvic splanchnic nerves (cavernous nerves)

Closes arteriovenous anastomoses

Relaxes smooth muscles in helicine arteries (branches of deep artery of penis)

Arterial blood flows into the cavernous spaces in corpora cavernosa

At the same time, venous return is decreased by the pressure within the tunica albuginea

74
Q

What compounds increase penile erection?

A

Inhibitors of cGMP-selective phosphodiesterase-type 5 (PDE5) relax smooth muscles in helicane arteries

See figure

75
Q

Nerves of the pelvic region

A 
Lumbar plexus:
Iliohypogastric nerve
Ilioinguinal nerve
Genitofemoral nerve
Obturator nerve
Femoral nerve
Lateral cutaneous nerve of the thigh
Sacral plexus:
Sciatic nerve
Superior gluteal nerve
Inferior gluteal nerve
Pudenal nerve
Posterior cutaneous nerve of the thigh
Direct branches to muscles of the pelvis
76
Q

Autonomic nerves of pelvis

A

SNS: superior hypogastric plexus, hypogastric nerve, sacral sympathetic trunk

PSNS: pelvic sphlanic nerves

PSNS and SNS: inferior hypogastric plexus

See figure

77
Q

What are the roles of the somatic nerves of the lumbar and sacral plexus?

A

Provide motor innervation (to the muscles of the anterolateral abdominal wall, muscles of the lower extremity, gluteal muscles, pelvic floor muscles, muscles of the perineum

Provide sensory (cutaneous) innervation (incl. pain) (to the skin of the anterolateral abdominal wall, skin of the lower extremity, skin of the gluteal region, skin of the perineum, mucosa of the lower urethra, vagina, vestibule, anal canal)

78
Q

Roles of the autonomic nerves of the pelvis?

A

Provide motor, secretory sensory innervation to the pelvic viscera

Provide sympathetic innervation (from sacral sympathetic trunk) to the skin of the lower extremity, gluteal region and perineum

Provide parasympathetic innervation (from S2-S4 parasympathetic center) to the smooth muscles of the rectum, to the corpora cavernosa of the penis/clitoris

Anatomy (MPAS) (22 decks)

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