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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

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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
Location of urethra in men vs women
Women: urethra is tightly connected to the anterior wall of the vagina Men: Prostate surrounds proximal urethra See figure
26
Male urethra
Urethra in neck of bladder Prostatic urethra Intermediate (membranous) urethra Spongy (penile) urethra Navicular fossa See figures
27
What is the membranous part of the male urethra sensitive to?
Injury during insertion of urethra catheter
28
What is the widest part of the male urethra?
Prostatic
29
What does the prostatic male urethra contain?
Openings of the ejaculatory ducts and of the prostatic ductules
30
Pathology of prostatic male urethra
Benign prostatic hypertrophy (BPH) Prostatic urethra can become obstructed by proliferating tissue
31
Where is the spongy part of the male urethra located?
Within the corpus spongiosum of the penis
32
How long is the female urethra?
Shorter than male urethra, only 4 cm long
33
Location of the external urethral orifice in females
In the vestibule Anterior to the vaginal orifice
34
How are the female urethra and the vagina connected?
Through connective tissue Pass together through pelvic diaphragm, perineal membrane and external urethral sphincter
35
Parts of the urinary bladder
Ureter Detrusor muscle Internal urethral sphincter External urethral sphincter (inurogenital diaphragm) Membranous urethra Prostatic urethra See figure
36
SNS and PSNS control of bladder
PSNS stimulates detrusor muscle SNS stimulates external urethral sphincter
37
What happens to location of bladder when it is full? Clinical significance?
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
What is the space of retzius?
Space between bladder and os pubis See figure
39
What covers the top of the bladder fundus and apex?
Parietal peritoneum
40
Where is the safest spot for a catheter?
The median and paramedic suprapubic area of the anterior abdominal wall Does not contain vital blood vessels or nerves See figure
41
Ultrasound with urinary bladder and catheter
Catheter needs to be clamped to allow filling of the bladder to investigate polyps, tumours or signs of cystitis See figure
42
What are the male reproductive organs outside the pelvis?
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
What are the male reproductive organs within the pelvis?
Vas deferens Prostate gland Seminal vesicles
44
What are the accessory sex glands?
Prostate gland Seminal vesicles Form the liquid component of ejaculate
45
What is the role of the testis?
produces spermatozoa (tubuli seminiferi) produces testosterone (Leydig cells)
46
What ensheathe the testis and epididymis?
Tunica vaginalis testis
47
Where are the testis located?
In the scrotum: extraperitoneal
48
Blood and lymph vessels of the testis? Drainage?
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
What are the male reproductive organs in the pelvis? Location?
Seminal vesicle Prostate Vas deferens Located beneath the peritoneal lining (extraperitoneal), subperitoneal
50
Structure and location of vas deferens
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
What is the largest accessory gland of the male reproductive system? Size?
Prostate 3 x 4 x 2 cm (chestnut size)
52
Location of prostate
Between bladder and perineal membrane
53
Where do the prostate's ducts open?
Prostatic part of male urethra
54
What is the prostate embedded inside?
A fibromuscular stroma Contains smooth muscle
55
How much of the ejaculate volume is composed of prostatic secretions?
20-30% of ejaculate volume
56
Prostatic secretion characteristics
Acidic (pH 6.4) Serous Milky
57
Content of prostatic secretions
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
Why are the testis located outside the abdomen?
Temperature control is important for sperm production Risk of developing testicular cancer increases in undescended testis
59
What nerves supply the deep arteries of the penis? Importance? Location?
PSNS nerves (pelvic sphlanchnic nerves S2-S4) Essential for penile affection Course lateral to the rectum and the prostate
60
What structures join to form the ejaculatory duct?
The seminal vesicle Ampulla of vas deferens Ejaculatory duct then enters urethra
61
Where does the arterial supply of the prostate originate from?
Inferior vesical artery See figure
62
Venous drainage of prostate
Prostate veins drain into the vesicoprostatic plexus which drains into the internal iliac vein.
63
Parts of penis
Glans Body Root See picture
64
What are the roots of the penis covered by?
Scrota raphae
65
What does the penis contain?
2 corpora cavernosa (contain arterial blood) 1 corpus spongiosum surrounding the urethra (contains venous blood, softer, contains urethra)
66
What is the scrotum?
Pouch of skin and muscle (cremaster muscle) Homologous to the labia major in women
67
What does the scrotum contain?
Testis Epididymis Blood vessels
68
Arteries of penis
All arteries are branches of the internal pudendal artery
69
Veins of penis
Deep dorsal vein drains blood from corpora cavernosa into the prostatic venous plexus
70
Corpora cavernosa and corpus spongiosum in erection
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
What are the corpus cavernous formed by?
Both crura of the penile root converge anteriorly to form the corpora cavernousa
72
What is the corpus spongiosum formed by?
The bulb of the penis continues anteriorly to form the corpus spongiosum and the glans penis
73
What events occur during penile erection
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
What compounds increase penile erection?
Inhibitors of cGMP-selective phosphodiesterase-type 5 (PDE5) relax smooth muscles in helicane arteries See figure
75
Nerves of the pelvic region
``` 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
Autonomic nerves of pelvis
SNS: superior hypogastric plexus, hypogastric nerve, sacral sympathetic trunk PSNS: pelvic sphlanic nerves PSNS and SNS: inferior hypogastric plexus See figure
77
What are the roles of the somatic nerves of the lumbar and sacral plexus?
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
Roles of the autonomic nerves of the pelvis?
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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