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test 5 > Lecture 41 Clinical anatomy of the Urinary System > Flashcards

Lecture 41 Clinical anatomy of the Urinary System Flashcards

1
Q

what are the three constrictors?

A

see pics;

  • Ureter pelvic junction
  • crossing iliac artery ( near bifurcation)
  • UVJ ( ureterovesicle junction)
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2
Q

What is the anatomy of the female pelvis?

A

” water under the bridge”

uterine vessels ( uterine artery and vein) cross over the ureter

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3
Q

What is the anatomy of the male pelvis?

A

” water under the bridge”

the ductus deferens crosses over the ureter

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4
Q

urinary tract stones are more common in what sex?

A

men from 20-60 years old

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5
Q

urinary stones are made up of what?

A

calcium, phosphate, oxalate, urate, and other soluble salts

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6
Q

what can cause a stone?

A

saturated urine and PH changes

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7
Q

what region in a male has pain because of a urinary tract stone?

A

infra scapular region in the groin, it can radiate into the scrotum..

can cause hematuria, can be caused by bacteria

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8
Q

what are complications of a urinary tract stone?

A

infection, urinary obstruction, renal failure

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9
Q

What nerves are affected to cause pain due to a kidney stone?

A

sympathetics at T11-L2, visceral afferent going to CNS

  • high levels of these fibers affect the UPJ ( ureter pelvic junction)
  • Lower levels of the fibers affect the UVJ ( ureter valvic junction)
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10
Q

Fulano has a kidney stone and has pain on the skin over the upper medial thigh, upper scrotal areas what nerve is affected?

A

Ilioninguinal nerve

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11
Q

Bob has pain because of a kidney stone on the skin over the anterior abdominal muscles, pubic symphisis. what nerve is affected?

A

Iliohypogastric or subcostal nerve

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12
Q

what is the location of the urinary bladder?

A

posterior to the pubic symphyses area

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13
Q

when the urinary bladder is empty what is the shape?

A

4-sided pyramid, resides in true pelvis

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14
Q

when the urinary bladder is full what is the shape?

A

ovoid; protrudes anterior and superiorly into the abdominal cavity

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15
Q

Where is the apex of the urinary bladder located?

A

it is attached to the umbilicus by the median umbilical fold

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16
Q

Where is the base of the urinary bladder located? where does the ureter enter and urethra exit?

A

posteriorinferiorly

  • ureter enters at the posterior inferior edges
  • urethra exits inferiorly
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17
Q

what is the blood supply of the urinary bladder?

A

superior and inferior vesicle artery

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18
Q

what is the lymphatic drainage of the urinary bladder?

A

external iliac nodes

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19
Q

what id the difference between the female urinary bladder versus the male’s?

A

female has a rectouterine pouch
male has a rectovessicle pouch

look at pic

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20
Q

Urinary bladder interior anatomy:

what is a bladder trigone?

A

smooth area of the bladder in the non-distended state.

21
Q

what is the bladder trigone bound by?

A

Ureteral orifices (2): open into the poster lateral aspect of the bladder ( two sides of triangle)

Urethra: commences at the neck of the bladder as the internal urethral orifice ( point of triangle)

22
Q

when the bladder is filling what occurs to the detrusor muscle?

A

relaxes

23
Q

when the bladder is emptying what occurs to the detrusor muscle?

A

it contracts to empty ( push)

24
Q

( urinary bladder) what is the innervation of the detrussor muscle?

A

autonomic innervation, smooth muscle of bladder wall

25
Q

( urinary bladder) where is the internal urethral sphincter located ? what is the innervation?

A

at the neck of the bladder
continuation of detrusor muscle
autonomic innervation

see pics

26
Q

( urinary bladder) what Is the location purpose and innervation of the sphincter urethra?

A
  • external urethral sphincter
  • located in deep perineal space
  • skeletal muscle
  • somatic innervation ( pudendal nerve)

see pics

27
Q

What is the difference between the ligamentous support of the urinary bladder between male and female?

A

female: pubovessical ligament
male: puboprostatic ligament

28
Q

what is the purpose of the ligamentous support of urinary bladder?

A

condensations of tendinous arch of pelvic fascia/loose connective tissue

perineal membrane and associated muscles, levator ani of the pelvic floor

the hold the neck of the bladder in place and help support and suspend the bladder.

29
Q

What is the parasympathetic innervation of the bladder?

A

S2-S4 Pelvic Splanchnic, then through the inferior hypogastric to the bladder

30
Q

what is the sympathetic innervation of the bladder?

A

T10-T12 Lesser and Least Splanchnics
- L1 &L2 Lumbar splanchnic
and reach the bladder through the hypogastric plexus ( only to very superior aspect of bladder)

31
Q

what is the somatic motor innervation of the bladder to the external urethral sphincter?

A

Pudendal S2-S4

32
Q

Pain from the bladder refers to where?

A

perineum ( area between the vagina and anus in women nd penis and scrotum for men)

can also be involved in increased urinary frequency due to increased urinary urge

33
Q

The detrusor muscle relaxation is _______ and detrusor muscle contraction is ______.

A

sympathetic ( when you are scared you don’t think of peeing)

parasympathetic

34
Q

The internal urethral sphincter relaxation is _______ and the urethral sphincter contraction is _______.

A

parasympathetic

sympathetic

35
Q

At the external urethral sphincter the pudendal nerve has what innervation?

A

somatic

36
Q

the sensation of filling/fullness of the bladder ( stretch) has what innervation?

A

visceral afferents accompanying parasympathetics ( pelvic splanchnic)

37
Q

what sphincter do infants have no control of ?

A

external sphincter or of the voiding reflex ( automatic voiding)
- it is learned

adults have this it is called continence of bladder and bowel

38
Q

Describe the female urethra:

A

internal urethral sphincter: under sympathetics contracts,
under parasympathetics relaxes

  • the urethra is about 4 cm in length…
  • the external urethral orifice opens into the vestibule of the vagina

females commonly have ascending UTI’s more frequently than men because of a shorter urethra, its proximity to the vagina and anus, or due to intercourse

external urethral sphincter: under somatic efferents control ( voluntary-pudendal nerve)

39
Q

Describe the male urethra. prostatic, membranous and penile/spongy

A

prostatic urethra: situated within anterior half of the prostate.

Membranous urethra: located within the deep perineal pouch associated with sphincter urethrae

Penile/spongy urethra: proximal portion contains openings for the bulbourethral glands

40
Q

An improperly placed catheter in a male can damage what part? ( urethral catheterization)

A

the bulb of the penis deep to the first bend

urethral catherterization= putting flexible tube through urethra

41
Q

What are the two bends that the catheter must pass on a male penis?

A

bends have to be straightened to pass the catheter

1st: spongy urethra, easily manipulated
2nd: located at the membranous urethra and is fixed

42
Q

What is a suprapubic catheterization?

A
  • a urinary bladder catheter inserted through the skin about 1 inch above the symphysis pubis
  • with general or local anesthetic
  • used for closed drainage and may be left of a long time, it is sutured to the abdominal skin
43
Q

what are the pros and cons of suprapubic catheterization?

A

pros= lower incidence of urinary tract infection, ease of voiding naturally when the catheter is clamped and ease of ambulation

cons: must initially be inserted through the abdominal wall by a physician and the insertion site needs to be cleaned daily

44
Q

where does the catheter go through in a female patient?

A

the urinary meatus

45
Q

what are important for stability of pelvic organs and to maintain continence?

A

pelvic organs and perineal muscles

  • the urethra does not tighten when you laugh to you can pee a little, also cough and excursive the intrabdominal pressure rises

with stress incontinence, the bladder neck prolapses through the pelvic floor and it sags and fails to support the bladder

46
Q

What is cystocele? what causes it?

A

prolapse of the bladder into the vaginal canal.

  • repetitive straining of the bowel movements
  • constipation
  • chronic or wet cough
  • heavy lifting
  • being overweight
47
Q

At what location is the renal transplant placed ?

A

attached and placed at the region of the iliac fossa

48
Q

what is nut cracker syndrome?

signs?

A

compression of the left renal vein between the superior mesenteric artery and aorta

left flank pain, pelvic pain, hematuria, and gonadal varies. hematuria can be microscopic or macroscopic

49
Q

what is a clinical correlate of left renal compression aka nutcracker syndrome in males?

A

varicocele, veins of the left scrotum become dilated, incompetent and cause retention of blood in the testicles..

these dilated veins feel like a bag of worms.

test 5 (27 decks)

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