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Abd / SS > Module 7 : Urinary Tract > Flashcards

Module 7 : Urinary Tract Flashcards

1
Q

kidneys - 3 stages of development

A
  • arise from the mesoderm

- pronephros, mesonephros, metanephros

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2
Q

pronephros

A
  • form early in the fourth embryological week
  • non functioning
  • rudimentary
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3
Q

mesonephros

A
  • form late in the fourth embryological week
  • function as interim kidney (in-between)
  • becomes the mesonephric duct
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4
Q

mesonephric duct

A
  • male > epipdymis, vas deferens, ED

- female > mullein duct > uterus, vagine (NOT FROM MESONEPHRIC DUCT)

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5
Q

metanephros

A
  • permanent kidney
  • forms in the fifth week of gestation
  • FUNCTION begins about eight weeks gestational
  • during fetal growth kidneys migrate from pelvis to abdomen (12-15)
    + result of rapid caudal growth and not really migration
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6
Q

ureters

A
  • develop from the mesonephric duct (wollfian duct) - 4 weeks gestation
  • incorportated into bladder trigone
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7
Q

urinary bladder

A
  • develops from urogenital sinus
  • continuous with allantois
  • infants and children - bladder is abdominal organ and becomes true pelvic after puberty
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8
Q

allantois

A
  • develops from yolk sac
  • becomes urachus
  • becomes median umbilical ligament
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9
Q

urachus

A
  • pathway bladder travels through after puberty to reside in the true pelvis
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10
Q

kidney location

A
  • retroperitoneal (perirenal space)
  • parallel to psoas muscle
  • right kidney lower than left due to liver
  • IVC and aorta more anterior
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11
Q

kidney lie

A
  • oblique lie in paravertebral gutters
  • UPPER POLES MORE MEDIAL AND POSTERIOR THAN LOWER POLES
  • MEDIAL MARGINS MORE ANTIEOR THAN LATERAL MARGINS
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12
Q

ureters location

A
  • enter posterolateral aspect of bladder

- ANTERIOR TO ILIAC VESSELS

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13
Q

ureters size

A
  • 2-8mm in diameter (narrow close to bladder)

- 30cm in length

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14
Q

bladder location

A
  • extraperitoneal (outside peritoneum)
  • posterior to symphysis pubis
  • empty stat - sits in true pelvis
  • distended state - into false pelvis/ abdominal cavity
  • superior to prostate
  • anterior to rectum
  • anterior to uterus
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15
Q

kidney shape and structure

A
  • bean shape RENIFORM
  • lateral aspect is convex and medial aspect concave
  • has 4 layers of supportive tissue
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16
Q

kidney size

A
  • adults
    + length 9-12
  • children
    + vary with age
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17
Q

kidney supportive tissue layers - inner to outer

A
  • capsule
  • perirenal fat
  • renal fascia
  • pararenal fat
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18
Q

kidney capsule

A
  • thin and fibrous

- specular reflector

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19
Q

perirenal fat

A
  • continuous with renal sinus
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20
Q

renal fascia/ grotas fascia

A
  • anchor kidney to posterior abdominal wall

- ptosis = kidney falls with fascia tears

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21
Q

kidney parenchyma

A
  • functional tissue
  • 2 parts
    + cortex
    + medulla
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22
Q

kidney cortex

A
  • outer portion below renal capsule
  • site of urine production
  • contain functional unit (nephrons)
  • arches over renal pyramids
  • columns known as COLUMNS OF BERTIN
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23
Q

kidney medulla

A
  • inner portion
  • consists of pyramids
    + triangular structures (8-18)
    + base directed toward sinus
    + apices open into renal sinus (minor calyces)
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24
Q

kidney sinus

A
  • fatty central portion
  • continuous with perirenal fat
  • contains calyces (major and minor), renal pelvis, vessels, nerves
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25
Q

minor calyces

A
  • 8-18

- receive urine from pyramids

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26
Q

major calyces

A
  • INFUNDIBULA
  • 2-3
  • join to form renal pelvis
    + renal pelvis leaves sinus as ureter
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27
Q

hilum

A
  • slit like entrance
  • from anterior to posterior in hilum
    + renal vein
    + renal artery
    + ureter
    + third branch of renal artery
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28
Q

ureters

A
  • long mucosal lined tubes
  • right ureter shorter than left (right kidney lower than left)
  • peristalsis and gravity transport urine
  • 3 natural points of narrowing
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29
Q

3 natural points of narrowing in the ureter

A
  • UPJ
  • pelvic brim
  • UVJ
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30
Q

UPJ

A
  • ureteropelvic junction
  • junction of renal hilum and proximal ureters
  • first point of natural narrowing
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31
Q

pelvic brim/iliac vessels

A
  • ureters are posterior to iliac vessels and can become compressed between them and the pelvic brim
  • second point of natural narrowing
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32
Q

UVJ

A
  • ureterovesicle junction
  • entrance of ureters into bladder
  • third point of natural narrowing
  • narrowest
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33
Q

bladder shape and size

A
  • dependant on urine volume
  • capacity = 300/500ml
  • volume = AP x L x W x 0.52
  • post vid < 100ml not significant
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34
Q

bladder lining

A 
4 layers
  \+ mucosa
   \+ submucosa
   \+ muscle 
   \+ serosa
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35
Q

bladder lining - mucosa

A
  • inner layer containing rugae
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36
Q

bladder lining - submucosa

A
  • connective tissue
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37
Q

bladder lining - muscle

A
  • detrusor muscle

- 3 layers

38
Q

bladder lining - serosa

A
  • peritoneum covering superior surface
39
Q

trigone

A
  • located on base/posterior surface bladder
  • triangular area between the openings of the ureters urethra
  • constant shape and position
40
Q

bladder neck

A
  • urethral orifice

- constant shape and position

41
Q

apex

A
  • most anterior and superior portion of bladder
  • site of median umbilical ligament attachment
  • changes with bladder fullness
42
Q

urethra

A
  • membraneous canal exiting the bladder at the trigone
  • females = cancel pierces the urogenital diaphragm
  • males = longer, 3 areas (prostatic, membraneous, penile)
43
Q

blood supply to kidneys

A

renal arteries&raquo_space; segmental arteries&raquo_space; interloper arteries&raquo_space; arcuate arteries&raquo_space; interlobular arteries&raquo_space; afferent arterioles&raquo_space; glomerulus

44
Q

renal arteries

A
  • arise form lateral aspect of the abdominal aorta just below the level of the SMA
  • supply 1/4 of total cardiac output to kidneys
  • divide into segmental arteries
45
Q

segmental arteries

A
  • divide into interlobar arteries
46
Q

interlobar arteries

A
  • travel between the pyramids

- branch into arcuate arteries

47
Q

arcuate arteries

A
  • at the base of the pyramids

- branch into interlobular arteries

48
Q

interlobular arteries

A
  • travel in the renal cortex

- branch into afferent arterioles

49
Q

afferent arterioles

A
  • carry blood into the the glomerulus of the nephron
50
Q

kidney capsule - US appearance

A
  • echogenic line bordering cortex
51
Q

cortex - US appearance

A
  • homogeneous
  • even thickness
  • echogenicity equal or slightly less echogenic than the liver
52
Q

medulla - US appearance

A
  • triangular
  • hypoechoic
  • equidistant
53
Q

Corticomedullar junction - US appearance

A
  • pulsation and bright reflection of arcuate arteries

- marker for measuring cortical thickness

54
Q

sinus - US appearance

A
  • highly echogenic central area

- over hydration = small echo lucent areas within the sinus

55
Q

vessels - US appearance

A
  • linear anechoic tubes

- best assessed in transverse

56
Q

cortex look - neonates

A
  • more echogenic

- thin compared to pyramids

57
Q

pyramids look - neonates

A
  • hypo echoic and large
58
Q

sinus look - neonates

A
  • indistinct
  • very little fat
    BY 6 MONTHS SHOULD LOOK LIKE ADULT
59
Q

ureters - US look

A
  • difficult to visualize unless dilated
  • anechoic tubular structures
  • utreteral jets
    + indicate flow of urine is not obstructed
60
Q

bladder - US look

A
  • appears cystic/anechoic
  • transverse
    + superior - appears rounded
    + inferior - square
  • when distended walls appear thin and smooth
  • check for wall irregularities
61
Q

check for jets when?

A
  • if ureters dilated or hydronephrosis
62
Q

if space occupying region in bladder check what?

A
  • kidneys
63
Q

function of kidney

A
  • remove metabolic waste by producing urine
  • balance amount of water and electrolytes leaving and entering the body
  • maintains blood pressure
64
Q

how much fluid does the kidney process ?

A
  • 180L/day

- 99% returned to body 1% in urine

65
Q

nephron

A
  • functional unit of the kidney
  • filter blood and produce urine
  • milions in the kidney
  • 2 types
66
Q

2 types of nephrons

A
  • juxtamedullary (deep)

- cortical (superficial)

67
Q

2 main components of the nephron

A
  • renal corpuscle

- renal tubule

68
Q

renal corpuscle

A
  • network of pros capillaries (glomerulus)

- membrane filtration slits (Bowmans capsule)

69
Q

renal tubule

A
  • proximal convoluted tubule (PCT)
  • distal convoluted tubule (DCT)
  • loop of henle
  • collecting duct
70
Q

function of nephron

A
  • controlling blood concertino and volume
  • regulate pH (electrolyte)
  • removing toxins
    + osmosis and active transport
71
Q

route of blood to nephron

A

renal artery&raquo_space; interlobar artery&raquo_space; arcuate artery&raquo_space; interlobular artery&raquo_space; afferent artery&raquo_space; glomerulus

72
Q

3 processes in urine production

A
  • filtration
  • reabsorption
  • secretion
73
Q

glomerular filtration

A
  • afferent arteriole transport blood to glomerulus
  • increased pressure forces water and dissolved substances through membrane
  • filtrate passes through an opening at bottom of Bowmans capsule and enters renal tubule
  • RBS do not pass through membrane but leave via efferent article
74
Q

tubular reabsorption

A
  • nutrients in filtrate are absorbed back into the blood stream
    + water glucose vitamins
  • reabsorption occurs via peritbular cappilares PCT ascending and descending loop of henle
75
Q

tubular secretion

A
  • waste secreted into DCT
76
Q

ADH (antidiuretic hormone)

A
  • secreted by posterior pituitary
  • aids in retaining water in body
  • decrease in blood volume stimulates release of ADH
77
Q

aldosterone

A
  • secreted by adrenal cortex
  • acts on PCT
  • controls rate of sodium reabsorption
    + increased in the blood = increased water = increased blood volume
  • decrease in blood volume stimulates the formation of angiotenisisn
  • influenced by angiotensin system
78
Q

renin

A
  • secreted by juxtaglomerular capsule
  • acts as a catalyst
    + renin (released by kidneys) stimulates formation of angiotenisisn
    + angiotensin stimulates release of aldosterone
  • respond to decrease in blood pressure
79
Q

juxtaglomerular apparatus

A
  • located at point where DCT afferent and efferent arteriole come in contact
  • granular cells (afferent) release renin
  • macular densa cells (DCT) inhibit renin release
  • regulates blood pressure
80
Q

lab tests

A
  • waste products accumulate in blood with kidney disfunction
  • 60% loss of renal function before blood tests are elevated
  • only need one kidney to live
81
Q

blood tests

A
  • serum creatinine
  • blood urea nitrogen
  • serum electrolyte
82
Q

serum creatinine

A
  • end product of muscle creatine phosphate metabolism
  • appears in blood levels constant
  • easily excreted by the kidney
  • MORE SENSITIVE THAN BUN
  • increased values renal failure, chronic nephritis, urinary tract obstruction
83
Q

blood urea nitrogen

A
  • BUN
  • end product of protein metabolism
  • formed in liver from ammonia and readily secreted by the kidneys
  • reflects protein intake and renal excretory capacity
  • increased levels in renal dysfunction and dehydration
  • decreased levels in severe hepatic damage malnutrition and over hydration
84
Q

serum electrolytes

A
  • chloride, potassium, sodium, bicarbonate
  • increases in acute renal failure glomerularnephritis
  • decreased chronic and acute renal failure
85
Q

urine tests

A
  • RBC
  • WBC
  • pyuria
  • proteinuria
  • pH
  • Specific gravity
86
Q

red blood cells

A
  • inflammation tumors calculi
87
Q

white blood cells

A
  • infection

- inflammation

88
Q

pyuria

A
  • pus

- indicates infection

89
Q

proteinuria

A
  • protein in urine
  • nephritis
  • polycystic disease stones carcinomas
90
Q

pH

A
  • acidic = increased hydrogen ions

- alkaline = decreased ions, stones

91
Q

specific gravity

A
  • ability to concentrate urine
  • low levels in renal failure
  • increased levels in decreased urin output (dehydration)

Abd / SS (14 decks)

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