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Anatomy > Module 8 Urinary System > Flashcards

Module 8 Urinary System Flashcards

1
Q

– urine and endocrine function

A

Kidneys

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2
Q

– conveys urine from kidneys to urinary bladder; A conduit only, like a host

A

Ureters

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3
Q
  • stores urine

- A hollow muscular organ contained in the pelvic cavity that stores urine temporarily just until the person can hold it

A

Urinary bladder

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4
Q

– conducts urine from bladder to outside
o Males: It also conducts spermatozoa from ejaculatory ducts to outside
o For females, it is relatively short. For males, it is relatively longer. Dahil mahaba ang urethra, bihira magkaroon ng infection than females. Contamination in females is very high, especially those who do not wash their perineum.

A

Urethra

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5
Q

FUNCTIONS OF THE URINARY SYSTEM 1

A
  • Elimination of waste products
    o Nitrogenous wastes (creatinine, uric acid)
     Serum creatinine dictates renal function. If slightly elevated, it means something is wrong with your kidneys.
    o Toxins
    o Drugs
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6
Q

FUNCTIONS OF THE URINARY SYSTEM 2

A
  • Regulates aspects of homeostasis

o Water balance - The function of the kidney is to hold water as much as possible para in cases na hindi tayo umiinom, may reserve
o Electrolytes
o Acid-base balance in the blood
o Blood pressure- When you have high BP, dapat urologist kasi the kidneys are the one responsible for maintaining your BP.
o Red blood cell production
o Activation of vitamin D

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7
Q

KIDNEYS: Location

A

Location: Retroperitoneal, in lumbar region

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8
Q

KIDNEYS: Position

A

o Left kidney higher than the right - Because of the presence of the liver on the right that pushes the right kidney a little bit lower
o Upper poles: T12 vertebrae
o Lower poles: L3 vertebrae
o Hilum/Hili: Lie at Transpyloric plane opposite L1 vertebrae

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9
Q

The __ is reddish-brown in color and soft in consistency. It is about 11 cm in length, 6 cm wide, and 3 cm in thickness at the middle. It has upper and lower poles, anterior and posterior surfaces, concave medial and convex lateral borders.

A

kidney

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10
Q
  • A vertical slit on the medial border
  • Through it, branches of the renal artery enter the gland, and the veins and ureter leave
  • Leads into the renal sinus (wide space inside the kidney)
A

Hilum

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11
Q

Structures found in the sinuses:

A
  • Branches of renal artery
  • Tributaries of the renal veins
  • Renal calyces
  • Renal pelvis
  • Lymph vessels, nerves and fats
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12
Q

Kidney: Relations (Anterior)

A

Anterior: peritoneum and abdominal organs

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13
Q

Kidney: Relations (Posterior)

A 
muscles on posterior abdominal wall namely:
o Psoas major
o Quadratus lumborum
o Transversus abdominis
o Diaphragm
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14
Q

Right Kidney: Relations (Anterior)

A

To liver, hepatic flexure, descending part of the duodenum, and adrenal gland.

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15
Q

Left Kidney: Relations (Anterior)

A

To splenic flexure, stomach, pancreas, jejunum, spleen and adrenal.

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16
Q
  • Surrounds each kidney but easily stripped off

- Fits the kidneys tightly but is not bound to it

A

Renal capsule/ True capsule

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17
Q
  • Surrounds the kidney
  • Provides protection to the kidney
  • Helps keep the kidney in its correct location
A

Adipose capsule or perirenal fat

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18
Q
  • Lies in the fascial plane underneath renal fascia (space of Gerota)
  • Forms the fatty capsule of the kidney
  • Passes medially into the hilum
  • Insinuates itself between renal vessels
A

Perirenal fat

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19
Q
  • Derived from fascia transversalis or endoabdominal fascia
  • Consist of anterior and posterior layers that splits at the lateral border of the kidney
  • Between layers is Gerota’s space
    o This space gives you access to your blood vessels
  • Believed to be open inferiorly
A

Renal Fascia of Gerota

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20
Q
  • Anterior layer fuses with the opposite side and blends with walls of renal blood vessels, aorta and vena cava
A

Renal Fascia of Gerota

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21
Q
  • Posterior layer blends with fascia of psoas and quadratus lumborum muscles
A

Renal Fascia of Gerota

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22
Q
  • Fused superiorly and form separate compartment for adrenal gland
A

Renal Fascia of Gerota

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23
Q

Very important itong Gerota’s Fascia for surgeons, because when you locate this fascia you will have easy access sa vessels. In doing renal surgery, it is important to have full control of the blood vessels. Normally, there should only be 1 renal artery and 1 renal vein for each kidney. But sometimes we have what you call the normal anatomic variations, wherein you have 2-3 renal arteries and 2-3 renal veins. If these will go to your hilum, we call this __.

A

accessory renal arteries

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24
Q

FACTORS MAINTAINING KIDNEYS IN POSITION

A
  1. Renal fascia
  2. Adipose Capsure
  3. Renal pedicle
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25
Q
  • Consist of structures at the hilus namely renal vessels, ureters, and nerves
  • Cushioning effect of the adjacent organs
A

Renal pedicle

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26
Q

Kidney: Gross Structure

A
  • Convex anterior and posterior surface

- Parenchyma consists of cortex and the medulla

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27
Q

Kidney: Gross Structure 2

A
  • Medial concave margin called HILUS, leading to a cavity called RENAL SINUS
    o Within sinus lie the renal pelvis, calyces, and the renal blood vessels
    o Sinus is lined by fibrous membrane continuous with the true capsule and fibrous coats of the vessels and collecting system
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28
Q

Structures of the Renal Sinus

A
  1. Renal Artery
  2. Renal Vein
  3. Nerves
  4. Lymphatics
  5. Renal Pelvis
  6. Calyces
  7. Adipose Tissue
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29
Q

When you remove all of the pedicles, arteries, veins including your pelvis and your calyces, you will have there a space known as your __.

A

renal sinus

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30
Q
  • Consists of subdivisions called renal pyramids
  • Between the pyramids are the renal columns of Bertini
    o The renal columns of Bertini is part of your renal cortex, not the medulla
  • BASES OF THE PYRAMIDS are directed towards cortex
  • Apices called renal papilla are received into minor calyces
A

Renal Medulla

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31
Q

(Renal Medulla)

– perforated tips of the papilla; through which the urine will pass going to the minor calyces

A

Cribosa

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32
Q

Cortex – consists of the following:

A

a. cortex cortices
b. cortical arches
c. medullary rays

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33
Q

– refers to the subcapsular zone of cortex

A

cortex cortices

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34
Q

– portion of the cortex between pyramids and cortex

A

cortical arches

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35
Q

– radially directed striations representing bundles of tubules.

A

medullary rays

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36
Q
  • Refers to the kidney parenchyma served by one papilla

- One renal pyramid and its overlying cortex

A

Renal Lobe

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37
Q
  • Refers to the medullary ray with the immediately associated cortical tissue
A

Renal Lobule

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38
Q
  • Constitute the tubular functional unit of the kidney
  • Part 1: Nephron
  • Part 2: Collecting Tubules
  • These 2 parts arises from separate embryonic primordia
A

Uriniferous Tubules

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39
Q

o Secretory part concerned with urine formation
o Each part occupies a definite position
o The cortex and medulla is lined by specific lining epithelium specialized for a particular role in urine formation

A

Nephron

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40
Q

o Concentrates urinary solute to form a hypertonic urine

o Your collecting tubules are basically your renal pyramids

A

Collecting Tubules

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41
Q

(Excretory Ducts)

– From 4-14 in number; Cup-shaped tubes, each of which embraces on or 2 or more or the renal papilla

A

Minor Calyces

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42
Q

(Excretory Ducts)
– formed by the union of minor calyces
o 3 major calyces: superior, middle, and inferior

A

Major calyces

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43
Q

(Excretory Ducts)

  • Formed by union of major calyces
  • Funnel-shaped structure occupying renal sinus
  • Represents the expanded beginning of the ureter
A

Renal pelvis

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44
Q

Blood supply of the kidneys (from artery and vein)

A

Aorta&raquo_space; Renal artery&raquo_space; Segmental Artery&raquo_space;
Lobar artery» interlobar artery&raquo_space; Arcuate artery
» interlobular artery&raquo_space; Afferent arteriole
» Glomerulus&raquo_space; Efferent arteriole
» Peritubular capillaries and vasa recta
» Interlobular vein&raquo_space; Arcuate vein
» Interlobar vein&raquo_space; Renal vein
» Inferior vena cava

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45
Q

Blood supply of the kidneys

A
  • Both renal arteries arise from the aorta.
  • Both renal veins drain into the IVC.
  • Both arteries and veins arise/drain just opposite each other.
  • The kidneys consume 20% of the heart’s cardiac output.
  • The arteries generally lie posterior to the vein within the renal hilum.
  • The renal pelvis is generally infero-posterior to the vessels.
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46
Q

Kidney: Length

A
  • Right renal artery is longer than the left.

- Right renal vein is shorter than the left.

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47
Q

Kidney: Crossings

A
  • Right renal artery crosses the IVC posteriorly

- Left renal vein crosses the aorta anteriorly

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48
Q

Renal Artery: Major Branches

A
  • Renal artery branches into the anterior and posterior segmental arteries
  • Posterior segmental artery – supplies the posterior segment of the kidney
  • Anterior segmental artery  4 additional segmental arteries:
  • These 5 segmental branches are responsible for dividing the kidney into segments (Interlobar, arcuate, interlobular arteries, and afferent arteriole
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49
Q

Anterior segmental artery: 4 additional segmental arteries

A

o Apical – superior segmental artery
o Upper – anterosuperior segmental artery
o Middle – antero-inferior segmental artery
o Lower – inferior segmental artery

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50
Q
  • Ascend between the pyramids and renal columns

- No branches to the renal parenchyma

A

Interlobar Artery

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51
Q
  • Located at the corticomedullary junction

- On top of the pyramids

A

Arcuate Artery

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52
Q
  • Lie between medullary rays
A

Interlobular Artery

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53
Q
  • Goes to the renal glomeruli
  • A terminal branch
  • Delivers blood to glomerulus for filtration
A

Afferent Arteriole

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54
Q

KIDNEY: NERVE SUPPLY AND LYMPHATIC DRAINAGE

A
  • From renal sympathetic plexus distributed along branches
    of renal vessels
  • Afferent fibers travel through renal plexus and enter spinal
    cord in the T10-12 spinal nerves
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55
Q
  • Conveys urine produced in the kidney to the bladder through peristaltic motion
  • Thick walled expandable muscular ducts with a narrow lumen that carry urine from the kidneys to the urinary bladder
A

URETERS

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56
Q
  • Usually 25 cm in length in adults
  • Continuous with the renal pelvis
  • Completely retroperitoneal but adheres closely to the
    parietal peritoneum
  • Descends anterior to the psoas
A

URETERS

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57
Q
  1. To the right of the inferior vena cava
  2. Pelvis is covered by the 2nd part of the duodenum
  3. The blood vessel crossing in front of it are the Right colic artery, the testicular artery or ovarian artery, ileocolic artery and the superior mesenteric artery in the root of the mesentery
A

Right Ureter

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58
Q
  1. To the left side or lateral to the inferior mesenteric vein
  2. Its pelvis is more exposed than the right and covered only by the peritoneum below the renal vessels
  3. The blood vessel crossing its anterior surface are upper left colic, the testicular testicular or ovarian artery and 3 or more left colic vessels
A

Left Ureter

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59
Q

Ureter: Relations

A
  • Emerges from the renal hilus
  • Runs behind peritoneum of psoas in which separates it
    from tips of lumbar vertebra transverse processes
  • Enters pelvic cavity by crossing bifurcation of the common
    iliac artery in front of sacroiliac joints and enters bladder at
    lateral angle
  • Male: Crossed by vas deferens at its termination
  • Female: Related to uterine artery (beneath it)
  • Enters bladder obliquely. No valve at point of entrance
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60
Q

Ureters: Physiologic Constrictions

A
  1. Ureteropelvic junction – at the junction between the ureter and the renal pelvis
  2. At the pelvic brim, where ureter crosses the common iliac artery
  3. Ureterovesical junction – as the ureter inserts into the urinary bladder
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61
Q

Blood supply of the Ureter: Abdominal Portion (Artery)

A
  1. Renal artery
  2. Testicular / Ovarian artery
  3. Superior vesical artery
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62
Q

Blood supply of the Ureter: Pelvic Portion (artery)

A
  1. Vesical Artery

2. Middle vesical artery

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63
Q

Blood supply of the Ureter: Venous drainage

A
  1. Renal vein
  2. Testicular / Ovarian vein
  3. Superior vesical vein
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64
Q

URETER: NERVE SUPPLY

A
  • Derived from the adjacent autonomic plexus which contain pain fibers
  • Renal, aortic, superior, and inferior hypogastric
  • Afferent fibers from the ureters enter the spinal cord via dorsal roots T11-L1
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65
Q

URETER: LYMPHATIC DRAINAGE

A
  • Generally follow the course of the renal vein and drain into the lumbar (lateral aortic) lymph nodes
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66
Q

URETER: LYMPHATIC DRAINAGE 2

A
  • Upper ureteral lymphatics join those of the kidney
  • Middle ureteral lymphatics drain to the common iliac lymph nodes
  • Lower ureteral lymphatics drain to the common, external, or internal iliac lymph nodes
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67
Q

The __, a hollow viscus with strong muscular walls, is characterized by its distensibility. It is a temporary reservoir for urine.

A

urinary bladder

68
Q

URINARY BLADDER: Location

A

o Pelvis
o Anterior and inferior to the peritoneal cavity
o Posterior to the pubic bone

69
Q

URINARY BLADDER: Relations (Female - Infero-lateral)

A

– prevesical space of Retzius

70
Q

URINARY BLADDER: Relations (Female - Posteriorly)

A

– vagina and cervix,separated from them by vesicovaginal septum

71
Q

URINARY BLADDER: Relations (Female - Inferiorly)

A

– rests directly o pelvic floor.

72
Q

URINARY BLADDER: Relations (Female - superiorly)

A

– loosely covered by peritoneum which allows distension of the organ. Superior surface related to ileum and pelvic colon, uterus lies on it.

73
Q

URINARY BLADDER: Relations (Male - Inferolateral)

A

– rectum, separated from it by the 2 seminal vesicles and ductus deferens and by fascia of Denonvillier’s (prostatoperitoneal membrane)

74
Q

URINARY BLADDER: Relations (Male - Superiorly)

A

– Loosely covered by perineum which allows distension of the organ

75
Q

URINARY BLADDER: Relations (Male - Inferiorly)

A

– pelvic floor

76
Q
  • Found between pubic and bladder
  • Limited below by puboprostatic ligament in males
  • Laterally extends as far as internal iliac artery
  • Superiorly, continues with interval between peritoneum and transversalis fascia which extends up to umbilicus, limited on each side by lateral umbilical ligaments. Surgeons utilize space to enter the bladder extraperitoneally
A

PREVESICAL SPACE OF RETZIUS

77
Q

Parts of the Urinary Bladder

A
  1. fundus
  2. apex
  3. body – with 2 ureteral orifice
  4. base
  5. neck
78
Q

(Parts of the Urinary Bladder)

– points toward the superior edge of pubic symphysis

A

Apex

79
Q

(Parts of the Urinary Bladder)

– opposite the apex, formed by the somewhat convex posterior wall

A

Fundus

80
Q

(Parts of the Urinary Bladder)

– the major portion of bladder between apex and fundus

A

Body

81
Q

(Parts of the Urinary Bladder)

– where the fundus and inferolateral surfaces meet inferiorly

A

Neck

82
Q

(Ligament)

- From back of symphysis pubis to bladder neck and prostate

A

Medial puboprostatic ligament

83
Q

(Ligament)

- From pelvic fascia at the area of levator ani muscle to the neck of the bladder and prostate

A

Lateral puboprostatic ligament

84
Q

(Ligament)

- From apex of the bladder to the umbilicus

A

Median umbilical ligament

85
Q

(Ligament)

- with the median ligament, stabilizes bladder anteriorly

A

Lateral umbilical ligament

86
Q

__ are considered as your TRUE bladder ligaments.

A

Medial and Lateral PUBOPROSTATIC ligaments

87
Q

__ are your FALSE ligaments though all of them will hit the bladder in its proper position.

A

Medial and Lateral UMBILICAL ligaments

88
Q

INTERIOR OF THE BLADDER

A
  • RUGOSE MUCOSA if empty, smooth of distended
  • VESICAL TRIGONE
  • URETERAL ORIFICE
  • RETROTRIGONAL FOSSA
89
Q

o A triangular area bounded by the right and left ureteral orifices
o Found at the posterior bladder wall that remains smooth even of empty
o The ureteral orifices are interconnected by one elevated mucous fold called interureteric ridge
o The most sensitive part of the bladder

A

VESICAL TRIGONE

90
Q
  • is not circular due to vesical crest or uvula (a bulging produced by the middle lobe of prostate)
A

URETERAL ORIFICE

91
Q

o Found at the interior bladder fundus
o Usually deepens by an increase in the intravesical pressure
o Urine usually stagnate in the said fossa

A

RETROTRIGONAL FOSSA

92
Q

BLOOD SUPPLY: URINARY BLADDER

A
  • From Internal iliac artery
    1. Superior vesical artery
    2. Inferior vesical artery
93
Q

o Supply superolateral wall

o Branches out after the gluteal artery

A

Superior vesical artery

94
Q

o Continuation of the internal iliac artery
o Female: it arises from uterine artery
o Supplies bladder floor, prostate, and prostatic urethra

A

Inferior vesical artery

95
Q

URINARY BLADDER: VENOUS DRAINAGE

A
  • From Prevesical plexus which drain into inferior vesical vein
  • Like the arteries, which are all derived from the internal iliac artery, the veins are all tributaries of the internal iliac veins
96
Q

Venous Drainage of the Bladder (Male)

A
  • Vesical venous plexus and prostatic plexus – envelops the base of the bladder and prostate, including the seminal vesicles, ampulla of the vas, and inferior ends of the ureters
  • These go through the internal iliac veins through the inferior vesical veins
  • There is also some drainage into the sacral veins thus entering the vertebral venous plexus (aka Batson’s plexus)
97
Q

Venous Drainage of the Bladder (Female)

A
  • The vesical venous plexus which envelops the proximal urethra and bladder neck drains into the vaginal venous plexus.
98
Q

Urinary Bladder: LYMPHATIC DRAINAGE

A

Anterior part of the bladder: External iliac lymph nodes Posterior part of bladder: Iliac lymph nodes

99
Q

(URINARY BLADDER: NERVE SUPPLY)
- Considered the filling nerve since they inhibit the detrusor muscle and increased muscle tone of internal urethral sphincter

A

Hypogastric Plexus (SNS)

100
Q

(URINARY BLADDER: NERVE SUPPLY)

  • Considered the emptying nerve since they stimulate contraction of detrusor muscle and elevation of the trigone with relaxation of internal urethral sphincter
  • Accompanied by voluntary relaxation of external sphincter via pudendal nerve
A

Pelvic Splanchnic Nerve (PSNS)

101
Q
  • Is from the superior surface of the bladder near its posterior border to the uterus, at the junction of the uterine body and cervix.
  • The vesicouterine pouch of peritoneum is between the bladder and uterus.
  • Normally empty
A

Peritoneal Reflections in the Female

102
Q
  • Is from the superior surface of the bladder, over the ductus deferens and seminal vesicles.
  • The bladder is relatively free floating except for its neck where it is attached firmly by the puboprostatic ligaments.
A

Peritoneal Reflections in the Male

103
Q

DIFFERENCES IN BLADDER BETWEEN MALE AND FEMALE (Between the bladder)

A

MALE: Between the bladder and the rectum are the ampulla of vas and seminal vesicles

FEMALE: Between the bladder and the rectum are the cervix and superior part of vagina

104
Q

DIFFERENCES IN BLADDER BETWEEN MALE AND FEMALE (Bladder Neck)

A

MALE: Bladder neck opens into the prostatic lumen

FEMALE: Bladder neck opens into the short female urethra

105
Q

DIFFERENCES IN BLADDER BETWEEN MALE AND FEMALE (Bladder Neck)

A

MALE: There is a bulge just beneath the trigone caused by the posterior lobe of the prostate

FEMALE: There is usually an extrinsic compression at the superior margin caused by the anteverted uterus

106
Q
  • Long muscular tube, 15 to 20 cm, conveys urine from the urinary bladder to the exterior through the external urethral orifice, located at the tip of the glans penis.
  • Note: Do NOT confuse URETHRA from URETER!
A

URETHRA

107
Q

PART OF THE MALE URETHRA

A
  1. Prostatic Urethra
  2. Membranous Urethra
  3. Penile Urethra
108
Q
  • Widest and most dilatable portion
  • 3 cm long
  • Posterior wall: Urethral crest (a longitudinal elevation)
  • Grooves along sides of the crest are called prostatic
    sinuses and receives openings of prostatic glands
    o The secretory prostatic ducts open into the prostatic
    sinuses.
  • Utricle – at the summit of the crest; opens into urethra
  • Ejaculatory ducts open at the lateral margins of utricle
A

Prostatic Urethra

109
Q
  • Least dilatable
  • Found within urogenital diaphragm
  • Surrounded by the urethral sphincter
A

Membranous Urethra

110
Q
  • Enclosed in the bulb and corpus spongiosum of the penis
  • Becomes dilated as fossa navicularis at the area of the
    glans penis
  • Terminates at external urethral meatus
  • External urethral meatus – narrowest part of the urethra
A

Penile Urethra

111
Q
  • 1.5 in long
  • Extends from the neck of the bladder to vestibule where it
    opens about 1 cm below clitoris
  • Traverses the sphincter urethrae
  • Paraurethral glands
A

FEMALE URETHRA

112
Q
  • Homologue of prostate gland

- Open on either side of urethral orifice

A

Paraurethral glands

113
Q

BLOOD SUPPLY: URETHRA

A

internal pudendal and vaginal arteries and veins.

114
Q

URETHRA: LYMPHATICS

A
  • Sacral lymph nodes

- Internal iliac lymph nodes

115
Q

URETHRA: INNERVATION

A
  • Pudendal nerves

- Pelvic splanchnic nerves

116
Q
  • On either side of the lower thoracic and upper lumbar spine
  • Usual location: Between T11-L3
  • In upright position descend by 2-3 cm
  • Right is slightly lower than the left
  • Long axis is directed DOWNWARDS, LATERALLY, AND ANTERIORLY
A

KIDNEYS

117
Q

KIDNEYS: 2 poles

A

Upper – broad due to presence of adrenal glands

Lower – pointed

118
Q

KIDNEYS: 2 borders

A

Lateral – convex

Medial – concave with hilum in the middle

119
Q

KIDNEYS: 2 surfaces

A

Anterior – irregular

Posterior – flat

120
Q
  • Covers the kidneys

- May be separated from them

A

Fibrous Capsule

121
Q
  • Layer of fat surrounding the fibrous capsule

- Fills up area in the renal sinus

A

Perirenal Fat

122
Q
  • Fibroareolar sheath surrounding the kidney and perirenal fat
A

Renal Fascia of Gerota

123
Q
  • Fat that surrounds the renal fascia
  • More abundant posteriorly and at lower pole
  • Fills up paravertebral gutter
  • Forms a cushion for kidney
A

Pararenal Fat

124
Q

Cortex

A

Cortical arches – form caps over the bases of the pyramids

Renal columns – dip between pyramids

125
Q
  • About 10 conical masses called renal pyramids
  • Tubules form pyramids with apices called papilla that discharge urine into the minor calyces
  • Bases are covered by cortical arches
A

Medulla

126
Q
  • Bounded by the leaves of the Gerota’s fascia
  • The leaves fuse superiorly, laterally, and medially
  • It encloses the kidneys, adrenal glands, renal vasculature, and proximal ureter
  • The fascial envelope is functionally open caudally just above the pelvic brim
  • Ureter emerges from the perirenal space and traverses
    caudad in anterior pararenal space
A

Perirenal Space

127
Q

Anterior Pararenal Space (Boundaries)

A

Posterior: Anterior portion of renal fascia
Anterior: Posterior parietal peritoneum
Lateral: Lateral conal fascia

128
Q

Anterior Pararenal Space (Contains)

A
  • Pancreas
  • Duodenum – 2nd-4th parts
  • Ascending and descending colon
  • Vascular supply to spleen, liver, pancreas and duodenum
129
Q

Posterior Pararenal Space (Boundaries)

A

Posterior: Transversalis fascia
Anterior: Posterior portion of Gerota’s fascia

130
Q

Posterior Pararenal Space (Contains)

A

Fat, scattered vessels and nerves

131
Q

The long axis of the kidneys is directed __, parallel to the lateral border of psoas muscles.

A

downward and outward

132
Q

ULTRASOUND (Kidney)

A
  • Normal size of kidneys in adults: 11-15 cm

- Right kidney is shorter than the left kidney by generally not more than 1.5 cm

133
Q
  • Local bulge or convexity along the lateral aspect of the left kidney
  • This may be either due to impression of the spleen or fetal lobulation or both
A

Dromedary Hump

134
Q

Kidneys are visualized on the X-ray due to presence of __

A

perirenal fat

135
Q

Kidneys are contained within renal capsule and surrounded by perirenal fat and enclosed within the __.

A

Gerota’s fascia

136
Q

Perirenal hemorrhage, pus, and urine are contained within the fascia and detected on __.

A

CT and Ultrasonography

137
Q

Renal Arteries

A
  • Renal arteries branch from the abdominal aorta laterally
    between L1 and L2, below the origin of the superior mesenteric artery
  • The right renal artery passes posterior to IVC
  • There may be more than 1 renal artery (on one or both sides) in 20-30% cases
138
Q

Renal Veins

A
  • Renal veins drain into IVC
  • Renal veins lie anterior to the arteries.
  • Left renal vein is longer and passes anterior to the aorta
    before draining into the IVC
  • The Left gonadal vein drains into left renal vein while the
    Right gonadal vein drains directly into IVC
  • Common variants include retroaortic and circumaortic left
    renal veins
139
Q

This is where you can see if there is one or two artery going to the kidney.

A

Renal Angiography

140
Q

Relationship of the Right Kidney: Anteriorly

A 
– Right adrenal gland
– Liver
– Second part of duodenum
– Hepatic flexure of colon
– Small intestine
141
Q

Relationship of the Right Kidney: Posteriorly

A

– Diaphragm
– Medial and lateral arcuate ligaments
– Psoas major muscle, quadratus lumborum muscle, transversus abdominis muscle
– Subcostal vessels
– Subcostal, iliohypogstric and ilioinguinal nerves
– 12th rib

142
Q

Right Kidney (Upper and Lower Pole)

A

 Upper pole: Adrenal gland

 Lower pole: 1 inch above the iliac crest

143
Q

Right Kidney (Lateral and Medial Border)

A

Lateral border:
o Right lobe of liver
o Hepatic flexure of colon

Medial border:
o Above hilum: Adrenal gland
o At hilum: Renal artery and vein, and pelvis of ureter
o Below hilum: Ureter

144
Q

Relationship of the Left Kidney: Anteriorly

A 
– Left adrenal gland
– Spleen
– Stomach
– Pancreas
– Splenic vessels
– Splenic flexure and descending colon
– Jejunum
145
Q

Relationship of the Left Kidney: Posteriorly

A

– Diaphragm
– Medial and lateral arcuate ligaments
– Psoas major muscle, quadratus lumborum muscle, transversus abdominis muscle
– Subcostal vessels
– Subcostal, iliohypogstric and ilioinguinal nerves
– 11th and 12th ribs

146
Q

Left Kidney (Upper and Lower Pole)

A
  • Upper pole – adrenal gland

* Lower pole – 1 inch above iliac crest

147
Q

Right Kidney (Lateral and Medial Border)

A

Lateral border:
o Spleen
o Descending colon

Medial border:
o Above hilum: Adrenal gland
o At hilum: Renal artery and vein, and pelvis of ureter
o Below hilum: Ureter

148
Q
  • Consists of glomeruli and renal tubules

- Normal thickness: 2.5 cm

A

Renal Cortex

149
Q
  • Consists of multiple renal pyramids which have their base to the periphery and their conical end directed towards the renal hilum
  • Their tips are called papillae
  • Each minor calyx receives 1-3 papillae
A

Renal Medulla

150
Q
  • Shows corticomedullary differentiation
  • This is approximately 100 seconds following contrast
    administration
  • Shows renal lesions well
A

Nephrogram Phase

151
Q
  • Shows excretion of contrast into the collecting system
  • This is approximately 8 minutes following contrast
    administration
  • Shows urothelial lesions well, such as transitional cell
    carcinoma, stones, blood clot
A

Pyelogram Phase

152
Q
  • 3D reconstructed image from CT scan of the badomen and pelvis
  • Quickly replaces the conventional IV Urogram
  • 3d reconstruction is performed through the right kidney and follows the normal ureter (arrows) all the way to the ureter’s insertion into the bladder
A

CT IVP

153
Q

Calyces

A

Medulla sits in the fornix of the minor calyx
Fornix - sharp and concave
Papillae drain into minor calyces
Minor calyces coalesce to form 3-4 major calyces
Major calyces combine to form the pelvis

154
Q
  • Broad dilated part of the urine collecting system
  • Located in the hilum
  • Renal pelvis drains into the ureter
A

Renal Pelvis

155
Q
  • 25-30 cm in length and 3 mm diameter
  • Course: downward from renal pelvis to midsacral region
  • Then posterolaterally in an arc downwards
  • Then inward and anteriorly to enter the bladder trigone on
    either side of the midline
A

URETERS

156
Q
  • Lateral to the ductus deference and enter urinary bladder

posterosuperiorly just above the seminal vesicle

A

URETERS (MALES)

157
Q
  • Medial to the origin of the uterine artery and continues to the level of the ischial spine
  • It is crossed superiorly by the uterine artery
  • Then passes close to the lateral portion of the fornix of vagina to enter the posterosuperior angle of the bladder
A

URETERS (FEMALES)

158
Q

URETERAL VASCULATURE

A
  • Blood is supplied by the ureteral branches of renal and
    testicular/ovarian arteries, and abdominal aorta
  • Renal and testicular/ovarian veins supply venous drainage
159
Q
  • Hollow muscular vesicle for storing urine temporarily
  • Bladder is higher in position in children and slightly higher in males than females
  • It is relatively larger in children than in adults
  • Size and shape vary considerably
A

URINARY BLADDER

160
Q

URINARY BLADDER: Shape

A

o Tetrahedral – when empty

o Transversely oval or round – when full

161
Q
  • When empty, it is completely within the pelvis
  • Inferior aspect projects 5-10 mm above the symphysis pubis
  • Separated from pubic bones by Retropubic space (Retzius)
  • Floor is parallel to superior aspect of the pubic rami
  • Dome is surrounded in male and flat or slightly concave in
    female
A

URINARY BLADDER

162
Q

o Lies 3-4 cm behind lower part of symphysis pubis
o Rests on the prostate in male
o It has the urethral orifice

A

Neck of bladder

163
Q

URINARY BLADDER (Females)

A
  • The peritoneum is reflected from the superior surface of the bladder to the anterior wall of the uterus at the junction
    between the body and cervix
  • The enclosed space is the vesicouterine pouch
164
Q

URINARY BLADDER (Males)

A
  • The peritoneum is reflected from the bladder to the superior surface of the ductus deferens and seminal vesicles
  • Bladder is relatively free to move except at the neck which is fixed by the puboprostatic ligaments (male) and
    pubovesical ligaments (female)
165
Q

Peritoneal reflection (Males and Females)

A

o Male: Rectovesical pouch

o Female: Vesicouterine and rectouterine pouch

Anatomy (10 decks)

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