Random Flashcards
Right KIDNEY is Lower than the Left kidney
where does the upper pole of the Left Kidney lie?
where does the upper pole of the Right Kidney lie?
left: 11th RIB, closely related to the Spleen (below it)
Right: TRANSPYLORIC PLANE
KIDNEYS lie on a muscular wall composed of which 3 muscles?
the URETERS exit the hilum and pass Inferiorly on which muscle before crossing the Pelvic Brim (and common/external iliac artery)
- DIAPHRAGM, QUADRATUS LUMBORUM, TRANSVERSUS ABDOMINIS
- ureters pass PSOAS MAJOR
KIDNEY blood flow starting from AORTA -> RENAL ARTERY
and ending at RENAL VEIN -> IVC
renal artery
-> SEGMENTAL ARTERY (1 for each segment)
-> INTERLOBAR ARTERY (each renal column)
-> ARCUATE ARTERY (arches over base of pyramids)
-> CORTICAL RADIATE ARTERY (radiates out through cortex)
-> AFFERENT ARTERIOLE
-> GLOMERULUS
-> EFFERENT ARTERIOLE
-> PERITUBULAR CAPILLARIES / VASA RECTA
-> CORTICAL RADIATE VEIN
-> ARCUATE VEIN
-> INTERLOBAR VEIN
-> renal vein
URETERS length:
URETHRA length female:
VAGINA length:
ureters: 25-30 cm
female urethra: 4cm
Vagina: 8cm
Arteries that supply URETERS
- RENAL artery
- GONADAL artery
- COMMON ILIAC artery
- INTERNAL ILIAC artery
- SUPERIOR VESICAL artery
- MIDDLE RECTAL artery
Bowman’s Capsule has Juxtaglomerular wall lined by PODOCYTES (foot proccess) that has tightly interdigitated PEDICELS with gaps for filtrate to pass through.
how big are the gaps?
25nm
- type of Epithelium in the
PCT:
Loop Of Henle Cortex:
Loop of Henle Medulla:
DCT:
Collecting Duct:
PCT: SIMPLE COLUMNAR
Loop Of Henle Cortex: CUBOIDAL (thick)
Loop of Henle Medulla: SIMPLE SQUAMOUS (thin)
DCT: CUBOIDAL
Collecting Duct: Columnar or cuboidal
JUGTAGLOMERULAR APPARATUS
there are 3 cell types that regulate nephron activity. MACULA DENSA (detect Na+, regulate GFR)
GRANULAR / JUXTAGLOMERULAR (secrete Renin)
EXTRAGLOMERULAR MESANGIAL CELLS
where are they each
Macula Densa: DCT where comes close to renal corpuscle
Juxtaglomerular: AFFERENT ARTERIOLE
Mesangial: BETWEEN AFFERENT and EFFERENT ARTERIOLES, CENTRE of GLOMERULUS
which part of the NEPHRON has:
- Brush Border of Microvilli?
- cells that Secrete H+ ?
- abundant in Mitochondria?
- microvilli: PCT
(few in dct) - DCT secretes H+
- Mitochondria: PCT
Development of Kidney.
- where does Pronephros disappear? (ducts persist)
- when is Mesonephros functional from?
- when is Metanephros functional from?
- by 5th week pronephros disappears
- Mesonephros functional weeks 6-10
- Metanephros functional from week 9
BLADDER muscle lining internal walls is called:
- which Nerves cause it to contract
DETRUSOR MUSCLE
(none in the Trigone - smooth space between 3 openings)
- PELVIC SPLANCHNIC NERVES (S2-S4) (parasympathetic)
INTERNAL Urethral Sphincter is Smooth Muscle (involuntary) under what NS control and which nerves keep it closed?
EXTERNAL Urethral Sphincter is Skeletal Muscle (voluntary) under what NS control and which nerve?
Internal: Autonomic Nervous System
- SYMPATHETIC stimulation
via *HYPOGASTRIC NERVES
(parasympathetic will relax to open)
External: Somatic nervous system
- PUDENDAL NERVE
PARASYMPATHETIC Nerves originate where?
which nerves
SYMPATHETIC Nerves originate where?
which nerves
SOMATIC Nerves are where?
which nerves
Parasympathetic nerves originate S2-S4
- travel to bladder in PELVIC SPLANCHNIC NERVES
Sympathetic nerves originate L1-L2 (L3)
- travel via HYPOGASTRIC PLEXUSES
Somatic nerves are S2-S4
- PUDENDAL
70% of SEMINAL FLUID comes from the Seminal Vesicle and 25% from Prostate.
what are its characteristics and why
- ZINC RICH : Stabilise DNA
- NUTRITIVE to SPERMATOZOA
- ALKALINE to neutralise Vaginal pH
- Gonads are originally at what before they are pulled down?
- they are connected to the Labioscrotal Swelling by what? regression of this is what pulls them down.
- Remnant of this exists as what?
- L1 originally
- GUBERNACULUM
- gubernaculum remnant: ROUND LIGAMENT of UTERUS and OVERY
Pelvic Inlet pathway:
(35-50 degree angle)
Pelvic Outlet pathway
inlet:
- promontory of SACRUM
- arcuate line of ILEUM
- ILEOPECTINAL Line
- posterior surface PUBIC CREST
outlet:
- ISCHIOPUBIC RAMUS
- ISCHIAL TUBEROSITIES
- SACROTUBERAL LIGAMENTS
- distal SACRUM
Pelvic sub-pubic arch Angle in
females:
males:
females: 80-85 DEGEES
males: 50-60 DEGREES
Pelvic sub-pubic arch Angle in
females:
males:
females: 80-85 DEGEES
(oval shape)
males: 50-60 DEGREES
(heart shape)
ERECTION caused by which nervous system?
which nerves?
PARASYMPATHETIC Fibres (Ventral Rami)
- Vasodilation of arteries (relax)
(Cavernous, Bulbourethral and Circumflex arteries)
PELVIC SPLANCHNIC NERVES* S2-S4
Testes CREMASTER muscle is innervated by which nerves
GENITOFEMORAL NERVE L1-L2
SCROTUM Layers
S - SKIN
D - DARTOS and SMOOTH MUSCLE
E - EXTERNAL SPERMATIC FASCIA
C - CREMASTER MUSCLE and FASCIA
I - INTERNAL SPERMATIC FASCIA
T - TUNICA VAGINALIS (parietal and visceral layers)
Urogenital and Anal Triangle are separated by what
ISCHIAL TUBEROSITY
(ug : pubic symphysis
anal: coccyx)
Puborectalis forms a sling around the Perineal flexure (junction between Rectum and Anus). what Angle does it create to prevent Defactation
80 DEGREE ANGLE
- Relax muscle: increase angle for defacation
anteriorly the Labia Minora bifurcate and the medial portions fuse to form the…
lateral folds form the…
- FRENULUM of the Clitoris (joins the Glans Clitoris)
- lateral folds: PREPUCE of the Clitoris
space Inferior to the Pelvic Floor:
PERINEUM
what are the Glands of Montgomery?
where are they found?
what do they do?
SEBACEOUS GLANDS found in the AREOLA (coloured area around the nipple - due to melanocytes) with sweat glands
- secrete SEBUM (oily secretions) to LUBRICATE the nipple, keep it supple, and help Latching
what is Polymastia, Polythelia, Amastia, Amazia
Polymastia: NUMEROUS BREASTS
Polythelia: NUMEROUS NIPPLES
Amastia: NO BREAST TISSUE
Amazia: ONLY NIPPLE development (no mammary glands)
where is Milk produced in the BREAST?
How is it secreted?
which Hormones Inhibit milk production?
when/why is Inhibition of prolactin lifted?
- in LACTOCYTES - CUBOIDAL cells Lining the ALVEOLI
- Suckling stimulates
PROLACTIN stimulates Lactocytes to produce milk
OXYTOCIN is secreted from Posterior Pituitary and stimulates MYOEPITHELIAL CELLS surrounding the Lactocytes to CONTRACT
-> Milk squeezed out of alveoli, through Lactiferous Ducts and pooled in Lactiferous Sinus - OESTROGEN, PROGESTERONE and other PLACENTAL Hormones INHIBIT PROLACTIN and milk-synthesis in PREGNANCY
- INHIBITION LIFTED after birth of placenta and due to RAPID FALL fall in OESTROGEN
at birth the breast has Lactiferous ducts but NO Alveoli.
how do the breasts/mammary glands change at..
PUBERTY:
POST-PUBERTY:
PREGNANCY (what increase?):
Puberty:
LITTLE BRANCHING of lactiferous ducts. any slight enlargement is due to growth of Adipocyte and fibrous Stroma
Post-Puberty:
-MORE BRANCHING &ALVEOLI FORM at ends of Lactiferous Ducts (granular polyhedral cells)
ADIPOCYTE DIFFERENTIATION from Mesenchymal cells into INTERLOBAR STROMA
Pregnancy:
(INCREASE OESTROGEN, PROGESTERONE, PROLACTIN, hPL)
- Breast growth more UNIFORM
- INCREASE SIZE and PIGMENTATION NIPPLES (due to increased oestrogen)
- INCREASED BLOOD FLOW due to INCREASED VASCULAR BRANCHING and DILATED VEINS
- FAT DEPOSITION and INCREASE in GLANDULAR DUCTS (oestrogen)
- INCREASED NO. ALVEOLI and LOBULES (due to Progesterone and hPL)
- Sebaceous Glands produce LUBRICANT
- HYPERPLASIA (CELLULAR REPRODUCTION) of DUCTAL, ALVEOLAR and MYOEPITHELIAL elements
- WATER, ELECTROLYTE and ADIPOSE Content
which Liver function Test would be most Elevated in a healthy PREGNANT woman
ALKALINE PHOSPHATASE
BREAST Blood Supply by which arteries/veins?
venous drainage from which plexus around the Areola into the veins?
AXILLARY artery/vein
-> LATERAL THORACIC
-> LATERAL MAMMARY
INTERNAL THORACIC artery/vein
-> MEDIAL MAMMARY
POSTERIOR INTERCOSTAL artery/vein
- CIRCULAR VENOUS PLEXUS -> veins
BREAST has 20-40 LYMPH NODES
Lymphatic Drainage from which Plexus?
name the Lymph Nodes
and % to each
- SAPPEY’S PLEXUS
75% to AXILLARY NODES
- APICAL
- HUMERAL (lateral)
- CENTRAL
- PECTORAL (anterior)
- SUBSCAPULAR (posterior)
(named in relation to pectoralis Minor)
25% to PARASTERNAL NODES
NERVE supply to the Nipple?
sensation (suckling) by which cutaneous Mechanoreceptors?
4TH INTERCOSTAL NERVE (T2-T6)
- MEISSNER’S CORPUSCLE
- MERKEL DISC ENDINGS
what can DIABETES cause in Fetus
- HIGHER AMNIOTIC FLUID levels
- Fetal OVERGROWTH (>95th)
highest Haemoglobin levels are in ..
NEWBORNS : 20-24
Foetus: 16-18 g/dl
Adult: 11-15 g/dl
OOGENESIS
1. how many oocytes at birth
2. primary oocytes arrest in?
3. what completes the meiosis I of primary oocytes?
4. what does this form?
5. what are these arrest in?
6. when do they complete meiosis II
- 2 million at birth (7 million created but from 20 weeks, start to die)
- Primary oocytes in PROPHASE I
- PUBERTY
- SECONDARY OOCYTES and 1ST POLAR BODY
- secondary oocytes in METAPHASE II
- FERTILISATION
-> OVUM and 2ND POLAR BODY
Uterine Cycle phases
and their lengths
- MENSES (3-5 days)
breakdown endometrium - PROLIFERATIVE PHASE (varies)
endometrium regrows - SECRETORY PHASE (14 FIXED)
(in line with luteal phase)
endometrium thickening in preparation for embryo
how does PROGESTERONE inhibit LH and FSH in the Luteal Phase
BLOCKS + FEEDBACK of OESTROGEN on the Hypothalamus (GnRH)
Ovary attached to anterior abdominal wall by..
SUSPENSORY LIGAMENT of the OVARY
how do Granulosa Cells make OESTROGENS
stimulated by FSH
- CONVERT ANDROGENS from the THECA INTERNA cells (stimulated by LH)
from CHOLESTEROL & ACETATE (STEROID Hormone)
how accurate are Ultrasounds?
how accurate are Symphysial Fundal Height test
- ultrasound 40-50%
- symphysial fundal height: 25-35%
causes of Microcephaly
- Viral (zika virus)
- Chromosomal
- Craniosynostosis (sutures fuse early)
- Alcohol
- Drug
GI Disorders - Gastroschisis, Omphalocele, Echogenic Bowel
- which is associated with Chromosomal disorders?
- which is when the Bowel/Liver is outside the Abdomen
- which is due to Genetic, Cystic Fibrosis, CMV
- chromosomal: Omphalocele
- bowel/liver outside: Gastroschisis
- genetic,CF,CMV : Echogenic bowel
- what is meant by Gravidity and Parity
- lengths of each trimester
- when it Term, pre-term and post-term
- when does the nhs aim to have women delivered by
- Gravidity: number of times been pregnant
Parity: number of pregnancies beyond 20 weeks - 1st trimester: <12 weeks
2nd trimester: 12-24 weeks
3rd trimester: 24> - Term = 37-40 weeks
pre-term: <37
post-term: >40
- delivered by 42 weeks
methods of estimating due date:
which most accurate?
LMP (from last menstrual period, -3months + 7 days)
CRL (crown rump length)
Timed Coitus
Embryo Transfer, IVF
- CRL accurate (within 7 days)
- what is there a Low level of in pregnancy
- Renal effects in pregnancy
- Skeletal effects in pregnancy
- Respiratory effects in pregnancy
- Blood effect
- Low CREATININE, Low UREA
- INCREASED BLOOD FLOW,
INCREASED GFR
Proteinuria, Glycosuria - OSTEOPENIA (bone weakening, stage before osteoporosis)
increased OSTEOBLAST activty - INCREASED TIDAL VOLUME
INCREASED Resp RATE
DECREASED MAX INSPIRATORY VOL in 3RD Trimester
Mild Respiratory ALKALOSIS - Increase red blood cell mass but HAEMOGLOBIN DECREASE
- iron deficiency
hormone that stimulate Ca2+ influx for Uterine Contractions
OXYTOCIN
(posterior pituitary)
Labour stages
1ST: onset to FULL DILATION
Latent: upto 3cm
Active: 3-10 cm
2ND: Full Dilation to DELIVERY OF FETUS
3RD: birth to DELIVERY OF PLACENTA
Anti-Mullerian Hormone is secreted from which cells
SERTOLI cells
(in seminiferous tubules)
Testes lymphatic drainage into:
Scrotal Skin drains into:
PARA-AORTIC NODES
scrotal skin: INGUINAL NODES
Vas Deferens passes through the…
Lateral to…
Medial to…
before joining with seminal vesicle to form ejaculatory duct.
- where does Vas Deferens store Spermatozoa
- what does Ejaculatory Duct drain into of the Prostate
THROUGH INGUINAL CANAL
LATERAL to INFERIOR EPIGASTRIC ARTERY
MEDIAL to ALL STRUCTURES of PELVIC SIDE WALL
- Terminal Vas stores in AMPULLA
- ejac duct -> COLLICULUS SEMINALIS / VERUMONTANUM
Epididymis ducts length:
Ejaculatory Duct length:
Prostate gland approx weight:
epididymus: 6M
Ejactulatory Duct: 2cm
Prostate: 20g
- what provides 60-70% of the Ejaculate?
what provides 1/3rd of the semen volume? - what does Seminal Vesicle secretions contain from their COLUMNAR secretory epithelium with GOBLET cells?
- what does Prostate gland secretions contain?
- what do Bulbourethral gland (Cowper’s) secretions contain?
60-70% from SEMINAL VESICLE
1/3rd from PROSTATE
- Seminal vesicle: MUCOID MATTER with FRUCTOSE, CITRIC ACID, PROSTAGLANDINS, FIBRINOGEN, NUTRIENTS
- Prostate: ENZYMES to activate sperm,
PSA (Prostate specific antigen) protease for semen coagulation - watery
NUTRIENTS - Bulbourethral / Cowper’s: LUBRICATING MUCUS
Prostate Gland is made up 70% Glandular and 30% Fibromuscular (anterior stroma over top)
- Transitional zone makes up how much of Glandular?
what proportion of Cancers arise from it? - Central zone makes up how much of Glandular?
what proportion of cancers arise from it? - Peripheral zone makes up how much of Glandular?
what proportion of cancers arise from it?
- TRANSITIONAL 5-10%
- 20% CANCERS
- gives rise to BPH - CENTRAL 25%
- 1-2% CANCERS - PERIPHERAL 70%
- 70% CANCERS
- most commonly affected by CHRONIC PROSTATITIS
in case of BPH (Benign Prostatic Hyperplasia) what may be the target for Drugs
5-ALPHA-REDUCTASE
(converts testosterone to dihydrotestosterone)
Acrosome (thick cap) of Spermatozoa are formed mainly from what in the cell
GOLGI APPARATUS
Urogenital System DERIVED from which Germ Layer
INTERMEDIATE MESODERM
Mesonephric Duct gives off a Ureteric Bud growing from it which enters the Metanephros and grows into it. rest of mesonephric duct goes into the urogenital sinus.
- What does the Ureteric Bud of the MESONEPHROS give rise to
- what does the METANEPHROS give rise to
- Pronephros arrives when and has regressed by when
- 4 stages of Nephron Development
- URETERS, RENAL PELVIS, MAJOR/MINOR CALYCES, *COLLECTING DUCTS
- NEPHROS - BC, PCT, LOH, PCT
becomes the true kidney - 4th week, gone by 5th week but persists as ducts for mesonephros
- 1- Mesenchyme forms VESICLES
2- vesicles become S-SHAPES and Connect to Ureteric Bud (collecting ducts)
3- TUBULES develop CUP-SHAPES CAPSULE (BC)- Tubules ELONGATE. GLOMERULUS becomes ROUND & MATURE
- Bladder and Urethra are DERIVED from which Germ Layer
- Trigone of the bladder is formed from what
- Urethra in the Glans (males) is derived from which Germ layer
- Allantois from the Cloaca which connects bladder to umbilicus regresses and becomes what remnant
- what are Smooth Muscle and Connective Tissue, including Endometrial stroma and Myometrium derived from
- where is the Prostate derived from
- ENDODERM
-> Gut Tube -> Cloaca -> UG sinus - vesical part
(and Anorectal canal) - TRIGONE is from caudal ends of MESONEPHRIC DUCTS
- GLANS URETHRA (distal part of spongy urethra) from ECTODERM
- Urachus
- SPLANCHNIC MESODERM
- PROSTATE: ENDORDERM (Urogenital Sinus)
what do the Mesonephric Ducts become
MALES: EPIDIDYMUS and VAS DEFERENS
EFFERENT DUCTULES (mesonephric tubules)
SEMINAL VESICLE, EJACULATORY DUCT
as well as TRIGONE of bladder
which signalling molecule is switched on for Male differentiation?
which is switched on for Female?
- which is also involved in signalling pathways in the early development of external genitalia?
Male: SOX9
Female: WNT4
- FGF8
- size of Filtration surface per Kidney
- Volume of Urine produced per day
- Rate of filtration / GFR
- RBF =
- RPF =
- FF =
- Renal Plasma Clearance definition
- both cell layers in filtration surface have what
- 6m^2
- 1.4 L
- GFR = 125 ml/min or 180L / DAY
- RBF = 1200 ml/min
- RPF = 625 ml/min (55% of rbf)
- FF = GFR/RPF = 125/625 x100 = 20%
- RPC is the volume of plasma that is cleared of a known substance per unit of time
- Negatively Charged Glycoproteins
Hydrostatic Pressure in Glomerulus (HPg):
Blood Colloid Osmotic Pressure (OPg):
Hydrostatic Pressure in Capsule (HPc):
so what is NET FILTRATION PRESSURE in Kidney
HPg = 60 mmHg OUT
OPg: 32 mmHg IN
HPc: 18 mmHg IN
NET FILTRATION PRESSURE = 10 mmHg OUT
which hormone BLOCKS RENIN and acts to Lower Blood Pressure
ANP secreted due to STRETCH OF HEART
-> also causes VASODILATION as well as blocking renin from juxtaglomerular/granular cells
what provides an energy source for Na+ Cl- Reabsorption from the Ascending limb of Loop of Henle
- how much Na+ and Cl- pulled out with each
K+
- K+ MOVES OUT into INTERSTITIAL SPACE
pulls 1 NA+ and 2 CL- out too
-> Blood
- K+ secreted back into lumen by Na+-K+ ATPase or absorbed into blood or stored in interstitium
Diuretics - substances that increase urine production / increase excretion of salts and water.
examples of some and what they do:
- CARBONIC ANHYDRASE INHIBITOR
inhibits Na+, HCO3- reabsorption from PCT - LOOP DIURETICS
inhibit Na+, 2Cl-, K+ reabsorption from ascending loop - THIAZIDES
inhibits Na+ reabsorption from DCT - K+ SPARING DIURETICSW
block ALDOSTERONE and inhibit Na+ reabsorption from Collecting Duct (spares K+)
- How much HCO3- is reabsorbed in the PCT?
how much is reabsorbed in the DCT and Collecting Duct - how is HCO3- formed in the PCT vs the DCT/CD
- how are the HCO3- and H+ TRANSPORTED out of the PCT cells vs the DCT/CD Cells
- PCT: 85-90%
DCT/CD : 10-15% - PCT: DE NEVO SYNTHESIS.
- broken down in lumen into CO2 + H20
- CO2 diffuses into cell and combined with H20 with presence of CARBONIC ANHYDRASE to form H2CO3 and REGENERATE HCO3- (and H+)
DCT/DC: HCO3- CREATED in CELLS from CO2 and H2O
- PCT: HCO3- TRANSPORTED WITH NA+
and H+ is Exchanged for Na+ into the Lumen
DCT/CD: HCO3- EXCHANGED FOR CL-
H+ is transported out with Cl- (using ATP)
- Clearance rate equation =
- Glucose clearance rate =
Sodium clearance rate =
Chloride clearance rate
Potassium clearance rate =
Phosphate clearance rate =
Inulin clearance rate =
Creatinine clearance rate = - when does Creatinine Secretion Increase?
- another marker for GFR
- what is the standard surrogate marker for assessing renal function
- C = UV/P
- Glucose clearance rate = 0 ml/min
Sodium clearance rate = 0.9
Chloride clearance rate = 1.3
Potassium clearance rate = 12
Phosphate clearance rate = 25
Inulin clearance rate = 125 ml/min (GFR)
Creatinine clearance rate = 140 ml/min - when GFR DROPS BY 50%
- CYSTATIN C (may be affected by inflammatory phenoma)
- CREATININE
which cells produce ERYTHROPOIETIN
- how many amino acids is it made up from
INTERSTITIAL PERITUBULAR CELLS
(kidneys and small amount in liver)
- 165 amino acids, glycosylated
what can increased/enhanced SYMPATHETIC activity lead to
- HYPERTENSION
- Insulin Resistance
