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Anatomy > renal anatomy > Flashcards

renal anatomy Flashcards

1
Q

compare the length of urethras in males and females?

A

male urethra is much longer than female urethra

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2
Q

explain how male urethras have a dual function?

A

both urine and semen pass through

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3
Q

what makes up the upper urinary tract?

A

kidneys

ureters

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4
Q

what makes up the lower urinary tract?

A

bladder

urethra

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5
Q

what bony structures mare the transition from abdomen to pelvis?

A

iliac crests

L4

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6
Q

at what vertebra level does the abdominal aorta bifurcate?

A

L4

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7
Q

what surface of the kidneys touches the peritoneum?

A

anterior surface

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8
Q

what groups of skeletal muscles protect the kidneys?

A

muscles of the anterolateral abdominal wall
muscles of the posterior abdominal wall
muscles of the back

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9
Q

what are the 3 muscles of the anterolateral abdominal wall?

A

external oblique
internal oblique
transversus abdominis

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10
Q

what are the 3 important structures of the renal hilum?

A

renal artery
renal vein
ureter

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11
Q

what are the 2 muscles of the posterior abdominal wall?

A

psoas major

quadratus lumborum

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12
Q

which is more anterior- psoas major or quadratus lumboru,?

A

psoas major

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13
Q

what surrounds the kidney?

A

the renal capsule

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14
Q

where does the perinephric fat lie?

A

surrounds renal capsule, deep to renal fascia

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15
Q

what type of fascia is renal fascia?

A

deep fascia

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16
Q

where doe the paranephric fat lie?

A

between the visceral peritoneum and the renal fascia

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17
Q

compare the position of the kidneys to the quadratus lumborum muscles?

A

kidneys lie anterior to quadratus lumborum muscles

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18
Q

compare the position of the kidneys to the psoas major muscles?

A

kidneys lie lateral to psoas major

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19
Q

which vertebral bodies does the right kidney lie lateral to?

A

L1, L2, L3

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20
Q

which vertebral bodies does the left kidney lie lateral to?

A

T12, L1, L2

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21
Q

why is the right kidney more inferior than the right?

A

due to size of liver

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22
Q

what ribs protect the kidney?

A

floating ribs 11 and 12

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23
Q

what regions/quadrants are the kidneys within?

A

R kidney: RUQ, right lumbar region

L kidney: LUQ, left lumbar region

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24
Q

which sac is the hepatorenal recess part of?

A

the greater sac

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25
Q

compare the location of the renal veins and renal arteries?

A

renal veins are anterior to renal arteries

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26
Q

compare the location of the common iliac veins and the common iliac arteries?

A

common iliac arteries are anterior to common iliac veins

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27
Q

where does lymph from the kidneys drain to?

A

lumbar lymph nodes

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28
Q

where are lumbar lymph nodes found?

A

located around abdominal aorta and IVC

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29
Q

where does lymph from the ureters drain to?

A

lumbar lymph nodes + iliac lymph nodes

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30
Q

where are iliac lymph nodes found?

A

around common, internal and external iliac vessels

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31
Q

the utereric arterial blood supply is from branches of which arteries?

A 
renal artery
abdominal aorta
common iliac artery
internal iliac artery
vesical artery
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32
Q

compare an infrarenal and suprarenal AAA?

A

infrarenal aneurysm starts below level of renal arteries

suprarenal aneurysm starts above the level of renal arteries

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33
Q

what is the management of an AAA?

A

EVAR

endovascular aneurysm repair using a stent inserted through the femoral artery

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34
Q

when associated with an infrarenal AAA, what is renal artery stenosis caused by?

A

atherosclerosis

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35
Q

when associated with a suprarenal AAA, what is the renal artery stenosis?

A

proximity to aneurysm

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36
Q

what is a bifid renal pelvis?

A

anatomical variation when there is 2 pelvises extending from the major calyces instead of 1 pelvis

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37
Q

what is a bifid ureter?

A

anatomical variation in where there are 2 ureters at one side, these join before reaching the bladder

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38
Q

what is a unilateral duplicated ureter?

A

anatomical variation in where ther are 2 ureters at one side, these do not join

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39
Q

what is a retrocaval ureter?

A

anatomical variation where the ureter wraps behind the IVC instead of remaining lateral to it

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40
Q

what is a horseshoe kidney?

A

anatomical variation where the kidneys are connected

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41
Q

what is an ectopic pelvic kidney?

A

anatomical variation where a kidney is in the pelvis instead of the abdomen

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42
Q

what are the 3 reasons for a solitary kidney?

A

agenesis
patholoical nephrectomy
nephrectomy for donation

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43
Q

how many pyramids does a human kidney medulla contain?

A

27 pyramids

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44
Q

what gives the pyramids in the medulla the striped appearance/.

A

nephrons arranged axially

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45
Q

where does the collecting duct pass it’s filtrate?

A

minor calyx

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46
Q

are nephrons within the cortex or medulla of a kidney?

A

medulla

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47
Q

the glomerulus filters blood arriving from water vessel?

A

branches of renal artery

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48
Q

what do the minor calyces join to form?

A

a major calyx

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49
Q

what do the major calyces join to form?

A

renal pelvis

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50
Q

the diameter of urine drainage tubes increases until what junction?

A

pelviureteric junction

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51
Q

where are the 3 anatomical sites of ureteric constriction?

A
  • pelviureteric junction
  • where ureter crosses common iliac artery
  • ureteric orfice
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52
Q

what does the ureteric orfic open into?

A

the bladder

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53
Q

the ureter crosses the common iliac artery at what bony landmark?

A

pelvic brim

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54
Q

what does the pelvic brim divide?

A

the upper false pelvis and the lower true pelvis

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55
Q

what is the medical name for kidney stones?

A

renal calculi

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56
Q

what is the name for renal calculi with connections between them?

A

staghorn calculi

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57
Q

what type of muscle lines the wall of the ureter?

A

smooth muscle

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58
Q

what does the ureter do in order to dislodge an obstruction?

A

waves of peristalsis

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59
Q

what type of pain does a patient feel when there is something lodged within one of the ureters and why?

A

colicky paindue to peristalsis waves

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60
Q

what is renal failure?

A

failure to adequately filter blood to produce urine

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61
Q

do obstructions within calyces or ureter cause unilateral or bilateral kidney problems?

A

unilateral

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62
Q

do obstructions within the bladder cause unilateral or bilateral kidney problems?

A

unilateral or bilateral

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63
Q

do obstructions within the urethra cause unilateral or bilateral kidney problems?

A

bilateral

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64
Q

what is hydronephrosis?

A

back pressure into the kidney causing enlargment

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65
Q

why does hydronephrosis cause pain?

A

because it stretches the renal capsule

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66
Q

embryologically, what becomes the permanent kidney?

A

metanephros

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67
Q

what does the metanephros form from?

A

ureteric bud

metanephric blastema

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68
Q

is the kidney endoderm, ectoderm or mesoderm?

A

mesoderm

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69
Q

is the bladder endoderm, ectoderm or mesoderm?

A

endoderm

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70
Q

why does kidney agenesis occur?

A

because the ureteric bud doesn’t come into contact with the metanephric blastema

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71
Q

which becomes the nephron- ureteric bud or the metanephric blastoma?

A

metanephric blastoma

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72
Q

embryologically, where do the kidneys develop?

A

in the pelvis

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73
Q

why does ectopic pelvis kidney occur?

A

failure of kidney to ascend

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74
Q

what are the rounded apexes of the renal pyramids called?

A

papilla

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75
Q

when the ureter crosses the pelvic brim (pelvic inlet), what part of the pelvis does it pass into?

A

the true pelvis

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76
Q

describe the location of the false pelvis?

A

from iliac crests to pelvic inlet (or brim)

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77
Q

describe the location of the true pelvis?

A

pelvic inlet to pelvic floor

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78
Q

in which cavity is the false pelvis in?

A

abdominal cavity

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79
Q

in which cavity is bladder in?

A

the pelvic cavity (true pelvis)

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80
Q

there are openings in the pelvic diaphragm to allow which 3 tracts to pas into the perineum?

A

alimentary tract
reproductive tract
renal tract

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81
Q

what does the pelvic diaphragm extend between?

A

sacrum to the pubis

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82
Q

which is the only part of the urinary system to be in the perineum?

A

urethra

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83
Q

when the ureters cross the common iliac arteries do they pass anteriorly or posteriorly?

A

anteriorly to the arteries

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84
Q

the ureters enter the posterior bladder wall in which direction?

A

inferomedial

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85
Q

in the anatomical position, what is the most inferior part of the peritoneal cavity in a male?

A

rectovesicle pouch

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86
Q

what is the function of the round ligament of the uterus?

A

attaches uterus to the perineum

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87
Q

what canal is the round ligament of the uterus found in?

A

inguinal canal

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88
Q

what are 2 pouches of peritoneum in the female?

A

recto-uterine pouch (of douglas)

vesico-uterine pouch

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89
Q

in the anatomical position, what is the most inferior part of the peritoneal cavity in a female?

A

recto-uterine pouch of douglas

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90
Q

compare the location of the ureter to the suspensory ligament of the ovary?

A

suspensory ligament of the ovary is lateral to the ureter

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91
Q

compare the location of the ureter to the uterine tubes and uterine artery?

A

the ureter runs inferiorly to both the uterine tubes and uterine artery
‘water under the bridge’

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92
Q

compare the location of the ureter to the vas deferens?

A

ureter runs inferiorly to the vas deferens

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93
Q

are the arteries entering the pelvis mainly from the internal or external iliac arteries?

A

internal iliac arteries

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94
Q

are the veins draining the pelvis mainly the internal or external iliac veins?

A

internal iliac veins

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95
Q

which arteries do the prostatic arteries often branch from?

A

the vesical arteries

96
Q

what form the three points of the trigone of the bladder?

A

ureteric orfices x2

internal urethral orfice

97
Q

where is the prostate in relation to the bladder?

A

prostate is directly inferior

98
Q

when empty, in which pelvis is the bladder contained in?

A

true pelvis

99
Q

when full in which pelvis is the bladder contained in?

A

can expend into false pelvis

100
Q

which border of the bladder is in contact with the peritoneum?

A

superior

101
Q

what is the name of the part of the urethra which passes through the prostate?

A

prostatic urethra

102
Q

around the internal urethral orfice, what muscle is present in males?

A

internal urethral sphincter

103
Q

which muscle forms the bladder wall?

A

detrusor muscle

104
Q

why does the detrusor muscle encircle the ureteric orfices?

A

contracts during bladder contraction to prevent reflux of urine into the ureters

105
Q

which muscle makes the internal urethral sphincter muscle?

A

the detrusor

106
Q

what is the function of the internal urethral sphincter muscle?

A

contracts during ejaculation to prevent retrograde ejaculation of semen into the bladder

107
Q

which is the most anterior organ in the pelvis?

A

the bladder

108
Q

what separates the uterus and the bladder?

A

vesicouterine pouch

109
Q

what position is the uterus in?

A

anteflexed position

110
Q

compare the relation of the bladder to the peritoneum when full and empty?

A

no change

111
Q

what are the 2 routes of catherisation?

A 
urethral
suprapubic (ie through abdominal wall)
112
Q

why may a suprapubic method of catheterisation be used over uretheral catheterisation?

A

if there is a urethral obstruction

113
Q

how long is the female urethra?

A

4cm

114
Q

is the external urethral sphincter voluntary or involuntary?

A

voluntary

115
Q

how long is the male urethral?

A

20cm

116
Q

is the internal urethral sphincter voluntary or involuntary?

A

involuntary

117
Q

what part of the urethra is within the penis? (also known as the penile urethra)

A

spongy urethra

118
Q

which cylinder of erectile tissue of the penis is the spongy urethra within?

A

corpus spongiosum

119
Q

where is sperm produced?

A

seminiferous tubules

120
Q

where is sperm stored?

A

epididymis

121
Q

the vas deferens joins with the seminal duct to form what?

A

the ejaculatory duct

122
Q

what is produced int he seminal glands?

A

semen

123
Q

what part of the urethra does the ejaculatory duct drain into?

A

the prostatic urethra

124
Q

what is the embryological origin of the testes?

A

posterior abdominal wall

125
Q

what is contained within the spermatic cord?

A 
testicular artery
testicular vein
vas deferens
lymphatic vessels
nerves
126
Q

within the scrotum, what sac do the testis sit within?

A

tunica vaginalis

127
Q

what is contained between the visceral and parietal layers of tunica vaginalis?

A

serous fluid

128
Q

what is the name for too much fluid within the tunica vaginalis?

A

hydrocele

129
Q

what is the function of the appendix testis?

A

none

130
Q

what venous plexus drains blood from the testes?

A

pampiform plexus

131
Q

what is the name for hwen the spermatic cord twists and disrupts the blood supply to the testis?

A

torsion

132
Q

what does the pampiform plexus drain into?

A

testicular vein

133
Q

where does the right testicular vein drain?

A

directly into the IVC

134
Q

where does the left testicular vein drain?

A

to the left renal vein then to the IVC

135
Q

what is in contact with the inferior aspect of the prostate gland?

A

levator ani muscle

136
Q

what are the 3 zones of the prostate gland?

A

2 peripheral zones

1 central zone

137
Q

which zones are felt on palapation of prostate? (PR)

A

peripheral zones

138
Q

which zones within the prostate do cancers most likely arise in?

A

peripheral zones

139
Q

what are the 3 cylinders of erectile tissue within the penis? (and describe location)

A

corpus cavernosum x2 posteriorly

corpus spongiosum x1 anteriorly

140
Q

what does the corpus spongiosum transmit?

A

spongy urethra

141
Q

what does the corpus cavernosum transmit?

A

deep arteries of the penis

142
Q

what are the scrotal and penile raphes?

A

ridges of skin within the midline

143
Q

which cylinder of erectile tissue is directly posterior to the midline raphe?

A

corpus spongiosum

144
Q

what is paraphimosis?

A

when the prepuce is retracted and the glans swells

145
Q

what is the management of paraphimosis?

A

circumsicion

146
Q

what is the medical name for foreskin?

A

prepuce

147
Q

what is the blood supply to the penis?

A

deep arteries of the penis

148
Q

what artery are the deep arteries of the penis a branch of?

A

the internal pudendal artery

149
Q

what artery is the internal pudendal artery a branch of?

A

the internal iliac artery

150
Q

what is the blood supply to the scrotum?

A

internal pudendal artery from the internal iliac artery and branches of the external iliac artery

151
Q

where does lymph from the scrotum and post of the penis (not the glans) drain to?

A

superficial inguinal lymph nodes

152
Q

where are superficial inguinal lymph nodes found?

A

in superficial fascia in the groin

153
Q

where does lymph from the testes drain to?

A

lumbar lymph nodes

154
Q

what are the 5 types of nerve fibre modality?

A 
somatic sensory
visceral afferent
somatic motor
parasympathetic
sympathetic
155
Q

what nerve modality controls ureteric peristalsis?

A

sympathetic or parasympathetic

156
Q

what nerve modality controls bladder contraction?

A

sympathetic or parasympathetic

157
Q

what nerve modality controls the external sphincter?

A

somatic motor

158
Q

what nerve modality controls the levator ani?

A

somatic motor

159
Q

what nerve modaliry controls the internal sphincter?

A

sympathetic/parasympathetic

160
Q

what part of the urinary system is different with regards to pain being carried by somatic sensory instead of visceral afferent nerve fibres?

A

distal urethra

part of the perineum so somatic sensory

161
Q

from which spinal cord levels is there sympathetic outflow?

A

T1 to L2

162
Q

do sympathetic fibres reaching the body wall synapse in the sympathetic chain?

A

yes

163
Q

do sympathetic fibres reaching the smooth muscles/glands of the body synapse in the sympathetic chain? (ignoring supply of the head)

A

no

164
Q

what are the 2 groups of nerves which carry sympathetic supply to the smooth muscles /glands (organs) of the body?

A

cardiopulmonary splanchnic nerves

abdominpelvic splanchnic nerves

165
Q

how do sympathetic nerve fibres reach the structures of the head?

A

synapse in sympathetic chain then ‘hitch a ride’ with arteries which supply the same structures

166
Q

what is the name of the connections between the anterior rami of the spinal cord and the sympathetic chain?

A

rami communications

167
Q

how many cervical sympathetic chain ganglia are there?

A

3

superior, middle inferior

168
Q

which splanchnic nerves do the sympathetic nerve fibres which supply the kidneys, ureter and bladder leave with?

A

abdominopelvic splanchnic nerves

169
Q

are the sympathetic nerve fibres within the abdominopelvic splanchnic nerves pre or post synaptic neurones?

A

pre synaptic neurones

do not synapse at the sympathetic chain

170
Q

where do the sympathetic nerve fibres which carry supply to the kidneys, ureters and bladder (within abdominopelvic splanchnic nerves) synapse?

A

abdominal sympathetic ganglia

171
Q

where are abdominal sympathetic ganglia located?

A

around central branches of the abdominal aorta

eg coeliac’s trunk, SMA, IMA

172
Q

where do the postsynaptic sympathetic nerve fibres go once synapsing at the abdominal sympathetic ganglion?

A

take part in the periarterial plexus on the arteries which are heading to the same organ that they innervate

173
Q

apart from sympathetic nerve fibres, which other nerve modalities are present in periarterial plexuses on the arteries heading to the kidneys, ureters and bladder?

A

parasympathetic supply

visceral afferent

174
Q

what are the 7 in total cranial/spinal nerves which contain parasympathetic supply?

A

CN III, VII, IX, X

S2,3,4

175
Q

what group of nerves carry parasympathtic supply to the hindgut and pelvic organs?

A

pelvic splanchnic nerves

176
Q

compare abdominopelvic splanchnic nerves and pelvic splanchnic nerves?

A

abdominopelvic splanchnic: sympathetic supply

pelvic splanchnic: parasympathetic supply

177
Q

what carries parasympathetic fibres to the kidneys?

A

vagus nerve

178
Q

what carries parasympathetic fibres to the bladder?

A

pelvic splanchnic nerves

179
Q

what carries parasympathetic fibres to the ureters?

A

vagus nerve

180
Q

what spinal cord level do pelvic splanchnic nerves come from?

A

S2,3,4

181
Q

what 3 main parts of the urinary tract are supplied by somatic motor innervation?

A

distal urethra
external urethral sphincter
levator ani

182
Q

what is the main nerve swhich supplies the external urethral sphincter with somatic motor supply?

A

pudendal nerve

183
Q

which spinal nerves make up the pudendal nerve?

A

S2,3,4

184
Q

which nerve modality stimulates the detrusor muscle to contract and via what nerve(s)?

A

parasympathetic fibres from pelvic splanchnic nerves

185
Q

during ejaculation, which nerve modality stimulates the contraction of the internal urethral sphincter?

A

sympathetic fibres

186
Q

which nerve modality inhibits the contraction of the internal urethral sphincter to allow urine to follow into the urethra?

A

parasympathetic fibres

187
Q

which nerve modality stimulates the external urethral sphincter to contract and via what nerve(s)?

A 
somatic motor
pudendal nerve (S2,3,4)
188
Q

which nerve modality stimulates the levator ani muscle to contract and via what nerves(s)?

A 
somatic motor
pudendal nerve (S2,3,4)
189
Q

why is pain from the distal part of the urethra much more localised than pain from elsewhere in the urinary tract?

A

perineum has somatic sensory supply

elsewhere has visceral afferent supply

190
Q

what is the name of the posterior aspect of the flank region?

A

loin

191
Q

where is pain from the kidney itself felt?

A

loin on the affected side

192
Q

where is the pain from a calculus obstructing the ureter felt?

A

radiation from loin to groin on affected side

193
Q

where is the pain from the bladder usually felt?

A

suprapubic region

194
Q

where is the pain from the distal urethra felt?

A

localised in the perineum

195
Q

visceral afferents from the kidneys run back to the spinal cord alongside which- sympathetic or parasympathetic nerve fibres?

A

sympathetic nerve fibres

196
Q

which spinal cord levels do visceral afferents from the kidneys enter?

A

T11 to L1

197
Q

which is the most common differential for loin pain?

A

muscular

198
Q

visceral afferents from the ureters run alongside which- sympathetic or parasympathetic nerve fibres?

A

sympathetic nerve fibres

199
Q

which spinal cord levels do visceral afferents from the ureters enter?

A

T11 to L2

200
Q

visceral afferents from the superior part of the bladder (which touches the peritoneum) run along side which- sympathetic or parasympathetic nerve fibres?

A

sympathetic nerve fibres

201
Q

which spinal cord levels do visceral afferents from the superior part of the bladder enter?

A

T11- L2

202
Q

visceral afferents from the inferior part of the bladder (ie part that doesn’t touch the peritoneum) run alongside which- sympathetic or parasympathetic nerve fibres?

A

parasympathetic nerve fibres

203
Q

which spinal cord levels do visceral afferents from the inferior part of the bladder enter?

A

S2,3,4

204
Q

visceral afferents from the superior part of the urethra run alongside which- sympathetic or parasympathetic nerve fibres?

A

parasympathetic nerve fibres

205
Q

somatic sensory nerve fibres from the inferior part of the urethra are carried by what nerve back to the spinal cord?

A

pudendal S2,3,4

206
Q

visceral afferents from the testis run alongisde which- sympathetic or parasympathetic nerve fibres?

A

sympathetic nerve fibres

207
Q

which spinal cord level do visceral afferents from the superior urethra enter?

A

S2,3,4

208
Q

which spinal cord level do visceral afferents from the testis enter?

A

T10-11

209
Q

what within the bladder do visceral afferent fibres sense?

A

stretch

distension

210
Q

what spinal roots is the sciatic nerve made from?

A

L4,5

S1,2,3

211
Q

what area does the iliohypogastric nerve supply?

A

skin of lateral gluteal redion

212
Q

what spinal roots is the iliohypogastric nerve made from?

A

L1

213
Q

what area does the ilioinguinal nerve supply?

A

skin around perineum area

214
Q

what spinal roots is the ilioinguinal nerve made from?

A

L1

215
Q

what area does the lateral cutaneous nerve of the thigh supply?

A

skin of the lateral side of the thigh

216
Q

what spinal roots is the lateral cutaneous nerve of the thigh made from?

A

L2,3

217
Q

what does the genitofemoral nerve supply?

A

skin of the perineum

218
Q

what spinal roots is the genitofemoral nerve made from?

A

L1,2

219
Q

what does the femoral nerve supply?

A

anterior compartment of the thigh

220
Q

what spinal roots is the femoral nerve made from?

A

L2,3,4

221
Q

what does the obturator nerve supply?

A

medial compartment of the thigh

222
Q

what spinal roots is the obturator nerve made from?

A

L2,3,4

223
Q

the femoral nerve reaches the anterior compartment of the thigh by passing under what?

A

the inguinal ligament

224
Q

the obturator nerve reaches the medial compartment of the thigh by passing through what?

A

the obturator foramen of the pelvis

225
Q

which nerve supplies the lateral muscle compartment of the leg?

A

superficial fibular

226
Q

which nerve supplies the anterior compartment of the leg?

A

deep fibular

227
Q

which nerve supplies the posterior compartment of the leg?

A

tibial

228
Q

which nerve supplies the intrinsic muscles of the foot?

A

tibial

229
Q

which nerve becomes the saphenous nerve?

A

the femoral nerve

230
Q

what nerve supplies the skin of the posterior thigh?

A

posterior cutaneous nerve of the thigh

231
Q

which nerve supplies the skin of the anterior thigh?

A

femoral nerve

232
Q

which nerve supplies the skin of the lateral leg?

A

sciatic nerve

233
Q

which nerve supplies sensation to the plantr aspect of the foot?

A

tibial nerve

234
Q

which nerve supplies the sensation to the lateral aspect of the foot?

A

sural nerve

235
Q

which nerve supplies the sensation to the medial aspect of the foot?

A

saphenous nerve

236
Q

which nerve supplies the sensation to the dorsum of the foot? *except the 1st web space)

A

superficial fibular

237
Q

which nerve supplies the sensation to the 1st web space of the dorsum of the foot?

A

deep fibular

Anatomy (4 decks)

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