renal anatomy Flashcards
1
Q
compare the length of urethras in males and females?
A
male urethra is much longer than female urethra
2
Q
explain how male urethras have a dual function?
A
both urine and semen pass through
3
Q
what makes up the upper urinary tract?
A
kidneys
ureters
4
Q
what makes up the lower urinary tract?
A
bladder
urethra
5
Q
what bony structures mare the transition from abdomen to pelvis?
A
iliac crests
L4
6
Q
at what vertebra level does the abdominal aorta bifurcate?
A
L4
7
Q
what surface of the kidneys touches the peritoneum?
A
anterior surface
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
9
Q
what are the 3 muscles of the anterolateral abdominal wall?
A
external oblique
internal oblique
transversus abdominis
10
Q
what are the 3 important structures of the renal hilum?
A
renal artery
renal vein
ureter
11
Q
what are the 2 muscles of the posterior abdominal wall?
A
psoas major
quadratus lumborum
12
Q
which is more anterior- psoas major or quadratus lumboru,?
A
psoas major
13
Q
what surrounds the kidney?
A
the renal capsule
14
Q
where does the perinephric fat lie?
A
surrounds renal capsule, deep to renal fascia
15
Q
what type of fascia is renal fascia?
A
deep fascia
16
Q
where doe the paranephric fat lie?
A
between the visceral peritoneum and the renal fascia
17
Q
compare the position of the kidneys to the quadratus lumborum muscles?
A
kidneys lie anterior to quadratus lumborum muscles
18
Q
compare the position of the kidneys to the psoas major muscles?
A
kidneys lie lateral to psoas major
19
Q
which vertebral bodies does the right kidney lie lateral to?
A
L1, L2, L3
20
Q
which vertebral bodies does the left kidney lie lateral to?
A
T12, L1, L2
21
Q
why is the right kidney more inferior than the right?
A
due to size of liver
22
Q
what ribs protect the kidney?
A
floating ribs 11 and 12
23
Q
what regions/quadrants are the kidneys within?
A
R kidney: RUQ, right lumbar region
L kidney: LUQ, left lumbar region
24
Q
which sac is the hepatorenal recess part of?
A
the greater sac
25
compare the location of the renal veins and renal arteries?
renal veins are anterior to renal arteries
26
compare the location of the common iliac veins and the common iliac arteries?
common iliac arteries are anterior to common iliac veins
27
where does lymph from the kidneys drain to?
lumbar lymph nodes
28
where are lumbar lymph nodes found?
located around abdominal aorta and IVC
29
where does lymph from the ureters drain to?
lumbar lymph nodes + iliac lymph nodes
30
where are iliac lymph nodes found?
around common, internal and external iliac vessels
31
the utereric arterial blood supply is from branches of which arteries?
```
renal artery
abdominal aorta
common iliac artery
internal iliac artery
vesical artery
```
32
compare an infrarenal and suprarenal AAA?
infrarenal aneurysm starts below level of renal arteries
| suprarenal aneurysm starts above the level of renal arteries
33
what is the management of an AAA?
EVAR
| endovascular aneurysm repair using a stent inserted through the femoral artery
34
when associated with an infrarenal AAA, what is renal artery stenosis caused by?
atherosclerosis
35
when associated with a suprarenal AAA, what is the renal artery stenosis?
proximity to aneurysm
36
what is a bifid renal pelvis?
anatomical variation when there is 2 pelvises extending from the major calyces instead of 1 pelvis
37
what is a bifid ureter?
anatomical variation in where there are 2 ureters at one side, these join before reaching the bladder
38
what is a unilateral duplicated ureter?
anatomical variation in where ther are 2 ureters at one side, these do not join
39
what is a retrocaval ureter?
anatomical variation where the ureter wraps behind the IVC instead of remaining lateral to it
40
what is a horseshoe kidney?
anatomical variation where the kidneys are connected
41
what is an ectopic pelvic kidney?
anatomical variation where a kidney is in the pelvis instead of the abdomen
42
what are the 3 reasons for a solitary kidney?
agenesis
patholoical nephrectomy
nephrectomy for donation
43
how many pyramids does a human kidney medulla contain?
27 pyramids
44
what gives the pyramids in the medulla the striped appearance/.
nephrons arranged axially
45
where does the collecting duct pass it's filtrate?
minor calyx
46
are nephrons within the cortex or medulla of a kidney?
medulla
47
the glomerulus filters blood arriving from water vessel?
branches of renal artery
48
what do the minor calyces join to form?
a major calyx
49
what do the major calyces join to form?
renal pelvis
50
the diameter of urine drainage tubes increases until what junction?
pelviureteric junction
51
where are the 3 anatomical sites of ureteric constriction?
- pelviureteric junction
- where ureter crosses common iliac artery
- ureteric orfice
52
what does the ureteric orfic open into?
the bladder
53
the ureter crosses the common iliac artery at what bony landmark?
pelvic brim
54
what does the pelvic brim divide?
the upper false pelvis and the lower true pelvis
55
what is the medical name for kidney stones?
renal calculi
56
what is the name for renal calculi with connections between them?
staghorn calculi
57
what type of muscle lines the wall of the ureter?
smooth muscle
58
what does the ureter do in order to dislodge an obstruction?
waves of peristalsis
59
what type of pain does a patient feel when there is something lodged within one of the ureters and why?
colicky paindue to peristalsis waves
60
what is renal failure?
failure to adequately filter blood to produce urine
61
do obstructions within calyces or ureter cause unilateral or bilateral kidney problems?
unilateral
62
do obstructions within the bladder cause unilateral or bilateral kidney problems?
unilateral or bilateral
63
do obstructions within the urethra cause unilateral or bilateral kidney problems?
bilateral
64
what is hydronephrosis?
back pressure into the kidney causing enlargment
65
why does hydronephrosis cause pain?
because it stretches the renal capsule
66
embryologically, what becomes the permanent kidney?
metanephros
67
what does the metanephros form from?
ureteric bud
| metanephric blastema
68
is the kidney endoderm, ectoderm or mesoderm?
mesoderm
69
is the bladder endoderm, ectoderm or mesoderm?
endoderm
70
why does kidney agenesis occur?
because the ureteric bud doesn't come into contact with the metanephric blastema
71
which becomes the nephron- ureteric bud or the metanephric blastoma?
metanephric blastoma
72
embryologically, where do the kidneys develop?
in the pelvis
73
why does ectopic pelvis kidney occur?
failure of kidney to ascend
74
what are the rounded apexes of the renal pyramids called?
papilla
75
when the ureter crosses the pelvic brim (pelvic inlet), what part of the pelvis does it pass into?
the true pelvis
76
describe the location of the false pelvis?
from iliac crests to pelvic inlet (or brim)
77
describe the location of the true pelvis?
pelvic inlet to pelvic floor
78
in which cavity is the false pelvis in?
abdominal cavity
79
in which cavity is bladder in?
the pelvic cavity (true pelvis)
80
there are openings in the pelvic diaphragm to allow which 3 tracts to pas into the perineum?
alimentary tract
reproductive tract
renal tract
81
what does the pelvic diaphragm extend between?
sacrum to the pubis
82
which is the only part of the urinary system to be in the perineum?
urethra
83
when the ureters cross the common iliac arteries do they pass anteriorly or posteriorly?
anteriorly to the arteries
84
the ureters enter the posterior bladder wall in which direction?
inferomedial
85
in the anatomical position, what is the most inferior part of the peritoneal cavity in a male?
rectovesicle pouch
86
what is the function of the round ligament of the uterus?
attaches uterus to the perineum
87
what canal is the round ligament of the uterus found in?
inguinal canal
88
what are 2 pouches of peritoneum in the female?
recto-uterine pouch (of douglas)
| vesico-uterine pouch
89
in the anatomical position, what is the most inferior part of the peritoneal cavity in a female?
recto-uterine pouch of douglas
90
compare the location of the ureter to the suspensory ligament of the ovary?
suspensory ligament of the ovary is lateral to the ureter
91
compare the location of the ureter to the uterine tubes and uterine artery?
the ureter runs inferiorly to both the uterine tubes and uterine artery
'water under the bridge'
92
compare the location of the ureter to the vas deferens?
ureter runs inferiorly to the vas deferens
93
are the arteries entering the pelvis mainly from the internal or external iliac arteries?
internal iliac arteries
94
are the veins draining the pelvis mainly the internal or external iliac veins?
internal iliac veins
95
which arteries do the prostatic arteries often branch from?
the vesical arteries
96
what form the three points of the trigone of the bladder?
ureteric orfices x2
| internal urethral orfice
97
where is the prostate in relation to the bladder?
prostate is directly inferior
98
when empty, in which pelvis is the bladder contained in?
true pelvis
99
when full in which pelvis is the bladder contained in?
can expend into false pelvis
100
which border of the bladder is in contact with the peritoneum?
superior
101
what is the name of the part of the urethra which passes through the prostate?
prostatic urethra
102
around the internal urethral orfice, what muscle is present in males?
internal urethral sphincter
103
which muscle forms the bladder wall?
detrusor muscle
104
why does the detrusor muscle encircle the ureteric orfices?
contracts during bladder contraction to prevent reflux of urine into the ureters
105
which muscle makes the internal urethral sphincter muscle?
the detrusor
106
what is the function of the internal urethral sphincter muscle?
contracts during ejaculation to prevent retrograde ejaculation of semen into the bladder
107
which is the most anterior organ in the pelvis?
the bladder
108
what separates the uterus and the bladder?
vesicouterine pouch
109
what position is the uterus in?
anteflexed position
110
compare the relation of the bladder to the peritoneum when full and empty?
no change
111
what are the 2 routes of catherisation?
```
urethral
suprapubic (ie through abdominal wall)
```
112
why may a suprapubic method of catheterisation be used over uretheral catheterisation?
if there is a urethral obstruction
113
how long is the female urethra?
4cm
114
is the external urethral sphincter voluntary or involuntary?
voluntary
115
how long is the male urethral?
20cm
116
is the internal urethral sphincter voluntary or involuntary?
involuntary
117
what part of the urethra is within the penis? (also known as the penile urethra)
spongy urethra
118
which cylinder of erectile tissue of the penis is the spongy urethra within?
corpus spongiosum
119
where is sperm produced?
seminiferous tubules
120
where is sperm stored?
epididymis
121
the vas deferens joins with the seminal duct to form what?
the ejaculatory duct
122
what is produced int he seminal glands?
semen
123
what part of the urethra does the ejaculatory duct drain into?
the prostatic urethra
124
what is the embryological origin of the testes?
posterior abdominal wall
125
what is contained within the spermatic cord?
```
testicular artery
testicular vein
vas deferens
lymphatic vessels
nerves
```
126
within the scrotum, what sac do the testis sit within?
tunica vaginalis
127
what is contained between the visceral and parietal layers of tunica vaginalis?
serous fluid
128
what is the name for too much fluid within the tunica vaginalis?
hydrocele
129
what is the function of the appendix testis?
none
130
what venous plexus drains blood from the testes?
pampiform plexus
131
what is the name for hwen the spermatic cord twists and disrupts the blood supply to the testis?
torsion
132
what does the pampiform plexus drain into?
testicular vein
133
where does the right testicular vein drain?
directly into the IVC
134
where does the left testicular vein drain?
to the left renal vein then to the IVC
135
what is in contact with the inferior aspect of the prostate gland?
levator ani muscle
136
what are the 3 zones of the prostate gland?
2 peripheral zones
| 1 central zone
137
which zones are felt on palapation of prostate? (PR)
peripheral zones
138
which zones within the prostate do cancers most likely arise in?
peripheral zones
139
what are the 3 cylinders of erectile tissue within the penis? (and describe location)
corpus cavernosum x2 posteriorly
| corpus spongiosum x1 anteriorly
140
what does the corpus spongiosum transmit?
spongy urethra
141
what does the corpus cavernosum transmit?
deep arteries of the penis
142
what are the scrotal and penile raphes?
ridges of skin within the midline
143
which cylinder of erectile tissue is directly posterior to the midline raphe?
corpus spongiosum
144
what is paraphimosis?
when the prepuce is retracted and the glans swells
145
what is the management of paraphimosis?
circumsicion
146
what is the medical name for foreskin?
prepuce
147
what is the blood supply to the penis?
deep arteries of the penis
148
what artery are the deep arteries of the penis a branch of?
the internal pudendal artery
149
what artery is the internal pudendal artery a branch of?
the internal iliac artery
150
what is the blood supply to the scrotum?
internal pudendal artery from the internal iliac artery and branches of the external iliac artery
151
where does lymph from the scrotum and post of the penis (not the glans) drain to?
superficial inguinal lymph nodes
152
where are superficial inguinal lymph nodes found?
in superficial fascia in the groin
153
where does lymph from the testes drain to?
lumbar lymph nodes
154
what are the 5 types of nerve fibre modality?
```
somatic sensory
visceral afferent
somatic motor
parasympathetic
sympathetic
```
155
what nerve modality controls ureteric peristalsis?
sympathetic or parasympathetic
156
what nerve modality controls bladder contraction?
sympathetic or parasympathetic
157
what nerve modality controls the external sphincter?
somatic motor
158
what nerve modality controls the levator ani?
somatic motor
159
what nerve modaliry controls the internal sphincter?
sympathetic/parasympathetic
160
what part of the urinary system is different with regards to pain being carried by somatic sensory instead of visceral afferent nerve fibres?
distal urethra
| part of the perineum so somatic sensory
161
from which spinal cord levels is there sympathetic outflow?
T1 to L2
162
do sympathetic fibres reaching the body wall synapse in the sympathetic chain?
yes
163
do sympathetic fibres reaching the smooth muscles/glands of the body synapse in the sympathetic chain? (ignoring supply of the head)
no
164
what are the 2 groups of nerves which carry sympathetic supply to the smooth muscles /glands (organs) of the body?
cardiopulmonary splanchnic nerves
| abdominpelvic splanchnic nerves
165
how do sympathetic nerve fibres reach the structures of the head?
synapse in sympathetic chain then 'hitch a ride' with arteries which supply the same structures
166
what is the name of the connections between the anterior rami of the spinal cord and the sympathetic chain?
rami communications
167
how many cervical sympathetic chain ganglia are there?
3
| superior, middle inferior
168
which splanchnic nerves do the sympathetic nerve fibres which supply the kidneys, ureter and bladder leave with?
abdominopelvic splanchnic nerves
169
are the sympathetic nerve fibres within the abdominopelvic splanchnic nerves pre or post synaptic neurones?
pre synaptic neurones
| do not synapse at the sympathetic chain
170
where do the sympathetic nerve fibres which carry supply to the kidneys, ureters and bladder (within abdominopelvic splanchnic nerves) synapse?
abdominal sympathetic ganglia
171
where are abdominal sympathetic ganglia located?
around central branches of the abdominal aorta
| eg coeliac's trunk, SMA, IMA
172
where do the postsynaptic sympathetic nerve fibres go once synapsing at the abdominal sympathetic ganglion?
take part in the periarterial plexus on the arteries which are heading to the same organ that they innervate
173
apart from sympathetic nerve fibres, which other nerve modalities are present in periarterial plexuses on the arteries heading to the kidneys, ureters and bladder?
parasympathetic supply
| visceral afferent
174
what are the 7 in total cranial/spinal nerves which contain parasympathetic supply?
CN III, VII, IX, X
| S2,3,4
175
what group of nerves carry parasympathtic supply to the hindgut and pelvic organs?
pelvic splanchnic nerves
176
compare abdominopelvic splanchnic nerves and pelvic splanchnic nerves?
abdominopelvic splanchnic: sympathetic supply
| pelvic splanchnic: parasympathetic supply
177
what carries parasympathetic fibres to the kidneys?
vagus nerve
178
what carries parasympathetic fibres to the bladder?
pelvic splanchnic nerves
179
what carries parasympathetic fibres to the ureters?
vagus nerve
180
what spinal cord level do pelvic splanchnic nerves come from?
S2,3,4
181
what 3 main parts of the urinary tract are supplied by somatic motor innervation?
distal urethra
external urethral sphincter
levator ani
182
what is the main nerve swhich supplies the external urethral sphincter with somatic motor supply?
pudendal nerve
183
which spinal nerves make up the pudendal nerve?
S2,3,4
184
which nerve modality stimulates the detrusor muscle to contract and via what nerve(s)?
parasympathetic fibres from pelvic splanchnic nerves
185
during ejaculation, which nerve modality stimulates the contraction of the internal urethral sphincter?
sympathetic fibres
186
which nerve modality inhibits the contraction of the internal urethral sphincter to allow urine to follow into the urethra?
parasympathetic fibres
187
which nerve modality stimulates the external urethral sphincter to contract and via what nerve(s)?
```
somatic motor
pudendal nerve (S2,3,4)
```
188
which nerve modality stimulates the levator ani muscle to contract and via what nerves(s)?
```
somatic motor
pudendal nerve (S2,3,4)
```
189
why is pain from the distal part of the urethra much more localised than pain from elsewhere in the urinary tract?
perineum has somatic sensory supply
| elsewhere has visceral afferent supply
190
what is the name of the posterior aspect of the flank region?
loin
191
where is pain from the kidney itself felt?
loin on the affected side
192
where is the pain from a calculus obstructing the ureter felt?
radiation from loin to groin on affected side
193
where is the pain from the bladder usually felt?
suprapubic region
194
where is the pain from the distal urethra felt?
localised in the perineum
195
visceral afferents from the kidneys run back to the spinal cord alongside which- sympathetic or parasympathetic nerve fibres?
sympathetic nerve fibres
196
which spinal cord levels do visceral afferents from the kidneys enter?
T11 to L1
197
which is the most common differential for loin pain?
muscular
198
visceral afferents from the ureters run alongside which- sympathetic or parasympathetic nerve fibres?
sympathetic nerve fibres
199
which spinal cord levels do visceral afferents from the ureters enter?
T11 to L2
200
visceral afferents from the superior part of the bladder (which touches the peritoneum) run along side which- sympathetic or parasympathetic nerve fibres?
sympathetic nerve fibres
201
which spinal cord levels do visceral afferents from the superior part of the bladder enter?
T11- L2
202
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?
parasympathetic nerve fibres
203
which spinal cord levels do visceral afferents from the inferior part of the bladder enter?
S2,3,4
204
visceral afferents from the superior part of the urethra run alongside which- sympathetic or parasympathetic nerve fibres?
parasympathetic nerve fibres
205
somatic sensory nerve fibres from the inferior part of the urethra are carried by what nerve back to the spinal cord?
pudendal S2,3,4
206
visceral afferents from the testis run alongisde which- sympathetic or parasympathetic nerve fibres?
sympathetic nerve fibres
207
which spinal cord level do visceral afferents from the superior urethra enter?
S2,3,4
208
which spinal cord level do visceral afferents from the testis enter?
T10-11
209
what within the bladder do visceral afferent fibres sense?
stretch
| distension
210
what spinal roots is the sciatic nerve made from?
L4,5
| S1,2,3
211
what area does the iliohypogastric nerve supply?
skin of lateral gluteal redion
212
what spinal roots is the iliohypogastric nerve made from?
L1
213
what area does the ilioinguinal nerve supply?
skin around perineum area
214
what spinal roots is the ilioinguinal nerve made from?
L1
215
what area does the lateral cutaneous nerve of the thigh supply?
skin of the lateral side of the thigh
216
what spinal roots is the lateral cutaneous nerve of the thigh made from?
L2,3
217
what does the genitofemoral nerve supply?
skin of the perineum
218
what spinal roots is the genitofemoral nerve made from?
L1,2
219
what does the femoral nerve supply?
anterior compartment of the thigh
220
what spinal roots is the femoral nerve made from?
L2,3,4
221
what does the obturator nerve supply?
medial compartment of the thigh
222
what spinal roots is the obturator nerve made from?
L2,3,4
223
the femoral nerve reaches the anterior compartment of the thigh by passing under what?
the inguinal ligament
224
the obturator nerve reaches the medial compartment of the thigh by passing through what?
the obturator foramen of the pelvis
225
which nerve supplies the lateral muscle compartment of the leg?
superficial fibular
226
which nerve supplies the anterior compartment of the leg?
deep fibular
227
which nerve supplies the posterior compartment of the leg?
tibial
228
which nerve supplies the intrinsic muscles of the foot?
tibial
229
which nerve becomes the saphenous nerve?
the femoral nerve
230
what nerve supplies the skin of the posterior thigh?
posterior cutaneous nerve of the thigh
231
which nerve supplies the skin of the anterior thigh?
femoral nerve
232
which nerve supplies the skin of the lateral leg?
sciatic nerve
233
which nerve supplies sensation to the plantr aspect of the foot?
tibial nerve
234
which nerve supplies the sensation to the lateral aspect of the foot?
sural nerve
235
which nerve supplies the sensation to the medial aspect of the foot?
saphenous nerve
236
which nerve supplies the sensation to the dorsum of the foot? *except the 1st web space)
superficial fibular
237
which nerve supplies the sensation to the 1st web space of the dorsum of the foot?
deep fibular
