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US > Session 1: Introduction + Anatomy > Flashcards

Session 1: Introduction + Anatomy Flashcards

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1
Q

Which anatomical landmark is a guide to find the level of the kidneys?

A

12th rib

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2
Q

How are the kidneys located in relation to each other?

A

Left kidney is slightly elevated.

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3
Q

Why might the right kidney be slightly lower down than the left kidney?

A

Because the right kidney is pushed down by the liver.

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4
Q

Where can the hilum of the kidney generally be found?

A

At around L1 (where the ureter leaves the kidney through the hilum)

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5
Q

Renal dimensions

A

6-7 cm wide and 9-14 cm long.

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6
Q

Sexual dimorphism of the kidneys.

A

Males kidneys are generally larger

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7
Q

Discrepancy of what size between the kidneys might indicate what?

A

More than two cm between the kidneys could be pathological.

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8
Q

A kidney smaller than how long, could mean what?

A

Smaller than 8cm long could mean chronic kidney disease

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9
Q

Relation of kidneys to psoas major.

A

Kidneys are generally described to sit on top of psoas major.

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10
Q

Bony landmarks of the left and right kidneys respectively.

Upper pole

A

T11-12 (L)

T12 (R)

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11
Q

Bony landmarks of the left and right kidneys respectively. (Lower pole)

A

L2-3 (L)

L3-L4 (R)

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12
Q

If a patient has problems with their kidneys, what kind of pain may they complain about? (Location-wise)

A

Renal angle pain.

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13
Q

Is it easy or difficult to palpate the kidneys.

A

Difficult

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14
Q

How are the kidneys attached?

A

They are not attached.

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15
Q

If the kidneys are not attached, what holds them in place?

A

Fat and fascia

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16
Q

Fascial layers of the kidneys.

A

Anterior renal fascia

Posterior renal fascia

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17
Q

Another name for the posterior renal fascia.

A

Garota’s fascia

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18
Q

Fat layers of the kidneys.

A

Pararenal fat also called paranephric

Perirenal fat also called perinephric

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19
Q

Where can the paranephric fat be found?

A

External to Garota’s fascia and extraperitoneal. It is associated with the lumbar region.
This means that pararenal fat is not enclosed within the fascia of the kidneys.

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20
Q

Where can perinephric fat be found?

A

It surrounds the kidneys within the renal fascial layers so proximal to the kidneys.
It is continuous with the fat found in the renal sinus of the kidneys.

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21
Q

Dimensions of the ureter.

A

25-30 cm long

Diameter = 1.5 mm

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22
Q

In relation to the peritoneum, where can the ureter be found?

A

Retroperitoneal

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23
Q

In relation to the lumbar vertebrae where can the ureter be found?

A

Lateral to the tips of the transverse processes of the lumbar vertebrae.

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24
Q

How is the ureter divided into segments?

A

An abdominal segment
Pelvic segment
Intramural segment

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25
Q

Where is the ureter divided into segments?

A

Pelviureteric junction.

Abdominal to Pelvic at approx L4

Pelvic to intramural around the level of the bladder.

26
Q

Most common areas of ureteric injury.

A

Near the pelvic brim.

27
Q

If not for injury near the pelvic brim, how can the ureter be damaged in other ways?

A

If there’s a problem with the gonadal vessels since there ureters are crossed by gonadal (testicular or ovarian vessels).

28
Q

How does the ureter enter the bladder in respect to its wall.

A

It runs obliquely through the bladder wall and runs between the muscle fibres (detrusor muscles).

29
Q

Length of the intramural part of the ureter.

A

1.2-2.5 cm.

30
Q

What is the point called of which the ureter enter the bladder?

A

Vesicular ureter junction.

31
Q

How is retrograde flow prevented at the vesicular ureter junction?

A

There is no sphincter at the VUJ but there is a flap to prevent retrograde flow.
Also the fact that the ureter passes diagonally through the bladder wall’s musculature prevents urine reflux.

32
Q

What is the epithelial lining of the ureter called?

A

Urothelium also called transitional epithelium.

It is continuous lining the bladder, ureter and pelvis of the kidney.

33
Q

Give some positional changes of the ureter. (Remember there are two).

A

Retrocaval position of the right ureter around the IVC.

Duplexed ureter where one is not entering the bladder.

Duplexed ureter both entering the bladder.

Both ureters entering same side of the bladder.

34
Q

Can retrocaval position of the ureter around the IVC happen to the left ureter?

A

No, this is because the IVC can be found slightly to the right of the spine.

35
Q

What is retrocaval position of the right ureter around the IVC?

A

Instead of following IVC longitudinal to descend it, the ureter ‘wraps’ around the IVC.

36
Q

If there is a duplexed ureter where on is not entering the bladder, where might it enter?

A

It might enter the urethra directly.

37
Q

Complications of a duplexed ureter entering the urethra directly.

A

Constant dribbling of urine and frequent UTIs.

38
Q

Complications of a duplexed ureter entering the bladder.

A

No complications.

39
Q

Compications of both ureters entering on same side of the bladder.

A

No complications.

40
Q

Common anatomical reason of the common cause of UTIs in women compared to men.

A

The external urethral meatus is so close to the vagina. This means it is more common in women (other than poor wiping technique)

41
Q

What controls the Internal urinary sphincter?

A

Sympathetic innervation. (Makes it contract)

42
Q

What happens if the sympathetic innervation control of the internal urinary sphincter doesn’t work?

A

This means that it won’t contract. During point and shoot at time of ejaculation (shoot) which is under sympathetic innervation. This means that it contracts during ejaculation to prevent retrograde flow of ejaculate into the bladder.

43
Q

Anatomical part of the urinary system responsible for continence.

A

Extra urinary sphincter.

44
Q

Broad functions of the nephron.

A

Glomerulus filters huge volumes of ECF
Reabsorption of most substances in PCT (Proximal convoluted tubule)
Controlled reabsorption of salts and water in distal convoluted tubule.
Controlled secretion of hydrogen ions
Passive loss of waste products.

45
Q

Which arterioles enter and leave the glomerulus?

A

Afferent (arrive) and efferent (exit).

46
Q

Types of nephron.

A

Cortical nephron and juxtamedullary nephron.

47
Q

Main difference between cortical and juxtamedullary nephron.

A

Loop of henle is much longer in juxtamedullary nephron.

48
Q

Why are the kidneys so vulnerable to ischaemic damage?

A

Because of the large cardiac output which goes to the kidneys. (22%)

49
Q

What is the renal blood flow (amount)?

A

1.1 L/min

50
Q

What is the renal plasma flow?

A

Haematocrit which is usually around 45%.
If RBF is 1.1 L/Min
0.55 x 1.1 L/min = 605 mL/min of plasma.

51
Q

Full course of blood supply of the kidneys.

A

Aorta -> Renal artery -> Segmental artery -> interlobar or lobular artery -> Arcuate artery -> Interlobular artery -> Afferent arteriole -> Glomerulus -> Efferent arteriole -> Peritubular capillaries or vasa recta.

It will go venous now.

Peritubular capillaries and vasa recta -> Interlobular vein -> Arcuate vein -> Interlobar or lobular vein -> Segmental vein -> Renal vein -> IVC.

52
Q

What else can the kidneys be supplied by?

A

Sometimes by the superior mesenteric, suprarenal, testicular or ovarian arteries

53
Q

In relation to ductus deferens, how does the ureter run to enter the bladder?

A

Ureter passes under ductus deferens superior to seminal vesicles.

54
Q

In relation to the ovary and uterine artery, how does the ureter run to enter the bladder?

A

Ureter descends posterior to ovary and into base of broad ligament, passing under the uterine artery.

55
Q

Anatomical position of the bladder.

A

Located in the lesser pelvis when empty, extends into the abdominal cavity when full.

It’s posterior to the pubic symphysis.
Anterior to the anterior wall of the vagina in females, and anterior to the rectum in males.

Inferiorly the muscles of the pelvic diaphragm support the bladder. Also inferiorly it is supported by the endopelvic fascia.

Superiorly and somewhat posteriorly the bladder is covered by parietal peritoneum.

56
Q

What is rugae and the trigone?

A

The rugae is mucosa which is a ‘rough’ part of the bladder wall. These rugae cover most of the bladder wall.

The trigone is a triangular area in the bladder wall which is smooth and has a different embryological origin.

57
Q

Function of the detrusor muscle in the bladder neck.

A

The detrusor muscle runs circularly as involuntary internal sphincter.

58
Q

What attaches to the anterior angle or apex of the bladder?

A

It is a site of attachment of urachus.

59
Q

What is urachus?

A

A fibrous remnant of fetal allantois which is seen as a median umbilical ligament on anterior abdominal wall.

60
Q

Anatomical position of the bladder.

A

Positioned inferiorly to the neck of the bladder.
Superiorly to the external urethral sphincter.
Levator ani muscle lies inferolaterally to the prostate.
Prostate is also anterior to the ampulla of the rectum making it possible to palpate it during a digital rectum examination.

US (29 decks)

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