Session 1 - Lecture 1 - Anatomy Flashcards
1 - skip
Urinary System
2 - Comments from previous cohort (2017)
- The order of the lectures was generally good and, even if it felt overwhelming at the time, when looking back over them, they were structured well and useful revision material
- There was always good notes in the workbook
- Examsoft (Examplify) quizzes were very useful
- Urinary is a very difficult subject and I understand that cannot be changed
- Lectures were fast-past and detailed
- Guest clinical lectures were challenging
- Later in the unit the group work questions were sometimes challenging
“Comments from peers in previous years
1. overall underlying message from colleagues - Urinary physiology is a bit difficult. The amount of material is q substantial, only so much trimming and still allow you to do the jobs in a year’s time when you’re on the wards. Can be overwhelming to begin with, when they look back at materials provided in workbook, at lecture notes they’ve made, when they look back, that they are able to use those resources as a useful guide for their revision
3. ExamSoft quizzes useful – more useful if you do them as you go along – guide understanding in bitesize chunks – will release all of the quizzes again at the end of unit – but if you do them as you go along, and try, I know this semester is q tough, all the phys units together, but try and keep on top of urinary, don’t let it drift, bc every week is going to build on the previous week – more so than probably any other unit – in order to understand what we’re going to do next need to understand the previous stuff – later on, going to be asked to apply that in order to understand the clinical scenarios
qs, urge you to use the DB – guarantee if you have a q someone else is thinking the same thing – plz ask the q, absolutely if you want to talk to me about things, plz put the q on Bb so that other ppl can get the benefit of your q and also only answering q once.
6. So, clinical lecturers will be coming in and out of unit –given LO
Key and core unit that no matter what discipline of medicine you later go onto to study, you will always be impacting on the kidneys and the way they manage the body – doesn’t matter what discipline, the kidneys are so susceptible to damage and pts die so easily bc we don’t manage their fluids – that’s what kills pts, so it’s absolutely crucial”
3 - Session iLO’s
Session iLO’s
– Describe the function of kidneys
– Describe the structure and relationships of the kidneys, ureters, bladder and urethra in both the male and female
– Describe the blood supply and venous drainage and the relationship between the major components
– Describe the structural makeup of the kidneys, to include the macroscopic and microscopic arrangement
– Describe the histological structure of the kidney and the nephron
– Describe the fluid compartments of the body
– Describe in general terms how two kidneys handle substances in order to achieve balance
“So, do some anatomy, spend some time in DR, actually going to remove kidneys – from posterior approach bc Dr Hamilton will sulk if you mess up the GI – so turn cadavers over and get at kidneys from back – another opportunity later on and look at kidneys at the front – today is first opportunity to look at kidneys in situ in cadaver material. Give you an intro – point out some of the anatomy, and just give you a general quick run through about the kidneys.”
4 - Milieu interieur
Milieu interieur
• Function in all parts of the body depends on maintenance of a stable internal environment
• Urinary system is a major contributor,
– controls concentration of a wide range of ions and small organic molecules
• Function of the Kidney
– Regulation: control the concentrations of key substances in extracellular fluid
– Excretion: excretes waste products
– Endocrine: synthesis of renin, erythropoietin, prostaglandins
– Metabolism: active form of Vitamin D, catabolism of insulin, PTH calcitonin
“So, first of all, that belief that I have that the kidneys are the most important thing in the body is based largely on the idea that all functioning aspects of the body depend on internal environ being maintained in stable way – to maintain that – kidneys are that major contributor – thing that controls the conc of a wide range of ions found in ECF. Organic molecules, pH, H+ ions, that control is ultimately down to the kidney – the balance that is so fundamental to be maintained is done by the kidneys. Now many people when they first study Urinary system they have the idea that excretion is what kidneys do – but actually excretion is probs the least of the kidney functions – it’s an important function, and again, if it’s not working, then pts die, but the day to day function and fundamental importance that kidneys have is maintaining that stable environm – again need to think about other functions that kidneys do – endocrine function ,talked about erythropoietin, prostaglandins, briefly about RAAS and the metabolic functions – vit D, thyroid hormone, calcitonin, all those regulatory functions are done by the kidneys remember, so it’s a v important organ.”
5 - Metabolic Activity
ORGAN | WEIGHT (kg) | RESTING BLOOD FLOW (ml/min) | RESTING BLOOD FLOW (ml/min/g) | CARDIAC OUTPUT (%) BRAIN 1.4 750 0.55 14 HEART 0.3 250 0.8 5 KIDNEYS 0.3 1200 4 22 LIVER 1.5 1300 0.85 23 MUSCLES 35.0 1000 0.03 18 SKIN 2.0 200 0.10 4 BONE 27.0 800 0.03 14
Kidneys - Vulnerable to ischaemic damage
“And we get an indication of that importance when you look at just a simple diagram at some of the major organs in the body and we look at the blood flow per ml, or per g of that organ, and you’ll see that per g the kidneys take a huge proportion of your CV output – 22% of everything that your heart is doing is simply to keep the kidneys alive. So 4 ml per min per g of bloodflow into the kidneys, and if you compare that with the brain which is taking 0.55 – you’ll see just how ravenously hungry for blood flow the kidneys are, and that’s bc what they do is incredivlhy metabolically demanding, and in order to do what they do – they need oxygen and they need glucoswe. Now what happens – the consequence, and the reason that pts die when mishandle fluids is bc w/o that blood supply, if kidneys become ischaemic, if they become starbed of blood, then they are incredibly susceptible to dmg, and they are dmgd v quickly, so ad rop in blood flow and blood pressure, haemorrhage, those kind of things are significant impactors of kidney function, and once they are damaged, we get to them quickly enough ,we can sustain them and allow recovery, if not, we are on a pathway to chronic kidney uinjiury, and ultimately to death. So kidneys are v vulnerable.”
6 - Anterior view
Anterior - L. Kidney - Ureter - Bladder - SI joint - Ischial spine T11 T12 L1 L2 L3 L4 L5
“1. retroperitoneal – so in order to show this img had to remove everything, all GI contents, peritoneum etc, and left right at back are kidneys. It’s important that we understand where the kidneys are located -we can’t see them particularly easier, not easiest thing to examine/feel/biopsy a kidney - need to know what lvl - L kidney sits slightly higher than right bc liver is here and it’s q big, shoves it down a bit, so upper pole of R kidney (usually) is thought of as being a lil bit lower than the L kidney - usually between T12 and L2/L3 depending on left or right.
2. You can see that retroperitoneally we have the ureters – muscular tube, peristaltic action, it’s smooth muscle, and what joins the kidney to the bladder – we have 2 ureters, one for each kidney. We will discuss next week when we talk about dvlpmntal abnormalities, sometimes that one kidney one ureter doesn’t hold – but normally we expect 1 kidney, 1 ureter – joins it in a concavity on the surface of the kidney that we call the hilum (just like in the lungs, and other strucutres, only just means concavity – there is the ureter leavin the hilum of the kidney and the ureters descend on either side of the spinal column down to the bladder.) Something else we can think about when thinking about stripped back img is relationship they have to bony structure – remember rhtye are muscular, thin, persitaltcic smooth muscle tubes, but q often, pts can present with abdo pain that we would oassociate with osbtructions in ureter such as a stone – but if we were to img those pts, we wouldn’t be able to see the ureters, but we need ot have an idea where they might be on xray, so we can check carefully if there is a stone on the tube, so we remember they run along tips of transverse procresses and they cross the pelvic brim usually somewhere lclose to the SI joint, so we can see that joint v easily on an x ray and although doesn’t show terribly well here, if you go onto app yourself, you’ll see that in certain views you can look down into pelvic bowel and see ischial spine and ureters bend around pelvic bowel and enter back of baldder around about the lvl of the ischial spine, so depending on where oyu’re looking on an xray, you can have a mental picture of where you expect the ureters to be. Now, that img is not an img we’d see v often, when we go down to the DR …”
7 - Draw where the kidneys sit in relation to other structures (prosection)
- Right crus
- Abdominal aorta
- Aortic hiatus (T12)
- Inferior vena cava
- Caval hiatus (T8)
- Central tendon of the diaphragm
- Esophageal hiatus (T10)
- Muscular portion of the diaphragm
- Esophagus
- Diapghagm
- Left crus
- Quadratus lumborum m. -
- Psoas minor and major mm. -
- Iliac crest -
- Iliacus m. -
- Inguinal ligament -
- Iliopsoas m.
“And look at prosections, might see imgs that look a bit more like this – actually one of our cadavers, if you look at this – will see again, see kidneyts, although musculature is here posterior to kidneyts in abdo dissection, actually removed all thre GI contents that sit on top, bc we can see the kidneys, can see the blood vessels, see the bifurcation, and this is the entrance ot the pelvic bowel and we can just see the v top of vbladder shown below. Still looking retroperitoneal img of these organs.”
8 - Anterior abdominal anatomy
See image
“SO I’ve put a few more things back on here, can see a shot of abdomen, got stomach, liver, small and large intestines in place.”
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