Unit 10: Kidneys and urination Flashcards
What is the flow of waste from the kidney in the collecting system out of the body?
Minor calyx
Major calyx
Renal pelvis
Ureter
Bladder
Urethra
What ribs cover the posterior aspect of the kidney?
Ribs 11 and 12
What is the gross structure of he kidney?
Concave medial border
Convex lateral border
Adrenal gland on superior pole
Inferior pole
Hilum - VAN, lymphatics and ureter etc
What muscles does the kidney sit on posteriorly?
Quadratus lumborum
Psoas major
Transverse abdominus muscle
What is the role of the peri and pararenal fat?
Thermal insulation
Fixes into structure
Protection
Perirenal fat also invades into the hilum of the kidney.
What are the layers surrounding the kidney?
Perirenal fat
Renal fascia
Pararenal fat
What is the arterial blood supply to the adrenal glands?
- Superior suprarenal - branch from inferior prhrenic
- Middle suprarenal - branch from AA
- Inferior suprarenal - branch from renal artery
What is the venous drainage of the adrenal glands?
Left suprarenal vein - empties into left renal vein
Right suprarenal vein - empties directly into IVC
What is located anteriorly to the right kidney?
Liver
Second part of duodenum
Ascending colon and hepatic flexure
What are the important anatomical relationships to the left kidney?
Spleen - superior - located by splenorenal ligament
Anteriorly:
Splenic flexure and descending colon
Jejunum
Stomach
Pancreas
What are the division of the renal artery in the kidney?
Segmental arteries
lobar arteries
Interlobar arteries
Arcuate arteries
Interlobular arteries
Afferents capillary
(Glomerulus capillary)
Efferent capillary
peritubular capillaries
vesa recta (arounf loh)
interlobular veins …..
What are the three points on constriction along the ureter?
- When the ureter leaves the kidney
- When the ureter crosses the pelvic brim and crosses over the common illiac vein/artery
- Where it enters into the bladder
What are the walls of the ureter made of?
Smooth muscle - allows peristalsis
What region of the bladder do the ureters enter into?
THe base
(think of flat endge of triangle)
Why is the constriction of the ureter important clinically?
Areas where kidney stones are most likely to build up
This can be very painful and smooth muscle undergoes spasm
Cause hematuria
Urinary obstruction
Infection
Severe cases - renal failure
What is the blood supplt to the ureter?
Ureteric branch of the renal artery (proximally)
Ureter branch of gonadal artery (distal)
Ureter branch of superior mesenteric artery (more distally)
What forms the posterior abdominal wall?
The lumbar vertebrae, the pelvic girdle and the posterior abdominal wall muscles
What are the five posterior abdominal wall muscles?
The quadratus lumborum
Iliacus
Psoas major
Psoas minor
Diaphragm
What is the function, innervation and location of the illiacus muscle?
F: flexion and lateral roation of the thigh at the hip joint
Innervation: femoral nerve L2 to L4
Basic location: surface of illiac fossa and AIIS combines with tendons of psoas to insert on the lesser trochanter
What is the function, innervation and location of the Psoas major?
F: fllexion of the hip, lateral flexion of the vertberal coloum
I: anterior rami of L1-L3
L: transverse process of vertebral bodies of T12 to L5, travel deep to inguinal ligament and attaches to lesser trochanter of femur
What is the function, innervation and location of the of the psoas minor?
F: flexion of the vertberal column
I: antior rami of L1 spinal nerve
L: vertebral bodies of T12 and L1, attaches to pectineal line of the pubic bone
What is the function, innervation and location of the quadratus lumborum?
F: extension and lateral flexion of the vertberal column, depress and fix the 12th rib during inspiration
I: Anterior rami of T12-L4
L: superior from 12 rib, transverse process of L1-L4, inferiorly to the illac crest
What are the different components of fascia in the posterior abdmonial wall?
Psoas fascia - most anterior and covers psoas major
Thoracocolumbar fascia - divided into posterior, middle and anterior layers, deep back muscles are contained within the middle and posterio layers, the quadratus lumborum is between the middle and anterior
THis fascia fuses with the fascia of the internal oblique and transverse abdominal laterally, as it does so it covers latissimus dorsi.
Superiorly thickens to form the lateral arcuate ligament
What structures does urine flow through within the kidney after exiting the nephron?
Nephron
Renal papilla
Minor calyx
Major calyx
Renal pelvis
Ureter
What are some important gross features of the kidney?
Renal pyramids (nephrons)
Renal columns (connective tissue)
Renal cortex
Renal medulla
Renal capsule
What is the venous supply to the kidney?
What renal vein is longer?
Left renal vein drains into IVC (longer)
Right renal vein drains into IVC
What is the arterial supply to the kidney?
Which artery is longer?
Right renal artery - from AA - longer
Left renal artery - from AA - shorter
What are the different branches of the renal artery within the kidney?
Segmental arteries
Lobar
Interlobar artery
Arcuate artery
Interlobular artery
Afferent arteriole - glomerulus - efferent arteriole
What level is the renal hilum?
L2
What are the different layers surrounding the kidney?
Perirenal fat - margined off by the anterior and posterior renal fascia
Pararenal fat - this is borders by the transversalis fascia posteriorly and the retroperitoneal organs and eventually the parietal peritoneum anteriorly.
How can you differentiate between the right and left adrenal gland?
Right is party hat shaped or pyramid shaped
Left is shaped like a demilune
What is the venous drainage of the adrenal gland?
Right suprarenal - from IVC directly
Left supradrenal - from renal vein
What is the arterial supply to the right adrenal gland?
Each adrenal gland has
Superior adrenal artery - from inferior phrenic artery
Middle adrenal artery - from the AA
Inferior adrenal artery - from the renal artery
What structures overly the right kidney?
Liver most superiorly
Duodenum near the hilum
Hepatic flexure mid laterally
Ileum - over the inferior pole
What structures overly the left kidney?
The spleen most superiorly
The stomach - medial and superiorly
The colic flexure - mid laterally
Descedncing colon - lateral and inferiorly
jejunmun - inferior pole
Where are the three constrictions over the ureter?
1) the uteropelvic junction (helim of the kidney)
2. where it crosses the pelvic brim over the common illiac artery
3. the utero vesical junction (entrance to the bladder)
Where are kidney stones most likley to be found?
Why?
The three constrictions of the ureter
The renal calcyces
The renal pelvis
Due to their narrower diamter
What is the ureter blood supply?
Abdominally from the common illiac mainly
Middle - gonadal arteries branches (contributes to above and below)
pelvic region - internal illiac or vesical artery branches
What is the function of the bladder?
Temporary storage or urine and assist in expulsion of urine
What features allows the bladder to accomodate up to 400-600ml of urine?
Folded internal lining - rugae - allow expansion of bladder wall
What are the external features of the bladder?
Apex - points superiorly towards the pubic symphysis
Body - main part located between the apex and the fundus
Fundus of base - triangle shape most posteriorly
Neck - formed by convergence of fundus and the two inferolateral surfaces, is continuous with the urethra
Where do the ureters open into the bladder?
Enter by orifices, in the fundus of the bladder
Orficies are marked internally by the trigone (smooth muscle wall due to different embryological origin) enter at an angle and are relatively superior.
What is the key musculature in the bladder?
Detrusor muscle - smooth muscles orientated in multiple direction so retains structural integrity when stretched
When might the detrusor mucsle become hypertrophic?
Conditions that onstruct urin flow such as prostate enlargement
Increase work of detrusor to generate more flow to help pass urine
What is the main arterial supply of the bladder?
Superior vesical branch of the internal illiac artery is found in both sexes - may also have contribution from the obturator and inferior gluteal arteries
Females - contribution from vaginal artery
Males - inferior vesical artery
What is the venous drainage of the bladder?
Vesical venous plexus - empties into the internal illiac veins
Males - this is continuous with the prostate venous plexus in teh retropubic space (recives blood from dorsal vein of penis)
How does the bladder shape change when filling?
Extend superiorly - becomes suprapubic
How does the bladder shape change during pregnancy?
Early - increased urination due to growing foetus
Mid pregnancy - little change - may return to normal
Later pregnancy - increased urination - as foetus descends
Due to expansion of uterus, push the bladder anteriorly and inferiorly but pulled with umbilcus by the median umbilical ligament so becomes narrow/flattend. The urethra become streteched and distored. Muscles of the bladder become less effective - lead to stress incontinence - as are stretched
What are the different peritoneal pouches?
Females
Rectouterine - between uterus and rectum
Vesicouterine - between uterus and rectum
Males
Rectovesical - between rectum and bladder
What is the location of the internal urethral sphincter?
Males - circular smooth muscle, autonomic control located in neck of bladder wall as fuses with urethra
Females - functional sphincter (no muscle), formed by the bladder neck and the proximal urtethra
What is the location of the external urethra sphincter?
Skeletal muscle found in the perineal membrane
What is the innervation to the bladder?
Sympathetic - hypogastric nerve T12-L2 relax detrusor
Parasympathetic - pelvic splanchinc nerve S2,3,4
Somatic - internal pudendal nerve S2,3,4 - contract external urethral sphincter
Sensory afferents - from brain to bladder
What ligaments hold the proximal urethra/ neck of bladder in place?
Females - pubovescial ligaments
Males - puboprostate ligaments
Wraps around the urethra and anchors to the pubic bone
Describe the passage of the female urethra?
4cm long
Curved course
Pass inferiorly through the pelvic floor into the perineum, passes through the deep perineal pouch and perineal membrane (receives conncetionf from paraurethral gland) before opening into the vestibule between labia minora
Opening is superior and posterior to the clitoris, anterior to vagina
Describe the passage of the a=male urethra.
Long - 20 cm
Bends twice along course
Pass through prostate, deep perineal pouch, perineal membrane and immediately etners the root of the penis by being anteriorly in its course (this angle changes when the penis is flaccid)
Has a pre-pubic and infrapubic angle - this creates a 90 degree angle between the membranous and spongy urethra
What are the different sections of the male urethra?
Preprosatic
Prostatic - pass through prostate
Membranous - through perineal membrane
Spongy or penile
Label the bladder
Ureters
opening of ureters
Trigone
Urethra
INternal urethral orifice
Label the bladder
Trigone
Superior surface
Median umbilical ligament
Apex
Inferolateral surfaces
Urethra
Base
Ureters
Label the posterior abdominal wall muscles
Green - quadratus lumborum
Yellow - illiacus
Pink - psoas minor
Red - psoas major
label this image
Seminal vesicle
Ductus defernes
Prostate
Ejaculatory duct
Urethra
Bladder
Anal aperture
Rectum
Label this image
Uterine tube
Ovary
Uterus
Vagina
Bladder
Urethra
Anal apeture
Anal canal
Rectum
What are the different angles of the uterus?
Anteflexion - describes how body of uterus points anteriorly and superiorly over the bladder
Angle of anteversion - angle pointing inferiorly from the cervix to the vaginal canal
What are the different terms used to describe the location of the uterus?
Retroversion - fundus points superiorly - increased risk of prolaspe
Retroflexion - fundus points posteriorly, can compress onto rectum
Label the image of the male urethra and associated structures
Internal urethral sphincter
Prostate
External us
Penis
Navicular fossa
External urethral orifice
Spongy urethra
Membranous urethra
Bulbo-urtheral gland and duct
Perineal membrane
Deep perineal pouch
Prostatic part of urethra
Preprostatic part of urethra
Label the image of the female urethra and the associated structures
External urethral sphincter
Deep perineal pouch
perineal membrane
Glans clitoris
External urethra orifice
Duct of paraurethral gland
Vaginal opening
Greater vestibular gland
Paraurethral gland
