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Renal Anatomy > Ureter, Urinary Bladder, Urethra > Flashcards

Ureter, Urinary Bladder, Urethra Flashcards

1
Q

Where is the ureter located?

A

Retroperitoneal from renal pelvis down to bladder and attached to the posterior abdominal wall

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2
Q

Anatomical Course of Ureter

Descends along anterior surface of ____

First step

A

Descends along anterior surface of psoas major

L2-L5

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3
Q

Anatomical Course of Ureter

Crosses the ____ at level of ____ to enter pelvic cavity

Second step

A

Crosses the pelvic brim at level of sacroiliac joints to enter pelvic cavity

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4
Q

Anatomical Course of Ureter

Descend along ____

Third step

A

Descend along lateral pelvic walls

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5
Q

Anatomical Course of Ureter

Turn anteromedially at the level of ____ to travel transversely towards bladder

Fourth step

A

Turn anteromedially at the level of ischial spines to travel transversely towards bladder

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6
Q

Anatomical Course of Ureter

Pierces lateral aspect of bladder walls in ____ manner

Fifth step

A

Pierces lateral aspect of bladder walls in oblique manner

Creates a one-way valve preventing backflow of urine

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7
Q

Name the 3 constrictions of the ureter

A
  1. Ureteropelvic junction
  2. Pelvic inlet (where ureters cross the iliac vessels)
  3. Vesico-ureteric junction (narrowest - entrance to bladder)
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8
Q

Clinical significance of constrictions

A

Common sites of obstruction by calculi

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9
Q

Ureteral Pain

What does ureteral pain result from?

A

Strong peristaltic waves of contraction pass down ureter in attempt to pass stone onward -> Smooth muscle spasms causes colicky pain

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10
Q

Ureteral Pain

How does ureteral pain come about? (spinal cord)

A

Afferent nerve fibers of renal pelvis and ureter enter spinal cord at segments T11, T12, L1 and L2 -> Pain referred to corresponding dermatomal distribution along flank, loin and groin

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11
Q

Ureteral Pain

Ureter lies in close proximity to the ____ nerve and pain is referred along ____ branch of the nerve -> Pain over tip of penis (male) and labia major (female)

A

Ureter lies in close proximity to the genitofemoral nerve and pain is referred to genital branch of the nerve -> Pain over tip of penis (male) and labia major (female)

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12
Q

Ureteral Pain

Ureter lies in close proximity to the ____ nerve and pain is referred along ____ branch of the nerve -> Pain over front of thighs

A

Ureter lies in close proximity to thegenitofemoral nerve and pain is referred along femoral branch of the nerve -> Pain over front of thighs

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13
Q

Urinary bladder is a ____ and ____ organ

A

Urinary bladder is a hollow and distensible organ

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14
Q

Where is the urinary bladder located?

A

On floor of pelvic cavity, inferior to peritoneum and posterior to pubic bones

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15
Q

Urinary bladder expands ____ into abdomen when full

A

Urinary bladder expands superiorly into abdomen when full

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16
Q

Male Urinary Bladder

Upper part of posterior surface is covered by ____

A

Upper part of posterior surface is covered by peritoneum

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17
Q

Male Urinary Bladder

Lower part of posterior surface separated from the ____ by ____ , seminal vesciles and the rectovesical fascia

A

Lower part of posterior surface separated from the rectum by vasa deferens, seminal vesicles and the rectovesical fascia

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18
Q

Male Urinary Bladder

Neck of bladder rests upper surface of ____

A

Neck of bladder rests upper surface of prostate

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19
Q

Female Urinary Bladder

Posterior surface separated from ____ by ____

A

Posterior surface separated from rectum by vagina

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20
Q

Female Urinary Bladder

Superior surface related to ____

A

Superior surface related to uterovesical pouch

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21
Q

Female Urinary Bladder

Neck of bladder rests directly on upper surface of ____

A

Neck of bladder rests directly on upper surface of urogenital diaphragm

no prostate

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22
Q

Internal features of bladder

What is the muscle in the urinary bladder?

A

Detrusor (smooth muscles)

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23
Q

Function of detrusor muscle

A

Contracting in response to signals from nervous system and empty bladder when necessary

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24
Q

What is the neck of the bladder formed by?

A

Convergence of the fundus and 2 inferolateral surfaces

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25
Q

Internal features of bladder

When bladder is empty, the walls of it have a series of ridges, thick mucosal folds known as ____ that allow for ____ of bladder

A

When bladder is empty, the walls of it have a series of ridges, thick mucosal folds known as rugae that allow for expansion of bladder

Only seen when bladder is empty

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26
Q

Internal features of bladder

What is the trigone of the bladder?

A

Smooth triangular region on base of internal urinary bladder and is seen in between 2 ureteric orifices/openings and internal urethral orifice

No rugae even when urinary bladder is empty (always smooth)

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27
Q

What are the layers of the bladder wall?

A
  • Mucosal - transitional epithelium
  • Lamina propria
  • Submucosa
  • Detrusor muscle
  • Peritoneum
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28
Q

Function of submucosa of urinary bladder

A

Provides support and elasticity to the bladder

29
Q

What are the 2 key functions of the urinary bladder?

A
  1. Temporary storage of urine
  2. Assist in expulsion of urine
30
Q

What is the maximum capacity of the urinary bladder?

A

About 500ml

31
Q

What can cause urinary retention?

A

Obstruction distal to bladder neck
- Benign Prostatic Hyperplasia
- Bladder stone (cystolithiasis)
- Large blood clot (haematuria)
- Urethral structures

32
Q

Where are the 2 sphincters located and what are their names?

A

Urethra
Internal and External urethral sphincter

33
Q

Sphincters are ____ muscles that open and close passages in the body to regulate flow of substances such as ____ through the body

A

Sphincters are circular muscles that open and close passages in the body to regulate flow of substances such as bile, urine and feces through the body

34
Q

What forms the internal urethral sphincter?

A

Circular muscle fibres at base of bladder becomes thickened

35
Q

Where is the internal urethral sphincter located?

A

Bladder neck

36
Q

Internal urethral sphincters are ____ muscle fibers under ____ control

A

Internal urethral sphincters are smooth muscle fibers under autonomic control

37
Q

Function of internal urethral sphincters in males and females

A

Maintains urinary continence - controls release of urine into urethra

38
Q

Function of internal urethral sphincters in males

A

Prevents seminal regurgitation during ejaculation

39
Q

External urethral sphincters are ____ muscle under ____ control

A

External urethral sphincters are skeletal muscle under voluntary/somatic control

40
Q

Which nerve is the external urethral sphincter innervated by?

A

Pudendal nerve (S2-4)

Provides voluntary control over micturition

41
Q

What are the blood supplies of the bladder?

A
  • Superior vesical
  • Inferior vesical
  • Obturator
  • Uterine arteries (female)
42
Q

Lymph of urinary bladder mostly drains into ____ nodes and a few from superolateral surface drains into ____ nodes

A

Lymph of urinary bladder mostly drains into internal iliac nodes and a few from superolateral surface drains into external iliac nodes

43
Q

Veins of bladder do not follow arteries but form a plexus that converges on ____ plexus in groove between ____ and ____ which drains backwards across the pelvic floor into the ____ veins

A

Veins of bladder do not follow arteries but form a plexus that converges on vesico-prostatic plexus in groove between bladder and prostate which drains backwards across the pelvic floor into the internal iliac veins

44
Q

Which nervous system regulates function of bladder?

A

Autonomic nervous system

45
Q

Sensory pathway of bladder

A

Afferent nerve fibers from bladder wall to CNS and signals to the brain the need to urinate when bladder becomes full

bladder contains stretch receptors to detect bladder filling

46
Q

What is the sympathetic nerve that innervates the bladder?

A

Hypogastric nerve (L1-L2)

47
Q

Function of sympathetic innervation of bladder

A
  • Inhibits contraction of detrusor muscle
  • Contracts internal urethral sphincters which closes
    -> Urinary retention
48
Q

What is the parasympathetic nerve that innervates the bladder?

A

Pelvic splanchnic nerve (S2-4)

49
Q

Function of parasympathetic innervation of bladder

A
  • Stimulate contraction of detrusor muscles
  • Inhibit action of internal urethral sphincter
    -> Micturition
50
Q

What is the somatic nerve that innervates the bladder?

A

Pudendal nerve (S2-4)

51
Q

Function of somatic innervation of bladder

A

Controls external urethral sphincter -> voluntary control over micturition

52
Q

Micturition reflex in infants

When bladder reaches its micturition threshold, stretch receptors on bladder wall send signals to ____ via the ____ nerves. Interneurons within spinal cord relays signals to ____ which causes ____ of detrusor muscle and ____ of internal urethral sphincter and ____ of urination -> ____ spinal reflex

A

When bladder reaches its micturition threshold, stretch receptors on bladder wall send signals to S2, S3 and S4 via the pelvic splanchnic nerves. Interneurons within spinal cord relays signals to parasympathetic efferent fibres which causes contraction of detrusor muscle and relaxation of internal urethral sphincter and initiation of urination -> primitive spinal reflex

53
Q

Micturition reflex in adults

Facilitated and inhibtied by ____ and subject to ____

A

Facilitated and inhibtied by higher brain centers and subject to voluntary facilitation and inhibition

54
Q

Micturition reflex in adults

What is the simple stretch reflex inhibited by in adults?

A

Activity of cerebral cortex until the time and place for micturition are favourable

55
Q

Micturition reflex in adults

What happens when it is not convenient to urinate?

A

CNS sends back an inhibitory signal to keep sphincters closed and prevent voiding

56
Q

Micturition reflex in adults

Inhibitory fibres pass downwards with ____ to ____ of spinal cord to innervate ____ nerve

A

Inhibitory fibres pass downwards with corticospinal tracts to S2-4 of spinal cord to innervate pudendal nerve

57
Q

Micturition reflex in adults

Spinal cord through ____ nerves signals detrusor muscle of bladder to ____ and internal urethral sphincter to ____ . Voluntary ____ of external urethral sphincter closes urethra and micturition follows.

A

Spinal cord through pelvic splanchnic nerves signals detrusor muscle of bladder to contract and internal urethral sphincter to relax . Voluntary relaxation of external urethral sphincter closes urethra and micturition follows.

58
Q

Function of urethra

A

Vessel responsible for transporting urine from bladder to external opening in the perineum

59
Q

Difference of urethra between males and females

A
  • Female: Short (3-4cm)
  • Males: Long (15-20cm)
60
Q

Why are females more susceptible to UTI?

A
  1. Shorter urethra -> easier for pathogens to enter and infect urinary tract
  2. Urethral proximity to anus -> bacteria from large intestine often cause UTI -> proximity allows bacteria to easily access urethra
61
Q

What are the 3 types of bladder dysfunction due to spinal cord injury?

A
  1. Atonic bladder
  2. Automatic bladder
  3. Autonomous bladder
62
Q

When does atonic bladder occur?

A

Spinal shock
- Immediately after spinal injury and may last for a few days to several weeks

63
Q

Atonic bladder:
Bladder becomes greatly ____ and overflows.
Bladder wall muscle is ____, internal sphincter muscle tightly ____ and external sphincter muscle ____

A

Atonic bladder:
Bladder becomes greatly distended and overflows.
Bladder wall muscle is relaxed, internal sphincter muscle tightly contracted and external sphincter muscle relaxed

64
Q

Which spinal cord lesion does automatic reflex bladder occur at?

A

Cord lesion above level of parasympathetic outflow (S2-4)
- Injury above T12

65
Q

If injury above T12: disrupts brain’s ability to control bladder but ____ remains intact

A

If injury above T12: disrupts brain’s ability to control bladder but reflex arc remains intact

66
Q

Automatic Bladder:
Bladder fills and empties ____
Afferent signals unable to reach brain and patient has no awareness of bladder filling -> Loss of descending control over ____ and no ____ control over urination

A

Automatic Bladder:
Bladder fills and empties automatically
Afferent signals unable to reach brain and patient has no awareness of bladder filling -> Loss of descending control over exernal urethral sphincter and no voluntary control over urination

67
Q

Which spinal cord lesion does autonomous reflex bladder occur at?

A

Sacral segments
- Injury below T12

68
Q

If injury below T12: damaged ____ outflow to bladder and ____ does not function

A

If injury below T12: damaged parasympathetic outflow to bladder and spinal reflex does not function

detrusor muscle paralysed and cannot contract

69
Q

Autonomous bladder:
Bladder fills to capacity and ____
Continual ____ occurs once bladder is full and bladder may be partially emptied by manual compression of lower part of anterior abdominal wall
=> recurrent ____ and back-pressure effects on ____ and ____

A

Autonomous bladder:
Bladder fills to capacity and overflows
Continual dribbling occurs once bladder is full and bladder may be partially emptied by manual compression of lower part of anterior abdominal wall
=> recurrent UTI and back-pressure effects on ureters and kidneys

Renal Anatomy (3 decks)

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