Urinary Flashcards
what vertebral levels can the left kidney be found between?
T11-L2
what vertebral levels can the right kidney be found between?
T12-L3
why is the right kidney lower than the left?
the lived displaces it inferiorly
what are the layers of facia/fat which surround the kidney? (4)
deep to superficial
- renal capsule
- perirenal fat
- renal fascia
- pararenal fat (mainly on the posteriolateral aspect of the kidney)
describe the path of urine from the renal pyramid to the ureter
renal pyramid-minor calyx-major calyx-renal pelvis- ureter
which vessel is more anterior, the renal veins or renal arteries?
renal veins
describe the vessels which blood must pass through to get into the renal vein from the renal artery.
renal artery-segmented-lobar- interlobular- arcuate artery- arcuate vein- interlobular- lobar- segmented- renal vein
where do interloper arteries become afferent arterioles?
through the cortex
What is pelvic kidney?
failing of a kidney to ascend. it remains in the pelvis at the level of the common iliac artery.
What is horseshoe kidney?
the kidneys are fused and situated in the pelvis. The kidneys become too close during their ascent, fuse, and become stuck underneath the IMA
What problems can arise from a horse shoe kidney?
not much really, slightly more prone to obstruction.
what is renal agenisis?
complete failure of one or both kidneys to develop, it’s most commonly unilateral
what is renal hypoplasia?
the kidneys develop with normal architecture, but are of smaller size than normal.
In an adult, how long are ureters?
25cm
what type of muscle can be found in the wall of the ureters?
smooth muscle
where do the ureters fun in relation to psoas major?
they run anteriorly
where do the ureters cross the pelvic brim?
at the sacroiliac joint
what vessels do the ureters cross at the pelvic brim?
bifurcation of the common iliac arteries.
at what level do the ureters move anteriorly?
the level of the ischial spines
what’s the significance of the oblique manner at which the ureters enter the bladder?
it creates a one-way valve, where high intramural pressure collapses the ureters, preventing the back-flow of urine.
which arteries supplies the abdominal part of the ureter?
renal arteries and gonadal
which arteries supply the pelvic part of the ureter?
superior and inferior vesical arteries
venous drainage of the ureters is carried out by which vessels?
they match the corresponding arteries
what delivers the nervous control of the ureters?
renal, testicular/ovarian and hypogastric plexuses
what vertebral levels is the ureteric nervous supply via? so what dermatome is ureteric pain referred?
T11-T12
-flank, loin and groin
what vessel is at risk during a hysterectomy and why?
ureters
-2cm above the ischial spine the ureters run under the uterine artery (water under the bridge)
what three locations along the ureter are narrowest and therefore at risk of a renal stone being stuck.
- uretopelvic junction
- pelvic brim
- where the ureter enters the bladder
what is the bladder an embryological derivative of?
the hind gut
what are the two main functions of the bladder?
- temporary storage of urine
- assists in the expulsion of urine
what’s the largest volume of urine a bladder can hold?
600ml (or 20ml if alcohol is involved ;) )
What is the trigone int he bladder?
a triangular area in the funds, marked by the ureters and urethra. it’s a smooth walled area.
what sphincters control the outflow of urine, and how do they differ between men and women?
internal and external sphincter
the internal sphincter is only present in men
what is the specialised muscle of the bladder wall called?
detruser muscle
is the internal sphincter under somatic or autonomic control?
autonomic, and is thought to prevent seminal regurgitation during ejaculation
what muscle makes up the external sphincter?
skeletal, so it’s under voluntary control
how is arterial supply to the bladder deliverd?
superior and inferior vesical arteries, via the internal iliac. the obturator, inferior gluteal and vaginal arteries also contribute small branches.
how is venous drainage of the bladder achieved?
vesical venous plexus
what nerve delivers sympathetic innervation to the bladder? and what are it’s nerve roots?
hypogastric nerve
T12-L2
what nerve delivers parasympathetic innervation to the bladder? and what are it’s nerve roots?
pelvic nerve
S2-S4
what nerve delivers somatic innervation to the bladder? and what are it’s nerve roots?
pudendal nerve
S2-S4
What is the bladder stretch reflex?
it’s a primitive spinal reflex, where micturition is stimulated in response to stretch.
what is the reflex arc which causes the bladder stretch reflex?
- bladder fills with urine and the sensory nerves detect this and transmit it to the spinal chord
- interneurones within the spinal cord relay the signal to the parasympathetic efferents
- the pelvic nerve acts to contract the detrusor muscle and stimulates micturition.
The bladder stretch reflex is not functional in adults (thank goodness), but when do we still need to consider it?
- childhood
- spinal injuries
- neurodegenerative diseases
where does a spinal cord transection occur if it produces ‘reflex bladder’ and why?
above S2
-afferent signals are unable to reach the brain, and there will be no awareness of the bladder filling. there is also no control over the external urethral sphincter, so it is constantly relaxed !
where does a spinal cord transection occur if it produces ‘flaccid bladder’ and why?
S2-S4
damages the parasympathetic outflow to the bladder. the detrusor muscle will be paralysed. the bladder will fill uncontrollably until overflow incontinece occurs.
what epithelia lines the urethra?
stratified columnar
how long (on average) is the male urethra?
15-20cm
what for sections can the male urethra be separated into?
pre-prostatic, prostatic, membranous and spongy
what two angles make male catheterisation difficult?
prepubic angle and the infrapubic angle
how can the prepubic angle be overcome during catheterisation?
holding the penis upwards
what three constrictions does the male urethra have?
- internal urethral sphincter
- external urethral sphincter
- external urethral orifice
how long is a female urethra?
4cm
what is the clinical significance of the short female urethra?
it predisposes women to urinary tract infections
what epithelia is found in the ureters?
urothelium- transitional epithelium
what epithelia can be found in the bladder?
bladder
