Urinary Flashcards
1
Q
What are the anterior relations of the left kidney? (6)
A
- Left adrenal gland
- Spleen
- Splenic flexure
- Jejunum
- Stomach
- Pancreas
2
Q
What are the anterior relations of the right kidney? (5)
A
- Hepatic flexure
- Liver
- Jejunum
- Right adrenal gland
- Duodenum (2nd part)
3
Q
What are the muscles that posteriorly relate to the kidneys? (4)
A
- Quadratus lumborum
- Psoas major
- Transversalis abdominus
- Diraphragm
4
Q
What are the nerves that posteriorly relate to the kidneys? (3)
A
- Ilioigunas
- Iliohypoglossal
- Subcostal (T12)
5
Q
What are the bones that relate posteriorly to the kidneys?
A
- 11th and 12th rib (right)
- 12th rib (left)
6
Q
What type of epithelium lines the kidneys?
A
Stratified Transitional
7
Q
What is the order of the kidney hilum contents anterior to posterior?
A
- Renal vein
- Renal artery
- Renal pelvis
8
Q
Label internal structure of kidney
A
See notes
9
Q
Label kidney capsules
A
See notes
10
Q
Describe the lymphatic drainage of the kidney
A
Paraaortic nodes —> Lumbar lymph trunk —> cisterna chyli —> thoracic duct
11
Q
Name the 4 kidney capsules in order
A
1) Renal/fibrous capsule
2) Perirenal fat
3) Renal fascia
4) Pararenal fat
12
Q
What is the renal/fibrous capsule adherent to?
A
Kidney surface
13
Q
What is perirenal fat made up of?
A
Solid and protective adipose tissue
14
Q
What is renal fascia a continuation of?
A
Extraperitoneal fascia
15
Q
At what level do the afferent sympathetic nerves from the kidney enter the sympathetic chain?
A
T11-T12
16
Q
What does the sympathetic chain connect to to innervate the kidneys?
A
Renal plexus
17
Q
What vertebrae to the kidneys extend over?
A
T12 - L3 (3 vertebrae in length)
18
Q
What artery gives rise to the renal artery?
A
Superior mesenteric artery
19
Q
What level does the superior mesenteric artery give rise to the renal artery?
A
L1
20
Q
What vein gives rise to the renal vein?
A
Inferior vena cava
21
Q
What level does the IVC give rise to the renal artery?
A
L2
22
Q
Why is the left renal vein shorter than the right venal vein?
A
Due to anatomical position of aorta slightly to the left of midline
23
Q
Why is the right kidney inferior to the left kidney?
A
Presence of liver
24
Q
Label vasculature of kidneys
A
See notes
25
What vertebral level are the adrenal glands at?
T12
26
What kidney capsule layer are the adrenal glands found in?
Renal fascia
27
What covering other than the renal fascia are the adrenal glands found in?
Perinephric fat
28
What are the posterior relations of the left adrenal gland?
- Stomach
| - Pancreas
29
What are the posterior relations of the right adrenal gland?
Liver
30
Label adrenal gland layers
See notes
31
What is the shape of the right adrenal gland?
Pyramidal
32
What is the shape of the left adrenal gland?
Semi lunar
33
Blood supply to the adrenal gland comes from branches of which 3 arteries?
- Aorta
- Renal artery
- Inferior phrenic artery
34
Label diagram of posterior abdominal wall
See notes
35
Label diagram of abdominal sympathetic plexi
See notes
36
How long is the ureter?
25cm
37
What is the diameter of the ureter?
3cm
38
What type of epithelium lines the ureter?
Stratified transitional
39
What type of tube is the ureter?
Muscular
40
What are the 3 parts of the ureter?
- Abdominal
- Pelvic
- Intravesical
41
Is the abdominal ureter intra/retroperitoneal?
Retroperitoneal
42
Where does the abdominal ureter lie? (2)
- On medial aspect of psoas muscle
| - Anterior to transverse process of lumbar vertebrae
43
Where does the pelvic ureter begin?
When ureter enters the pelvis
44
Where does the pelvic ureter enter the pelvis?
At the pelvic brim at L4 level of common iliac bifurcation
45
What is anterior to the pelvic ureter entering the pelvis?
Sacroilliac joint
46
Where does the pelvic ureter cross anteriorly and medially?
Level of ischial spine
47
Where does the pelvic ureter enter the bladder?
Vesicouteric junction at the posterolateral bladder wall
48
What does the ureter lie close to in males?
Seminal vesicles
49
What does the ureter lie under in males?
Vas deferens
50
Where does the ureter run laterally to in females?
Cervix
51
What does the ureter run under in females?
Uterine vessels
52
When does the ureter become the intravesical ureter?
When it enters the bladder wall
53
What angle does the intravesical ureter enter the bladder wall at?
Oblique
54
How long does the intravesical ureter run in the bladder wall?
1cm
55
Why does the ureter run obliquely in the bladder wall?
1 way valve to prevent urine backflow because of high intramural pressure
56
Where does the intravesical ureter open into the bladder?
Internal uteric orifice
57
The local arteries and veins that supply/drain the ureter branch from what vessels? (5)
- Internal vesical
- Internal iliac
- Gonadal
- Aorta
- Renal
58
Where does the lymph from the ureters drain to?
Paraaortic nodes
59
What innervates the ureters?
Autonomic plexuses
60
Name wheRe 3 positions where the diameter of the ureter is the narrowest
1. Uteropelvic junction (renal pelvis and ureter)
2. Pelvic brim (ureter entering pelvis and crossing over common illiac bifurcation
3. Vesicoureteric junction (ureter obliquely enters bladder wall)
61
Why are the 3 ureter constrictions clinically significant?
Most likely locations of renal/uteric calculus obstructions (stones)
62
Label ureter
See notes
63
Label bladder
See notes
64
What muscle forms the bladder?
Detrusor muscle
65
What type of muscle is detrusor muscle?
Smooth
66
What are the folds of the bladder known as when it is empty?
Rugae
67
What type of epithelium lines the bladder?
Transitional
68
What embryological remnant is attached to the bladder apex?
Urachus
69
What is the urachus?
Obliterated allantois - connected foetal bladder to yolk sac
70
Where is the urachus attached?
Bladder apex
71
What folds does the urachus continue in?
Median umbilical folds
72
What are the median umbilical folds?
Peritoneum fold on anterior abdominal wall
73
What is found in the medial umbilical folds?
Medial umbilical ligament
74
What does the bladder sit in when empty?
The true pelvis
75
What is the bladder posterior to when empty?
Pubic symphisis
76
What does the bladder become when it expands in volume?
Intraabdominal
77
Where can the bladder be palpated when full?
Suprapubic regions
78
What is the capacity of the bladder?
500ml
79
What lies inferior to the bladder in men?
Prostate
80
What lies inferior to the bladder in women? (2)
- Perineal membrane
| - Pelvic fascia
81
What lies superior to the bladder? (5)
- Uterus
- Vagina
- Peritoneum
- Coils of ilium
- Sigmoid colon
82
What lies lateral to the bladder?
- Obturator internus
| - Levator ani
83
What is the arterial blood supply to the bladder?
Internal and external vesical arteries
84
What are the internal and external vesical arteries branches of?
Internal iliac artery
85
What is the venous drainage of the bladder?
Vesical venous plexis
86
What does the vesical venous plexus go to in men?
Prostatic plexus
87
Where does the vesical venous plexus ultimately drain to?
Internal iliac veins
88
Where does the lymph of the bladder drain to?
Internal and external iliac nodes
89
What is the sympathetic innervation of the bladder via?
Sympathetic trunk
90
What is the parasympathetic innervation of the bladder via?
Pelvic splanchnic nerves (S2-S4)
91
What plexus directly innervates the bladder?
Pelvic/inferior hypogastric plexus on each side of the bladder
92
What action of the bladder causes urination?
Contraction
93
Label urethra diagram
See notes
94
What length is the female urethra?
4cm
95
Where is the female urethra embedded?
Anterior wall of vagina
96
Where is the external urethral meatus opening/orifice?
Vulvar vestibule
97
What is the length of the male urethra?
20cm
98
What is the different in shape between the male and female urethra and why is this clinically significant?
Males curves more, female=direct. Harder to catheterise a male
99
List the parts of the male urethra
- Preprostatic urethra
- Prostatic urethra
- Intermediate/membranous urethra
- Penile/spongy urethra
100
Where is the preprostatic urethra found and what are its boundaries?
Found in bladder neck
| Internal urethral orifice to prostate
101
Where is the prostatic urethra?
Within prostate
102
What merges in the prostatic urethra?
Reproductive (prostatic) and ejaculatory ducts
103
Where do the prostatic ducts open in the prostatic urethra?
In the prostatic sinus either side of uretheral crest
104
How many prostatic ducts open in the prostatic urethra?
15-20
105
Where do the ejaculatory ducts open in the prostatic urethra?
Either side of the prostatic uricle
106
What does the intermediate/membranous urethra pass through?
- Pelvic floor
- Penrineal membrane
- External urethral sphincter
107
Where is the penile/spongy urethra?
Corpus spongiosum and bulb of penis
108
What type of tissue is the penile/spongy urethra?
Erectile
109
Where is the external urethral orifice/external urethral meatus found?
Glans of penis
110
Label a prostatic urethra
See notes
111
What type of muscle is the internal urethral sphincter?
Smooth
112
What is the internal urethral sphincter innervated by sympathetically?
Inferior mesenteric ganglion from sympathetic trunks
113
What is the internal urethral sphincter innervated by parasympathetically?
Lumbar splancnic nerves (L1-L2)
114
What is the purpose of the internal urethral sphincter?
Contraction prevents urination and reflux of semen into bladder during ejaculation
115
What type of muscle is the external urethral sphincter?
Skeletal
116
What is the purpose of the external urethral sphincter?
Continence
117
What nerve and nerve type supplies the external urethral sphincter?
Pudendal nerve (somatic motor)
118
What muscle aids in continence?
Levator ani
119
Where can the hilum of the kidneys be palpated?
Left=L1
Right=L2
3 fingerbreaths from midline
120
What type of pain do the kidneys produce?
"Loin to groin pain"
121
What dermatome is kidney pain referred to?
T12
122
Why is kidney pain referred to T12 dermatome?
Visceral afferents in least splanchnic nerve enter spinal cord at T12
123
What abdominal regions does kidney pain correspond to?
Flanks and pubic region
124
What type of pain is caused by a ureter stone and what is it caused by?
Waves of peristalsis cause spasmic pain
125
Where is the pain from a ureter stone felt?
```
Male = scrotum
Female = labia majora/minora
```
126
Label bladder/ureter/uretheral system overall
See notes
