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Semester 3 > Urinary Session 1 > Flashcards

Urinary Session 1 Flashcards

1
Q

Which organ is as metabolically demanding as the kidneys?

A

Liver

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2
Q

What are the functions of the kidneys?

A

Regulation of key ECF components
Excretion of waste products
Endocrine synthesis
Metabolism

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3
Q

What hormones does the kidney synthesise?

A

Renin
Erythropoietin
Prostaglandins

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4
Q

Describe the metabolic function of the kidney.

A

Activates vitamin D
Catabolism of insulin
PTH

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5
Q

What is osmolality?

A

Solute per kg of solvent

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6
Q

What is osmolarity?

A

Number of osmoles of solute per litre

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7
Q

In humans why is osmolality and osmolarity approximately equal?

A

Constant conditions in the body

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8
Q

Why must the kidney control concentrations of electrolytes?

A

Variable ingestion and loss of salts and water needs to be balanced so cells don’t shrink or swell and so there aren’t huge changes in BP, tissue fluid or cell function

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9
Q

Why must the kidney control the concentration of bicarbonate in the plasma?

A

So ECF pH is constant

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10
Q

Why does the glomerular ultra-filtrate have the same osmotic pressure as blood plasma?

A

Everything but RBCs are removed

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11
Q

Describe the outcomes of blood entry into the vascular pole at the glomerulus.

A

Fraction enters capillaries to create a constant filtration pressure
Rest moves into glomerular tuft

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12
Q

What determines the GFR?

A

Afferent arterioles bringing blood into the glomerulus and efferent arterioles bringing blood out

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13
Q

Where is the major site of reabsorption in the nephron?

A

PCT

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14
Q

How does the organisation of vasculature in relation to the peritubular capillaries aid reabsorption in the PCT?

A

Efferent blood supply from glomerulus runs around peritubular capillaries for quick reabsorption and to ensure secretions remain go into the tubule

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15
Q

What type of reabsorption occurs in the PCT?

A

Iso-osmotic

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16
Q

Approximately what percentage of each of the components in the ultrafiltrate is absorbed in the PCT?

A 
Na+: 60-70%
Water: 60-70%
K+: 80-90%
HCO3-: 90% (normally)
Glucose and a.a.: 100%
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17
Q

How is an osmotic gradient established in the medulla?

A

Countercurrent multiplication at the loop of Henle

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18
Q

Which part of the nephron facilitates obligatory reabsorption?

A

PCT

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19
Q

Which part of the nephron facilitates controlled reabsorption and H+ secretion?

A

DCT

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20
Q

What is the function of the DCT?

A

Fine tune components of the filtrate

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21
Q

Where is the major site of variable electrolyte and water reabsorption?

A

DCT

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22
Q

Describe the filtrate in the DCT.

A

Hypotonic

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23
Q

What electrolyte movements occur in the DCT?

A

Sodium and calcium removed

Hydrogen ions actively secreted

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24
Q

Does water always follow electrolyte movement in the DCT?

A

No

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25
Q

What does the DCT communicate with due to its close proximity?

A

Glomerulus

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26
Q

Describe the passage of the collecting duct.

A

From medulla to pelvis through high osmolarity of the medulla

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27
Q

How can the permeability of the collecting duct be altered?

A

ADH can stimulate insertion/removal of aquaporins in the epithelial cells

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28
Q

Where is the filtrate in the nephron considered to be in relation to the body?

A

Outside

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29
Q

How does the renin-angiotensin system control ECF volume?

A

Altering Na+ recovery

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30
Q

How does the ADH system control ECF osmolarity?

A

Altering water permeability

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31
Q

What is special about the epithelial cells in the nephron?

A

Have necessary tight gap junctions meaning different transporters can be kept on different sides to allow transport across epithelium (polarised)

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32
Q

In normal water/electrolyte balance what percentage of water, sodium and chloride is recovered?

A

99%

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33
Q

What percentage of HCO3-, glucose and a.a. Is recovered by the nephron in normal water/electrolyte balance?

A

100%

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34
Q

At what rate do the kidneys filter blood?

A

180l per day

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35
Q

What is the first line investigation for imaging the renal tract?

A

Ultrasound

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36
Q

What are the advantages of using ultrasound to image the renal tract?

A 
Cheap
Quick
Can differentiate b/w cysts and tumours
Identifies fatty tumours
Identifies obstructions in collecting ducts
Measures blood flow
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37
Q

What are the disadvantages of using ultrasound to image the renal tract?

A

V. operator dependent
Can’t identify if a tumour is benign
Only able to see arteries in transplant kidneys as these are more superficial
Only see collecting ducts with large fluid load
Do not determine cause of collecting duct obstruction

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38
Q

Describe the 2 methods that can be used to use ultrasound to image the renal tract.

A

Probe that identifies bloodflow towards and away

Insert probe up rectum for prostate biopsies

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39
Q

What are the clinical implications of horseshoe kidney?

A

More susceptible to obstruction

May be additional renal arteries from iliac vessels –> complication in surgery

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40
Q

What is crossed renal ectopia?

A

2 kidneys on one side of the midline

Still have 2 distinct collecting systems and ureters

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41
Q

Do the ureters in crossed renal ectopia usually enter the bladder on the correct sides?

A

Yes

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42
Q

What does taking a plain radiograph of a pt it the supine position to look at kidneys, ureter and bladder (KUB) identify?

A

Calcification

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43
Q

What are the problems with using a KUB plain radiograph?

A

Hard to distinguish between renal fat and calcification
Need more than one film to localise findings
Calcification can be confused with phlebolith of the pelvic vessels

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44
Q

What is phlebolith of the pelvic vessels?

A

Localised, usually rounded calcification of a vein

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45
Q

Is the tissue which crosses the midline in horseshoe kidney usually functioning?

A

Yes

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46
Q

What are the advantages of using cT scans to image the renal tract?

A

No contrast needed (although may enhance image)
Identifies tiny stones
Using iodine and timing can give arterial and venous phases
Staging of cancer - liver metastases identified
Can be taken in any plane

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47
Q

What are the disadvantages of using CT scans to image the renal tract?

A

Cost

Exposure to radiation

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48
Q

What is pelvic kidney?

A

Failure of a kidney to ascend from the pelvis during development

49
Q

How does pelvic kidney present on investigation?

A

On imaging only one kidney is visible but it has a normal size and renal function so there must be another one somewhere

50
Q

What is duplex kidney?

A

Where the superior, middle and inferior poles do not converge causing two ureters which do not join to form

51
Q

Is duplex kidney pathological?

A

No, number of calices is normal and most pts are fine but there is an increased tendency for kidney problems

52
Q

What is MRI of the renal tract particularly good for investigating?

A

Local staging of bladder and prostate tumours inc. local lymph node involvement

53
Q

What is the gold standard investigation for renal artery stenosis?

A

MRI angiography

54
Q

How is MRI angiography carried out?

A

Pt given contrast to make bloodflow visible

55
Q

When might a micturating cystogram be used?

A

Suspected bladder leak or reflux

56
Q

How is a micturating cystogram performed?

A

Catheterise pt and inject dye
Completely fill bladder
Allow to urinate

57
Q

What iatrogenic cause might lead to bladder leak/reflux?

A

Damage during surgery, especially if there is lots of inflammation +/- bladder stuck to bowel

58
Q

When is an ate grade pyelogram carried out therapeutically?

A

In obstruction of the collecting duct causing impaired kidney function +/- infection

59
Q

What can be used to look for strictures in the urethra?

A

Micturating cystogram

Urethrogram

60
Q

When might arteriography be used?

A

Therapeutically for artery embolus or renal artery stenosis

61
Q

How is arteriography carried out when imaging the renal tract?

A

Dye put into aorta which travels to renal arteries so they can be examined

62
Q

What is a DMSA scan?

A

Radionuclide scan that compares function of L+R kidneys

63
Q

How is a DMSA scan performed?

A

Radioactive nucleotide marker+chemical with properties that determine kidney uptake –> taken up in kidneys and slowly excreted until steady state reached

64
Q

What does a missing patch within the outline of a kidney on DMSA scan indicate?

A

No activity e.g. scar tissue

65
Q

What does a rounded lesions in DMSA scan indicate?

A

Lump - needs further investigations to identify

66
Q

How does a DTPA renogram differ to a DMSA scan?

A

Series of images and corresponding graph of radioactivity produced over time to give a representation of % activity

67
Q

Is DTPA renogram or DMSA scan more accurate?

A

DMSA scan

68
Q

How can a DTPA renogram be used to investigate suspected kidney obstruction?

A

Give chemical that stresses kidney to increase urine output

69
Q

What can kidney obstruction be confused with by using a DTPA renogram?

A

Collecting system dilation

70
Q

At what level are the superior poles of the kidneys positioned?

A

T11/12

71
Q

What are the approximate dimensions of a normal kidney?

A

Length: 11-12 cm
Width: 5-7.5 cm
Depth: ~3 cm

72
Q

Which kidney sits more caudally and why?

A

Right due to the position of the liver

73
Q

Describe the path of the ureters.

A

Run posteriorly down tips of the vertebral transverse processes and then moves anteriorly to pass over pelvic brim

74
Q

From deep to superficial, what are the surrounding layers of the kidney?

A

Renal capsule
Perirenal fat
Renal fascia
Pararenal fat

75
Q

What does the renal fascia enclose?

A

Kidneys and suprarenal glands

76
Q

Where does the left renal vein run towards the kidney?

A

Posterior to the SMA

77
Q

Why is the right renal vein shorter than the left?

A

Does not pass over aorta

78
Q

What are the renal hila?

A

Entrances to renal sinus where kidney serving structures enter and exit

79
Q

How does the drainage of the suprarenal and gonadal veins on the right compare to those on the left?

A

On the right drain directly into IVC, on left drain into left renal vein

80
Q

Describe the position of renal arteries in relation to renal veins.

A

Symmetrical and posterior

81
Q

Where do the renal arteries typically divide?

A

Close to the hilum

82
Q

Describe the travel of urine though the kidney.

A

Renal pyramid –> collected in minor calyx –> minor calices merge to form major calyx –> renal pelvis –> ureter

83
Q

Approximately how long is the ureter?

A

25 cm

84
Q

What make up the renal pyramids?

A

Medullary rays

85
Q

What does the parenchyma of the kidney consist of?

A

Muscle portion = cortex and medulla

86
Q

Describe the path of filtered arterial blood into and around the kidney.

A

Abdominal aorta –> renal arteries –> ant and post segmental branches –> interlobar arteries –> arcuate arteries –> interlobular arteries –> afferent arterioles –> capillary network –> efferent arterioles

87
Q

Where are the interlobar arteries located in the kidney?

A

Either side of every renal pyramid

88
Q

How are interlobular arteries arranged in relation to arcuate arteries?

A

At 90 degrees

89
Q

When do the interlobular arteries divide into afferent arterioles?

A

In the cortex

90
Q

Where can additional aberrant arteries that supply the kidney arise from?

A

SMA
Suprarenal arteries
Gonadal arteries

91
Q

Describe the path of the abdominal part of the ureter.

A

Utero pelvic junction –> anterior surface of psoas major –> cross pelvic brim sacroiliac joint level –> cross bifurcation of common iliac arteries

92
Q

What gives blood supply to the abdominal part of the ureters?

A

Renal and gonadal arteries and veins

93
Q

What provides blood supply to the pelvic part of the ureters?

A

Superior and inferior vesical arteries and veins

94
Q

Define the path of the pelvic part of the ureters.

A

Lateral pelvic walls –> turn anteromedially at ischial spines to move in transverse plane towards bladder –> pierce bladder obliquely on lateral aspect

95
Q

How does the entrance of the ureters into the bladder allow it to act as a one-way valve?

A

High intramural pressure collapses the opening

96
Q

What is the relevance of the phrase ‘water under the bridge’ in hysterectomy?

A

~2cm superior to the ischial spines the ureters run underneath the uterine artery

97
Q

Where is ureteric pain referred to?

A

Dermatomes of T11-L2

98
Q

When do the ureters run close to the ovaries?

A

When they cross the pelvic brim

99
Q

Where is the bladder covered by peritoneum?

A

Superior aspect

100
Q

What is the median umbilical ligament a remnant of?

A

Foetal allantois

101
Q

How long is the male urethra?

A

20 cm

102
Q

What portions is the male urethra split into?

A

Preprostatic
Prostatic
Spongy

103
Q

What makes up the neck of the bladder?

A

Convergence of fundus and 2 inferolateral surfaces

104
Q

What runs in a circle around the bladder neck to act as an involuntary sphincter?

A

Detrusor muscle

105
Q

What is detrusor muscle?

A

Smooth muscle fibres running in 3 directions to allow stretch

106
Q

What type of innervation does detrusor muscle have?

A

Sympathetic and parasympathetic

107
Q

How long is the female urethra?

A

4 cm

108
Q

What is continence mainly controlled by in the female urethra?

A

Anatomical bend

109
Q

Who has an internal urethral sphincter?

A

Males only

110
Q

What is the purpose of the internal urethral sphincter in males?

A

Autonomic circle of smooth muscle fibres prevent seminal regurgitation on ejaculation

111
Q

What is the trigone?

A

Smooth wall in fundus that cannot distend

112
Q

Where is the bladder located?

A

Posterior to pubic bone and pubic symphysis

113
Q

Why can the bladder not be palpated when empty?

A

Lies entirely in the true pelvic cavity

114
Q

How does the shape of the bladder change upon filling?

A 
Empty = tetrahedron
Full = spherical
115
Q

What is the interureteric fold?

A

Ridge between 2 urethral openings

116
Q

How is the mucosa in the bladder arranged?

A

In rugae except for in trigone

117
Q

What does the external urethral sphincter consist of?

A

Skeletal muscle under voluntary control

118
Q

When might mucosa thickness be decreased?

A

Long term urinary retention

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