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Urinary System Flashcards

1
Q

Zones affected by BPH

A

Transitional zone

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2
Q

Arterial supply of the ovaries

A

Ovarian artery (branch of aorta)

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3
Q

Describe the 3 fascial layers of the spermatic cord and their origins

A
  1. External spermatic fascia from the external oblique aponeurosis
  2. Cremasteric fascia and cremaster from internal oblique aponeurosis
  3. Internal spermatic fascia from the transversalis fascia
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4
Q

What features must substances have to be used to measure GFR

A
  1. Inert
  2. Free filtration from the plasma at the glomerulus
  3. Not absorbed or secreted in at the tubules
  4. Plasma concentration constant during urine collection
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5
Q

3 divisions of the male urethra

A
  1. Prostatic
  2. Membranous
  3. Penile (Bulbous)
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6
Q

Testicular lymphatic drainage

A

Para-aortic nodes

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7
Q

Lateral relations of the uterus

A
  • Broad ligament

- Ureter lies superolateral to the supravaginal cervix

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8
Q

Arterial supply of the testes

A

Testicular artery (branch of the aorta)

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9
Q

Describe the course of the ovarian ligament

A

Runs within the broad ligament to the cornu of the uterus

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10
Q

Describe the course of the left renal vein

A
  • Longer
  • Passes in front of the aorta at the level of the SMA (L1)
  • Receives the adrenal vein and gonadal vein
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11
Q

Describe the structure of the uterine wall

A
  1. Perimetrium - outer serous coat
  2. Myometrium - middle coat of smooth muscle - vascular layer
  3. Endometrium - inner mucous coat - active in the menstrual cycle
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12
Q

Where is the timing of micturition controlled

A

Pontine micturition centre

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13
Q

What is the forward continuation of the bulb of the penis and what does it contain

A

Corpus spongiosum surrounds the penile urethra

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14
Q

Scrotal exploration - layers of incision

A
  1. Skin
  2. Dartos muscle (superficial fascia)
  3. External spermatic fascia
  4. Cremaster muscle
  5. Internal spermatic fascia
  6. Parietal layer of tunica vaginalis
    (7. Visceral layer of tunica vaginalis)
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15
Q

What converts 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol

A

1-alpha-hydroxylase

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16
Q

Capillary pressure within the afferent capillaries

A

50mmHg

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17
Q

Layout of the hilum of the kidney

A

From anterior to posterior:

  1. Renal vein
  2. Renal artery
  3. Pelvis of the ureter
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18
Q

Venous drainage of kidney

A

Renal vein into IVC

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19
Q

Where is calcium and phosphate reabsorbed and how is this regulated

A
  • Both actively reabsorbed in PCT and ascending loop of Henle
  • Any remaining is reabsorbed in DCT/collecting duct
  • Absorption in the DCT/collecting duct is regulated by PTH
  • PTH stimulates calcium reabsorption and phosphate excretion
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20
Q

Venous drainage of testes

A

Pampiniform venous plexus forms right and left testicular veins

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21
Q

Level of the kidneys

A

T12-L3

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22
Q

What occurs in the descending loop of Henle

A
  • Water is removed
  • NaCl is added from medulla
  • More concentrated from addition of NaCl and reduction in volume from removal of H2O (1200mosmol/L)
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23
Q

Describe the division and distribution of the renal artery

A
  • Anterior (75% of flow)

- Posterior (25% of flow)

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24
Q

Actions of angiotensin 2

A

Stimulates:

  • Arterial vasoconstriction
  • Release of ADH
  • Drinking
  • Release of aldosterone
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25
Superior relations of left kidney
- Spleen | - Adrenal gland
26
Describe the posterior relations of the right kidney
- Diaphragm - 12th rib - Psoas major, quadratus lumborum, transversus abdominis - Subcostal, iliohypogastric, ilioinguinal nerves
27
Where is the prostate plexus of veins and nerves situated
True (fibrous) capsule
28
Describe the lobes of the prostate
1. Posterior lobe - posterior to urethra and inferior to plane defined by ejaculatory ducts 2. Median lobe - lies between ejaculatory ducts and is posterior to urethra 3. Right and left lobes - separated by a shallow posterior median groove 4. Isthmus - narrow, anterior to urethra
29
Describe ductus deferens
- Thick wall and small lumen - Begins at tail of epididymis - Ascends posterior to testes - Penetrates anterior abdominal wall via inguinal canal - Crosses over external iliac vessels to enter pelvis - Ends by joining duct of the seminal gland to form ejaculatory duct
30
At what BP does autoregulation fail
- <80 | - >180
31
Name of opening of fallopian tube
Ostium
32
Describe the suspensory ligament
- Prominent fold of peritoneum - Attached to superior poles of the ovaries - Passes up over the pelvic brim and external iliac vessels to blend with the peritoneum over psoas major - Contains ovarian vessels, lymphatics, and nerves - Becomes continuous with mesovarium
33
Anterior relations of the uterus
- Uterovesical pouch of peritoneum - Lies on superior surface of bladder - Supravaginal cervix directly related to bladder
34
Ureter narrowings
1. Pelviureteric junction 2. Cross the pelvic brim 3. Passage through wall of the urinary bladder
35
Course of spermatic cord
1. Begins at the deep inguinal ring lateral to the inferior epigastric vessels 2. Passes through inguinal canal 3. Exits at superficial ring 4. Ends in the scrotum
36
Location of female urethral orifice
Vestibule of vagina directly anterior to the vaginal orifice
37
What stimulates renin release
1. Decrease in afferent arteriole pressure 2. Reduction in Na+ (detected by macula densa) 3. Renal sympathetic nerve stimulation
38
What do the juxtaglomerular cells secrete
Renin
39
Describe dartos fascia
- Fat-free fascial layer - Includes smooth muscle fibres (dartos muscle) - Continuous anteriorly with Scarpa's fascia - Continuous posteriorly with Colle's fascia
40
What forms the juxtaglomerular apparatus
1. Juxtaglomerular cells of the afferent arteriole | 2. Macula densa cells in the DCT
41
What encapsulates the testes
Visceral layer of tunica vaginalis (closed peritoneal sac)
42
Where is the penis anchored to the body
Right and left crura are attached to the inferior pubic rami and the perineal membrane
43
Lymphatic drainage of the male urethra
- Prostatic and membranous = obturator and internal iliac nodes - Penile = deep and superficial inguinal nodes
44
Venous drainage of the ovaries
- Right ovarian vein drains into IVC | - Left ovarian vein drains into left renal vein
45
Where is potassium reabsorbed and how is this regulated
- Active reabsorption in PCT and ascending loop of Henle | - Aldosterone stimulates secretion of K+ into the DCT
46
Describe the cardinal ligament
- Located at base of broad ligament - Extends from cervix to lateral pelvic walls - Contains uterine artery and vein
47
Embryological origins of the adrenal gland
- Medulla = neural crest (ectoderm) | - Cortex = mesoderm
48
Anatomical relations of the vagina
- Anterior = fundus of bladder and urethra - Lateral = levator ani, visceral pelvic fascia, ureters - Posterior = anal canal, rectum, recto-uterine pouch
49
Lymphatic drainage of prostate
Internal iliac nodes
50
Describe the structure of the fallopian tubes
- Covered by peritoneum (apart from intramural part) - Outer longitudunal muscle coat - Inner circular muscle layer - Columnar ciliated lining
51
List the parts of the fallopian tubes
1. Infundibulum 2. Ampulla 3. Isthmus 4. Uterine
52
Function of Onuf's nucleus
The neurons of Onuf's nucleus are responsible for controlling external sphincter muscles of the anus and urethra in humans
53
Zones affected by carcinoma
Peripheral zone
54
Describe atonic bladder
- Occurs in initial phase of spinal shock and can last weeks - Bladder wall muscle relaxed - Sphincter vesicae is contracted - Urethral sphincter relaxed - Bladder becomes distended and eventually empties as overflow
55
Embryological origin of the urethra
Cloaca
56
Describe how the ureters enter the bladder
- Pass obliquely through the muscular wall | - Ureteric orifice is in the trigone
57
What is Gerotas fascia
Eponymous name for renal fascia
58
Describe the round ligament
- Remnant of the Gebernaculum - Extends from uterine horns to the labia majora via the inguinal canal - Maintains anteverted position of uterus
59
Innervation of the penis
Pudendal nerve
60
Blood supply to the prostate
Prostatic arteries - derived from internal iliac (especially inferior vesical)
61
What stimulates EPO production
- Haemorrhage - Respiratory disease - High altitude - Vasoconstriction - Increased levels of RBC degradation products
62
Describe the anterior relations of the left kidney
- Suprarenal glands - Spleen - Stomach - Pancreas - Left colic flexure - Jejunum
63
Describe the course of the membranous urethra
- Passes through the pelvic floor and deep perineal pouch - Surrounded by external urethral sphincter - Narrowest and least dilatable portion of urethra
64
What covers the outer surface of each penile crus
Ischiocavernosus muscle
65
Injury at what spinal level would a patient lose awareness of bladder distension
L1-2
66
What surrounds the three cylinders of erectile tissue
Buck's fascia
67
What is the isthmus of the uterus
Internal OS
68
What is the role of renin
Stimulates the conversion of angiotensinogen to angiotensin 1
69
Describe the renal fascia
- Encloses the kidney, suprarenal glands, and perirenal fat - Extends along the ureter as periureteric fascia - Superiorly is continuous with the fascia of the diaphragm - Medially blends with fascia of aorta and IVC - Laterally continuous with the transversalis fascia
70
Anatomical relations of the bladder
- Anterior = pubic symphysis - Posterior: Males = rectum and seminal vesicles. Females = vagina and supravaginal cervix - Superior = peritoneum, coils of small bowel, sigmoid, body of uterus - Lateral = loose connective tissue
71
Innervation of the external urethral sphincter
Pudendal nerve
72
Pressure within Bowman's capsule
10mmHg
73
Where does fertilisation typically occur
Ampulla of the tube
74
Lymphatic drainage of the kidney
Directly into the para-aortic nodes
75
Describe the sympathetic innervation of the bladder
- Runs in the hypogastric plexus - L1-2 - Inhibits micturition
76
Outline the venous drainage of the bladder
- Males = Vesicoprostatic plexus - Females = vesicouterine plexus *Both plexuses drain into the internal iliac vein
77
Posterior relations of the uterus
- Rectouterine pouch of Douglas
78
Where is the internal spermatic fascia derived
Transversalis fascia
79
Arterial supply of the female urethra
Internal pudendal and vaginal arteries
80
Lymphatic drainage of the scrotum
Superficial inguinal nodes
81
Level of hilum of left kidney
L1 (Transpyloric plane)
82
Best substance for GFR calculation
Inulin
83
Fundus of bladder
Opposite apex. Formed by convex posterior wall.
84
Describe the course of the penile (bulbous) urethra
- Passes through the bulb and corpus spongiosum of the penis - Ends at the external urethral orifice (meatus) - Receives the bulbourethral glands proximally
85
Lymphatic drainage of the ovaries
Para-aortic nodes
86
What inhibits FSH production in males
Inhibin
87
What guides the testes on their descent from posterior abdominal wall to scrotum
Gubernaculum
88
Describe the course of the prostatic urethra
- Begins as continuation of the bladder neck - Passes through prostate gland - Receives the ejaculatory ducts - Widest part
89
Line of Brodel
Avascular line which delineates the segments supplied by the anterior and posterior branches of the renal artery
90
Describe the anterior relations of the right kidney
- Suprarenal gland - Liver - Duodenum - Right colic flexure
91
Describe the parasympathetic innervation of the bladder
- Run in the sacral outflow (S2/3) and innervate detrusor and internal sphincter - Fibres in the pudendal nerve control the external sphincter
92
What separates bladder from pubic symphysis
Retropubic space of Retzius
93
Where is aldosterone released from
Zona glomerulosa of the adrenal cortex
94
Length and diameter of female ureter
- 4cm long | - 6mm wide
95
Lymphatic drainage of the bladder
External iliac nodes to para-aortic nodes
96
What connects the ovaries to the posterior aspect of the broad ligament
Mesovarium
97
Actions of atrial natriuretic peptide
- Increased GFR - Inhibits reabsorption of Na+ Leads to the increased excretion of both sodium and water
98
Action of aldosterone
Causes retention of Na+ in the DCT in exchange for K+/H+
99
What is the navicular fossa
Dilation of the bulbous urethra in the glans of the penis
100
Course of ureter in the pelvis
1. Enters pelvis after crossing iliac bifurcation 2. Runs down ischial spine 3. Crosses obturator nerve and anterior branches of internal iliac 4. Turns medial to reach bladder 5 (Male). Passes under vas deferens 5 (Female). Crosses close to lateral fornix of vagina and below uterine artery
101
Where is the cremasteric fascia derived
Internal oblique
102
How is glucose reabsorbed
With Na+ bound to a protein carrier in the PCT
103
Where is ADH produced and then released from
- Produced in supraoptic nucleus of the hypothalamus | - Released from posterior pituitary
104
Anatomical relations of the adrenal glands
- Posterior = diaphragm - Inferior = upper pole of kidney - Anterior (right side) = liver, IVC - Anterior (left side) = stomach across the lesser sac
105
Arterial supply of the scrotum
- Posterior scrotal branches of perineal artery - Anterior scrotal branches of deep external pudendal artery - Cremasteric artery
106
What is the tributary of the testicular veins
Pampiniform plexus
107
What surrounds the two corpus cavernosa
Tunica albugenia
108
Arterial supply of seminal glands
- Inferior vesical | - Middle rectal
109
Dimensions of the uterus
7cm x 5cm x 3cm
110
Length and diameter of ureters
- 25-30cm | - 3mm
111
Outline the arterial supply of the male urethra
- Prostatic urethra = inferior vesical artery - Membranous urethra = bulbourethral artery (branch of internal pudendal) - Penile urethra = directly by branches of the internal pudendal
112
Where is Onuf's nucleus
Located in the ventral part of the anterior horn of the sacral region (S1-3)
113
Kidney filtration rate
120ml/minute
114
Ureter abdominal relations
- Anterior = peritoneum, colic vessels, gonadal vessels, ileum, mesentery (right side), sigmoid (left side) - Posterior = psoas major, psoas minor tendon, genitofemoral nerve, iliac bifurcation
115
Location of the bulbo-urethral (Cowper) glands
Posterolateral to the intermediate part of the urethra, largely embedded in the external urethral sphincter
116
What occurs in the DCT
- Water is reabsorbed due to low osmolality | - Na+ reabsorption under the control of Aldosterone
117
Lymphatic drainage of vagina
- Upper and middle 1/3rd = external iliac | - Lower 1/3rd = superficial inguinal
118
Apex of the bladder
Points towards the pubic symphysis when bladder empty
119
Describe the internal urethral sphincter
- Males ONLY | - Prevents retrograde ejaculation
120
Describe the posterior relations of the left kidney
- Diaphragm - 11th and 12th ribs - Psoas major, quadratus lumborum, transversus abdominis - Subcostal, iliohypogastric, ilioinguinal nerves
121
Number of minor calyces
12
122
Length of ductus deferens
45cm
123
What occurs in the PCT
- Reabsorption of 70% of NaCl (Na+ via ATP-dependent pump) - Reabsorbs all amino acids and glucose - Volume of ultrafiltrate decreases - Osmolality is unchanged - Vulnerable to ischaemic change
124
Osmolality of ultrafiltrate
300mosmol/L
125
Where is the external spermatic fascia derived
External oblique
126
What stimulates the release of atrial natriuretic peptide
Release from the heart in response to increased atrial stretch as a result of raised ECF
127
What stimulates ADH release
- Osmoreceptors in the hypothalamus detect increases in the osmolality of the ECF - Reduced circulating volume - Reduced arterial pressure - Angiotensin 2
128
Structure of epithelium in Bowman's capsule
- Podocytes - Do not form continuous layer - Contain foot processes
129
Tributaries of the ejaculatory ducts
- Duct of seminal glands | - Ductus deferens
130
Describe the shape and position of the right adrenal gland
- Pyramidal | - Embraces upper pole of kidney
131
Describe the uterosacral ligament
Extends from cervix to sacrum
132
Location and size of the seminal glands
- 5cm long - Lie between fundus of bladder and rectum - Superior to prostate
133
Describe the shape and position of the left adrenal gland
- Crescentic | - Embraces medial border of the kidney above the hilum
134
Superior relations of right kidney
- Liver | - Adrenal gland
135
How is autoregulation achieved
1. Myogenic - increase in pressure due to increase in flow causes distension of vessels, which causes smooth muscle contraction to reduce flow 2. Metabolic
136
Arterial supply to ductus deferens
Artery to ductus deferens - arises from superior vesical artery - Anastomoses with testicular artery
137
Function of FSH in males
Acts on sertoli cells of the testes and is important for spermatogenesis
138
Outline the capsules of the prostate gland
1. True capsule = thin, fibrous sheath surrounding the prostat 2. False capsule = condensed extraperitoneal fascia continuous with the fascia surrounding the bladder and Denonvilliers fascia posteriorly 3. Pathological capsule = BPH compresses the normal peripheral part of the gland, creating a capsule
139
Urethral epithelium
Stratified columnar
140
List the coverings of the kidney from in to out
1. Renal capsule 2. Perirenal fat (perinephric fat) 3. Renal fascia 4. Pararenal fat
141
Describe the arterial supply of the bladder
- Superior vesical arteries = anterosuperior parts of bladder - Inferior vesical arteries (A.K.A. vaginal arteries in females) = fundus and neck
142
Volume of semen provided by the prostate
20%
143
Describe the vascular course within the kidney
1. Renal arteries enter hilum 2. Branches to form interlobar arteries which ascend between pyramids 3. Branch to form arcuate arteries 4. Branch to form interlobular arteries 5. Afferent arteries arise from interlobular arteries 6. Give rise to glomerular capillaries
144
Normal resting bladder pressure
3cmH2O
145
What is the fate of angiotensin 1
Converted to angiotensin 2 by ACE in the lungs
146
Innervation of the scrotum
- Anterolateral = genital branch of genitofemoral - Anterior = anterior scrotal (branch of ilioinguinal) - Posterior = perineal branch of pudendal - Postero-inferior = perineal branches of posterior cutaneous nerve of thigh
147
Embryological origin of the ureter
Mesonephric duct
148
Length of male urethra
15-20cm
149
Describe the internal structure of the kidney
- Medulla | - Cortex (which extends into the medulla to divide it into triangular renal pyramids)
150
What substance is used to measure renal plasma flow and why
- Para-aminohippuric acid (PAH) | - Completely removed from the plasma in a single pass through the kidney
151
Parts of the cervix
1. Supravaginal - between isthmus and vagina | 2. Vaginal
152
Ligaments of the neck of the bladder
- Men = puboprostatic ligament | - Women = pubovesical ligament
153
How much is total renal blood flow
- 1.25L/minute | - 25% of cardiac output
154
Describe automatic reflex bladder
- Seen after spinal shock in injuries above S2-4 | - Bladder empties reflexly every 3-4 hours
155
What is the narrowest part of the male urethra
Membranous urethra
156
What occurs in the ascending loop of Henle
- IMPERMEABLE TO WATER - Responsible for active NaCl reabsorption - Osmolality of fluid leaving ascending limb 100mosmol/L
157
Venous drainage of the penis
Dorsal vein of the penis runs in groove between the corporal bodies and drains into the prostatic venous plexus
158
Outline the lymphatic drainage of the uterus
- Fundus = para-aortic, inguinal - Body = iliac - Cervix = external iliac, sacral, internal iliac
159
Outline the structure of the uterus
1. Fundus 2. Body 3. Cervix
160
Blood supply of uterus
Uterine artery - branch of internal iliac
161
Outline the venous drainage of the adrenal glands
- Right = short vein direct to IVC | - Left = long vein which contributes to left renal vein
162
3 divisions of the ureters
1. Abdominal 2. Pelvic 3. Intravesical
163
Origin of cremasteric artery
Inferior epigastric artery
164
Describe the Mesosalpinx
Broad ligament of the peritoneum that drapes over the fallopian tubes
165
3 common bladder abnormalities following spinal cord injury
1. Atonic bladder 2. Automatic reflex bladder 3. Autonomous bladder
166
Outline the two possible courses of efferent arterioles in the kidney
1. Supply of capillaries to the renal tubules (peri-tubular) 2. Vasa recta that supply blood to the medulla
167
Lymphatic drainage of the penis
- Glans and distal spongy urethra = Deep inguinal (bilateral) - Skin of penis = superficial inguinal
168
Length of the vagina
7cm
169
List the contents of the spermatic cord
- Testicular artery (from aorta) - Cremasteric artery (from inferior epigastric) - Artery of Vas deferens (from inferior vesical) - Genital branch of the genitofemoral cremaster - Sympathetic fibres (run on arteries) - Parasympathetic fibres (run on ductus deferens) (- Ilioinguinal nerve - runs on cord and not in it) - Ductus deferens - Pampiniform plexus - Lymphatic
170
Innervation of the prostate
Sympathetic, parasympathetic, sensory from inferior hypogastric plexus
171
Structure of the testes
- Outer Tunica albuginea - Inward-reaching septum between lobules of minute - Highly coiled semineferous tubules (joined to rete testes by straight tubules)
172
Origin of the tunica vaginalis
Closed sac of peritoneum
173
Arterial supply of the penis
Common penile artery - terminal branch of the internal pudendal artery
174
Outline the parts of the epididymis
1. Head 2. Body 3. Tail - continuous with vas deferens
175
Name given to the apex of the renal pyramids and what do they represent
Renal papilla - where urine is screted into the renal calyces of the renal pelvis
176
Ureter epithelium
Transitional
177
Function of LH in males
Stimulates Leydig cells to produce testosterone
178
Position of the ureters
Overly the transverse processes of L2-L5
179
What stimulates the release of aldosterone
- Angiotensin 2 - Raised potassium - Raised ACTH
180
Describe the clinical divisions (zones) of the prostate
1. Central zone - surrounds ejaculatory ducts (25% vol) 2. Transitional zone - central, surrounds urethra (5-10% vol) 3. Peripheral zone - main body of gland (65% vol)
181
Length of fallopian tubes
10-12cm
182
What forces govern glomerular filtration
1. Hydrostatic | 2. Osmotic (plasma proteins which arent filtered oppose hydrostatic pressure)
183
Length of cervix
2.5cm
184
Rate of urine production
1ml/kg/hr
185
Outline the blood supply of the ureters
Segmental: - Renal - Testicular and ovarian - Internal iliac - Inferior vesical

The Abdomen (8 decks)

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