Urinary System

Question 1

What structures make up the urinary system?

Answer 1

2 kidneys, 2 ureters, urinary bladder and urethra

Question 2

What process is responsible for the movement of urine down the ureters?

Answer 2

Peristalsis

Question 3

Where do the ureters end?

Answer 3

Posterior wall of the bladder, enter obliquely and in line with the symphysis pubis bone.

Question 4

What is the cell type that lines the renal pelvis, ureters and bladder?

Answer 4

Transitional epithelium

Question 5

What is the advantage of transitional epithelium lining the urinary system?

Answer 5

It can stretch and relax meaning the volume of the structures can change.

Question 6

What is micturition?

Answer 6

This is the process of urinary excretion

Question 7

What happens during micturition?

Answer 7

As bladder volume increases the pressure increases. This causes the detrusor muscles in the bladder wall to contract and relaxation of the internal urethral sphincter muscle. Voluntary contraction of external urethral sphincter muscle allows passage of urine from the body.

Question 8

What advice can be given to patients who need to improve their bladder control?

Answer 8

Pelvic floor exercises
These strengthen the pelvic floor muscles and help pt to regain control of contraction inhibiting urination.

Question 9

What is the bladder trigone?

Answer 9

This is an anatomical section of the bladder consisting of the 2 posterior openings for the ureters and the anterior urethral orifice at the neck of the bladder.

Question 10

What is bladder retention and what can cause it?

Answer 10

Inability to empty bladder despite being full.
May be caused by blocked urethra or weakening/impairment of the detrusor muscles allowing bladder contraction or relaxation of sphincter muscles.

Question 11

What is the normal glomerular filtration rate (GFR) for a healthy male and female?

Answer 11

Male - 125ml/min

Female 105ml/min

Question 12

List the 4 sections of the nephron?

Answer 12

1. Bowmans capsule/glomerulus
2. Proximal convoluted tubule
3. Loop of Henle (ascending and descending limb)
4. Distal convoluted tubule

Question 13

Where are the proteins aquaporins found and what is their role?

Answer 13

These are found in the walls of the collecting ducts and allow the reabsorption of water back into the blood depending on how much the body needs.

Question 14

What is the role of using contrast media during pre-treatment CT imagine?

Answer 14

Contrast media allows us to visualise the blood vessels easier. Blood vessels run alongside the lymphatic system therefore for patients who have lymph node involvement we can use contrast to get a better prediction of where the nodes are.

Question 15

What two kidney functions need to be checked before administering contrast media?

Answer 15

Creatinine clearance

GFR

Question 16

Give two things we tell patient to avoid if they are having frequent/excessive urination problems?

Answer 16

Caffeine (teas and coffees)

Alcohol

Question 17

What is a diuretic ?

Answer 17

A substance that promotes urine production by reducing water reabsorption into the blood and therefore lowering blood volume.

Question 18

What is ADH, where is it produced and what is its function?

Answer 18

Anti-diuretic hormone
Produced in the posterior pituitary
stimulates increased water reabsorption in the DCT and collecting ducts
Reduces volume of urine

Question 19

What two hormones do the kidney produce and what are their function?

Answer 19

Erythropoietin - stimulates red blood cell production

Calcitriol - natural form of vitamin D, maintains calcium levels

Question 20

What is renin?

Answer 20

An enzyme produced by the kidney involved in the control of blood pressure.

Question 21

What is hydronephrosis?

Answer 21

A condition where one or both kidneys become stretched and swollen as a result of a build of urine inside them caused by a blockage downstream.

Question 22

Give 4 etiological factors of bladder cancer

Answer 22

Tobacco
Age (being over 55)
Industrial carcinogens
Chronic bladder infections

Question 23

Give 5 signs and symptoms of presenting bladder cancer

Answer 23

1.Haematuria
2.Pain when urinating (cystisis)
3.Difficulty passing urine (Dysuria)
4.Hydronephrosis
5.Acute retention

Question 24

Give 3 signs and symptoms of advanced stage bladder cancer

Answer 24

Bone pain
Lower limb oedema
Reduced appetite/weight loss

Question 25

Explain the difference between a CT urogram and a cystogram?

Answer 25

CT urogram - contrast media is injected into the vein to visualise the entire urinary system via CT scan

Cystogram - dye is injected into the bladder via a catheter and is used for an x-ray of the urinary bladder.

Question 26

What is the name of the clinical investigative procedure that uses a camera on a flexible tube to look up the urethra?

Answer 26

Cystourethroscopy

Question 27

What 3 things can a cystourethroscopy do?

Answer 27

1. Visualise the internal anatomy of the urethra/bladder
2. biopsy the tissue
3. Surgical resection of tumour

Question 28

What is the most common type of bladder tumour?

Answer 28

transitional cell carcinoma

Question 29

What lymphatic nodes are commonly affected by bladder cancer spread?

Answer 29

1. Obturator nodes
2. External/internal iliac nodes
3. Para-aortic nodes

Question 30

How are non-muscle invasive bladder cancers treated?

Answer 30

Carcinoma in situ - no surgery, just immunotherapy with BCG

T1 and Ta - Surgery - trans urethral resection of the bladder followed by intravesical chemotherapy or intravesical BCG therapy (immunotherapy)

If patient is high risk of becoming muscle invasive they may have a cycstectomy - removal of bladder or part.

Question 31

Describe the positioning of the kidneys:

Answer 31

1. Right kidney is a cm lower than the left kidney due to liver
2. Run from T12 to L3
3. Rest on the anterior psoas muscle
   Lie either side of the vertebral colum
4. run through the transpyloric place

Question 32

Describe the position of the Ureters:

Answer 32

1. 25/30cm tubes that transport urine from the kidney to the bladder
2. Run from L1 to L5
3. 5cm from midline

Question 33

Describe the anatomical position of the bladder in males and females:

Answer 33

Male:
Posterior to the synthesis pubis
Anterior to the rectum
Superior to the prostate gland

Female:
Posterior to the synthesis pubis
anterior to the uterus and upper vagina
superior to the urethra and pelvic floor muscles