Urinary System Flashcards
Function of kidneys
6
fluid balance
acid-base balance
maintenance of elecrolytes (K)
excreting waste
Production of EPO and Renin
Activation of vitamin D
Position of kidneys
retroperitoneal
lower border of 12th ribe to L3
Hilum at L1
right kidney sits slightly lower than left
Gerota’s fascia
conains kidney, fibrous capsule and perinephric fat
Hilum of kidney
transpyloric plane
VAP AP
anterior to posterior
Vein
Artery
Pelvis (ureter)
vessel for kidney transplant
external iliac
Relations to the right kidney
superior to inferioir
- anterior:
adrenal, liver, duodenum, colon, small bowel - posterior:
diaphragm, 12th rib, psos major, 3 muscles: quadratus lumborum, transversus abdominus, 3nerves: subcostal, iliohypogastric, ilioinguinal
Relations to left kidney
superior to inferior
- anterior: adrenal, stomach, spleen, pancreas, colon, small bowel
- posterior: diaphragm, 12th rib, 3 muscles: psoas major, quadratus lumborum, trasversus abdominus, 3 nerces: subcostal, iliohypogastric, ilioinguinal
renal vessels orientation with IVC/aorta
aorta sits on the left side of the IVC
right renal artery is longer than the left and passes posterior to the IVC
left renal vein is longer and passes anterior to the aorta
blood supply and lymphatics of the kidneys
renal arteries - L2
accessory renal arteries are common
5 segmental arteries at the hilum
renal vein to IVC
para-aortic nodes
epithelium ureter
transitional
ureter course
retroperitoneal
closely adherent to parietal peritoneum
from renal pelivis, medial border of psoas major, anterior to the tranverse processes of L2 to L5. cross common iliac bifuraction anterior to SIJ and pass down lateral pelvic side wall. at the level of the ischial spine turn forward and medial enetring the posterior lateral bladder.
Entering obliquely prevents reflux
in males the ureter passes anterior to the vas
in females rhe ureter is posterior to the uterine vessels
three narrowings of the ureter
ureteropelvic junction
as the ureter crossed pelvic brim
vesicoureteric junction
blood supply ureter
upper 1/3: renal aretrues
middle 1/3: branches of aorta and gonadal arteries
lower 1/3: internal ilaic branches and inferior vesical artery
movements of the ureter
vermicular when touched
Position adrenal gland
superomedial aspect of each kidney
surrounded by perinephric fat
within gerota’s fascia
what is the adrenal medualla made up of?
nervous tissue derived from neural crest cells
chromaffin cells act as postganglionic neurons, secreting noradrenaline and adrenaline in response to preganglionic stimulation
phaeochromocytoma
catecholamine-secreting tumour of chromaffin cells
** alpha and beta blockade is needed prior to surgery
layers of the adrenal cortex
zona glomerulosa - mineralocorticoids (aldosterone)
zona fasciculata - glucocorticoids (cortisol)
Zona reticularis -
(innermost) androgen secreting (dhea)
Blood supply adrenal
superior adrenal artery - branch of inferior phrenic
middle adrenal - branch from aorta
inferior adrenal - branch of renal artery
venous drainage by a single vein. direct to IVC on right and into renl vein on left
Blood supply to the bladder
superior and inferior vesicular arteries from internal iliac
vesical venous plexus to internal iliac vein
nerve supply to detrusor muscle
via hypogastric plexus
sympathetic L1,2 - inhibit muscle contraction
parasympathetic - s2-4 - stimulate contraction
most common types of bladder Ca
TCC
SCC
Mixed
Adenocarcinaoma (that order)
PC bladder ca
painles haematuria
risk facotrs bladder ca
aniline dyes
smoking
beta-naphthylamine
schtistosoma haematobium
how does the ureter enter the bladder?
at the base, one th corners of the trigone
peritoneal relations of the bladder
coers the superior surface and and upper part of the posterior surfacr
layers encountered for SPC insertion
skin
subcut
scarpa
linea
transversalis
preperitoneal fat
posterior relations to the bladder
male - recto vesicle pouch (denonvilliers fascia)
vas x2
ureters
female - vesicouterine pouch
ureters
ligaments that anchor the neck of the bladder and pelvic part of the urethra to the pelvic boens
women - pubovesical
men - puboprostatic
