Urinary system Flashcards
Enumerate the components of the urinary system and their respective function
Kidneys- process a filtrate of the blood to form urine
Ureters - conduct urine from the kidney to bladder
Urinary bladder - temporary storage for urine
Urethra - passage thru which urine is voided
What are the functions of the urinary system?
Excretory - waste products of metabolism is excreted thru production of urine
Maintenance of body homeostasis - kidneys maintain the acid base balance of the body and maintain the normal body fluid by eliminating excess waster
Endocrine - releases of hormones like erythropoietin and renin ( control blood pressure)
Reproductive - exclusive to male urethra as passageways for semen. ( in females, urethra is for urinary function only)
Explain the gross structure of the kidney
Bean shaped, reddish brown organ
Retroperitoneal on the posterior abdominal wall
Extend from T12 - L3
120-170g avg 150g
10-12cm L x 5-6cm W x 3-4cm a-p thickness
Explain the position of the kidney
Left kidney is 1-2cm higher than the right kidney because of the presence of the liver in the right
In a Supine position - Left kidney superior pole - T12 Inferior pole - L3 Right kidney - IVC Left kidney - aorta
What structures can bee seen. Between the kidneys?
Celiac plexus and ANS ganglia
Explain the anterior anatomical relations of the kidney
Right kidney :
Transpyloric plane passes thru right pole
Hepatic flexure of the colon and duodenum
Right kidney is separated from the liver by the Hepatorenal recess
Left kidney: Tail of the pancreas Splenic flexure Stomach Jejunum Descending colon
Explain the posterior anatomical relations of the kidney
2/3 of the posterior kidney lie on the quadrants limbo rum ms ( part of the posterior abdominal wall)
Medially - psoas ms
Laterally - transversus abdominis
Upper 1/3 of posterior kidney lies on the abdominal surface and arcuate ligament of the diaphragm
What are the structures to take note of during surgery of the kidney via the posterior abdominal wall?
Sub costal or 12th intercostal nerve
Iliohypoogastric nerve
Ilioinguinal nerve
What is the main function of the renal fascia?
It provides or serves as a barrier against spread of infection
Note: renal fascia
- represents the TRUE capsule
- can be stripped off from normal parenchyma
- thin, fibrous glistening membrane which encloses the renal parenchyma
What is the adipose capsule found immediately outside the true capsule?
Perirenal/ perinephric fat
The renal capsules are compose of what structures?
Perirenal/perinephric fat
Gerota’s fascia/ fibrous renal fascia
Pararenal/ para nephron fat
What is the Pararenal or para euphoric fat?
Extra peritoneal fat of the lumbar region
What is the gerota’s fascia or fibrous renal fascia?
Fascia enclosing the Perirenal fat. Referred to as renal fascia
What is the Perirenal or perinephric fat?
Adipose capsule found immediately outside the true capsule
Explain the border curvature relationship of the kidney
Convex lateral border
Concave medial border
Explain the structure of the kidney
Convex lateral border
Concave medial border
Rounded poles , superior and inferior
Medial surface is concave indented by the hills which leads to the renal sinus
Differentiate renal sinus vs renal pelvis
Renal sinus is the area surrounding the calyces
Renal pelvis is the expanded upper end of the ureter.
It transmits renal vessels
Hilus
State the renal vessels from anterior to posterior
Renal vein
2 renal arteries
Ureter
Differentiate the shape of kidney and renal pelvis
Kidney is bean shape or ovoid shape
Renal pelvis is flattens, funnel shape
It is the expansion of the superior end of the ureter
Renal pelvis
Note: apex of the renal pelvis is continuous with the ureter
Receive 2-3 major calyces
The minor calyces of the renal pelvis is indented by what structure?
Renal papilla, the apex of the renal pyramid, from which the urine is excreted
Explain the internal appearance of the kidney
The renal pyramid contain the collecting tumbles and from the medulla of the kidney. The renal cortex contain the renal corpuscles.
The renal papilla, project into the minor calyces,into which they discharge urine, which then passes into the major calyces and renal pelvis
Enumerate the structures of the renal parenchyma
Cortex ( outer ) - dark brown and grainy
Medulla ( inner ) - light brown and striated
List and explain the parts of the outer renal parenchyma.
Cortical arches
Renal columns of bertin - in between pyramids
Medullary rays - long delicate processes separating tubules
Contains Nephron - only in cortex
Note: outer renal parenchyma is also known as cortex
Perforated tips located in the medulla or the inner renal parenchyma where the urine passes through.
Area cribosa
Note:
Medulla have 6-10 medullary pyramids
Apex - renal papilla and area cribosa
Base - medulAry rays made up of collecting tables and LH
Each medullary pyramids plus the cortical tissue at its base and along it’s side constitutes what structure?
Renal lobe.
Laterality and shaped of the suprarenal (adrenal ) glands
L suprarenal gland - crescent shape - superomedial
R - suprarenal gland - pyramid in shaped - more apical location
It is located between superomedial aspects of kidney and diaphragm
Suprarenal gland
Suprarenal gland is separated from the kidney via a what? Which is a part of what?
Thin septum , renal fascia
What is the major attachment of suprarenal gland?
Diaphragmatic crura.
Suprarenal gland is not attached to the kidney so the movement of the diaphragm may move the gland
Compare the left and right adrenal gland by shape, location and anatomical relations
Shape: L-crescent R-pyramid
Location: L-superomedial R-more apical, located anterolateral to the right crus of diaphragm
Anatomical relations: L-related to spleen , stomach, pancreas and left crus of diaphragm
R-in contact with liver, anterolaterally
In contact with IVC, anteromedially
What are the parts of adrenal glands?
Suprarenal cortex - derived from mesoderm
- secretes androgen and steroids, these hormones cause the kidneys to retain sodium and water in response to stress, increasing blood volume and blood pressure.
Suprarenal medulla - from neuroectoderm
- mass of nervous tissue permeated with capillaries and sinusoids associated with sympathetic nervous system
- chromaffin cells of medulla are related to sympathetic Anglian neurons and both derivation and function
Chromatin cells secretes?
Catecholamines
Where epinephrine and norepinephrine activates the body’s fight or flight response
Why does the suprarenal gland or adrenalin gland has abundant blood supply?
Because of its endocrine function
What are the arterial blood supply of the adrenal gland or suprarenal gland
Superior suprarenal a. Fom inferior phrenic a.
Middle suprarenal a from abdominal aorta
Inferior suprarenal a from the renal a
What are the venous drainage of the suprarenal glands via suprarenal veins
R suprarenal veins -> IVC
L suprarenal veins -> L renal vein
What are the nerve supply of the suprarenal glands
Celiac plexus and abdominopelvic splay chic nerves
Presynaptic sympathetic fibers - derived from the lateral horn of gray matter of spinal cord T10-L1
What is the main arterial blood supply to the kidneys?
Renal Artery
Which renal artery is longer?
Right renal artery
Where does the renal artery arises?
Arises from the IV disc between the L1 and L2
What are the vascular/Renal segments?
Apical Segmental a. Anteroinferior Segmental a. anterosuperior Segmental a. inferior Segmental a. posterior Segmental a.
Where does the venous drainage of the kidneys blood supply
Renal veins -> IVC
Left renal vein receives blood from?
L. suprarenal v
L gonadal v
L ascending lumbar v
what are the microvasculature of the kidney
interlobar a
afferent arteriole
efferent arteriole
peritubular capillaries
a microvasculature of the kidney that is present on each side of the renal lobe
interlobar a
a microvasculature of the kidney that serves as the entrance to the glomerus
afferent arteriole
a microvasculature of the kidney that serves as the exit from the glomerus
efferent arteriole
In the vasa recta, the microvasculature to the kidneys loop back into thecortex to become _____?
interlobular vein
What are the medullary blood supply?
vasa recta
What are the two types of vasa recta?
vasa recta vera - true vasa recta
vasa recta spuriae - false vasa recta
where does the vasa recta vera arise directly from?
arcuateor interlobular vein
participates in countercurrent exchange system
vasa recta vera
vasa recta spuriae extends to __?
cortex and the medulla
What are the parts of the ureter
renal pelvis
abdominal uereter - false ureter
pelvic ureter - true ureter
intravesical ureter
Ureters are muscular tube that is ____ in location and its length is ____. Ureters is continous superiorly with the ______.
retroperitoneal
20-25cm
renal pelvis
right ureter is parallel or lateral to _____ while the left ureter is parallel or lateral with the ______
IVC
abdominal aorta
Ureter runs in the medial part of ____
psoas muscles
ureter is obliquely crossed by ____
gonadal vessels
ureter lies anterior to the ______ from the ____
internal iliac artery
pelvic side wall
ureters enter the bladder _____?
posteriorly
ureters cross ________ to enter ______ near the bifurcation of ________
iliac vessels ; pelvis; internal and external arteries
Uereters courses under the uterine vessels very near the _____ of the uterus
isthmus
state the ureteric constrictions
- junction of tghe ureters and renal pelvis
- where the ureters cros the pelvic brim
- during passage thru the wall of urinary bladder
It is the most common pathalogic condition in the kidneys
kidney stones
What are the arterial blood supply of the ureters
renal a
testicular or ovarian a
abdominal a
common iliac a
These branches of the arterial blood supply of the ureter divide into ascending and descending branches and form ______ on the ureter wall
longitudinal anastomoses
Waht is the venus drainage of the ureter
renal v
gonadal v
Blood vessels of the ureters are easily traumatized during surgery, damage to the small blood vessels may lead to _____
ischemia
histological shape of ureter
stellate shaped lumen
What is the epithelial lining of ureter
transitional epithelium or urothelium - —-single layer of small basal cells
- intermediate layer of one to several layers of columnar cells
- umbrella cells (polyhedral) - binucleated / multinucleated
umbrella (polyhedral) cells expresses _____ whcih protect the lining of the ureter from toxic effects of urine
uroplakin proteins
The kidney is innervated by
- renal nerve plexus
- sympathetic and parasympathetic fibers from the abdominopelvic sphlanchnic nerves
The ureter is innervated by
renal, aortic, superior and inferior hypogastric nerves
_____ follow the sympathetic fibers to spinal ganglia and cord segments T11-L2
Visceral afferent pain fibers
In the renal calculi, pain is referred to the ______
(loin of the groin)
ipsilateral lower quadrant of the anterior abdominal wall
Afferent pain fibers follow sympathetic fibers to the ___
spinal ganglia and cord segments T11-L2
Name the corresponding innervation to the following organs: kidney, abdominal part of the uterus and suprarenal gland
kidney - renal nerve plexus
abdominal part of the uterus - renal, abdominal aortic and superior hypogastric plexus
suprarenal gland - celiac plexus and greater, lesser, least splanchnic nerves
a. renal lymphatic vessels drain into ____
b. superior part of ureter drain into ____
c. middles part of ureter drain into ____
d. inferior part of ureter drain into ____
e. suprarenal LV from medulla drain into ____
a. R and L lumbar lymph nodes
b. lumbar nodes
c. common iliac nodes
d. common, external, internal iliac nodes
e. lumbar lymph nodes
Extraperitoneal organ lying within the pelvis that is receptacle for urine storage
Urinary bladder
Urinary bladder have strong muscular wall called
Detrusor ms
State the shape of the urinary bladder and its location when it is empty and full
empty - tetrahedral; lies within the lesser pelvis
filled state - bladder is ovoid shapes; ascends abdominal cavity
Central and superoposterio part taht expands freely, rises above pubic crest
Fundus
Apex is the anterosuperior portion of the bladder, connected to anterior abdominal wall by ____
median umbilical ligament (remnant of the primitive urachus)
The posteroinferior portion of this part bladder that has two ureteric orifices
body
The base of the bladder lies on t he pelvic floor forming what?
TRIGONE
TRIGONE is a triangular area fromed by a line drawn between twe ureteric orifices and apex formed by the ___
internal urethral meatus
The neck of the bladder is continous with
urethra
This is attached directly to the base of the bladder, anterior to the rectum
prostate gland - base
The base of the urinary bladder among females rest directly on the ___ and is closely related to _____
pelvic floor inferior to the uterus
anterior vaginal wall
Fibrous cord extending from apex of the bladder to the umbilicus
Median Umbilical Ligament
Median Umbilical Ligament is a remant of
urachus
It stabilizes the bladder anteriorly
Lateral Umbilical Ligament and Medial Umbilical Ligament
medial puboprostatic (males ) or medial pubovesical ligament (females) is from the ___ to ___
From the back of symphysis pubis to bladder neck and prostate (males)
lateral puboprostatic (males ) or lateral pubovesical ligament (females) is from the ___ to ___
from pelvic fascia at area of levator ani to the neck of the bladder and prostate
Stabilizes the bladder neck
lateral puboprostatic (males ) or lateral pubovesical ligament (females)
What are the branches of the internal ilian artery
superior vesical a. - superolateral/anterosuprior wall
inferior vesical a.
the inferior vesical artery is replaces by what in the females
vaginal artery
inferiot vesical artery is consist of
ureter, fundus and neck of bladder, prostate and urethre
In the venous drainage of bladder, the pericesical plexus drains to ____ which drains to ____
inferior vesical v. ; internal iliac vein
Hypogastric Plexus or “Filling Nerves” is found in what vertebral level?
T11-L2
Inhibit detrussor muscle contraction
Hypogastric Plexus or “Filling Nerves”
Hypogastric Plexus or “Filling Nerves” increases _____ and stimulates _____
internal urethral sphincter tone
ejaculation
-sympathetic
Pelvic Splanchnic Nerves and Inferior Hypogastric Nerves or “Emptying Nerves” is found at what vertebral level
S2-S4
- parasympathetic
- relaxes the internal urethra sphincter
- contract the bladder
Lymphatic drainage of the bladder found in the anterior/superolaterl wall
external iliac node
Lymphatic drainage of the bladder found in the posterior/fundus and neck lymphatic vessels
internal iliac node
Lymphatic drainage of the bladder found in the neck of bladder lymphatic vessels
sacral nodes and/or common iliac nodes
What is the basic histological structure of the bladder
- mucosa (urothelium) - lined by transitional epithelium
- lamina propria
- muscularis mucosae (detrusor ms)
adventitia
Urothelium is made of
a. Basal layer
b. Intermediate layer
c. Umbrella cells
– cuboidal cells
– polygonal; has ability to stretch
– protective layer
Lamina propria is made of
connective tissue bed with capillaries, lymphatics and nerves
Inner, middle and outer layers of smooth muscles (detrusor muscles) is made of
longitudinal ms layer
circular ms layer
male urethra starts from ___ to ____
- bladder neck
- external meatus of glands penis
20cm in length
The 3 parts of urethra
- prostatic urethra - 3cm long - widest and most dilatable portion
- membranous urethra - 2cm long - shortest and least dilatable
- spongy or penile urethra - 15cm long
Parts of the prostatic urethra
- urethral crest
- prostatic sinuses - where prostate glands opens
- utricle
- ejaculatory ducts
This is where the urinary and reproductive system of males converge
prostatic urethra
membranous urethra is surrounded by ____
urethral shpincter ms
Prostatic urethra transverses through prostate gland and terminate at _____
superior fascia of urogenital diaphragm
Female urethra has this type of glands that is homologous of prostate gland in males) and are found at sites of _____
paraurethral glands
external urethral meatus
female urethra -
- 4cm long
- exclusively a urinary organ
What are the blood supply of the urethra for males and females
males
- prostatic vesels - inferior vesical and middle rectal artery - in prostatic urethra
- dorsal artery of penis - in membrabous and spongy urethra
females
- internal pudendal a
- vaginal artery
What are the venous drainage of the urethra for the males and females
males - prostatic venous plexus
females- internal pudendal vein
vaginal vein
What innervates the male’s urethra
?
prostatic nerve plexus - from hypogastric plexus
dorsal nerves of penis from pudendal nerve
Waht innervates the female’s urethra?
vesical nerve plexus
pudendal nerve
What are the histological parts of the male urethra
- urethral mucosa - large longitudinal folds
- prostatic urethra - lined by transitional epithelium
- membranous urethra is lined by stratified columnar and pseudostratified epithelium
- spongy urethra i slined by stratified columnar epithelium and pseudostratified columnar epithelium with stratified squamous epithelium distally
What are the histological parts of the female urethra (lining)
- Proximal part - lined by transitional epithelium
- distal part - lined by stratified squamous, non-keratinizing
- middle part - surrounded by external sphincter (striated ms)
Fibrous cord extending from apex of the bladder to the umbilicus
Median Umbilical Ligament
Median Umbilical Ligament is a remant of
urachus
It stabilizes the bladder anteriorly
Lateral Umbilical Ligament and Medial Umbilical Ligament
medial puboprostatic (males ) or medial pubovesical ligament (females) is from the ___ to ___
From the back of symphysis pubis to bladder neck and prostate (males)
lateral puboprostatic (males ) or lateral pubovesical ligament (females) is from the ___ to ___
from pelvic fascia at area of levator ani to the neck of the bladder and prostate
Stabilizes the bladder neck
lateral puboprostatic (males ) or lateral pubovesical ligament (females)
What are the branches of the internal ilian artery
superior vesical a. - superolateral/anterosuprior wall
inferior vesical a.
the inferior vesical artery is replaces by what in the females
vaginal artery
inferiot vesical artery is consist of
ureter, fundus and neck of bladder, prostate and urethre
In the venous drainage of bladder, the pericesical plexus drains to ____ which drains to ____
inferior vesical v. ; internal iliac vein
Hypogastric Plexus or “Filling Nerves” is found in what vertebral level?
T11-L2
Inhibit detrussor muscle contraction
Hypogastric Plexus or “Filling Nerves”
Hypogastric Plexus or “Filling Nerves” increases _____ and stimulates _____
internal urethral sphincter tone
ejaculation
-sympathetic
Pelvic Splanchnic Nerves and Inferior Hypogastric Nerves or “Emptying Nerves” is found at what vertebral level
S2-S4
- parasympathetic
- relaxes the internal urethra sphincter
- contract the bladder
Lymphatic drainage of the bladder found in the anterior/superolaterl wall
external iliac node
Lymphatic drainage of the bladder found in the posterior/fundus and neck lymphatic vessels
internal iliac node
Lymphatic drainage of the bladder found in the neck of bladder lymphatic vessels
sacral nodes and/or common iliac nodes
Fibrous cord extending from apex of the bladder to the umbilicus
Median Umbilical Ligament
Median Umbilical Ligament is a remant of
urachus
It stabilizes the bladder anteriorly
Lateral Umbilical Ligament and Medial Umbilical Ligament
medial puboprostatic (males ) or medial pubovesical ligament (females) is from the ___ to ___
From the back of symphysis pubis to bladder neck and prostate (males)
lateral puboprostatic (males ) or lateral pubovesical ligament (females) is from the ___ to ___
from pelvic fascia at area of levator ani to the neck of the bladder and prostate
Stabilizes the bladder neck
lateral puboprostatic (males ) or lateral pubovesical ligament (females)
What are the branches of the internal ilian artery
superior vesical a. - superolateral/anterosuprior wall
inferior vesical a.
the inferior vesical artery is replaces by what in the females
vaginal artery
inferiot vesical artery is consist of
ureter, fundus and neck of bladder, prostate and urethre
In the venous drainage of bladder, the pericesical plexus drains to ____ which drains to ____
inferior vesical v. ; internal iliac vein
Hypogastric Plexus or “Filling Nerves” is found in what vertebral level?
T11-L2
Inhibit detrussor muscle contraction
Hypogastric Plexus or “Filling Nerves”
Hypogastric Plexus or “Filling Nerves” increases _____ and stimulates _____
internal urethral sphincter tone
ejaculation
-sympathetic
Pelvic Splanchnic Nerves and Inferior Hypogastric Nerves or “Emptying Nerves” is found at what vertebral level
S2-S4
- parasympathetic
- relaxes the internal urethra sphincter
- contract the bladder
Lymphatic drainage of the bladder found in the anterior/superolaterl wall
external iliac node
Lymphatic drainage of the bladder found in the posterior/fundus and neck lymphatic vessels
internal iliac node
Lymphatic drainage of the bladder found in the neck of bladder lymphatic vessels
sacral nodes and/or common iliac nodes
Urothelium is made of
a. Basal layer
b. Intermediate layer
c. Umbrella cells
– cuboidal cells
– polygonal; has ability to stretch
– protective layer
Lamina propria is made of
connective tissue bed with capillaries, lymphatics and nerves
Inner, middle and outer layers of smooth muscles (detrusor muscles) is made of
longitudinal ms layer
circular ms layer
male urethra starts from ___ to ____
- bladder neck
- external meatus of glands penis
20cm in length
The 3 parts of urethra
- prostatic urethra - 3cm long - widest and most dilatable portion
- membranous urethra - 2cm long - shortest and least dilatable
- spongy or penile urethra - 15cm long
Parts of the prostatic urethra
- urethral crest
- prostatic sinuses - where prostate glands opens
- utricle
- ejaculatory ducts
This is where the urinary and reproductive system of males converge
prostatic urethra
membranous urethra is surrounded by ____
urethral shpincter ms
Prostatic urethra transverses through prostate gland and terminate at _____
superior fascia of urogenital diaphragm
Female urethra has this type of glands that is homologous of prostate gland in males) and are found at sites of _____
paraurethral glands
external urethral meatus
female urethra -
- 4cm long
- exclusively a urinary organ
What are the blood supply of the urethra for males and females
males
- prostatic vesels - inferior vesical and middle rectal artery - in prostatic urethra
- dorsal artery of penis - in membrabous and spongy urethra
females
- internal pudendal a
- vaginal artery
What are the venous drainage of the urethra for the males and females
males - prostatic venous plexus
females- internal pudendal vein
vaginal vein
What innervates the male’s urethra
?
prostatic nerve plexus - from hypogastric plexus
dorsal nerves of penis from pudendal nerve
Waht innervates the female’s urethra?
vesical nerve plexus
pudendal nerve
What are the histological parts of the male urethra
- urethral mucosa - large longitudinal folds
- prostatic urethra - lined by transitional epithelium
- membranous urethra is lined by stratified columnar and pseudostratified epithelium
- spongy urethra i slined by stratified columnar epithelium and pseudostratified columnar epithelium with stratified squamous epithelium distally
What are the histological parts of the female urethra (lining)
- Proximal part - lined by transitional epithelium
- distal part - lined by stratified squamous, non-keratinizing
- middle part - surrounded by external sphincter (striated ms)
Embryology, What are the 3 overlapping kidney systems
Pronephros - rudimentary and non-functional
mesonephros - functions for short time
metanephros - definitive kidneys - develops its own nephrons
Pronephros is an excretory organ which appears first beginning at what week of intrauterine life
4th
This regress in females, and serves as a conduit for the semen coming from the testes to the urethra for males
Wolffian/ mesonephric duct
metanephros appears in what week ?
5th
Metanephros collecting system originates from the ____ which delvelops from _____
ureteric bud
mesonephric duct
Embryology, structures that originates from the ureteric bud
ureter
renal pelvis
calyces
collecting tubules