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Anatomy 314 - Urogen > Urinary tract > Flashcards

Urinary tract Flashcards

1
Q

Ureters are

A

Muscular ducts: 25-30 cm long.

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2
Q

Are ureters retro or intraperitoneal?

A

Retroperitoneal throughout course.

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3
Q

Ureters function

A

Transport urine from the kidney to the bladder.

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4
Q

Ureters have two parts:

A

Abdominal part
Pelvic part

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5
Q

Abdominal part of ureters

A
  • Run inferiorly from renal pelvis at hilum.
  • Crosses brim of pelvis at bifurcation of common iliac arteries.
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6
Q

Pelvic part of ureters

A
  • Run along lateral wall of pelvis.
  • Swing anteromedially opposite ischial spine, superior to levator ani muscle.
    ➢enters base of urinary bladder at upper corners.
    ➢Passes obliquely through the bladder muscle – forms one-way valve.
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7
Q
A
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8
Q

Ureters: Constrictions

A

Three Constrictions:
1. Junction of ureters and renal pelvis.
2. Where ureters cross brim of pelvic inlet over the common iliac artery.
3. During passage through wall of urinary bladder.

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9
Q
A
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10
Q
A
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11
Q

Ureters: Blood supply
* Abdominal part:

A
  • Mainly from the renal artery (from the
    medial side of ureter)
  • Drained by renal and gonadal veins
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12
Q

Ureters: Blood supply
* Pelvic part:

A
  • From common iliac, internal iliac and gonadal arteries.
  • Branches anastomose along length of urethra.
  • Terminal end supplied by uterine arteries in female, and inferior vesical arteries in male.
  • Venous drainage - names correspond to arteries.
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13
Q

Ureters: Nerve supply

A
  • Renal, abdominal aortic, and superior & inferior hypogastric plexuses.
  • Pain sensation: visceral afferent fibres to spinal ganglia and cord regions T11-L2.
  • Ureteric pain: usually referred to lower quadrant of the anterior abdominal wall, including the groi
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14
Q

Urinary bladder is a

A

Hollow organ with strong muscular walls which is distensible.

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15
Q

Urinary bladder function

A

Temporary reservoir for urine

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16
Q

Most anterior of the pelvic organs.

A

Urinary bladder

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17
Q

Where is the urinary bladder situated when it is empty vs full?

A
  • in pelvic cavity when empty.
  • Expands into the abdominal cavity when full.
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18
Q
A
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19
Q

Urinary bladder: Location in adults

A
  • Empty bladder partially superior & posterior to pubic bones (retropubic space).
  • Superior surface level with superior margin of pubic symphysis.
  • Superior to pelvic floor, almost entirely within lesser pelvis.
  • Inferior to peritoneum.
  • Full bladder – extends into greater pelvis in
    extraperitoneal fat of anterior abdominal wall
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20
Q

Urinary bladder: Location in Infants and young children:

A
  • Located in abdomen even when empty → enters pelvic cavity around 6 years of age.
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21
Q

Urinary bladder: Shape when empty

A
  • Empty: pyramid-shaped (that has fallen onto one margin) with four surfaces:
  • Superior (only surface covered with peritoneum).
  • Posterior.
  • Two inferolateral.
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22
Q

Urinary bladder: Parts

A
  • Apex – behind symphysis pubis.
  • Base (Fundus) – opposite apex.
  • Body – between apex & base.
  • Neck – inferior at meeting of base and inferolateral surfaces.
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23
Q
A
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24
Q

Apex

A
  • Points towards top of pubic symphysis
  • Median umbilical ligament (remnant of the urachus) continues superiorly up anterior abdominal wall to umbilicus.
25
Q

Base

A
  • Inverted triangle shape, points posteroinferiorly.
  • Ureters enter at the upper corners.
  • Urethra drains from lower corner.
  • Smooth triangular area between ureters & urethra – trigone
26
Q

Inferolateral surfaces

A
  • Between levator ani and obturator internus muscles above attachment of pelvic diaphragm.
27
Q

Urinary bladder Wall composed of

A

smooth muscle – detrusor muscle

28
Q

Detrusor muscle: of the urinary bladder

A

➢Forms internal urethral sphincter at neck (only in males).
➢Urinary continence, prevents reflux of semen into bladder in males.
➢Loops that encircle ureteric orifices –form valves to prevent backflow of urine.

29
Q

Trigone of urinary bladder:

A

smooth area containing ureteric orifices & internal urethral orifice.

30
Q

neck of the urinary bladder surrounds

A

internal urethra orifice.
➢Anchored by fibromuscular bands:
pubovesical ligaments (in females);
pubroprostatic ligaments (in males).

31
Q
A
32
Q

Urinary bladder: Relations

A

Posterior:
* Seminal glands (males).
* Vas deferens (males).
* Rectovesical space and septum (males). * Superior part of vagina (females).

Anterior:
* Pubic symphysis. * Pubic bones.
* Retropubic space.

Superior:
* Peritoneum.
* Small intestines.
* Vesico-uterine space (females).

Infero-lateral
* Levator ani & obturator internus muscles.

33
Q

Urinary bladder: Arterial supply

A

Branches of internal iliac arteries.
➢Superior vesical artery supplies
anterosuperior parts.
➢Inferior vesical artery supplies fundus and neck in males.
➢Vaginal artery supplies fundus and neck in females.
➢Branches of obturator & inferior gluteal also contribute small branches.

34
Q

Urinary bladder AA

A
35
Q

Urinary bladder: venous drainage

A
  • Venous drainage via vesical venous plexus into internal iliac veins: veins have same names as arteries.
  • Vesical venous plexus also drains internal structures & penis of male (prostatic plexus)
  • In females, vesical plexus receives blood from clitoris and communicates with vaginal & uterine venous plexuses.
36
Q

Urinary bladder: VV

A
37
Q

Urinary bladder: Nerve supply

A
  • Sympathetic fibers from inferior thoracic and upper lumbar (T11-L2 or L3) to the vesical plexuses through the hypogastric plexuses and nerves.
  • Parasympathetic fibers from S2, S3 and S4 conveyed by pelvic splanchnic nerves and inferior hypogastric plexus.
    ➢ Motor to detrusor muscle and inhibitory (relaxation) to the internal urethral sphincter of bladder (only present in males).
  • Sympathetic innervation at ejaculation in males: contraction of internal urethral sphincter (prevents semen from entering bladder).
  • Reflex information and pain sensation follow parasympathetic fibers (subperitoneal part of bladder) or sympathetic fibers (superior surface) – pelvic pain line.
38
Q
A
39
Q
A
40
Q

Urinary bladder: Lymphatic Drainage

A

Inferior part & neck of bladder: drain to internal iliac nodes. Supero-lateral part into external iliac nodes.
Neck also drains into sacral and common iliac nodes.

41
Q

Urethra: common characteristics

A
  • Begins at base of bladder at internal urethral orifice.
  • Ends at external opening in perineum.
  • Course is different in males and females.
  • Females: conveys urine only.
  • Males: conveys urine and semen (not at the same time).
42
Q

Female urethra: short(4cm).

A
  • Passes inferiorly through pelvic floor into perineum.
  • Passes through deep perineal pouch & perineal membrane.
  • External urethral sphincter (skeletal muscle) surrounds urethra in the pouch.
  • Opens into vestibule (between labia minora).
  • Urethral opening: anterior to vaginal opening.
  • Posterior part of urethra is attached to anterior surface of vagina.
  • Paraurethral mucous glands (Skene’s glands) open onto lateral margin of external urethral orifice.
43
Q
A
44
Q

Urethra: Male

A

long (20cm).
* Two bends along its course.
* Begins at base of bladder and passes inferiorly through prostate gland.
* Passes through deep perineal pouch and perineal membrane to enter root of penis.
* As it exits deep perineal pouch, bends anteriorly in the root of penis.
* When penis is flaccid, 2nd bend inferiorly when passing to the body of penis.
* When erect, no bend between root and body.
* Divided into preprostatic, prostatic, membranous and spongy parts.

45
Q
A
46
Q

Preprostatic part: of male urethra

A

1cm long, extends from base of bladder to prostate gland, is associated with internal urethral sphincter (smooth muscle).

47
Q

Prostatic part: of male urethra

A

3-4cm long, surrounded by prostate gland.
➢Lumen is marked by longitudinal midline fold of mucosa:
urethral crest.
➢Depression on each side of crest: prostatic sinus
➢Ducts of prostate empty into sinuses.
➢Seminal colliculus: circular elevation midway along urethral crest.
➢Prostatic utricle (blind ended pouch) opens into seminal colliculus.
➢On each side of prostatic utricle is the opening of the ejaculatory duct (conveys sperm from testis into urethra).

48
Q

Membranous: of male urethra

A

passes through deep perineal pouch, surrounded by external urethral sphincter (skeletal muscle).

49
Q

Spongy part: of male urethra

A

surroundedbyerectiletissue(corpus spongiosum) of penis.
➢Enlarged at end of penis: navicular fossa.
➢Bulbourethral glands in the deep perineal pouch open into
the bulb at the base of the penis.
➢External urethral orifice: sagittal slit at end of penis.

50
Q
A
51
Q

Internal iliac artery Arises from

A

common iliac artery.

52
Q

Internal iliac artery descends

A

posteromedially into the lesser pelvis, medial to external iliac vein & obturator nerve, lateral to the peritoneum.

53
Q

Internal iliac artery supplies

A

pelvic viscera, pelvic walls & floor, perineum, gluteal region.

54
Q

Internal iliac artery divides into

A

anterior and posterior divisions.

55
Q

Many variations and connections (anastomoses) between branches of the internal iliac artery.

A
56
Q
A
57
Q
A
58
Q
A

Anatomy 314 - Urogen (10 decks)

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