Urinary Tract, Posterior Abdominal Wall and Pelvis (Uro) Flashcards
What two terms are used to refer to the adrenal glands?
Adrenal and Suprarenal
Where to the Adrenal glands lie?
Close to the upper pole of each kidney
Where does the Left adrenal gland lie near(2)?
Posterior to stomach and pancreas
Which arteries supply each gland? Where does each branch from?
Superior adrenal artery- Inferior phrenic artery
Middle adrenal artery- Abdominal aorta
Inferior adrenal artery- renal artery
Where does blood from each adrenal gland flow into?
Left adrenal gland- Left adrenal vein- left renal vein then IVC
Right adrenal gland- Right adrenal vein then IVC
What are the outer and inner parts of the adrenal gland respectively? What does each one secrete? outer-3 inner-1
Cortex and Medulla
Cortex- steroid hormones (Cortisol, aldosterone and testosterone)
Medulla- adrenaline
Name the structures
a- Kindey
b-Adrenal gland
c-Right adrenal gland
d-IVC
e-Aorta
f-Inferior phrenic artery
g-Superior adrenal artery
h-Middle adrenal artery
i-Inferior adrenal artery
j-Left adrenal vein
k-Renal artery
L-Renal vein
M-Ureter
N-Left gonadal vein
o-Right gonadal vein
What shape are the Kidneys? How long, wide and thick are they?
Bean shaped
11cm long
7cm wide
3cm thick
Are the kidneys within the peritoneum? What does this mean the Kidneys are?
Outside peritoneum
Extra-peritoneal
Where are the kidneys on either side of? What three layers cover it (inner to outer)?
Either side of upper lumbar vertebrae
Perinephric fat (fatty layer)
Renal fascia
Paranephric fat
Where is the Renal hilum what 4 structures pass through it?
Medial border of kidney
Renal vessels, nerves, lymphatics and ureter
What are the two arteries that supply the kidney? What are they branches of?
Left and right renal arteries
Branches of aorta
What two veins drain the kidneys? What do they join directly to? What level?
Left and right renal veins
Inferior vena cava
L1/L2
What are the three parts of the internal kidney?
Cortex, medulla and calyces
What is the outer part of the kidney called? What 5 structures of the nephron are found in this part?
Cortex
Parts:
-Glomeruli
-Bowman’s capsule
-Proximal tubules
-Distal tubules
-Part of collecting duct
What is the inner part of the kidney called? What is it arranged into? What two structures are present in this part?
Medulla
Pyramids
Parts:
-Loop of henle
-Collecting ducts
Where does urine travel into from the collecting ducts? Via what structure?
Minor Calyx
Via the renal papilla (Apex of medullary pyramid)
What do the Minor calyx merge to form? What do these structures merge to form? What is the final structure continuous with?
Merge to form major calyx
Merge to form Renal pelvis
Continuous with Ureter
Name the structures
a- Ureter
b- Renal pelvis
c- Major calyx
d- Minor calyx
e- Renal cortex
f-Renal pyramids
g- Renal papilla
h- Renal sinus
i- Renal columns
j- Renal capsule
Where do the ureters carry urine from and to? Describe the structure. How do they transport urine?
Kidney to Bladder
Narrow tubes with muscular walls
Via peristalsis
Describe the structure of the urinary bladder. Where is it located? Below what? What does this make it?
Hollow muscular organ
Pelvis, below peritoneum
Infra-peritoneal
What structure is the bladder located posterior to? What two structures is it located anteriorly to?
Posterior- Pubic symphysis
Anterior- Vagina and rectum
What is the name of the process of squeezing out urine? What is the smooth muscle in the bladder known as?
Micturition
Detrusor
Where do the ureters join the bladder? Where do they enter? What is this?
Posterior aspect of bladder near the base
The trigone
Smooth internal wall of the triangular area of the bladder
What is the formed when the ureter enters the trigon at an angle? What does this prevent? What characteristic of the Bladder mucosa prevents it tearing?
Rudimentary valve
Backflow of urine
Rugae (folds)
What arteries supply the bladder? What are they a branch of? What vein drains the bladder? What does this join?
Vesical arteries supply bladder and branch of internal iliac artery
Vesical veins drain bladder and drain into internal iliac vein
What two structures is the release of urine controlled by?
Internal and external urethral sphincters
Where is the internal urethral sphincter located?
What is it composed of and what type of control is it under?
Base of bladder (where it opens into the urethra)
Smooth muscle and under involuntary control
What is the shape of the bladder when it is empty? Where does it extend above when its full? How much urine can it accomodate?
Flat
Superior aspect extends above pubic symphysis
400-600mL
Where is the external urethral sphincter located in men and woman respectively? What is it composed of? What type of control is it under?
Inferior to prostate in males and in the deep perineal pouch in females
Skeletal muscle
Voluntary control
What is the somatic innervation of the Urinary bladder and urethral sphincters and spinal level? What does this allow?
Branches of the pudendal nerve (S2-S4)
Conscious control of external urethral sphincter
What is the sympathetic innervation of urinary bladder and urethral sphincters? What spinal level does this come from? What does it allow?
Branches of hypogastric nerve (Sympathetic chain T12-L2)
Relaxation of detrusor and contraction of the internal urethral sphincter, allowing storage of urine
Where does the Posterior Abdominal Wall extend to and from? What does it consist of (3 structures)?
Attachments of diaphragm to the pelvic brim
Lumbar spine with the psoas and quadratus lumborum muscles
What is the Parasympathetic Innervation of the Urinary bladder and Urethral sphincters? What spinal level? What does this allow?
Pelvic splanchnic nerves (S2-S4)
Contraction of the detrusor and relaxation of the urethral sphincter, allowing initiation of micturition
What two blood vessels ascend/descend with the posterior abdominal wall? What are found on each side of the lumbar spine involved in nervous transmission?
Aorta (with associated autonomic plexuses and lymph nodes)
Inferior vena cava
Sympathetic trunks
Name these structures
a- External Iliac artery
b-Ureter
c-Kidney
d-Testicular artery
e-Psoas major
f-Bladder
What descends on the surface of the psoas muscle lateral to aorta and IVC? What descends over this structure?
Ureters
Gonadal vessels (supply testes or ovaries)
Name structures a-h
A- femoral nerve
B- Genitofemoral nerve
C-Lateral femoral cutaneous nerve
D-Ilioinguinal nerve
E-Iliohypogastric
F-Subcostal nerve
G-Inferior vena cava
Name structures i-o
H-Aorta
I-Diaphragm
J- Left renal vein
K= Left gonadal vein
L- Gonadal artery
M-Quadratus lumborum muscle
N-Psoas muscle
O-Pelvic brim
What makes up the Lumbar plexus? With a contribution of? What 4 aspects do they innervate?
L1-L4 (t12 contirbution)
Skin
Muscles
abdominal wall
Thigh
What two nerves supplies the anterior abdominal wall muscles and skin of external genitalia?
Iliohypogastric and Ilioinguinal
What does the Genitofemoral nerve innervate?
Skin of external genitalia
What does the Lateral femoral cutaneous nerve and Femoral nerve supply respectively?
Skin over Lateral thigh
Muscles and skin of anterior thigh
What does the Obturator nerve supply?
Muscles and skin of medial thigh
Where does the abdominal aorta travel to and from? Where does it travel in terms of the midline? What does it bifurcate into when terminated?
T12-L4
Left of midline (posterior abdominal wall)
Bifurcates into left and right common iliac arteries
What are the three unpaired branches of the abdominal aorta? What levels does each leave the aorta?
Coeliac trunk- T12
Superior Mesenteric Artery- L1
Inferior Mesenteric Artery- L3
What are the four paired branches of the Abdominal aorta?
Renal
Adrenal
Gonadal
Lumbar
What two veins form the IVC at what level? Where does it ascend in terms of the midline?
Right and left common iliac veins
L5
Right to midline of posterior abdominal wall
What are the 3 functions of the bony pelvis? (3 structural and two others)
Supporting: spine torso and upper body
Locomotion
Housing and protecting pelvic viscera
Three main bones of the Bony pelvis?
Sacrum, Left Hip and Right hip
Name structures a-h
a-Ischium
b- Acetabulum
c- Pubis
d- Coccyx
e- Ilium
f-Sacrum
g- Lumbar vertebrae
h-Intercristal line
Name structures i-o
i- Intertubecular plane
j- Iliac tubercle
k- Anterior superior iliac spine
l- Superior pubic ramus
m- Inferior pubic ramus
n-Pubic tubercle
o- Pubic symphysis
What three smaller bones is the Hip bone composed of?
Ilium
Ischium
Pubis
What are the 5 articulations o the bony pelvis?
- Hip joint
- Sacroiliac joint
- Pubic symphysis
- Lumbosacral joint
- Sacrococcygeal joint
What does each of the 5 joints of the bony pelvis articulate?
Hip joint- Head of femur and acetabulum
Sacroiliac joint- Sacrum and Ilium
Pubic symphysis- Two pubic bones
Lumbrosacral Joint- 5th lumbar vertebra and sacrum
Sacrococcygeal- Sacrum and coccyx
What are the six surface landmarks of the Bony pelvis?
- Iliac crest
- Anterior superior iliac spine
- Iliac tubercle
- Pubic tubercle- Inguinal ligament
- Mid inguinal point
Which Surface landmark of the bony pelvis is this? What level is its highest point? What is this useful for?
Iliac crest
Intercristal line- L4/L5
Lumbar puncture
What surface landmark of the bony pelvis is this?
Anterior superior iliac spine (Most anterior point of ilium)
Which surface landmark of the bony pelvis is this? What cuts it in half?
Iliac tubercle
Intertubercular line
What surface landmark of the bony pelvis is this?
Pubic tubercle (Most medial point of pubic bone)
What surface landmark of the bony pelvis is this? Where does it run to and from?
Inguinal ligament
Anterior superior iliac spine to pubic tubercle
What is this structure? What surface landmark is in the centre? What artery is palpable?
Inguinal canal
Mid inguinal point
Femoral artery
What are the three differences in the Pelves of Males and females?
1.Wider circular pelvic inlet in females, narrow heart shaped inlet in males
2. Obtuse angle formed by inferior pubic rami in females acute angle formed in males
3. Females have wider and shorter sacrum, males have narrower longer sacrum
What five organs are found in the Pelvis of a female?
Bladder, rectum, vagina, uterus and ovaries
What four organs does the male pelvis contain?
Bladder
Rectum
Prostate
Seminal vesicles
What is the name for the collective muscles that support the pelvic organs below? What do they separate? What are there three functions?
Pelvic floor
Pelvis and perineum
Functions: Prevent herniation inferiorly, Control continence (sphincter action) and increase intra-abdominal pressure
Name the structures a-j
a- Pubic symphysis
b- Puborectalis
c- Pubococcygeus
d- Iliococcygeus
e- Sacrum
f- Ilium
g- Piriformis
h- Coccygeus
i- Ischial spine
j- obturator internus
What are the two main muscles of pelvic floor? What three muscles is one of them composed of?
Levator ani and Coccygeus
Levator ani:
1. Puborectalis
2. Pubococcygeus
3. Iliococcygeus
What is the function of the Puborectalis? How does it do this?
Controls passing of faeces
Forms sling around rectum and when contracted prevents faeces leaving the anal canal
What bones does the Pubococcygeus attach to?
Pubic bone anteriorly
Coccyx and sacrum posteriorly
What two nerves innervate the Levator ani?
S4 nerve
Pudenal nerve (S2-S4)
What are the two main arteries of the Pelvis? What do their branches supply?
Left and right Internal Iliac arteries
Pelvic viscera and some branches exit pelvis to supply the perineum and gluteal region
What are the 8 key branches of the internal iliac arteries?
Vesical
Uterine
Vaginal
Middle rectal
Internal pudendal
Superior and inferior gluteal arteries
Obturator artery
What do the Vesical, Middle rectal and Obturator supply?
Vesical arteries- supplies bladder
Middle rectal- rectum
Obturator artery- exits pelvis to supply lower limb
What is the structure called that drains the pelvis? What does it join to form?
Venous plexuses
Internal iliac veins
What are the 5 key nerves of the sacral plexus?
-Sciatic nerve
-Pudendal nerve
-Superior and Inferior gluteal nerves
-Pelvis Splanchnic nerves
Where do the Sciatic and Pudendal nerves come from and type of innervation? What does each supply?
Sciatic- L4-S3 exits pelvis and supplies lower limb
Pudendal nerve- S2-S4 and somatic: exits pelvis and supplies perineum
What do the Superior and inferior gluteal nerves innervate?
Gluteal region
Where do the Pelvic Splanchnic nerves come from? What do they carry? What do they innervate?
S2-S4
Parasympathetic fibres
Pelvis viscera
Where do Sympathetic fibres that innervate the Pelvic viscera derive from?
Lumbar Splanchnic nerves
How long is the Rectum and what are the names of the notable flexures present?
12cm long
Sacral flexure and Anorectal flexure
Three arteries that supply the Rectum and what they are a branch of?
Superior rectal artery- Inferior mesenteric artery
Middle rectal artery- Internal Iliac artery
Inferior rectal artery- Internal pudendal artery
What three veins drain the Rectum? What do they join to form? What does this make it a site of?
Superior, Middle and Inferior rectal arteries
Venous plexus
Portosystemic anastomoses
Describe the location of the perineum
Superficial and inferior to pelvic floor
Between pubic symphysis and coccyx
Between medial surfaces of the thighs
What shape is the Perineum? What can it be split into? What line splits it in to two segments?
Roughly diamond
Urogenital triangle (Anterior) and Anal triangle (posterior)
Split by imaginary line between the Ischial tuberosities
What are the four main layers of the Urogenital Triangle?
-Skin
-Perineal fascia
-Superficial pouch
-Perineal membrane
Describe the skin layer of the urogenital triangle
Urethra and vagina open out through the skin
What is the perineal fascia a continutation of?
Fascia overlying the abdominal wall muscles
What is the Superficial perineal pouch?
Potential space that contains the erectile tissues
What three muscles are found in the Superfifical perineal pouch?
Ischiocavernosus
Bulbospongiosus
Superficial transvers perineal muscles
What is the Perineal membrane? WHat does it provide atachment for?
Strong fibrous membrane
attachment of the ischiocavernosus and bulbospongiosus muscles
What does the Anal triangle contain?
Anal canal and anus
How long is the anal canal?
4cm
Where is the inferior part of the anal canal derived from? Below?
Ectoderm
Below pectinate line
Describe the epithelium of the inferior anal canal?
Stratified squamous
What artery supplies the inferior anal canal? What are they a branch of?
Middle and inferior rectal arteries
Internal iliac
What nerve supplies the external anal sphincter?
Pudendal
where does the superior anal canal derive from? WHat epithelium lines it?
Endoderm
Columnar epithelium
What artery supply the superior anal canal via??
Superior anal via infeiror mesenteric
Which one of the infeiror or superior anal canals has blood drained to the hepatic portal vein?
Superior
Fibres innervate the Internal anal sphincter?
Parasympathetic
WHat sits between the urogenital and anal triangles?
Perineal body
What does the perineal body act as?
Attachment for almost all the perineal and pelvic floor muscles
