Uro.... system Flashcards
Describe the general structure of the kidney.
What is its peritoneal relation?
Size and shape.?
retroperitoneal organ
- 120 - 200g
- 10 - 12cm long, 5-6cm wide, 4cm thick
2 different types of structures:
- urine formation: nephrons + uriniferous tubules
- urine collection: renal calyces + renal pelvis
What are the functions of the kidney?
-
homeostasis of bodily fluids (amount, osmolarity, pH, ion concentration)
∽ 180l primary urine filtered out of the blood/day -
excretion of metabolic end products (urine)
1.5 - 2l final urine formed/day - endocrine function (renin-angiotensin, vit D3, erythropoietin)
1 - 5
1) extremitas superior
2) extremitas inferior
3) hilum renale
4) sinus renalis
5) pyramidis renalis
6 - 10
Another name for #8.
6) capsula fibrosa
7) capsula adiposa
8) fascia renalis (= GEROTA)
9) medulla renalis
10) cortex renalis
11 - 13
11) papilla renalis
12) columna renalis
13) lobus renalis
What is a floating kidney?
What are other names?
loss of capsula adiposa → hypermobility of the kidney which descends into the pelvis
-
other names:
nephroptosis, nephroptosia, renal ptosis, renal descensus, renal prolapse
Which structures can be found in the cortex?
radii medullares (= medullary rays) = continuation of medullary substance
cortex corticis = contains radii medullares
labyrinthus corticis = area btw radii medullares
What are the projections of the kidney?
in fossa lumbalis
- right: Th12 → L3
- left: Th11 → L3
- hilum: L2
⇒ left kidney moves (2-3 cm) during deep inspiration
What are the boundaries of the kidney?
- laterally - medially
- cranially
- dorsally
laterally:
- 6) m. transversus abdominis
medially:
- 8) m. psoas major
cranially:
- diaphragm
- suprarenal gll.
dorsally:
- 7) m. quadratus lumborum
- n. subcostalis
- n. iliohypogastricus
- n. ilioinguinalis
What are the ventral boundaries of the kidney?
Differentiate btw right/left.
right:
- 1) right lobe of the liver
- 2) pars descendens duodeni
- 3) flexura coli dextra
- 4) loops of small intestine
left:
- 6) stomach
- 7) spleen
- 9) pancreas
- 10) flexura coli sinistra
- 11) radix mesocolica
- 12) loops of small intestine
What are the dorsal relations of the kidney clinically relevant?
contact to n. ilioinguinalis + n. iliohypogastricus explains why pain can spread up to the inguinal region in case of renal diseases
Explain the segmentation of the kidney.
5 segments
- segm. superius
- segm. anterius superius
- segm. anterius inferius
- segm. inferius
- segm. posterius
⇒ correspond to the arterial supply via a. renalis
What is the microscopic unit of the kidney?
Describe it.
nephron
- renal corpuscle
- glomerulus
forms together with renal tubule the uriniferous tubule
List some genetic abnormalities of the kidney.
- additional kidneys
- horseshoe kidney = fused kidneys
- renal aplasia = one kidney is missing
- renal hypoplasia = underdevelopment of one kidney
Explain the vasculature of the kidney
arterial supply:
- a. renalis dex./sin.
-
type I r. principalis ant./post.
* *type II** r. principalis ant./post./inf. - aa. interlobulares
- aa. arcuatae
- aa. corticales radiatae (= aa. interlobulares)
- arteriolae afferentes
drainage: beginning at glomerulus
- arteriolae efferentes
- vasa recta/peritubular cap.
- vv. corticales radiatae
- vv. arcuatae interlobulares
- vv. renales
- IVC
What are clinically important abberations of the renal vasculature?
- accessory renal aa.: persisting branches of aorta that didn’t redevelop during fetal dev., esp. important in case of surgeries
- abberant renal aa.: aa. don’t enter through hilum, but through sup./inf. pole
What is important abt v. renalis sin.?
Why is it clinically important?
3 tributaries:
- v. suprarenalis
- v. testicularis/ovarica
- v. phrenica inf.
⇒ cancer in the left renal v. can cause reflux into v. testicularis → dilation of scrotum (= varicocele)
What innervates the kidneys?
sympathetic innervation via plexus renalis
What are calices renalis?
Differentiate.
drain urine from papilla renalis into pelvis renalis
- major
- minor
What are the 2 shapes of the pelvis renalis?
type depends on calices renalis
volume: 3 - 8ml
- branching: minor calices open consistently into major which eventually open into pelvis renalis
- ampullary: minor and major calices open into pelvis renalis
What are the 2 ways for X-ray examinations to investigate the pelvis renalis?
- urogram: iodid containing contrast material injected intravenously, eventually excreted by kidney
- retrograde pyelogram: contrast material injected into ureters via a catheter
Which structures are connected by the ureter?
What are its 3 points of constriction?
pelvis renalis → urinary bladder
- exit from pelvis renalis
- crossing of a. iliaca communis/externa when entering the lesser pelvis
- wall of urinary bladder
Why are the points of constriction of the ureter clinically relevant?
⇒ renal colic = type of abdominal pain commonly caused by kidney stones, often wavelike in phases
What are the parts of the ureter?
- pars abdominalis in retroperitoneal space
- pars pelvica in lesser pelvis
- pars intramuralis in wall of urinary bladder
Explain the crossings of the ureter.
over - under - over - under
- over n. genitofemoralis
- under a./v. testicularis/ovarica
- over a. iliaca communis (left)/externa (right)
- under ductus deferens (male)/a. uterina (female)
What is important during a uterectomy?
a. uterina is close to ureter → injury/ligation of ureter can lead to loss of kidney
Which vessels supply and drain the ureter?
supply:
- pars abdominalis: a. renalis, aorta abdominalis, a. testicularis/ovarica, a. iliaca communis
- pars pelvica: a. iliaca interna, a. vesicalis inf. (in females also often a. uterina)
drainage:
→ v. testicularis → v. iliaca int. → plexus venosus vesicalis
Which structures form the bladder, vesica urinaria?
What is its peritoneal relation?
How much volume can it contain, when does usually the urge to void appear?
subperitoneal organ
- apex, corpus, fundus
- trigonum vesicae + 2 ostia ureteris (+ plica interureterica) + 1 ostium urethrae internum
- in males: uvula vesicae
capacity = 500ml, urge to void at 300 ml
Which structures surround the urinary bladder?
- paravesicular adipose tissue
- anteriorly spatium retropubicum (RETZIUS)
- posteriorly in males excavatio rectovesicalis
- in female*s excavatio vesicouterina
additionally posteriorly located in males from medial to lateral (cf. picture):
- ductus deferens
- gl. vesiculosa
- ureter
Why is the spatium retropubicum clinically relevant?
distended urinary bladder can be punctuated superiorly to symphysis pubica → suprapubic catheter
Which structures attach to the vesica urinaria?
Differentiate btw genders.
- both genders: lig. umbilicale medianum (obliterated urachus, connects to umbilicus)
- males: ligg. puboprostatica (1 on each side)
- females: ligg. pubovesicalia (1 on each side)
Explain the structure of the wall of the vesica urinaria?
from inside to outside
- mucosa
- m. detrusor vesicae
- tunica serosa (where overlied by peritoneum)
Which vessels supply/drain the vesica urinaria?
Innervation.
supply:
- aa. vesicales sup./inf. (from a. iliaca int.)
drainage:
- plexus venosus vesicalis → vv. vesicales → v. iliaca int.
innervation:
- parasymp: plexus hypogastricus inf. → contract m. detrusor vesicae → micturition
Explain the macroscopical structure of the female urethra.
Supply/drainage/innervation?
Clinical relevance?
from ostium urethrea internum (bladder) to ostium urethrae externum
- 3 - 5cm long
- closed by m. sphincter urethrae ext.
- supply/drainage/innervation are the same as for the bladder
⇒ cystitis (inflammation of the bladder) much more common in females due to short urethra
What is micturition?
Explain the process.
urination
closure of bladder/urethra by
- smooth m. sphincter urethrae int., innervated symphathetically
- striated m. sphincter urethrae ext., innervated by n. pudendus → voluntary
micturition
- relaxation of pelvic diaphragm → lowering of bladder
- contraction of m. detrusor vesicae
- relaxation of m. sphincter urethrae int./ext.
What seperates cavitas pelvis from cavitas abdominalis?
How is it subdivided?
seperated by apertura pelvis superior demarcated by linea terminalis
subdivision in craniocaudal direction
- cavitas peritonealis pelvis bounded by peritoneum inferiorly
- spatium extraperitoneale pelvis bounded by pelvic diaphragm
- regio urogenitalis (ant.) = spatium perinei sup./prof.
- *regio analis** (post.) = fossa ischioanalis
What are the contents of cavitas pelvis?
Differentiate btw male/female.
both:
- vesica urinaria
- ureters
- rectum
male:
- gll. vesiculosae
- ductus deferentes
- prostate
female:
- uterus
- vagina
- ovaria
- tubae uterinae
Where is plica rectovesicalis/rectouterina?
Which structures does it contain?
lat. folds bounding excavatio rectovesicalis/rectouterina (= DOUGLAS pouch)
⇒ contains plexus hypogastricus inf. (+ lig. rectouterium in females)
Explain the peritoneal relations in cavitas peritonealis of females.
2 pouches are formed instead of just 1 since peritoneum reflects on superior surface of vesica urinaria to cover uterus + adnexa → intraperitoneal → lig. latum
⇒ excavatio vesicouterina (ant.) + excavatio rectouterina (post.) = DOULGAS pouch
What are the parts of lig. latum?
What does it contain?
parts:
- mesometrium attaches at uterus
- mesosalpinx covers tuba uterina
- mesovarium covers ovaries
add. contents:
- a. ovarica
- a. uterina
- lig. ovarii proprium
- lig. teres uteri
- paracervical ganglion
for more information cf. …genital system
Which structures are connected by parametrium?
8 ligg. (each side 4)
laterally: cervix + pelvis = paracervix
- lig. cardinale (MACKENRODT)
- continues caudally as paracolpium
- contains branches of a./v. uterina
ventrally: cervix + canalis inguinalis/bladder
- lig. vesicouterinum
- lig. teres uteris
dorsally: cervix + sacrum
- lig. sacrouterinum
Why is the Douglas pouch clinically relevant?
only seperated by thin tissue layers from post. wall of vagina
→ Douglas abscesses can be removed
→ uterus, ovaries, tubae uterinae can be examined via endoscopy
What is the name of the fascia that seperates prostate from rectum?
fascia rectoprostatica
(= DENON-VILLIER)
Which mm. form the diaphragma pelvis?
What is their common function?
How do you call the opening that is formed by one of the 2 mm.?
Both are innervated by … ?
m. levator ani + m. ischiococcygeus
⇒ form hiatus levatorius for passage of urethra (+ vagina)
→ support pelvic/abdominal viscera + provide continence
both: innervated by plexus sacralis (S3/4)
1 - 3
Origin, insertion, innervation.
m. levator ani
-
ORIGIN:
- m. pubococcygeus/-rectalis: ramus sup.
- m. iliococcygeus: arcus tendineus m. levatorius (fascia of m. obturator int.)
-
INSERTION:**
- m. pubo-/iliococcygeus: sacrum, coccyx
- m. puborectalis forms sling around rectum
-
INNERVATION:
- plexus sacralis (S3/4)
- m. puborectalis also by n. pudendus
4
Origin, insertion, innervation
m. ischiococcygeus
- ORIGIN: spina ischiadica, lig. sacrospinale
- INSERTION: coccyx
- INNERVATION: plexus sacralis (S3/4)
What might be the reason for pelvic floor insufficiency?
What are consequences?
multiple vaginal births
→ descensus/prolapse of bladder (= cystocele), rectum (= rectocele)
→ incontinence
1 - 5
1) pubic bone
2) ischium
3) membrana obturatoria
4) m. obturator int.
5) membrana perinei
6 - 10
6) vesica urinaria
7) prostate
8) urethra - pars prostatica
9) urethra - pars intramuralis
10) urethra - pars membranacea
11 - 15
11) urethra - pars spongiosa
12) m. sphincter urethrae ext.
13) m. levator ani
14) fossa ischioanalis
15) peritoneum
16 - 20
What is formed by #17?
Another 2 names for #20.
16) corpus spongiosum
17) corpus cavernosum → crura of penis
18) m. ischiocavernosus
19) m. bulbospongiosus
20) fascia perinei profunda (= GALLAUDET), investing layer of perineal fascia
21 - 25
Another 2 names for #22. What is it continuous with?
What does #25 partially form?
21) skin
22) fascia perinei superficialis (= COLLES), membraneous layer of perineal fascia → continuous w/ fascia penis sup., tunica DARTOS
23) spatium superficiale perinei
24) spatium profundum perinei
25) m. transversus profundus (part of urogential diaphragm)
26 - 29
26) trigonum vesicae
27) ostium uteris
28) saccus subcutaneus perinei
29) paracystium
What are the contents of spatium profundum perinei?
Differentiate btw male/female.
male:
- urethra
- gll. bulbourethrales (COWPER)
- m. transversus profundus
female:
- vagina w/ urethra
- smooth m. instead of m. transversus profundus
What are the contents of spatium superficiale perinei?
Differentiate btw male/female.
female:
- gl. vestibularis maj. (BARTHOLIN)
- gll. vestibulares min. ∽ correspond to Cowper’s glands
both:
- erectile tissues
-
canalis pudendalis (ALCOCK) containing:
- n. pudendus
- a. + v. pudenda int.
What are the contents of fossa ischioanalis?
-
canalis pudendalis (ALCOCK) containing
- n. pudendus
- a. + v. pudenda int.
- a. + v + n. rectalis inf.
What are the boundaries of fossa ischioanalis?
- base: skin
- apex: m. levator ani, m. obturator int.
- med: m. sphincter ani ext., m. levator ani
- lat: tuber ischiadicum, m. obturator int.
- ventr: COLLES fascia
- dors: m. gluteus max., lig. sacrotuberale
Why is saccus subcutaneus perinei clinically relevant?
infections in this region can spread to ant. abdominal wall, scrotum/labiae majorae
Which n. innervates ALL perineal mm.?
n. pudendus
(= “shame” nerve)
What is a pudendal nerve block?
local anesthesia technique used in an obstretic procedure to anasthesize the perineum during labor
→ e.g. lidocaine injected through inner wall of vagina in direction of spina ischiadica
What is due to its location a common site for anal fistulas?
fossa ischioanalis
1 - 5
1) ischium
2) pubis
3) membrana obturatoria
4) m. obturator int.
5) membrana perinei
6 - 10
Another name for #10.
6) vagina
7) cervix
8) fornix lat.
9) vestibulum vaginae
10) ostium uteri (= ext. os)
11 - 15
Another 2 names for #15
11) m. levator ani
12) m. sphincter urethrae ext.
13) m. compressor urethrae
14) peritoneum
15) lig. cardinale (MACKENRODT), lig. cervicale lat.
16 - 20
Which structure is formed by #18?
16) labia min.
17) labia maj.
18) corpus spongiosum (both form bulbus vestibuli)
19) m. bulbospongiosus
20) corpus cavernosum clitoridis
21 - 26
Another 2 names for #22, 23.
21) m. ischiocavernosus
22) fascia perinei profunda, investing layer of per. fascia (= GALLAUDET)
23) fascia perinei superficialis, membraneous layer of per. fascia (= COLLES)
24) lig. teres uteri (= remnant of gubernaculum)
25) spatium perinei profundum
26) spatium perinei superficiale
What is an episiotomy?
surgical incision of perineum/post. vag. wall to enlarge opening for baby during labor
OTHERWISE: perineal tear can rupture m. levator ani, m. sphincter ani int./ext.
Since in some books more add. mm. are considered part of m. sphincter urethrae ext., list them.
- m. compressor urethrae = adjacent to original m. sphincter urethrae ext.
- m. sphincter urethrovaginalis = adjacent to vagina
