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Year 2 > Urogen HARC > Flashcards

Urogen HARC Flashcards

1
Q

The kidneys are a __________ organ located on the _______ abdominal wall

A

The kidneys are a retroperitoneal organ located on the posterior abdominal wall

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2
Q

. The glomeruli and Bowmans capsules are located within which area of the kidney?

A

The cortex. Loop of Henle extends into the medulla

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3
Q

Which of the suprarenal glands is most difficult to access surgically? Why?

A

Right suprarenal gland. The liver is in front of this structure which makes it harder to access.

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4
Q

In cases of ‘multiple endocrine neoplasia’ (tumour in the endocrine system), changes in levels of pressor amines produced in the medulla of the suprarenal gland may be detected in both the superior and inferior vena cava. Relating to venous drainage, explain this phenomenon.

Relating the above information to venous drainage, explain this phenomenon?

A

The veins of the suprarenal gland communicate with the lumbar veins, leading to the azygous veins. Thus high levels of pressor amines may be found in the SVC as well as the IVC

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5
Q

What is the function of kidneys?

A

to filter the blood of any waste products,

control the body’s fluid balance

regulate electrolyte levels

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6
Q

What are these functional units of kidneys called?

A

Nephrons

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7
Q

What is Chronic Kidney Disease (CKD)?

A

Chronic Kidney Disease (CKD) is a condition that results in a loss of kidney function over a period of several years. CKD is typically linked to dysfunction of the arterial supply going into the kidneys but can also be congenital or linked to kidney obstructions.

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8
Q

There are numerous causes of kidney disease, based on your knowledge of the kidneys and their function, what do you think the main ones are?

A

Diabetes, hypertension (as part of vascular disease) and glomerulonephritis

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9
Q

The ureters descend down the posterior abdominal wall towards the ______ and have a segmental arterial supply which varies along its course.

A

The ureters descend down the posterior abdominal wall towards the bladder and have a segmental arterial supply which varies along its course.

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10
Q

The pelvic parts of the urinary system consist of …….

A

the terminal parts of the ureters,

the bladder

the proximal parts of the urethra.

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11
Q

How would you describe the location of these ureteric narrowing’s?

What are the clinical implications of these?

A

At the ureteric junction of the renal pelvis

As the ureter crosses the common iliac vessels over the pelvic brim

At the vesicoureteric junction

Common site for kidney stones

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12
Q

What would be the clinical presentation of someone with a ureteral obstruction?

A

Frequency of urination

Problems beginning urination

Continuous feeling of a full bladder

Dysuria

Slow urine flow

UTI

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13
Q

What is renal colic?

A

Renal colic refers to the pain caused as a result of kidney stones, which results in a ‘spasm’ of the ureter

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14
Q

Which spinal cord levels would be involved in renal colic?

A

T11-L2: Ureteric innervation extending down towards the groin

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15
Q

The pathway of the ureters results in them passing closely to other structures within the abdomen. Why is this necessary?

A

This is necessary as its segmental blood supply necessitates it maintaining a close relationship to related structures.

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16
Q

In which direction would you mobilise the ureter in order to prevent devascularisation when carrying out a hysterectomy?

A

Laterally - towards the branches of the internal iliac which supply it as it approaches the bladder

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17
Q

The female urethra is notably _____ than the male, passing through the pelvic floor and into the ______ before opening into the _______ anterior to the vagina.

A

The female urethra is notably shorter than the male, passing through the pelvic floor and into the perineum before opening into the vestibule anterior to the vagina.

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18
Q

Where does the female urethra open into and what surround this??

A

Vestibular area of the vulva and it is surrounded by Skene’s glands which are homologous with the male prostate

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19
Q

The male urethra is longer and is divided into 4 parts. What are they?

A
  • Pre-prostatic
  • Prostatic
  • Membranous
  • Spongy
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20
Q

Which area is the membranous part of the male urethra located?

A

Deep perineal pouch

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21
Q

Is catheterisation easier on women or men and why?

A

In theory, urethral catheterization is much simpler in women because the urethra is short and straighter. In reality, the opening is often difficult to locate due to its size and position within the vestibular area of the vulva.

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22
Q

The Prostate

Which of the lobes is devoid of glandular tissue?

A

Anterior lobe

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23
Q

The Prostate

Which lobe is related to the trigone of the bladder?

A

Median lobe

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24
Q

What happens during benign enlargement of the prostate gland?

A

the median lobe enlarges upwards and encroaches the internal urethral sphincter, located at the neck of the bladder.

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25
Q

What would be the result of further enlargement of the median and lateral lobes on the urethra?

A

Elongation and lateral compression and distortion of the urethra

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26
Q

What would the clinical presentation of a benign enlargement of the prostate gland be?

A

May lead to cystitis, caused by pooling of urine behind the urethral orifice in the bladder

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27
Q

Operations on the prostate gland have a relatively high risk of ________ due to the presence of a large number of valve-less veins (prostatic venous plexus) draining into the internal iliac vein

A

Operations on the prostate gland have a relatively high risk of haemorrhage due to the presence of a large number of valve-less veins (prostatic venous plexus) draining into the internal iliac vein

28
Q

Surgically, how would you bypass the issue of haemorrhage in an individual suffering from prostatic cancer?

A

TURPS – Transurethral re-sectioning of the prostate

29
Q

The walls of the pelvis are formed by bones and ligaments that are partly lined with muscles covered with ____ and ____ _________

A

The walls of the pelvis are formed by bones and ligaments that are partly lined with muscles covered with fascia and parietal peritoneum.

30
Q

What passes through the obturator canal?

A

Obturator artery (from internal iliac), vein (to hypogastric vein) and nerve ( lumbar plexus L2-L4)

31
Q

Major components of the female reproductive system consist of…..

A

an ovary on each side and a uterus, vagina and clitoris in the midline

32
Q

What are the components of the broad ligament?

A
  • Mesometrium
  • Mesosalpinx
  • Mesovarium
  • Suspensory ligament of the ovary
  • Ovarian ligament
33
Q

What is another name for recto-uterine pouch?

A

pouch of Douglas

34
Q

The recto-uterine pouch (pouch of Douglas) frequently becomes the site for the accumulation of blood or pus.

What might be the cause of these accumulations?

A

Blood from a ruptured ectopic pregnancy

Pus from a ruptured pelvic appendicitis

35
Q

The angle of anteversion is formed between which axis’s?

A

Vaginal canal and cervix

36
Q

The angle of anteflexion is formed between which axis’s

A

Cervix and uterine body

37
Q

The vaginal wall is usually collapsed so that the anterior and posterior walls are in contact with one another. By using a________ to open the vaginal canal, a physician can see numerous important structures.

A

Speculum

38
Q

What is Culdocentesi?s

A

is a medical procedure involving the extraction of fluid from the recto-uterine pouch posterior to the vagina through a needle. The closeness of the peritoneal cavity to the posterior vaginal fornix enables this procedure, which can be used to drain a pelvic abscess, for example.

39
Q

Based on your knowledge of the area (vagina), which structures would the needle would need to pass through before entering the recto-uterine pouch?

A

Mucous membrane of vagina – muscular coat of vagina – connective tissue coat of vagina – visceral layer of pelvic fascia – visceral layer of peritoneum.

40
Q

How is innervation supplied to the ovaries and is the sensory innervation carried in sympathetic or parasympathetic nerve fibres?

A

Innervation via the ovarian plexus, which arises from the renal plexus.

Carried in the suspensory ligament of the ovaries, extending between the lateral pelvic wall and the ovary.

Visceral afferents carried in sympathetic innervation resulting in referred pain to T11/12 dermatomes.

41
Q

Visceral afferents carried in sympathetic innervation resulting in referred pain to T11/12 dermatomes.

Why this might be confused with pain caused by appendicitis?

A

Referred pain from appendicitis is vague – felt somewhere in the umbilical region and is similar in its presentation to the pain felt with an ovarian cyst. This is due to referred pain from the appendix going to T10 and from the ovaries to T11/12. Thus, on physical examination these can be difficult to distinguish. As the appendicitis pains become more localized to the right iliac fossa, it becomes easier to identify. The inconstancy of the position of the appendix is also a contributing factor in the confusion.

42
Q

The major components of male reproductive system are…..

A

the testis, epididymis, ductus deferens and ejaculatory duct on each side, and the penis and urethra in the midline.

43
Q

Function of Prostate?

A

Secretes alkaline fluid that usually constitutes roughly 30% of the volume of semen

44
Q

Functions of seminal vesicle

A

Secretions contribute significantly (50-70%) to the volume of the ejaculate (semen)

45
Q

Function of Bulbourethral gland?

A

Secretions contribute to lubrication of the urethra and the pre-ejaculatory fluid

46
Q

The layers of the scrotum and the spermatic cord contain?

A

e vessels, innervation and lymphatics vital to their function.

47
Q

What is varicocele?

A

varicocele is a condition whereby the veins of the pampiniform plexus are elongated and dilated. It occurs most commonly on the left side.

48
Q

n relation to the venous drainage of the testis, and relative pressure in the venous system, consider why varicocoeles occur more frequently in the left testis?

A

The left testicular vein forms a right-angled junction with the left renal vein which means the blood can backflow into the testicular vein. The right drains back into the IVC in the same direction so it is a smoother transition.

There is also a lack of valves between the testicular and renal veins so any pressure variation in the renal system impacts the left testicular vein. The left testis is located lower as well than the right which subjects it to different pressures.

49
Q

What else might be the cause of a dilated pampiniform plexus?

A

Renal vein entrapment syndrome. (Nutcracker Syndrome)

50
Q

The testes pass through the abdominal wall in an oblique pathway creating the wider_______ _____ in males which contains the spermatic cord

A

The testes pass through the abdominal wall in an oblique pathway creating the wider inguinal canal in males which contains the spermatic cord

51
Q

What is the only structure that runs through the inguinal canal?

A

the round ligament

52
Q

Which nerve pierces the internal oblique muscle and runs through part of the inguinal canal before terminating as the anterior scrotal nerve in males or anterior labial nerve in females?

A

Ilioinguinal nerve – branch of the lumbar plexus (L1) (doesn’t run through the deep inguinal ring) and is not part of the spermatic cord

53
Q

Lumps in the scrotum can be classified as testicular or extra testicular in origin. Can you think of any examples of each?

A

Testicular – testicular cancer (tumour), benign testicular tumours, orchitis and testicular torsion

Extra-testicular – hydrocoele, varicocoele, epididymal cysts, indirect inguinal hernias and epididymitis

54
Q

The laminated sheet and prosections shows different types of inguinal hernias: indirect and direct

Which one is direct and which one is indirect? Which is most common and is it more likely to occur in males or females?

A

A is direct (through the abdominal wall) and B is indirect (through the inguinal canal). Indirect and males due to the increased size of the inguinal canal.

55
Q

There are different types of inguinal hernias: indirect and direct

It is very difficult to distinguish between the two on clinical examination alone.

How are they classified surgically?

A

The inferior epigastric vessels are used as a landmark. An indirect hernia passes lateral, and a direct medial to the inferior epigastric vessels

56
Q

. The vas deferens is a direct continuation of which structure?

A

The tail of the epididymis

57
Q
  1. The genitofemoral nerve is involved in which reflex in males? What does this reflex result in?
A

The cremasteric reflex. One branch goes into the scrotum and the other to the inner thigh. Touching the inner thigh will cause a contraction of the cremasteric muscle raising the testicle closer to the body.

58
Q

An individual presenting with absent cremasteric reflex would likely have which condition?

A

Testicular torsion

59
Q

The median umbilical ligament is a remanent of which structure and what was its function?

A

The urachus which was for draining the bladder in-utero

60
Q

he parasympathetic innervation to the bladder is provided by the……….

A

he parasympathetic innervation to the bladder is provided by the pelvic splanchnic nerves (S2,3,4)

61
Q

Function of the pelvid splanchnic nerves in micturation?

A

This allows the bladder to fill and then contract using the detrusor muscle to force urine into the urethra. These nerves are also responsible for the innervation of the internal urethral sphincter, placing it under autonomic control.

62
Q

An autonomous bladder is when you no longer have parasympathetic innervation to the bladder and it cannot empty. How could this happen?

A

Cauda equina syndrome, trauma – slipped disc etc, meningomyelocele and spina bifida. Any lesion from S2 down.

63
Q

What is the function of the ischiocavernosus muscle?

A

Stabilise the erect penis and tenses the vagina during orgasm. It is also responsible for stopping the blood from flowing out of the corpora cavernosa during sexual arousal therefore maintaining

64
Q

Where are the bulbourethral glands located, what is their function and what is the female equivalent structure called?

A

Deep perineal pouch, secretion of pre-ejaculatory fluid to reduce damage to the spermatozoa. Female equivalent is the greater vestibular gland which is in the superficial perineal pouch and its secretions lubricate the vestibular area and vaginal opening preintercourse.

65
Q

The female external genitalia consists of….

A

consists of the clitoris and vestibular apparatus, together with skin and mucosal folds

66
Q

What is the function of the vestibular bulbs?

A

Female erectile tissue which becomes engorged during sexual arousal, opening up the space around the vestibular area

67
Q

Which nerve provides innervation to the clitoris?

A

Deep and dorsal clitoral nerves which are branches of the internal pudendal nerve.

Year 2 (33 decks)

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