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Unit 6: SXS > Week 8 > Flashcards

Week 8 Flashcards

1
Q

What are the pelvic urinary organs?

- describe general function

A
  • distal ureter: muscular tube, transmits urine by peristaltic waves
  • bladder: temporary reservoir, strong muscular walls (detrusor m)
  • urethra: passage for urine from bladder to exterior (also passage for semen in men)
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2
Q

Why would there be dilated and contracted segments in a ureter in an xray?

A
  • peristaltic contraction
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3
Q

Explain relationship of pelvic portion of ureters to the peritoneum

A
  • retroperitoneal, runs on lateral walls of pelvis, parallel to anterior margin of greater sciatic notch, between parietal pelvic peritoneum and internal illiac aa
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4
Q

What structure demarcates the beginning of the pelvis?

A

pelvic brim: promontory and ala of sacrum and terminal lines

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5
Q

In males what structure passes between the ureters and the peritoneum?

A

Ductus deferens

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6
Q

In females the ureter passes medial to what structure?

A

origin of the uterine a

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7
Q

3 primary sources of arterial blood to the pelvic portion of the ureters
- differences between males and females

A
  • males and females: common iliac and internal iliac
  • females: ovarian a (off of aorta) and uterine a (off of internal iliac)
    Males: inferior vesicle a (off of inernal iliac)
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8
Q

Describe iatrogenic compromise of ureteric blood supply.

  • above common iliac
  • below common iliac
A
  • arteries are very sensitive to damage/movement
  • ureters supplied medially
  • ureters supplied laterally
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9
Q

Venous drainage of pelvic part of the ureters

A
  • parallels to the arterial supply
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10
Q

Where does lymph drain in the area of the pelvic portion of ureters

A
  • common and internal iliac nodes
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11
Q

Innervation of the ureters

- autonomic plexuses that innervate the ureters

A
  • aortic, renal. superior and inferior hypogastric
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12
Q

Pathway of afferent innervation of the ureters

  • afferent superior to pelvic line
  • afferent inferior to pelvic line
  • where is ureteric pain usually felt?
A
  • follows sympathetics: aortic, renal and superior hypogastric plexuses –> aorticorenal and renal pre-vertebral ganglion –> lesser, least, or lumbar splanchnic –> paravertebral sympathetic ganglion –> white rami communicans –> anterior primary rami –> spinal n –> dorsal root –> DRG –> dorsal root –> dorsal rootlets –> T10-L2 dorsal horn
  • follows parasympathetic: inferior hypogastric plexus –> pelvic splanchnic nn (s2-4) –> sacral plexus –> anterior primary rami –> spinal n –> ventral root –> ventral rootlet –S2-S4 lateral horn
  • ipsilateral lower quadrant of abdomen, close to the groin
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13
Q

3 locations most often occluded with kidney stone

- how do you confirm?

A
  • junction of ureters and renal pelvis
  • where the ureters cross the external iliac a and pelvic brim
  • during the passage through the wall of the urinary bladder
  • CT
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14
Q

How does the position of the bladder change when empty vs full in and adult

A
  • empty: within the true pelvis

- full: extends up towards the umbilicus, more into the false pelvis

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15
Q

Components of the urinary bladder

A
  • apex: points toward superior edge of pubic symphysis
  • fundus:opposite the apex, formed by convex posterior wall
  • body: major portion, between apex and fundus
  • neck: where fundus and inferolateral surfaces meet inferiorly
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16
Q

What muscle composes the walls of the urinary bladder?

A

detrusor m

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17
Q

what is the function of the internal urethral sphincter in the male?

A
  • contracts during ejaculation to prevent retrograde flow of semen into the bladder (ejaculatory reflux)
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18
Q

Trigone of the bladder

  • what is it?
  • sensitive to?
  • made of?
A
  • triangular area of smooth muscle inside the dorsal wall of the bladder neck
  • very sensitive to expansion
  • ureteric orfices (opening in bladder where ureters insert to drop urine into bladder); and internal urethral orfice (where urethera inserts into the bladder to drain urine from bladder to outside world)
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19
Q

Blood supply of the urinary bladder

  • main art supplying bladder
  • art supplying the antero-superior parts of the bladder
  • differences in females vs males in supply to inferior bladder
A
  • internal iliac a
  • superior vesical
  • male: inferior vesical aa, females: vaginal aa
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20
Q

Venous drainage of the urinary bladder

  • veins that drain the urinary bladder are tributaries of the ..?
  • venous plexus most directly associated w/ bladder?
  • what does it drain through to reach the main v?
A
  • internal iliac vv
  • vesical venous plexus
  • drains through inferior vesical vv into internal iliac v
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21
Q

Innervation of the bladder: where are they from, what v used to deliver fibers, function?

  • sympathetics
  • parasympathetics
A
  • from inferior thoracic and upper lumbar spinal levela to vesical plexuses through hypogastric plexuses; prevents voiding of urine due to contraction of internal sphincter
  • from sacral spinal cord, conveyed by the pelvic splanchnic and inferior hypogastric plexus; motor to detrusor m and inhibitory to internal urethral sphincter
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22
Q

Four parts of male urethra

A
  • intramural part
  • prostatic arethra
  • intermediate part of urethra
  • spongy urethra
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23
Q

Blood supply to the urethra in males and females

A
  • males: prostatic branches of inferior vesical and middle rectal aa
  • females: pudendal and vaginal aa
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24
Q

Urethral innervation male

  • nerve fibers in prostatic plexus
  • where does prostatic plexus come from
A
  • mixed sympathetic, parasympathetic and visceral afferent fibers
  • pelvic plexus arising as organ-specific extensions of the inferior hypogastric plexus
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25
Q

Urethral innervation in females

  • what nerves supply the female urethra?
  • afferent
  • termination afferent
  • where are cell bodies
A
  • vesical nerve plexus and pudendal nerve
  • visceral afferent from most of urethra run in pelvic splanchnic nn
  • from pudendal n
  • s2-s4 spinal ganglia
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26
Q
  1. trace path of blood from renal a to renal v
A
  • renal a -> segmental a -> interlobar a -> arcuate a -> interlobular a -> afferent arteriole -> glomerulus -> efferent arteriole -> peritubular capillaries (for convoluted tubules) or vasa recta (for loop of henle) -> interloular v -> arcuate v -> interlobar v -> renal v
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27
Q
    • What is renal lobe?
      - what is renal lobule?
      - What is renal column?
      - What is renal pyramid?
A
  • pyramid and cortical tissue at its base and extending along side
  • medullary ray and its cortical tissue
  • medullary extension of renal cortex in between renal pyramids
  • conical region of medulla
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28
Q

What is major solute in the renal pyramid?

- how does this relate to concentrating urine?

A
  • urea

- secreted or reabsorbed to increase/decrease urine concentration

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29
Q
    • what is a medullary ray?
A
  • descending and ascending segments of cortical nephrons and a collecting tubule/duct, closely aggregated at the middle of the renal lobule, axis of the lobule
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30
Q

What is a uriniferous tubule?

A
  • nephron and collecting tubule
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31
Q

What does nephron consist of

A

renal corpuscle, proximal convoluted tubule, loop of henle and distal convoluted tubule

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32
Q

Where do you find the renal corpuscle?

A
  • throughout the cortex
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33
Q
  1. What is the vascular pole?

What is the urinary pole?

A
  • where the afferent and efferent arterioles enter and exit the glomerulus
  • where the ultrafiltrate exits the bowmans space and proximal convoluted tubule begins
34
Q

what cells make up the visceral vs parietal layer of the renal corpuscle?

A
  • visceral: podocytes over glomerular capillaries

- parietal: simple squamous epithelium, lines outer wall of bowmans capsule

35
Q

What cells do we find associated w. renal corpuscle?

A
  • podocytes, medangial cells, fenestrated endothelial cells, JG cells, macula densa and extraglomerular mesangial cells
36
Q
  1. Function of
    - podocyte
    - mesangial cell
    - fenestrated endothelial cells
    - which cells form filtration barrier?
    - JG cells: type of cell, found, release?
    - Macula densa: what do they do, function, where are they found
    - extraglomerular mesangial cells
    - which cells have role in maintaining blood vol/pressure
A
  • make up epithelial lining of bowmans capsule, foot processes wrap around capillaries and form filtration slits which acts as a sieve and control what gets into bowmans space
  • contractile, phagocytic and produce components of external lamina
  • block blood cells and platelets from entering bowmans capsule
  • podocytes and fenestrated endothelial cells
  • modified secretory smooth muscle cells. found on arteriole walls and release renin
  • sense concentration of NaCl in the DCT, part of the DCT and function to regulate glomerular blood flow to keep GFR constant and increase renin release
  • supportive
  • JG cells, macula densa, and extraglomerular mesangial cells
37
Q
  1. PCT and DCT
    - where are the convoluted tubules found?
    - where is majorities of filtrate reabsorbed? adaptations for reabsorption
A
  • cortex

- PCT; long microvilli, simple cuboidal epithelial cells. increased mitochondria

38
Q

Compare and contract appearance of PCT and DVT

  • cells
  • nuclei
  • brush border
  • length
A
  • P: eosinophilic and large; D: smaller, flatter, lighter
  • P: less apparent; D: more apparent
  • P: apical; D: none
  • P: takes up more space; D: shorter, less convoluted
39
Q
  1. LOH
    - blood vessels found here
    - limbs
    - where are these found
    - appearance of cells in ascending and descending?
    - thin limb found? appearance?
A
  • vasa recta
  • descending (thin descending limb) and ascending (thick ascending limb)
  • medulla
  • simple squamous epithelial cells with few organelles
  • medulla, simple cuboidal epithelium w/ many mito
40
Q
  1. Collecting Tubule
    - trace the path of urine from DCT to ureter
    - where are they found?
    - kinds of cells
A
  • DCT -> CD-> minor calyx -> major calyx -> renal pevlic -> ureter
  • medullary rays and medulla
  • principal and intercalated
41
Q

Principal vs Intercalated Cells in CT

  • organelles
  • folds
  • location
  • function
A
  • P: few; I: abundant mito
  • P: BM infoldings; I: apical folds
  • P: medullarys rays and medulla; I: medullary rays
  • P: Regulates reabsorption of H2O and electrolytes and secretion of K+; I: Reabsorption of K+ and helps maintain acid-base balance
42
Q

Mechanisms or properties by which antigens might become planted in the glomerulus providing surfaces for antibody attachment

A

any antigen that is small and + will get filtered and planted into the glomerulus because the cationic charge will be attracted to the anionic charge of the BM and then bind to antibody

43
Q

Common sources of antigen contributing to circulating immune complexes

  • endogenous
  • exogenous
A
  • DNA, tumor antigens, SLE or IgA nephropathy

- Infectious products strep proteins, Hep B/C, T pallidum, P. falciparum

44
Q

Neutrophils and monocyte causing glomerular injury

  • what do they do?
  • caused by?
  • results in?
  • pathway
A
  • infiltrate glomerulus in certain types of glomerulonephritis
  • usually because of activation of complement
  • results in generation of chemotactic agents but can also be mediated by Fc adherence and activation
  • neutrophils release protesases which cause GBM degradation -> free radicals from oxygen cause cell damage -> arachadonic acid metabolites reduce GFR
45
Q

Macrophages and t lymphocytes causing glomerular injury

  • when does this occur?
  • what happens?
A
  • infiltrate glomerulus in antibody and cell mediated reactions
  • release vast number of biologically active molecules
46
Q

Platelets causing glomerular injury

  • what happens?
  • what do they release?
  • treatment
A
  • aggregate in glomerulus during immune-mediated injury
  • release eicosanoids, growth factors, and other mediators may contribute to vascular injury and proliferation of glomerular clls
  • antiplatelet agents have beneficial effects
47
Q

Mesangial cells causing glomerular injury
- what is produced?
-

A
  • stimulated to produce several inflammatory mediators, including ROS, cytokines, chemokines, growth factors, eicanoids, NO, and endothelin- initiate inflammatory responses in glomerulus even in absence of leukocytic infiltration
48
Q
  1. Etiology of glomerulopathy based on IF
A
  • GVHD

- antibodies against PLA2, infection, post-infection- autoimmune

49
Q
  1. Etiology of glomerulopathy based on IF
A

Goodpasture

50
Q
  1. Predict characteristics of the deposit and consequences of them
A
  1. a
51
Q

Cycle that leads to progressive glomerular injury

what happens with podocytes

A

Injury -> loss of nephron -> unable to efficiently regenerate nephrons -> decrease functional renal mass -> remaining nephrons have to function receiving same blood flow and filtering the same amount of vol -> increased pressure per nephron -> increase BP -> increase stress on nephrons -> endothelial damage -> inflammation and proliferation

damage to podocytes -> increased production of ECM (collagen) -> fibrosis of BM

52
Q

11 exam and body part? what can you see? can you see adrenal glands or kidneys?

A
  • Normal AP/Frontal abdominal x-ray
  • Vertebra, pelvis, air in stomach and bowel
  • No
53
Q

12
What happens after injection of non-ionic iodinated contrast?
What is this called?

A

12 a

- Intravenous urogram and intravenous pyelogram

54
Q

What relativelt inexpensive and commonly available imaging test can we use to evaluate kidneys

A
  • renal ultrasound
55
Q

13
What is this?
- characteristics

A
  • Normal Renal ultrasound

- normal liver is more echogenis then normal renal cortex but renal fat is more echogenic than renal cortex and liver

56
Q

14

Imaging modality and body part depicted? Abnormality?

A
  • Renal US; polycystic kidney
57
Q

15
Imaging modality, body region, orientation and window?
Abnormality?
characteristics

A
  • Non contrast abdominal/pelvic CT, soft tissue window
  • polycystic kidneys
  • normal renal cortices are obscured by innumerable cysts
58
Q

16
Imaging modality, body region, orientation, window?
- abnormality

A
  • IV and oral contrast enhanced abdominal/pelvic CT, soft tissue window
  • cysts in kidneys
59
Q

Imaging modality also used that does not employ ionizing radiation?

A
  • MRI of abdomen
60
Q

17
Imaging modality, body region, and orientation
dx?

A
  • non-contrast MRI abdomen/ axial/ T2 fat sat

- Polycystic kidneys

61
Q

18
imaging modality, body region, and orientation are depicted?
dx?

A
  • Non-contrast MRI abdomen/pelvis, coronal, T2

- Polycystic Kidneys

62
Q

19

What is this?

A
  • polycystic kidney
63
Q 
20 
Imaging modality and organs depicted? 
- abnormality
- dx?
- next stop
A
  • renal US
  • dilated renal calyces and renal pelvis
  • hydronephrosis -> likely urinary obstruction more distal in urinary tract than can be assessed with US
  • order non contrast CT abdomen/pelvis
64
Q

21
imaging modality and part of the body
-abnormalities?
- dx?

A
  • Non contrast CT abdomen/pelvis/coronal/ soft tissue window
  • hydronephrosis, hydroureter, obstruction
  • obstructing L ureteral calculus w/ ipsilateral hydronephrosis and hydroureter
65
Q 
22
imaging modality and body part depicted? 
abnormalities
dx
causes
A
  • RUQ US
  • echogenic, atrophic kidney
  • chronic renal failure
  • HTN, DM
66
Q 
23
Imaging modality, body part, orientation and window?
how old is this patient? 
abnormalities?
dx?
A
  • IV and enteric C+ CT abdomen and pelvis, coronal, soft tissue
  • relatively elderly
  • expansile mass in the upper pole of r kidney
  • renal cell carcinoma
67
Q

24
imaging examination?
structures being pointed at?

A
  • non-contrast CT abdomen, axial, soft tissue window

- normal adrenal glands

68
Q

25
what imaging exam is this?
- structures being pointed at

A
  • contrast enhanced CT abdomen, coronal, soft tissue window

- normal adrenal glands

69
Q

26
Medical imaging examination is this?
- abnormality

A
  • Contrast enhanced CT abdomen, axial, soft tissue window

- right adrenal mass

70
Q

Are kidneys, suprarenal glands, urter and vessels intraperitoneal or retroperitoneal?

A
  • primarily retroperitoneal; originall formed as and remained retropertioneal viscera
71
Q

Function of kidney

Function of suprarenal glands

A
  • removes excess water, salts, and wastes

- part of endocrine system

72
Q

External and internal features of the kidney

A
  • E: hilum-> entrance to renal sinus
  • I: renal sinus -> occupied by renal pelvis, calices, vessels, nn and variable fat; renal pelvis -> flattened funnel-shaped expansion of superior end of ureter
73
Q

Pathway of urine flow

A
  • glomerulus -> PCT -> LOH -> DCT -> CD -> minor calyx -> renal pelvis -> ureter -> bladder
74
Q

Outcome in patient with urinary calculus

  • what happens to ureter?
  • sxs?
  • urine flow
A
  • If the stone is larger than normal lumen of the ureter it causes excessive distention of muscular tube
  • Causes severe intermittent pain as it is forced down ureter by waves of contraction
  • May cause complete or intermittent obstruction of urinary flow
75
Q

Vasculature of ureter

  • art
  • vein
A
  • supplied y branches from renal artery, testicular/ovarian aa, abdominal aorta, and common illiac
  • drain abdominal portion of ureters into renal and gonadal vv
76
Q

Suprarenal glands

  • art
  • vein
A
  • superior suprarenal a (off of inferior phrenic), middle suprarenal a (aorta), inferior suprarenal a (renal a)
  • r suprarenal v-> IVC; left suprarenal v -> left renal v -> IVC
77
Q

Renal vein entrapment syndrome

  • where does l renal v pass?
  • other name for this
  • sxs
A
  • In crossing the midline to reach the IVC the longer left renal v traverses an acute angle between the superior mesenteric artery anteriorly and the abdominal aorta posteriorly
  • downward traction of the SMA may compress the left renal v resulting in entrapment
  • nut cracker syndrome because appearance of the vein in the acute arterial angle in saggital view
  • hematuria, proteinuria, abdominal/flank pain, testicular pain
78
Q

Innervation of the kidney

  • sympathetics and para
  • afferent
A
  • renal plexus: SNS and PSNS fibers supplied by the abdominopelvic splanchnic nn
  • pain sensation follos sympathetic fibers retrograde to spinal ganglia and cord segments T11-12
79
Q

Innervation of the suprarenal glands

- sympathetic fibers

A
  • abdominal splanchnic nerves to celiac plexus
  • come from lateral horn from T10-L1 and go through paravertebral and preverterbral ganglia but do not synapse until they reach the chromaffin cells in the suprarenal medulla
80
Q

Innervation of the ureter to explain referred pain as result of kidney stone

A

visceral afferent fiber in kidney/ureter -> prevertebral ganglion -> abdominal splanchnic ganglion -> sympathetic trunk -> white rami -> primary anterior rami -> spinal n -> dorsal root -> dorsal root ganglion -> dorsal root -> dorsal rootlets -> dorsal horn (T11-L2)

Unit 6: SXS (6 decks)

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