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Urinary System > 1. The urinary system > Flashcards

1. The urinary system Flashcards

1
Q

What is the urinary tract comprised of?

A

Kidneys
Ureters
Urinary bladder
Urethra

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2
Q

Positioning of the kidneys

A

Retroperitoneal in upper abdomen
Surrounded by dense fibrous capsule
Capsule surrounded by renal fascia containing peri-renal adipose tissue

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3
Q

Right kidney in relation to left kidney

A

Right kidney is usually slightly lower than the left
Superior pole of R kidney: level of 11th intercostal space
Superior pole of L kidney: at the 11th rib

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4
Q

Where does the hilum to each kidney lie?

A

Hilum lies at about the level of L1

R and L- despite them being at different levels

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5
Q

What splits around the kidney to form the renal fascia?

A

Transversalis fascia

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6
Q

What else is enclosed in the renal fascia?

A

Adrenal glands
Perinephric fat
Great vessels

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7
Q

Spleen in relation to kidneys

A

Spleen is superior and lateral to the left kidney

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8
Q

Describe the posterior relations of the kidneys

A

Superior: related to diaphragm
Lateral: Transversus abdominus
Medially: quadratus lumborum and psoas major

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9
Q

Anterior relations of the right kidney

A

Liver
Hepatic flexure of colon
Hilus lies behind 2nd part of duodenum

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10
Q

Anterior relations of the left kidney

A

Stomach
Pancreas
Spleen
Splenic flexure

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11
Q

How much of the resting cardiac output do the kidneys require?

A

20-25%

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12
Q

What drives ultrafiltration?

A

Blood pressure

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13
Q

How is blood delivered under high pressure to the kidneys?

A

Abundant blood supply via renal arteries: short, direct branches from abdominal aorta

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14
Q

Where do renal veins drain?

A

IVC

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15
Q

IVC and aorta in relation to midline

A

Aorta: Left of midline
IVC: Right of midline

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16
Q

Describe the length and positioning of right renal artery

A

Right renal artery is longer than left

Passes behind IVC

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17
Q

Describe the length and positioning of left renal vein

A

Left renal vein is longer than right

Anterior to aorta, but inferior to superior mesenteric artery

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18
Q

How would an aneurysm in the aorta impact the kidneys?

A

Occlude flow from left kidney into IVC

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19
Q

List the branches of the aorta in the abdomen

A 
Celiac trunk
Superior mesenteric artery
Renal arteries on either side
Gonadal arteries
Inferior mesenteric artery
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20
Q

How do the gonadal veins drain?

A

Asymmetrically
Right: Directly into IVC
Left: Drains into renal vein, which drains into IVC

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21
Q

Where does each lobe of the kidney drain to?

A

Minor Calyx

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22
Q

What do minor calyces form in the renal sinus?

A

Major Calyx

23
Q

What do major calyces enter into?

A

Renal Pelvis

24
Q

How is the kidney formed embryologically?

A

It is formed from ~10 kidney like units

25
Q

What divides the renal medulla into discontinuous renal pyramids?

A

Renal columns

26
Q

Describe a renal pyramid

A

Bases: directed outwards towards renal cortex
Apex: projects inwards towards the renal sinus

27
Q

What do apical projections (renal papillae) contain?

A

Contains openings of the pappilary ducts draining the renal tubules
Surrounded by minor calyces

28
Q

Accessory arteries and ureters in the kidney

A

Relatively common

Failing of developmental process of everything to coalesce

29
Q

Describe the layers/ pathway through the kidney

A 
Renal Cortex
Renal papilla
Minor calyx
Major calyx
Renal pelvis
Ureter
30
Q

Why is the renal cortex granular looking?

A

Because of its random organisation

31
Q

Why is the renal medulla striated?

A

Because of radial arrangement of tubules and microvessels

32
Q

Describe the pattern of ureter descent

A

Run vertically down posterior abdominal wall in the vertical plane of the tips of the transverse processes of the lumbar vertebrae
Cross the pelvic brim anterior to the sacro-iliac joint and over the bifurcation of the common iliac arteries
Descend into pelvis proper anteromedially to enter bladder at the level of the ischial spine

33
Q

Where do ureters take blood supply from?

A 
Every major vessel they cross:
Renal arteries 
Gonadal arteries
Common iliac
Internal iliac arteries and its branches 
(May also take some from aorta)
34
Q

How does fluid move through the ureters? What does this require?

A

Peristalsis

Smooth muscle walls

35
Q

Where do ureters open?

A

Open obliquely through bladder wall

36
Q

List the 3 sites of ureteric constriction

A

Pelviureteric junction
Where ureter crosses pelvic brim
Where ureter traverses bladder wall

37
Q

What are the ureteric constrictions sites of?

A

Sites of renal colic caused by kidney stones attempting to pass

38
Q

Ureter epithelium

A

Transitional epithelium
Has tight junctions over it: urine cant pass out
When there is no urine passing through it individual cells move over each other giving a layered appearance (almost like stratified squamous, but these layers can still separate)

39
Q

How is the bladder classified as an organ in children and adults?

A

Adults: Pelvic organ
Children: Abdominal organ

40
Q

Shape of bladder

A

Triangular pyramid with apex pointing anteriorly and base posteriorly

41
Q

Bladder epithelium

A

Urothelium (transitional epithelium)

42
Q

Describe urothelium in the bladder

A

3-“layered” epithelium with very slow cell turnover
When it stretches it becomes smooth
Large luminal cells have highly specialised low-permeability luminal membrane: prevents dissipation of urine-plasma gradients

43
Q

Superior surface of bladder

A

Relatively flat

May become rounded when full

44
Q

What prevents back flow of urine into the kidney?

A

Valve at meeting point between each ureter and the bladder

45
Q

Describe the triangle that is formed by the entrance of ureters and exit of ureter

A

Trigone
Smooth area
Uroepithelium highly stretched and tightly adherent to layer below

46
Q

Urethra in females

A

Relatively short ~4cm
Straight
Held in place by pubovesical ligaments
Urethra passes through perineal membrane

47
Q

Urethra in males

A

Longer
Bladder separated from perineal membrane by prostate gland and puboprostatic ligament
Urethra runs through prostate and through urogenital diaphragm

48
Q

How many urinary sphincters are there?

A 
2
Sphincter vesicae (internal sphincter: smooth muscle)
Sphincter urethrae (external sphincter: striated muscle)
49
Q

Describe the Sphincter vesicae

A 
At neck of bladder
Reflex opening
In response to bladder wall tension
Relaxed by parasympathetic NS
Contracts by sympathetic NS
50
Q

Describe the Sphincter urethrae

A 
In perineum (in urogenital diaphragm)
Tone maintained by somatic motor nerves in pudendal nerve (S2, 3, 4)
Opened by voluntary inhibition of these nerves: voluntary inhibition must be learned
51
Q

Why is catheterising a male is more difficult?

A

There are 2 right angles and possibly a couple of constrictions

52
Q

Describe the male urethra layers

A 
Starting at the bladder 
Internal urethral orifice
Prostatic urethra
Membranous urethra (where external sphincter is)
Bulbar urethra
Penile urethra
Navicular fossa
External urethral meatus
53
Q

Describe the lymphatic drainage of the urinary system

A

Lymph drainage follows arterial supply (but goes in opposite direction)
Lymph drainage from bladder goes into nodes near internal iliac, common iliac, up ureters, nodes are implicated at gonadal arteries, inferior mesenteric, superior mesenteric and renal= paraaortic nodes

Urinary System (8 decks)

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