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Anatomy II > Uro.... system > Flashcards

Uro.... system Flashcards

1
Q

Describe the general structure of the kidney.

What is its peritoneal relation?

Size and shape.?

A

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
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2
Q

What are the functions of the kidney?

A
  • 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)
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3
Q

1 - 5

A

1) extremitas superior
2) extremitas inferior
3) hilum renale
4) sinus renalis
5) pyramidis renalis

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4
Q

6 - 10

Another name for #8.

A

6) capsula fibrosa
7) capsula adiposa
8) fascia renalis (= GEROTA)
9) medulla renalis
10) cortex renalis

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5
Q

11 - 13

A

11) papilla renalis
12) columna renalis
13) lobus renalis

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6
Q

What is a floating kidney?

What are other names?

A

loss of capsula adiposa → hypermobility of the kidney which descends into the pelvis

  • other names:
    nephroptosis, nephroptosia, renal ptosis, renal descensus, renal prolapse
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7
Q

Which structures can be found in the cortex?

A

radii medullares (= medullary rays) = continuation of medullary substance

cortex corticis = contains radii medullares

labyrinthus corticis = area btw radii medullares

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8
Q

What are the projections of the kidney?

A

in fossa lumbalis

  • right: Th12 → L3
  • left: Th11 → L3
  • hilum: L2

⇒ left kidney moves (2-3 cm) during deep inspiration

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9
Q

What are the boundaries of the kidney?

  • laterally - medially
  • cranially
  • dorsally
A

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
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10
Q

What are the ventral boundaries of the kidney?

Differentiate btw right/left.

A

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
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11
Q

What are the dorsal relations of the kidney clinically relevant?

A

contact to n. ilioinguinalis + n. iliohypogastricus explains why pain can spread up to the inguinal region in case of renal diseases

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12
Q

Explain the segmentation of the kidney.

A

5 segments

  • segm. superius
  • segm. anterius superius
  • segm. anterius inferius
  • segm. inferius
  • segm. posterius

⇒ correspond to the arterial supply via a. renalis

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13
Q

What is the microscopic unit of the kidney?

Describe it.

A

nephron

  • renal corpuscle
  • glomerulus

forms together with renal tubule the uriniferous tubule

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14
Q

List some genetic abnormalities of the kidney.

A
  • additional kidneys
  • horseshoe kidney = fused kidneys
  • renal aplasia = one kidney is missing
  • renal hypoplasia = underdevelopment of one kidney
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15
Q

Explain the vasculature of the kidney

A

arterial supply:

  1. a. renalis dex./sin.
  2. type I r. principalis ant./post.
    * *type II** r. principalis ant./post./inf.
  3. aa. interlobulares
  4. aa. arcuatae
  5. aa. corticales radiatae (= aa. interlobulares)
  6. arteriolae afferentes

drainage: beginning at glomerulus

  1. arteriolae efferentes
  2. vasa recta/peritubular cap.
  3. vv. corticales radiatae
  4. vv. arcuatae interlobulares
  5. vv. renales
  6. IVC
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16
Q

What are clinically important abberations of the renal vasculature?

A
  • 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
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17
Q

What is important abt v. renalis sin.?

Why is it clinically important?

A

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)

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18
Q

What innervates the kidneys?

A

sympathetic innervation via plexus renalis

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19
Q

What are calices renalis?

Differentiate.

A

drain urine from papilla renalis into pelvis renalis

  • major
  • minor
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20
Q

What are the 2 shapes of the pelvis renalis?

A

​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
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21
Q

What are the 2 ways for X-ray examinations to investigate the pelvis renalis?

A
  • urogram: iodid containing contrast material injected intravenously, eventually excreted by kidney
  • retrograde pyelogram: contrast material injected into ureters via a catheter
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22
Q

Which structures are connected by the ureter?

What are its 3 points of constriction?

A

pelvis renalis → urinary bladder

  1. ​exit from pelvis renalis
  2. crossing of a. iliaca communis/externa when entering the lesser pelvis
  3. wall of urinary bladder
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23
Q

Why are the points of constriction of the ureter clinically relevant?

A

⇒ renal colic = type of abdominal pain commonly caused by kidney stones, often wavelike in phases

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24
Q

What are the parts of the ureter?

A
  1. pars abdominalis in retroperitoneal space
  2. pars pelvica in lesser pelvis
  3. pars intramuralis in wall of urinary bladder
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25
Q

Explain the crossings of the ureter.

A

over - under - over - under

  1. over n. genitofemoralis
  2. under a./v. testicularis/ovarica
  3. over a. iliaca communis (left)/externa (right)
  4. under ductus deferens (male)/a. uterina (female)
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26
Q

What is important during a uterectomy?

A

a. uterina is close to ureter → injury/ligation of ureter can lead to loss of kidney

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27
Q

Which vessels supply and drain the ureter?

A

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

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28
Q

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?

A

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

29
Q

Which structures surround the urinary bladder?

A
  • ​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):

  1. ductus deferens
  2. gl. vesiculosa
  3. ureter
30
Q

Why is the spatium retropubicum clinically relevant?

A

distended urinary bladder can be punctuated superiorly to symphysis pubica → suprapubic catheter

31
Q

Which structures attach to the vesica urinaria?

Differentiate btw genders.

A
  • both genders: lig. umbilicale medianum (obliterated urachus, connects to umbilicus)
  • males: ligg. puboprostatica (1 on each side)
  • females: ligg. pubovesicalia (1 on each side)
32
Q

Explain the structure of the wall of the vesica urinaria?

A

from inside to outside

  1. mucosa
  2. m. detrusor vesicae
  3. tunica serosa (where overlied by peritoneum)
33
Q

Which vessels supply/drain the vesica urinaria?

Innervation.

A

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
34
Q

Explain the macroscopical structure of the female urethra.

Supply/drainage/innervation?

Clinical relevance?

A

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

35
Q

What is micturition?

Explain the process.

A

urination

closure of bladder/urethra by

  • smooth m. sphincter urethrae int., innervated symphathetically
  • striated m. sphincter urethrae ext., innervated by n. pudendus → voluntary

micturition

  1. relaxation of pelvic diaphragm → lowering of bladder
  2. contraction of m. detrusor vesicae
  3. relaxation of m. sphincter urethrae int./ext.
36
Q

What seperates cavitas pelvis from cavitas abdominalis?

How is it subdivided?

A

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
37
Q

What are the contents of cavitas pelvis?

Differentiate btw male/female.

A

both:

  • vesica urinaria
  • ureters
  • rectum

male:

  • gll. vesiculosae
  • ductus deferentes
  • prostate

female:

  • uterus
  • vagina
  • ovaria
  • tubae uterinae
38
Q

Where is plica rectovesicalis/rectouterina?

Which structures does it contain?

A

lat. folds bounding excavatio rectovesicalis/rectouterina (= DOUGLAS pouch)

⇒ contains plexus hypogastricus inf. (+ lig. rectouterium in females)

39
Q

Explain the peritoneal relations in cavitas peritonealis of females.

A

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

40
Q

What are the parts of lig. latum?

What does it contain?

A

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

41
Q

Which structures are connected by parametrium?

A

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
42
Q

Why is the Douglas pouch clinically relevant?

A

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

43
Q

What is the name of the fascia that seperates prostate from rectum?

A

fascia rectoprostatica

(= DENON-VILLIER)

44
Q

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 … ?

A

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)

45
Q

1 - 3

Origin, insertion, innervation.

A

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
46
Q

4

Origin, insertion, innervation

A

m. ischiococcygeus

  • ORIGIN: spina ischiadica, lig. sacrospinale
  • INSERTION: coccyx
  • INNERVATION: plexus sacralis (S3/4)
47
Q

What might be the reason for pelvic floor insufficiency?

What are consequences?

A

multiple vaginal births

→ descensus/prolapse of bladder (= cystocele), rectum (= rectocele)

→ incontinence

48
Q

1 - 5

A

1) pubic bone
2) ischium
3) membrana obturatoria
4) m. obturator int.
5) membrana perinei

49
Q

6 - 10

A

6) vesica urinaria
7) prostate
8) urethra - pars prostatica
9) urethra - pars intramuralis
10) urethra - pars membranacea

50
Q

11 - 15

A

11) urethra - pars spongiosa
12) m. sphincter urethrae ext.
13) m. levator ani
14) fossa ischioanalis
15) peritoneum

51
Q

16 - 20

What is formed by #17?

Another 2 names for #20.

A

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

52
Q

21 - 25

Another 2 names for #22. What is it continuous with?

What does #25 partially form?

A

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)

53
Q

26 - 29

A

26) trigonum vesicae
27) ostium uteris
28) saccus subcutaneus perinei
29) paracystium

54
Q

What are the contents of spatium profundum perinei?

Differentiate btw male/female.

A

male:

  • urethra
  • gll. bulbourethrales (COWPER)
  • m. transversus profundus

female:

  • vagina w/ urethra
  • smooth m. instead of m. transversus profundus
55
Q

What are the contents of spatium superficiale perinei?

Differentiate btw male/female.

A

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.
56
Q

What are the contents of fossa ischioanalis?

A
  • canalis pudendalis (ALCOCK) containing
    • n. pudendus
    • a. + v. pudenda int.
  • a. + v + n. rectalis inf.
57
Q

What are the boundaries of fossa ischioanalis?

A
  • 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
58
Q

Why is saccus subcutaneus perinei clinically relevant?

A

infections in this region can spread to ant. abdominal wall, scrotum/labiae majorae

59
Q

Which n. innervates ALL perineal mm.?

A

n. pudendus

(= “shame” nerve)

60
Q

What is a pudendal nerve block?

A

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

61
Q

What is due to its location a common site for anal fistulas?

A

fossa ischioanalis

62
Q

1 - 5

A

1) ischium
2) pubis
3) membrana obturatoria
4) m. obturator int.
5) membrana perinei

63
Q

6 - 10

Another name for #10.

A

6) vagina
7) cervix
8) fornix lat.
9) vestibulum vaginae
10) ostium uteri (= ext. os)

64
Q

11 - 15

Another 2 names for #15

A

11) m. levator ani
12) m. sphincter urethrae ext.
13) m. compressor urethrae
14) peritoneum
15) lig. cardinale (MACKENRODT), lig. cervicale lat.

65
Q

16 - 20

Which structure is formed by #18?

A

16) labia min.
17) labia maj.
18) corpus spongiosum (both form bulbus vestibuli)
19) m. bulbospongiosus
20) corpus cavernosum clitoridis

66
Q

21 - 26

Another 2 names for #22, 23.

A

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

67
Q

What is an episiotomy?

A

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.

68
Q

Since in some books more add. mm. are considered part of m. sphincter urethrae ext., list them.

A
  • m. compressor urethrae = adjacent to original m. sphincter urethrae ext.
  • m. sphincter urethrovaginalis = adjacent to vagina

Anatomy II (13 decks)

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