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Urinary system > The kidney and urinary tract > Flashcards

The kidney and urinary tract Flashcards

1
Q

What does the urinary tract consist of

A

Kidneys
Ureters
Urinary bladder
Urethra

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2
Q

Where does the kidney lie

A

Retroperitoneal in upper abdomen

They lie on the posterior abdominal wall

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3
Q

What surrounds the kidney

A

Surrounded by dense fibrous capsule
Outside the capsule is a fascial pouch (renal fascia) containing the peri-renal adipose tissue
Paranephric fat may be found outside the renal fascia
the fat allows the kidneys to move

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4
Q

Describe the differences between the right and left kidney

A

Right kidney is usually slightly lower than the left
Superior pole of the R kidney lies at the level of the 11th intercostal space and that of the L at the 11th rib
Hilum lies at about the level of L1 (R & L)

L1 is a large vertebrae- this is why they have their hilum at the same vertebral level

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5
Q

What are the kidneys overlapped by postero-superiorly

A

Overlapped postero-superiorly by the diaphragm and pleural cavity
The diaphragm intervenes between the kidneys and ribs

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6
Q

Describe the renal fascia

A

At the lateral margins of each kidney, the anterior and posterior layers of the renal fascia may fuse and connect with the transversalis fascia
Medially, and anteriorly, the fascia continues over the vessels in the hilum and fuses with the connective tissue associated with the abdominal aorta and IVC, in some cases it may continue to the other side and fuse with its companion layer
Posteriorly and medially, passes through the fascia surrounding the quadratus lumborum, and fuses with the fascia containing the psoas major
Inferiorly, both the anterior and posterior fascia fuse to enclose the ureters.

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7
Q

Where does the paranephric fat accumulate

A

Posteriorly and postero-laterally

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8
Q

Describe the posterior relations of the kidneys

A

The superior part of each kidney is related to the diaphragm which intervenes between ribs 11 and 12.
Laterally, the kidney is related to the transversus abdominis muscle
more medially, the quadratus lumborum muscle
more medially, the psoas major muscle
Also posteriorly related to the subcostal nerves (and some intercostals), iliohypogastric and ilio-inguinal nerves

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9
Q

Which nerves supply the kidney

A

The nerves (posterior) that supply the kidneys include: Relate to below.
o 11th intercostal and sub-costal nerves.
o Iliohypogastric nerve.
o Ilioinguinal nerve.

From renal, aortic, superior hypogastric, and inferior hypogastric plexuses

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10
Q

Describe the anterior relations of the right kidney

A

Liver (huge part of upper surface of kidney- separated from liver by a layer of peritoneum)
Medially- the desencing part of the duodenum ( region 2) is retro-peritoneal and contacts the kidney (hilus behind the duodenum)
Hepatic flexure

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11
Q

Describe the anterior relations of the left kidney

A

Superior pole- covered by intraperitoneal stomach and spleen
Moving inferiorly, the retroperitoneal part of the pancreas covers the middle part of the kidney
Also related to splenic flexure

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12
Q

What is meant by the flexures

A

Hepatic- ascending becomes transverse

Splenic- transverse to descending

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13
Q

Why do the flexures exist

A

Corners of colon attached to the posterior abdominal wall- giving an M- SHAPE of large intestine

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14
Q

Summarise the blood supply to the kidney

A

Abundant blood supply via renal arteries - short direct branches from abdominal aorta
Blood pressure drives ultrafiltration by glomerular capillaries
Renal veins drain into the IVC
renal arteries need to be short to keep the blood at high pressure for ultrafiltration

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15
Q

Describe the difference between the right and left renal arteries

A

The left renal artery usually arises from the abdominal aorta a little higher than the right
Right renal artery is longer ( aorta is to the left of the midline) and passes posteriorly to the IVC

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16
Q

Describe the difference between the right and left renal veins

A

The IVC usually lies to the right of the midline

Left renal vein is longer and passes in front of aorta underneath the superior mesenteric artery

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17
Q

Where do the renal arteries arise from

A

Just inferior to the origin of the superior mesenteric artery

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18
Q

What is a consequence of the passage of the left renal vein

A

Aneurysms ( in SMA or aorta) can occlude flow from the left kidney into the IVC

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19
Q

What happens to the renal arteries at the hilum

A

the renal arteries divide to anterior and posterior branches to supply the parenchyma

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20
Q

Describe the gonadal arteries

A

Arise at the same place in both sexes
Arise below the renal arteries
As gonads develop in the abdominal cavity- they descend (further in males)- dragging their blood supply with them

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21
Q

What does the celiac trunk supply

A

the foregut

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22
Q

Describe the differences in the drainages of the gonadal veins

A

right- drains into IVC

left- drains into renal vein which then drains into IVC

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23
Q

Where does blood from the gut drain into

A

The portal vein- goes to liver first

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24
Q

Describe the hilus

A

Anteriorly veins
Arteries
ureter

25
Q

Describe the development of the kidneys

A

Develop as functionally distinct lobes- which coalesce into one structure
each pyramid is therefore a developmental lobule of the kidney
Sometimes- the pyramids fail to coalesce- and so it is quite common to see distinct arteries and veins

26
Q

Summarise the structure of the kidney

A

Cortex granular-looking because of random organisation (glomerulus)
Medulla striated because of radial arrangement of tubules (loop of Henlé) and micro-vessels
Human kidney is multilobar – like a lot of simple kidneys stuck together
Each lobe drains through its own papilla and calyx

27
Q

Describe the renal columns

A

Each kidney consist of an outer renal cortex and an inner renal medulla
Extensions of the renal cortex (renal columns) project into the inner aspect of the kidney, dividing the renal medulla into the renal pyramids.

28
Q

Describe the renal pyramids

A

The bases of the renal pyramids are directed outwards towards the renal cortex, while the apex projects inwards towards the renal sinus
the apical projection is surrounded by a minor calyx

29
Q

Describe the minor calyx

A

The minor calices receive urine and represent the proximal parts of the tube that will eventually form the ureter.
In the renal sinus, several minor calices join to form the major calyx- and 2 or 3 of these unite to form the funnel shaped end of the renal pelvis- which is the funnel-shaped superior end of the ureters.

30
Q

What forms the glomerulus

A

renal arteries supplying each pyramid curve around the base and become arcuate arteries, where they anastomose with the branch curving around the same pyramid- glomerulus found here.

31
Q

Summarise the ureters

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 & bifurcation of the common iliac arteries
Descend anteromedially to enter bladder at the level of the ischial spine

32
Q

Describe the passage of the ureters

A

Renal pelvis forms ureters at uretero-pelvic junction
Ureters descend retroperitoneally on the medial aspect of the psoas major muscle
At the pelvic brim the ureters cross either cross the end of the common iliac artery of the beginning of the external iliac artery, enter the pelvic cavity and continue their journey into the bladder (move anteriorly and medially in bladder)

33
Q

Describe the blood supply of the ureters

A

Takes blood supply from every major blood vessel that it passes
o A renal arterial branch.
o A testicular or ovarian arterial branch.
o Small direct braches of the aorta itself.
o External and internal iliac arterial branches

34
Q

Where are the sits of constrictions of the ureters

A

3 sites of ureteric constriction:
1. pelviureteric junction
2. where ureter crosses pelvic brim
3. where ureter traverses bladder wall
Constrictions are sites of renal colic caused by kidney stones attempting to pass
Kidney stones lodge in these constrictions- as the upper muscle contracts- makes the pain worse

35
Q

How is urine transported by the ureter and how does the ureter enter the bladder

A

Urine transported by peristalsis of their smooth muscle walls
Open obliquely through bladder wall

36
Q

Describe the epithelium of the ureter

A 
Transitional epithelium
Individual cells slide over each other- looks stratified squamous- but when stretch they separate out and become simple squamous
Tight junctions- impermeable to urine
circular muscle- peristalsis
more sparse striated muscle
37
Q

Summarise the bladder

A

Pelvic organ
Triangular pyramid with apex pointing anteriorly and base posteriorly
Lined by urothelium (transitional epithelium)
3-layered epithelium with very slow cell turnover
Large luminal cells have highly specialised low-permeability luminal membrane
Prevents dissipation of urine-plasma gradients

38
Q

if you pass a stone without help, where will you experience pain

A

All 3 sites of constrictions

39
Q

What happens when the bladder is full

A

Rises into the abdomen
As ureter runs obliquely in, as the bladder swells (due to corrugated internal membrane), the ureters are pushed back and function as a self-shutting valve.
Ureters enter at supero-posterior angles

40
Q

Describe the structure of the bladder

A

Apex: directed towards the top of the pubic symphysis and attached to the umbilicus via the medial umbilical ligament
Base: inverted triangle and points posteriorly; ureters enter at upper corners, with the urethra draining inferiorly from the lower corner of the base
Interior: mucosal lining is smooth and firmly attached to underlying tissue
Trigone: smooth area between openings of ureters and urethra
Inferolateral surfaces: cradled by pelvic muscles

41
Q

What is special about the trigone

A

smooth- tightly adherent to the layers below- where bladder cancers are most likely to arise

42
Q

What happens to the superior surface of the bladder when it is full

A

slightly domed when empty

balloons upwards as the bladder fills and pushes visceral peritoneum backwards- allowing us to insert a catheter

43
Q

What is the role of the pubovesical ligament

A

Hold the urethra in place in females

44
Q

What is the role of the puboprosatic ligament

A

Holds the prostate in place (urethra passes through prostate)
urethra has to pass through perineal membrane- fixed structure

45
Q

Describe the difference between males and females

A

Women have 2 holes in the inferior peritoneum (vagina and ureter) while men have 1 (and a prostate).

46
Q

Describe the Sphincter vesicae (internal sphincter – smooth muscle)

A 
At neck of bladder
Reflex opening
In response to bladder wall tension
Relaxed by parasympathetic NS
Contracts by sympathetic NS
47
Q

Describe the Sphincter urethrae (external sphincter – striated muscle)

A

In perineum
Tone maintained by somatic nerves in pudendal nerve (S2, 3, 4)
Opened by voluntary inhibition of nerves

48
Q

in terms of the sphincters, what is different between males and females

A

§ In women, these sphincters are VERY close.

§ In men, these sphincters are further apart.

49
Q

Describe voluntary control of the external sphincter

A

Stretch receptors in bladder wall relay information to the spinal cord- which inhibits the motor neurone to the external sphincter- causing it to relax- babies and people with incontinence
However, cerebral cortex can learn to override this inhibition and keep the motor neurone stimulated to keep external sphincter closed

50
Q

Describe reflex control of the internal sphincter

A 
Bladder fills
stretch receptor activated
PSN stimulated
Bladder contracts
internal sphincter opens
51
Q

Describe the urethra

A

different in each sex, beginning at the base of the bladder and ending with an external opening in the perineum

52
Q

Describe the urethra in women

A

short urethra, travelling inferiorly through the pelvic floor and deep perineal pouch/membrane to open into the vestibule between the labia minora; small Skene’s (mucous) glands associated with lower end

53
Q

Describe the urethra in men

A

longer urethra, passes inferiorly through the prostate, through the deep perineal pouch and perineal membrane and enter the root of the penis (divided to preprostatic, prostatic, membranous and spongy parts)

54
Q

Why are women more at risk of STIs and bladder infections (cystitis)

A

urethra is shorter in women

warm, moist environment of vestibule

55
Q

Describe the lymphatics of the urethra

A 
Follows the arterial supply
Common iliac nodes
roots of gonadal artery nodes
inferior/superior mesenteric nodes
these are called paraaortic nodes
56
Q

List the parts of the male urethra

A 
Internal urethral orifice
Bladder neck, Bladder outlet
Prostatic urethra
Membranous urethra 
Bulbar urethra
Penile urethra 
Navicular Fossa 
External urethral meatus

Hard to pass catheter through as two bends
1st bend once it leaves the deep perineal pouch to course anteriorly in the root of the penis
when flaccid- the penis makes another bend, this time passing inferiorly when passing from the root to the body of the penis

57
Q

Describe the innervation of the kidney

A

renal, aortic and sup/inferior hypogastric plexuses all innervate (visceral efferents from both SNS and PSNS sources - visceral afferents return to T11-L2 leading to referred pain at their dermatomes - e.g. Posterolateral abdominal wall pain)

58
Q

Describe the lymphatics of the kidney

A

lateral aortic (lumbar) nodes at the origins of the renal arteries

Urinary system (8 decks)

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