anatomy Flashcards
(229 cards)
1
Q
wk1:why does the glad wrap layer(pleura+peritoneoum) matter
A
1) FLUID ACCUMULATION: peritoneal folds determine location and extent of fluids movement
2)SURGICAL/ INTERVENTIONAL: how many layers do i need to go through
3)SYMPTOMS/DIAGNOSIS: swell within the layers
4) INFECTION
5)MOVEMENT
FIMSS
2
Q
wk1:function of thoracic wall
A
allows for coordination and movement between thorax and lungs through the use of the pleura to prevent friction.
3
Q
wk1:what internal strucutures aid in the function of the thoracic wall( diaphragm)
+ innervation
A
-the diaphragm
primary muscle of inspiration
innervated by the phrenic nerve C3,C4.C5
bounded inferiorly by the abdominal viscera( changes in abdominal size can have influence on respiration and organ positioning)
4
Q
wk1: what internal strucutures aid in the function of the thoracic wall
A
- the pleura
simple epithelial layer referred to as mesothelium
decreases friction during breathing
allows coordination b/w thoracic cage and lungs
5
Q
wk1: why do we take a big breath before defacating
A
this will put pressure onto the abdominal from the diaphragm
6
Q
wk1:what is the left over section of the parietal(lines body wall) which is not covered by the pleura
A
costodiaphragmatic recess (allows to get fluid n not puncture lungs)
7
Q
which layer is the outer in the pleura
A
the parietal is outer and the inner is the vsiceral pleura
8
Q
which 2 organs share a single sheet of periteum+visceral
A
lung and gut because they origin from the same place in human developement
9
Q
difference between parietal and visceral
A
In anatomy, “parietal” refers to the outer layer of a membrane that lines the wall of a body cavity, while “visceral” refers to the inner layer of a membrane that directly covers an organ within that cavity; essentially, parietal is the “wall-lining” layer, and visceral is the “organ-covering” layer.
10
Q
+
A
are we in lungs–>pleura—>agaisnt body wall:parietal : against organ: viceral
are we not in lungs–>periteum–agaisnt body wall:parietal : against organ: viceral
11
Q
layers in adult hilum
A
a fascia then parietal,visceral (inseperable) (+ fluids)
12
Q
what is the pulmonary ligament
A
the point of reflection where the visceral pleura becomes the parietal pleura
13
Q
what layer senses pain
A
parietal pleura
14
Q
the 4 regions of the parietal
A
1)costal region
2)Mediastinal region
3)Diaphragmatic region
4)Cervical region
15
Q
costal region is…
A
covers internal surfaces of thoracic wall
16
Q
mediastinal region is…
A
covers lateral aspects of mediastinum
17
Q
diaphragmatic region is
A
covers superior surface of diaphragm not associated with mediastinal
18
Q
cervical region is….
A
extends in super thoracic aperture above 1st rib forming a plueral dome
19
Q
what is the parietal innervated by
A
phrenic and intercostal nerve
20
Q
what is mesentery
A
A mesentery in the gut is a double fold of tissue that attaches the intestines to the posterior abdominal wall, essentially holding them in place and allowing blood vessels, nerves, and lymph nodes to reach the intestines; it acts as a suspension system for the intestines within the abdomen.
21
Q
abdominal layers order
A
skin, superficial fascia,muscles, transversalis facia, extraparentonial fascia(fat), peritoneum
22
Q
difference b/w visceral and somatic pain
A
somatic=brief and outter
vsiceral=longer and inner(due to deep issues in the body)
23
Q
how do true ribs articulate with sternum
A
articulates with veterbrae and has individual costal cartilages(1-7)
Costal cartilages are bars of hyaline cartilage that connect the ribs to the sternum, forming the front part of the thoracic cage. They provide flexibility to the chest wall and allow for movement during breathing.
24
Q
how do false ribs articulate with sternum via costal cartilage
A
articulates with vertebrae through shared costal cartilages(8-10)
25
how do floating ribs articulate with sternum via costal cartilages
articulates only with vertebrae (11-12)
26
which are the typical ribs
ribs 3-9
27
which are the atypical ribs
1,2,10-12
28
important things when looking at X-Ray
RIPE
Rotation- medial clavicle equidistant from spinous process
Inspiration- 5,6 anterior ribs in MCL or 8-10 posterior ribs above diaphragm, poor inspiration?hyperexpandes?
Picture- straight vs oblique, entire lung fields
Exposure- IV discs spaces, spinous processes
29
what sits at the sternal angle
RATPLANT
Rib 2
Arch of Aorta
Tracheal Bifurcation
Pulmonary trunk
Ligamentum Arteriosum/ Left recurrent laryngeal nerve
Azygous vein
Nerves(cardiac plexus)
T4/5 + thoracic duct
30
what are the intercostal muscles
external intercostals
internal intercostals
innermost intercostals
31
external intercostals function,direction and innervation
elevate ribs during forced respiration
sexternal direction of fibres
intercostal nerves
32
internal intercostals function,direction, innervation
depress ribs during forced expiration
chinteenal direction of fibres
intercostal nerves
33
innermost intercostals function,direction, innervation
depress ribs during forced expiration
vertical direction of fibres
intercostal nerves
34
what is the diaphragm
assisting muscle respiration
innervated by the phrenic nerve (C3,C4,C5)
35
what are the different Hiatus’
T8,T10,T12
36
T8 hiatus
Vena Cava
contains IVC+right phrenic nerve
37
T10 hiatus
esophageal hiatus
oesophagus+vagus nerve
38
T12 hiatus
aortic hiatus
aorta+thoracic duct
39
40
what supplies the anterior intercostal arteries
right and left subclavian arteries drain into the internal thoracic artery which then drains into the anterior intercostal arteries
41
what supplies the posterior intercostal arteries
the descending thoracic aorta
42
what is the venous drainage in the right sided intercostals
azygous vein drains into the SVC
43
left side venous supply
1st-brachiocephalic Vein
2-3 left superior intercostal vein
4-8 accessory hemiazygous
9-12 hemiazygous
5-12 drain into azygous which drains into SVC
44
where to inject intercostal nerve block
inject at lower level of rib margin as that is where nerve is (VAN)
45
features of the phrenic nerve
descends anterior to subclavian artery, posterior to subclavian v
descends anterior to lung root
courses along pericardium (RA,LV)
pierces diaphragm and inner area inferior surface
right phrenic n pierces at T8 ( cabal hiatus), L phrenic n. pierces not at hiatus
46
features of vagus n
both vagus n pass posterior to the SC joint- having given off pharyngeal, superior laryngeal n
R recurrent laryngeal n loops around R subclavian
47
what is the hilum
region where roots enter organ
roots: main bronchi, pulmonary vessels, nerves, and lymphatics
48
what is the root
structures entering an organ
49
lung hilum
bronchi most posterior, veins most inferior
50
difference in bronchioles between mouth/nose and the respiratory bronchioles and onwards
mouth/nose: conducting zone (aka dead space
respiratory bronchioles onwards: gas exchange begins
51
the trachea
C shaped rings help keep it patent,bifurcates at carina
52
causes of carina angle widening
lobar collapse, enlargments of sorts
53
what is the superior boundary of the abdomen
costal margin/xiphoid process(boney process at the bottom of the sternum)
54
what is the lateral boundary of the abdomen
mid-axilliary line
55
what is the inferior boundary of the abdomen
illiac bones/pubic symphosis
56
what are the 4 quadrants of the abdomen
RUQ/LUQ/RLQ/LLQ
57
name all 8 layers of the anterior abdomen
sscs NOM NOM T tf pftp
1) Skin
2) superficial fascia
a- fatty tissue - camper fascia
b- deep membrane tissue- scarpa fascia
3) External Oblique Muscle
4) Internal Oblique Muscle
5) Transversus
(3-5 are flat muscles)
6) Transversalis (deep) fascia
7) Peritoneal fatty tissue
8) Peritoneum
58
what is the linea alba
median aponeurotic dense connective tissue of rectus abdominis
59
what is the linea semilunaris
lateral border of rectus abdominis
60
arcuate line
transverse line 1/3 between umbilcis + pubic symphysis
61
what are all the flat muscles in the abdomen
external oblique
internal oblique
transversus abdominis
62
what is the external oblique
- most superficial flat muscle of the abdomen:
runs inferomedially
aponeurotic into linea alba
63
what is the internal oblique
middle layer of the flat muscles of the abdomen
-runs superomedially
joins w transversus abdominis to form conjoint tendon
63
what is inferomedially
hands in pocket
ribs to linea alba
64
what is the transversus abdominis
the deepest flat muscle of the abdomen
transverse(directly across)
joins to the conjoint tendon
64
general function of abdomen
abdominl compression/ no hernias
65
what is the rectus abdominis
a part of the rectus sheath and is the "abs"
-paired segments running down from xiphoid to the pubic symphysis
-split into segments
-surrounded by the rectus sheath
66
function of rectus abdominis
trunk flexion
67
function of external oblique
ipsilateral lateral flexion/ contralateral trunk rotation
68
function external oblique
ipsilateral lateral flexion/ ipsilateral trunk rotation
69
transversus abdominis
abdominal pressure
70
what supplies the abdomen with blood
superior: continuation of internal thoracic artery
inferior: continuation of external illiac artery
71
what innervates the abdomen
intercostal nerves( T7-11) + subcostal nerves (T12),
-transverse/band shaped supply
72
what are all the umbilical ligaments
median UL
medial UL
lateral UL
73
What are the contents of the inguinal canal
illoinguinal nerve+ spermatic cord(vas deferens, arteries, nerves)
74
what is the goal of the inguinal canal
wants to get stuff inside the abdomen and into the scrotum
75
what are the layers of the inguinal canal
deepest layer: transversalis fascia
middle layer: internal oblique
superficial layer: external oblique
76
what does the transversalis fascia of the inguinal canal form
transversalis fascia forms the internal inguinal canal
- follows through as internal spermatic fascia
77
what does the internal oblique form in the inguinal oblique
forms the cremasteric muscle
this muscle holds the testes and raises/lowers them- follows through in inguinal canal
78
what does the external oblique form in the inguinal canal
at the end forms the superficial ring + external spermatic fascia
wraps back around to the inguinal ligament anterior+ inferior surface - runs from ASIS --> pubic tubercule
79
describe the descent of the testes
originate from the posterior wall of the body (retroperitoneal)
-exists abdominal cavity through the inguinal canal, 'catching' the layers of the abdominal with it
-pulled by Gubernaculum
80
regarding testes migration what is the tunica vaginalis/ peritoneum
the first layer that testes push through
1) open tube= processus vaginalis
2) closes= tunica vaginalis
normal= attached to inner scrotum
81
what is bell-clapper deformity
-high attachment onto spermatic cord
-testes more able to move freely
-cause testicular torsion
82
which 3 germ cell layers turn into the different gastrointestinal organs
endoderm
mesoderm
ectoderm/neural crest
83
what does the endoderm become
epithelium, parenchyma and the glands
84
what does the mesoderm become
lamina propia, blood vessels, muscularis mucosae, submucosal connective tissue, muscularis externa, adventitia
85
what does the ectoderm become
enteric nerves, nervous system, brain spinal cord
eyes+anus
86
what are the borders of the foregut
oesophagus to the ampulla of vater in the duodenum
87
what are the borders of the midgut
ampula of vater to the 2/3rds into the T.colon
88
what are the borders of the hindgut
2/3rds into T.colon to the rectum
89
what is the arterial supply of the foregut
celiac trunk (T12)
90
what is the arterial supply of the midgut
SMA(l1)
91
what is the arterial supply of the hindgut
IMA(L3)
92
what does the dorsal mesentry become
the greater omentum
93
what does the ventral mesentry of stomach become
falciform ligament
94
what does the mesentery between stomach and liver(ventral mesentery) become
lesser omentum
95
what is the omentum
a fold of the peritoneum
that surrounds the stomach and other organs in the body
96
how do the greater and lesser omentum communicate
via the gastro epiploic foramen/ foramen of Winslow
97
what does the oesophagus arise from
the gut tube
98
what does the liver arise from
arises from the ventral foregut endoderm
liver drives the foregut rotation!!
99
what is the pancreas formed from
2 seperate outgrowths, the ventral(ucinate part of the pancreas) and dorsal pancreatic bud
-as the gut tube rotates, it brings around both to meet each other and fuse together
100
what happens if the 2 pancreatic buds fail to merge?
can cause an annular process wherein the buds fuse around the duodenum obstructing it
101
what are the clinical presentations of an annular pancreas
-feeding problems
-abdominal distension
-vomiting
102
stages in foregut embryology
1) dilation of foregut
2) rotates 90 degrees CLOCKWISE, left side becomes ventral, right side posterior(explains how left vagus nerve is ventral, right is posterior)
3) ventral mesentery becomes lesser omentum, dorsal becomes greater omentum
103
what is lateral folding
involves the sides of the embryonic disc rolling up, forming a tube-like structure with the ectoderm on the outside and the endoderm in the middle, which will become the gastrointestinal tract
104
what is the midgut
the middle segment of the early gut tube that ultimately produces most of the small intestine and a significant portion of the large intestine
105
how does the midgut keep connection to the yolk sac
with the vitelline duct which is incorporated into the umbilical cord
106
what is midgut herniation
as the midgut begins to rapidly grow, it runs out of space within the abdominal cavity, and begins to herniate out into the umbilical cord
107
outline the rotation of the herniated midgut
the herniation creates a proximal and distal limb of the midgut tube around the superior mesentric artery.
growth of the midgut is limited to the cranial limb hence ROTATES around the sma in an anti-clockwis direction
108
what is meckel's diverticulum
patent vitelline duct; usually asymptomatic
rule of 2s: "2% of the population have it, it's typically 2 inches long, located 2 feet of the ileocecal valve and symptoms usually appear before 2 years of age
GASTROCHISIS= potruding small intestine(sac like)
Omphalocele= portruding transparent sac of organs
109
reason for great variations in possible locations of the appendix
the proximal end of the caudal limb grows inferiorly to create the ascending colon
110
when the ectoderm meets the endoderm gut tube what is formed
the pectinate line:
important for:
-lymphatic drainage of anal cancers
-portal venous anastomosis
-thrombosed internal vs external haemorrhoids
111
where is gallblader pain referred to
Gallbladder pain usually presents as RUQ pain with the potential for pain referred to shoulder tip. The gallbladder is located close to the peritoneum such that pain will be localised much faster. Pain can be referred to the shoulder tip as it may irritate the diaphragm and this results in phrenic nerve referral to the tip of the shoulder (like the liver). Pain can also be referred to the right upper back/flank region (following the dermatomal distribution).
112
what is the order for processing food
oesophagus--> stomach--> duodenum--> jejunum--> ileum -->cecum ascending colon--> descending colon-->sigmoid colon--> rectum --> anus
113
pancreatitis causes
inflammation of the pancreas
gallstones and alcohol (GET SMASHED)
-gallstones
-ethanol
-Trauma
-Steroids
-Autoimmune
-Scorpion poisoning
-Hpercalcaemia
-ERCP
-Drugs
114
symptoms of pancreatitis
epigastric pain radiating to the back
-pain when supine-relieved when sitting forward
-pain worse after meals
-abdominal guarding distension
-jaundice
115
diagnosis of pancreatitis( signs)
Cullens sign- bruising around umbilicus (sign of intraperitoneal bleeding )
grey turners sign- bruising of flanks( sign of retroperitoneal bleeding )
116
causes of pancreatic cancer( in head of pancreas)
smoking
alcohol abuse
obesity
117
symptoms of pancreatic cancer (in head of pancreas)
obstructive jaundice( obstruction of biliary tree)
weight loss
abdominal pain
118
diagnosis pancreatic cancer (in head of pancreas)
Courvoisier's law -
patient with PAINLESS JAUNDICE and ENLARGED GALLSTONES is unlikely to be gallstones, and is assumed to be an obstructing pancreatic or biliary tumour
119
cholecytisis causes
inflammation of gallbladder
may be associated with a stone
120
cholecytisis symptoms
constant RUQ pain --> worse after eating
-fever
-nasuea/vomiting
-sweating
121
cholecytisis diagnosis
Murphys sign- pain occurs on inspiration while you palpate above gallbladder.(inflamed gallbladder comes into contact)
122
define cholecystitis
Cholecystitis is inflammation of the gallbladder, typically caused by gallstones blocking the bile ducts. This leads to a buildup of bile and pressure inside the gallbladder, causing pain and inflammation. Cholecystitis can be either acute (sudden onset) or chronic (long-lasting).
123
difference between cholecytisis and cholelithiasis
cholecytisis= inflammation due to potential gallstone of the gallbladder or other reasons
cholelithiasis= galstone in galbladder
124
cholelithiasis vs choledocholithiasis
cholelithiasis- gallstone in gallbladder
docolithiasis- gallstones within bile duct
125
presentation of cholelithiasis
assymptomatic (no pain) but can cause cholecytisis
Fair Fat Female , fertile , forty
126
presentation of choledocholithiasis
can lead to pancreatitis if it blocks pancreatic duct
jaundice( as it is obstructive)
LFT- increase GGT increase ALP increase conjugated bilirubin
127
what is cholangitis and the two types
inflammation of bile duct
ascending- bacteria travels from duodenum into biliary tree
descending- bacteria travels from liver into biliary tree
128
how is cholangitis diagnosed
charcot's triad- jaundice+ fever + RUQ pain
Reynolds pentad- charcot's Triad + shock (hypotension, tachycardia) altered mental state
129
Inflammatory Bowel disease two main causes
IBD
ulcerative colitis- only large bowel; inflammation ascending from the rectum
Crohn's disease- any part of GIT, inflammation occurs in patches ('skip lesions")
130
IBD symptoms
-chronic diarrhoea
-haemtochezia( fresh stool blood)
-abdominal pain
131
what is apendicitis
blockage/ obstruction of appendix--> subsequent infection
132
symptoms of Appendicitis
umbilical pain(early) --> right iliac fossa pain (later)
nausea/vomiting
bloating
fever, sweats anorexia
133
how is pain presented with appendicitis and why
umbilical pain (early) to the right iliac fossa (later)
the appendix, initially inflamed, first irritates the visceral peritoneum, leading to referred pain near the belly button. As the inflammation progresses, the parietal peritoneum lining the abdominal wall becomes involved, causing localized, sharp pain in the right lower quadrant.
134
diagnosis of appendicitis
mcbruney's point- 1/3 of distance from ASIS to umbilicus( tenderness)
roving's sign - pain in RIF when palpating LIF
Rebound tenderness- pain when pressing down then lifting up quickly
135
what is portal hypertension
obstruction of blood flow to the liver ( eg. cirrhosis, thrombosis) results in high blood pressure in portal veins
the fact that the veins have no valves means more blood is forced through the anastomoses with the systemic venous system
symptoms: varices, splenomegaly, ascites
136
cirrhosis causes and definition
chronic liver damage( fibrosis occurs during repairs, impairing liver function)
fibrosis is the scarring and thickening of tissue
causes: excess alcohol, non-all fatty liver disease, Wilsons disease, hep c in section (+B.D)
137
symptoms of cirrhosis
clubbing
palmar erythema
dupuytren's contracture
petechiae + purpura
jepatosplenomegaly
asterisks
jaundice
138
what is GORD
Gastro-oesophageal reflux disease
causes:
gastric acid travels from the stomach to oesophagus
due to dysfunction of lower oesophageal sphincter (fails to close)
139
symptoms of GORD
burning chest pain( heart burn)
worst after meals or lying down
140
What are the causes of coeliac disease
autoimmune disease- abnormal response to gluten
autoantibodies for gluten target small intestine, causing malabsorption
chronic inflammation --> crypt hyperplasia, villous atrophy, loss of brush border
141
symptoms of coeliac disease
diarrhoea
steatorrhoea ( foul smelling, floaty stools)
bloating, flatulence
malabsorption symptoms (vitamin deficiency, weight loss, dermatitis herpetiformis)
142
name the order from the sinuses to the trachea
sinuses, nasopharynx, laryngopharynx, oesophagus, trachea
143
where does the oropharynx and the epiglottis branch off
off the laryngopharynx
144
how many segments in the right and left lung
right lung: 10 segments
left lung: 8 segments
145
order of trachea bifurcation
trachea, bronchi, bronchioles, terminal bronchioles, respiratory bronchioles, alveolar ducts, alveolar sacs
146
which bronchi is more likely to have pirated material stuck within it
the right bronchus because it is shorter, wider and more vertical
147
where does aspirated material go based on positions of body when aspirated
-erect
-on the right side
-supine
erect: posterior basal segment( right inferior lobe)
supine: superior segment (right inferior lobe)
laying on right side: posterior segment( right upper lobe)
148
what are the positions of the kidneys
- retroperitoneal
-right kidney=lower than left kidney
-right kidney: L1-L3. left kidney: T12-L2
-anterior to muscles like psoas major and quadrates lumborum
149
name all the layers ( of fascia) which the kidney is wrapped in PRPRK
lets do some pr pr k?
Paranephric fat
Renal fascia
Perinephric fat
Renal capsule
Kidney (at the centre of it all)
150
what shape is the bladder when full
oval shape when full and flat when empty
151
what are the 4 main sections of the bladder
apex, body, funds(base) and neck
152
what structures allow entry and exit of urine in the bladder
urethera= exit
ureter= entry
153
what are the two sphincters and their function
Internal urethral sphincter
Under autonomic (involuntary) control
External Urethral Sphincter
Same for everyone
Under voluntary control - basically what prevents you from peeing yourself
154
which sphincter prevents one from peeing themselves
the external urethral sphincter
155
outline the artery supply for kidneys
5
Renal artery -> segmental arteries -> interlobar arteries -> Arcuate arteries (these turn) -> interlobular arteries (aka cortical radiate arteries)-> afferent arterioles
156
clinical relevance of the fact that each of the 5 segments of the kidney are independently arterially supplied
obstruction in one causes ischaemia of that segment but not the others
157
what muscles make up the posterior abdominal wall
psoas major
psoas minor
quadratus lumborum
illacus
lumbar facia
transversus abdominis
158
where do the ureters run
from approx L1 to L2 ( lower in right side of body and run down along the transverse processes of veterbrae
159
what is the main vein and aorta running medially to the kidneys
the IVC and the abdominal aorta ( aorta to the left ivc to the right)
160
what is the names of the veins which come off the ivc and connect to the kidneys
the renal veins
161
where do the renal arteries sit in relation to the renal veins
posteriorly
162
what is the clinical releveance for the positioning of the internal illiac lymph nodes ( or hypergastric lymph nodes) along the ureter
when people have prostate metastatic cancer this can cause these lymp nodes to be enlarged which sit next to the urthers which enter the bladder via the trigone.This enlargement prevents urine from the kindey entering the bladder ---> hydronephrosis ( larger renal pelvis and larger ureter)
163
where does the thoracic duct sit in relation to the vertebral column, esophagus and aorta and azygous vein
The duct lies on the anterior surface of the vertebral column, behind the esophagus and between the aorta and azygos vein, from the eleventh through the seventh thoracic vertebrae
T12
164
draw a kidney
renal vein
renal artery
renal nerve
capsule
renal cortex
renal medulla
pyramid
major calyx
minor calyx
renal pelvis
165
where do the interlobular run
along the pyramids in the kidneys which then give rise to the arcuate arteries
166
how mant segments are there in the kidney
5
apical
upper
middle
lower
posterior
all supplied by different segmented arteries and veins
167
how does referred pain work with kidneys unilaterally and bilaterally VISCERAL ( if parietal then we would be able to locate exactly)
uni: lateral sides
bi: midline
uni
as when theres is a signal sent from the kidneys ( sitting medially) the message i sent from a T10 level but where it reaches in the brain there is no somatic mapping and hence when random sensory info from the T10 area of the skin ( more lateral) this can cause some collateral where the brain perceives that the pain must be coming from there
bi:
its nervous supply comes from both sides however a signal is relayed from both sides and since it again isnt somatically mapped it believes the pain must be coming from the midline
168
what is a nephron
a single functioning unit of the kidney
169
describe the structures of the nephron
glomelorus which exists within the bowmans capsule which leads to the proximal tubule which feeds into the loop of henele to the thin and then thick ascending limb to the distal convoluted tubule to the connecting duct all leading to the collecting duct
170
what are the 3 parts of the kidney embrylogically
pronephroi
mesonephroi( developed from the pronephroi)
metanephroi( permanent kidney @ 5 weeks)
171
embryologically where does the loop of henle, convoluted tubule derive from when compared to the collecting duct
they are all derived from the mesnchyme except for the collecting ducts from the uereteric bud
172
7 steps in nephronic development
1) mesenchymal cell condensation( aggregate)
2) epithelial vesicle
3) comma shaped body
4) s-shaped body
5) capillary loop staged glomerulus
6) maturing glomerullus
173
what does the uteretic bud give rise to
collecting duct
calyces
pelvic
ureter
174
what does the metanephric mesenchyme give rise to
all of nephron except for collecting duct
175
low nephron number is associated with what
increased risk of chronic kidney disease
176
what is BMP4
bone morphogenic protein 4. an inhibitor of uteretic budding and branching morphogenesis
177
where does the ureteric bud come from
branch from the mesonephric duct
178
what happens if we dont have a uronephric bud?
kideny agenisis( no kidney)
179
what can cause issues in kidney development
no ureteric bud formed (agenisis)
2 uteric buds--> duplex= two ureters
incorrect communication between ureteric bud and mesenchyme ( many possibilities)
180
what is the location of common obstructions within the ureter causing retrograde flow of urine
UPJ or PUJ ( close to kidney)
pelvic ureteric junction
UVJ VUJ ( close to bladder)
uterovesical junction
181
what happens when the ureteric bud emerges too distal or proximal to the coloca
too proximal= ureter not inserted correctly at the bladder causing an obstruction = back flow of urine = mega ureter --> can result in functionless kidney
too distal= ureter inserted too low = back flow of urine
182
what is the importance of a functional sphincter in a bladder
Since the ureter enters the blooder obliquely( slanting/sloped), this results in that when the bladder contracts or expands to a certain point this causes an obstruction of the ureters
183
how can kidney formation be abnormal
incorrect ascension
incorrect rotation
fusion of mesenchyme between both kidneys resulting in no ascension or rotation and instead horseshoe kidney
184
multiple renal arteries are present in ___ of people and hence _____ of all kidneys ( aus study)
22% and 12%
185
what are the 5 main functions of the kidney
1)regulation of water and electrolyte volume and osmolarity
- sodium, chloride, potassium, calcium, phosphate, magnesium
-arterial
2)regulation of acid-base balance
-hydorgen ions 9H+)
3) excretion of metabolic waste products and foreign chemicals
4) endocrine
renin( controls formation of angiotensin 2)
erythropoiten
5) glucogenesis= amino acid to glucose ( waste product is urea) (urea cycle)
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malfunction in kidney function and its symptom
1) regulation of water and electrolytes= hypertension, odema,osteoporosis, thirst, hyperkelimia
2) regulation of acid base balance=aciodosis
3) glucogenesis= malnutrition
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what exists within the bowmans capsule
glomerulus which contains an efferent and afferent arteriole coming in and out of it + fluid
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order of the nephron
glomerulus( within bowmans capsule), proximal convoluted tubule, loop of henele ( with descending and ascending sections), distal convoluted tubule, collecting duct
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describe glomerular filtration
only small molecules can pass through to the bowmans capsule such as: H2O, glucose, amino acids
PASSIVE NON-SELECTIVE
but larger proteins can't
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what is the filtrate
solution after blood has been filtered to lose large proteins
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tubular reabsorption
this when substances beneficial to the body move back into the blood from the filtrate ( Na+, Cl-, amino acids and glucose)
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tubular secretion
the movement of solutes from the peritubular capilliaries into the tubules eg. ammonium and hydrgoen ions
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exretion= ( equation)
filtration- reabsorption+ secretion
each substance which enters the nephron has different filtration, reabsorption and secretion
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why are glomerular capillaries such efficient filters
-high hydrostatic pressures driving filtration (55mmHg vs 18mmHg)
- very large fenestrations( openings/pores)
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what are the 3 barriers for glomerular filtration
1) single-celled capillary endothelium ( fenestrations)
2) non-celular basement membrane
3) single-celled epithelial lining of bowmans capsule
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Pgc
glomerular hydrostatic pressure favours filtration, this is the pressure within the gomerular- 55mmHg
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Pbc
hydrostatic pressure of filtration in bowmans capsule, opposes filtration- 15mmHg
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pi gc
this the plasma osmotic (colloid) pressure which opposes filtration- 30mmHg
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what is net glumerular pressure
Pgc-Pbc- pi gc = 55 - 15-30=10mmHg
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what is gfr
glomerular filtration rate
-volume of filtrate formed ( by the kidneys) each minute (ml/min)
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safe and dangerous gfr levels
60-120= normal
15-60= kidney disease
0-15= kidney failure
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how is gfr measured
estimated through renal clearance
volume of plasma that is completely cleared of a particular substance by the kidney per unit time
or through measuring renal clearance of creatinine
- creatinine is freely filtered
margin of error through the secretion that exists ( small amount)
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proximal convoluted tubule role
responsible for the majority of filtration
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distal convoluted tubule role
reconcentrate the urine by re absorbing ions causing water to follow and also be reabsorbed
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loop of henele role
to reabsorb electrolytes and water from urine
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what is the 1 uretheral exit of the bladder surrounded by
the internal ureteral sphincter
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what mucosa is the trigone made of
smooth mucosa
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what is the urothelium and its relevance in function
transitional epithelium
Highly elastic: this allows it to adapt to the degree of DISTENSION
Has an osmotic barrier (it is impermeable to water and salt) - and thus urine concentration will not be altered at this point. This also prevents reabsorption of toxic wastes (urea/creatinine), potassium, pathogens, etc
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what Is the muscular structure of the bladder
Has 3 layers of smooth detrusor muscle which contract in synergy when micturating
Acts as a reservoir with low pressure when underfilled and high pressure when over-expanded
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what are the two sphincters which help maintain continence
the internal uretheral sphincter( made of circular fibres of the detrusor muscle): involuntary and will contract when reaching a certain threshold
the external uretheral sphincter: voluntary at the urogenital diaphragm
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what is the critical threshold of the bladder
Bladder responds to pressure of about 40-60 mmHg → this is when mechanoreceptors are activated and micturition reflex is activated
Once we reach higher pressure → action potentials fire throughout the whole bladder
-this allows for the coordinated contraction of the whole bladder
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what controls our continence( generally speaking)
It is a combination of an
INVOLUNTARY SPINAL REFLEX and subject to VOLUNTARY CONTROL by
1) FACILITATORY & INHIBITORY CENTRES in the micturition centre of pons (in the brainstem)… and
2) LEARNING & BEHAVIOUR CENTRES in the cerebral cortex
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what are the inhibitions that take place to maintain incontinence
INHIBITION OF:
Sympathetic (T11-L2) fibres at alpha receptors (usually cause internal urethral constriction)
Somatic pudendal nerve (S2-S4) innervating the external urethral sphincter through the pelvic floor muscular surrounding urethra
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3 main ways in which we maintain continence
Stretch receptors stimulated (particularly at bladder neck and trigone) when critical level is reached
Visceral afferent sensory fibres send impulse to spinal cord (S2-S4 level) for reflex arc activation
ACTIVATION OF visceral motor parasympathetic fibres (pelvic splanchnic S2-S4) terminate on the cholinergic muscarinic receptors of bladder wall
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what is deafferentation
Deafferentation: interruption of the visceral afferents
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example of deafferentation ( neurosyphilis)
EXAMPLE: neurosyphilis (dorsal roots are affected which is where the visceral afferent sensory fibres would synapse to activate the spinal reflex arc)
The disruption in transmission of stretch signals from bladder to spinal cord results in an atonic bladder
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result of deafferentation
-The disruption in transmission of stretch signals from bladder to spinal cord results in an atonic bladder (flaccid and distended)
-Causes OVERFLOW INCONTINENCE (bladder doesn’t know when to empty anymore so will just overflow with a few drops at a time when it reaches the critical threshold)
-Can also lead to vesicoureteric reflux, hydronephrosis and cause AKI
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what is denervation
Denervation: interruption of both the afferent and efferent nerves
EXAMPLE: Diabetic autonomic neuropathy
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upper motor and lower motor neuron effects of denervation
Upper Motor Neuron Damage = Spastic Neurogenic Bladder (UMN usually inhibitory so when damaged you have a hyper-reflexive bladder… the detrusor muscle will contract inappropriately and not in coordination with voluntary control)
Urge incontinence
Lower Motor Neuron Damage = Flaccid Bladder (bladder becomes hypo-reflexive due to damage of peripheral parasympathetic nerves innervating detrusor muscle)
Urinary retention, overflow incontinence
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describe the entirety of spinal cord transection ( eg. spinal cord injury leading to spinal shock )
Spinal cord transection (above sacral region): interruption of the voluntary facilitatory and inhibitory pathways in the brain
EXAMPLE: motor vehicle accident resulting in spinal cord damage
Initially, in a state of traumatic SPINAL SHOCK so everything is suppressed, including the micturition reflex → bladder is flaccid & unresponsive
After the shock has passed, micturition reflex will return but not voluntary control from the descending pathways from the brain
This is called a neurogenic bladder (urge incontinence)
Patients in hospital will often have an IDC (indwelling catheter) put in to help them empty their bladder (urinary stasis can lead to bladder, kidney infection…)
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what is overflow incontinence
when you have a hypotonic / atonic bladder - involuntary leakage and “dribbling” (cauda equina syndrome, BPH)
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what is urge incontinence and causes
Urge → when you have an overactive / hyper-reflexive bladder - associated with a compelling desire to void (stroke, Multiple Sclerosis, Parkinson’s)
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what is stress incontinence and causes
Stress - this is the most common one. It is the involuntary leakage of urine during activities that increase intra-abdominal pressure.
Can happen when we are coughing, laughing, sneezing
When there is damage to the pelvic floor muscles which reduces closing pressure (can happen in pregnancy, aging, radiation exposure)
There can also be a neurogenic urethral sphincter incompetence
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how to treat overflow incontinence
catheterisation to prevent over-distension and urinary retention
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how to treat urge incontinence
anticholinergics to prevent overstimulation of detrusor muscle, sacral nerve stimulation devices to regulate nerve impulses to the bladder, surgery to increase bladder capacity (higher critical threshold), bladder training
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how to treat stress incontinence
aim is to strengthen the external urethral sphincter… through
Pelvic floor (Kegel) exercises (important to do in pregnancy)
Bulking agent (collagen, silicone) injections (enhances urethral support)
Mid urethral sling surgery (support to urethra to help it stay closed)
Pessary devices (mechanical support)
Bladder suspension operations (surgical lifting & securing of bladder neck/urethra)
Artificial urinary sphincters (in severe / refractory cases)
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