Anatomy Flashcards
(213 cards)
1
Q
what makes up the upper urinary tract?
A
the kidneys and the ureters
2
Q
what makes up the lower urinary tract?
A
bladder and urethra
3
Q
where might an upper urinary tract infection spread to?
A
the kidneys
4
Q
what does a lower urinary tract infection involve?
A
the urethra and the bladder
5
Q
what part(s) of the urinary tract are in the abdomen?
A
kidneys and proximal ureters
6
Q
where about in the abdomen are the kidneys located?
A
retroperitoneum
7
Q
at what vertebral level does the abdomen become the pelvis?
A
L4
8
Q
what anterior landmark shows the division between the abdomen and the pelvis?
A
the level of the hip bones
9
Q
what parts of the urinary tract are in the pelvis?
A
the distal ureters, the bladder and the proximal urethra
10
Q
where is the distal urethra found?
A
perineum
11
Q
what else happens at the division between the abdomen and pelvis?
A
bifurcation of the abdominal aorta
12
Q
what major vessel does the right kidney lie lateral to?
A
the IVC
13
Q
what major vessel does the left kidney lie lateral to?
A
the aorta
14
Q
why is the left renal vein longer than the right?
A
it has to cross over aorta to get to IVC which is to the right
15
Q
following the renal capsule what are the other layers surrounding the kidney?
A
perinephric fat then renal (deep) fascia then paranephric fat then visceral peritoneum
16
Q
what groups of muscles surround the kidney?
A
posterior abdo wall muscles
antero-lateral abdo wall muscles
muscles of the back
17
Q
what are the 3 layers of the anterolateral abdo wall muscles?
A
external oblique, internal oblique, transversus abdominis
18
Q
what muscle of the posterior abdo wall sits posterio-medial to the kidney?
A
quadratus lumborum
19
Q
what muscle of the back sits medial to the kidney?
A
psoas major
20
Q
what is the right kidney slightly lower than the left?
A
the liver
21
Q
at what vertebral level does the right kidney sit?
A
L1-L3
22
Q
at what vertebral level does the left kidney sit?
A
T12- L2
23
Q
when can the floating ribs be a problem to the kidneys?
A
if they are fractured the sharp displaced ends may contuse or lacerate the kidney
24
Q
what are the dimensions of a normal kidney?
A
- about 12cm long
- about 6cm wide
25
how should a regular kidney feel?
smooth, regular, firm
26
where do you palpate posteriorly when examining the kidney?
within the flank region just inferior to 12th rib
27
where do you palpate anteriorly when examining the kidney?
with the right/left upper quadrant
28
how do the kidneys move with breathing?
move inferiorly on inspiration then superiorly on expiration
29
what is the right kidney posterior to?
- liver and hepatorenal recess
- 2nd part of the duodenum
- ascending colon
- right colic flexure
30
what is the left kidney posterior to?
- the stomach
- the tail of the pancreas
- the hilum of the spleen and the splenic vessels
31
what is the hepatorenal recess part of?
the greater sac of the peritoneal cavity
32
where do the renal veins sit in relation to the renal arteries?
renal veins sit anterior to renal arteries
33
what arteries sit anterior to the common iliac veins?
the common iliac arteries
34
where does lymph from the kidneys drain to?
the lumbar nodes
35
where are the lumbar nodes located?
around the abdominal aorta and inferior vena cava
36
what is the ureteric arterial blood supply branches of?
- the renal artery
- the abdominal artery
- common iliac arteries
- internal iliac arteries
- vesical (bladder) artery
37
where does the lymph from the ureters drain?
to the lumbar nodes and iliac nodes
38
if there is both AAA and renal artery stenosis, what are the 2 possible reasons for this?
- the renal artery stenosis is combined with an infra-renal AAA (both caused by atherosclerosis)
- the renal artery stenosis is due to a suprarenal AAA
39
How can a suprarenal AAA cause renal artery stenosis?
occlusion of the proximal renal artery by the aneurysm
40
what is meant by the solitary kidney?
patient only has one kidney
41
reasons for a solitary kidney?
- agenesis
- nephrectomy (pathology)
- nephrectomy (donation)
42
what many pyramids does the medulla of the kidney contain?
27 pyramids
43
how many nephrons does each pyramid contain?
50,000 nephrons
44
what gives the pyramids their striped appearance?
regularly arranged nephrons
45
how are the nephrons arranged?
running axially towards the apex of each pyramid
46
main structures of a nephron from proximal to distal?
glomerulus, proximal convuluted tube, loop of Henle, distal convuluted tube, collecting duct
47
where does the collecting duct drain to?
through the pyramid to drain the modified filtrate into the minor calyx
48
how does urine drain from the kidney?
nephrons collecting duct to minor calyx to major calyx to renal pelvis to the ureter
49
what is the constriction called where the wider renal pelvis becomes the narrower ureter?
the pelviureteric junction
50
what are the 3 anatomical sites of ureteric constriction?
1. pelviureteric junction
2. ureter crossing the anterior aspect of the common iliac artery
3. ureteric orifice
51
what is the ureteric orifice?
opening into one corner of the trigone on the floor of the bladder
52
what do renal calculi result from?
from urine calcium salts
53
what can a ureteric constriction be due to?
interal obstruction eg impacted renal calculus or blood clot or external compression eg a tumour
54
what is the ureters response to obstruction?
increase peristalsis
55
how is renal failure defined?
failure to adequately filter the blood to produce urine
56
what is hydronephrosis?
water in the kidney
57
what affect does urine back pressure in the calyces have?
compresses the nephrons within the medullary pyramids leading to renal failure
58
why is acute hydronephrosis painful?
causes painful stretching of the renal capsule
59
where is the false pelvis?
from the iliac crests to the pelvic inlet
60
where is the true pelvis?
pelvic inlet to pelvic floor
61
where is the bladder found?
in the pelvic cavity
62
where does the urethra end up when it passes through the pelvic floor?
the perineum
63
what forms the pelvic floor?
the pelvic diaphragm
64
what is the levator ani muscle part of?
the pelvic diaphragm
65
what passes through the openings in the pelvic floor?
distal parts of alimentary, renal and reproductive tracts
66
what do the ureters pass anterior to, to enter the pelvis?
the common iliac vessels
67
what do the ureters do at the level of the ischial spine?
they turn medially to enter the posterior aspect of the bladder
68
in which direction to the ureters enter the bladder and why is this relevant?
enter the posterior bladder wall in an inferomedial direction - helps prevent reflux of urine back into ureter when the bladder contracts
69
in the anatomical position, what is the most inferior part of the male peritoneal cavity?
the rectovesicle pouch
70
what forms the roof over the pelvic organs?
the inferior part of parietal peritoneum
71
where does the pelvic diaphragm extend from?
from the sacrum to the pubis
72
what is the most inferior part of the female peritoneal cavity in the anatomical position?
rectouterine pouch (of douglas)
73
what is the vesico-uterine pouch?
pouch between the bladder and the uterus
74
what does the round ligament of the uterus do?
attaches uterus to the perineum via the inguinal canal
75
where is the suspensory ligament of the ovary in relation to the ureter?
suspensory ligament of the ovary is lateral to ureter
76
where does the ureter run in relation to the vas deferens?
ureter runs inferiorly to vas deferens
77
where is the uterine tubes and artery in relation to the ureter?
ureter runs inferiorly to the uterine tubes and uterine artery
78
arteries entering the pelvis are mainly branches from which artery?
internal iliac artery
79
where do pelvic veins drain to?
internal iliac vein
80
where do the prostatic arteries often branch from?
the vesical arteries
81
what forms the triangle shape on the internal aspect of the bladder known as the trigone?
the 2 ureteric orifices and the internal urethral orifice
82
where are the ureteric orrifices?
in the base (posterior aspect) of bladder
83
where is the internal urethral orifice?
on inferior aspect "floor" of bladder
84
where does the prostate lie in relation to the bladder?
prostate lies inferior to the bladder
85
what is the muscle that forms the main bulk of the bladder wall called?
detrusor muscle
86
what do the detrusor muscle fibres encircle?
the ureteric orifices
87
what does the detrusor muscle fibres do when the bladder contracts and what does this help prevent?
the tighten - helps prevent reflux of urine superiorly into the ureter
88
around the neck of the male bladder, what does the detrusor muscle form?
the internal urethral sphincter muscle
89
what does the internal urethral sphincter muscle do during ejaculation and why?
it contracts to prevent retrograde ejaculation of semen back into the bladder
90
why is most of the weight of the uterus borne of the bladder in females?
the body of the uterus usually lies superior to the bladder
91
what is the uterus separated from the bladder by?
the uterovesical pouch
92
where does an empty bladder lie and where does the peritoneum cover?
an empty bladder lies within the pelvis, peritoneum covers only its superior surface
93
where can a full bladder extend to and where does the peritoneum cover?
can extend out of the pelvis, peritoneum still only covers superior surface
94
what are the 2 ways to catheterise a patient?
1. urethral catheterisation
| 2. suprapubic catheterisation
95
how is a suprapubic catheterisation acheived?
through anterior abdo wall and avoiding peritoneal cavity
96
approximately how long is the female urethra?
4cm long
97
how does the levator ani muscle act as a sphincter on the urethra?
urethra must pass through it to reach the exterior of the body
98
is the external urethral sphincter voluntary or involuntary?
voluntary
99
approximately how long is the male urethra?
20cm
100
what is the spongy urethra within?
within corpus spongiosum
101
when would suprapubic catheterisation be used instead of urethral catheterisation?
would only be used in urethral obstruction
102
where do the testes begin to develop embryologically?
posterior abdomen
103
what does the teste travel down to get to the scrotum?
inguinal canal
104
what is contained within the spermatic cord?
testicular artery, testicular vein, vas deferens, lymphatics, nerves
105
what are the 2 different types of nerves found in the spermatic cord and what do they innervate?
- autonomic for smooth muscle of vas
| - and somatic for cremaster muscle
106
what is the name of the sac that the testis sit within?
tunica vaginalis
107
what is the epididymis covered by?
visceral tunica vaginalis
108
what is the appendix testis?
an embryological remnant - no function
109
what problem can the appendix testis cause?
can twist - torsion of appendix testis
110
what is excess fluid within the tunica vaginalis known as?
a hydrocele
111
what puts the testes at risk of twisting (torsion of spermatic cord)?
the testis and epididymis are attached to the spermatic cord superiorly and are quite mobile within the scrotum
112
what drains de-oxygenated blood from the testis?
the pampiniform venous plexus
113
what supplies the testis with oxygenated blood?
testicular artery `
114
where is the epididymis palpated?
at posterior aspect of the testis
115
where is the epididymis' proximal end (the head) located?
at the posterior aspect of the superior pole of the testis
116
where is the vas deferens palpated?
within the spermatic cord, superior to the testes within the scrotum
117
what does the vas deferens feel like?
a thick piece of string
118
where does the vas deferens begin?
begins at inferior pole of the testis
119
where does the right testicular vein drain to?
directly into IVC
120
where does the left testicular vein drain to?
drains to left renal vein then to IVC
121
the vas deferens passes superiorly within the spermatic cord to where?
the deep inguinal ring
122
once the vas deferens is at the deep inguinal ring, what does it do?
turns medially into the pelvis
123
what muscle is the posterior aspect of the prostate gland in contact with?
the levator ani muscle
124
function of the prostatic ducts?
drains the glandular secretions from the prostate into the prostatic urethra
125
what joins to make the opening of the ejaculatory duct?
combined duct of vas deferens and the duct from the seminal gland
126
what zone of the prostate is felt on a digital rectal examination?
peripheral zone of the prostate
127
from which zone of the prostate do most malignancies arise?
the peripheral zone
128
what transmits the deep arteries of the penis?
the (right and left) corpus cavernosum
129
where is the corpus cavernosums?
posterior penis
130
what does the corpus spongiosum transmit?
spongy urethra
131
what does the corpus spongiosum expand distally to form?
to form the glans
132
what is the root of the penis attached to?
laterally attached to ischium of pelvis
133
what happens to the 3 cylinders of erectile tissue during erection?
they become engorged with blood
134
what lies deep to the penile raphe?
spongy urethra within the corpus spongiosum
135
what is another name for foreskin?
prepuce
136
what is paraphimosis?
swelling of the glans
137
what can paraphimosis be due to?
retraction of the prepuce
138
what is the blood supply to the penis?
- deep arteries of the penis
| - branches of internal pudental artery
139
what is internal pudental artery a branch of?
internal iliac artery
140
what is the blood supply to the scrotum?
- internal pudental
| - branches of external iliac artery
141
where does lymph from the scrotum and most of the penis drain to?
superficial inguinal lymph nodes
142
what is the only part of the penis that lymph does not drain to the superficial inguinal nodes?
the glans
143
where does lymph from the testis drain to?
lumbar nodes
144
what does the normal renal system motor function nerves control?
- ureteric peristalsis
- bladder contraction
- urethral sphincter control
145
what part of the renal system does the lumbar and sacral plexus (motor and sensory) supply?
perineum (distal part of renal system)
146
what are the 5 types of nerve fibre?
- somatic sensory
- visceral afferent
- somatic motor
- parasympathetic and sympathetic nerve fibres
147
what does the somatic sensory nerve fibres relay/
sensations from the body wall (soma)
148
what does the visceral afferent nerve fibres convey?
sensations from our organs
149
what nerve fibres convey motor responses to our body wall?
somatic motor
150
what do parasympathetic and sympathetic nerve fibres stimulate?
smooth muscle, cardiac muscle or glands
151
what type of nerve fibre innervates the external sphincter and levator ani?
somatic motor
152
what fibre(s) convey pain from the urethra?
visceral afferent (in pelvis) and somatic sensory (in perineum)
153
what is the only means by which any type of nerve can comminucate with the CNS?
by being carried within the cranial nerves or spinal nerves
154
where do sympathetic nerve fibres leave the CNS?
only within the spinal nerves between spinal cord level T1-T12
155
what are the 2 groups of splanchnic nerves that the sympathetic fibres travel within to reach the smooth muscle/glans of the body?
- cardiopulmonary or abdominopelvic
156
how do sympathetic fibres supplying the head reach the head?
mainly by following (hitching a ride with) the arteries supplying the same structures
157
where does the sympathetic chains run from?
run the entire length of the vertebral column
158
what do the sympathetic nerves travel between?
the sympathetic chain and spinal nerves' anterior rami
159
where do the sympathetic fibres supplying the renal system leave the spinal cord?
between levels T10 and L2
160
what do the sympathetic fibres leave the spinal cord within (bilaterally)?
within the abdominopelvic splanchnic nerves
161
while the sympathetic nerve fibres are in the abdominopelvic splanchnic nerves, are the pre or post - synaptic?
pre-synaptic
162
where do the sympathetic nerve fibres supplying the renal system synapse?
at the abdominal sympathetic ganglia
163
where is the abdominal sympathetic ganglia located?
around the central branches of abdominal aorta eg coeliac trunk, SMA and IMA
164
what do the post-synaptic sympathetic nerve fibres for the renal system do after synapsing?
pass onto the surface if the arteries which are heading towards the organs they need to innervate
165
what is the collection of nerve fibres found on the outside of the arteries known as?
a periarterial plexus
166
what other nerve fibres are part of the periarterial plexuses?
parasympathetic and visceral afferent nerve fibres
167
what are the 4 cranial nerves that contain parasympathetic nerve fibres?
CN III, VII, IX and X
168
what other nerves carry parasympathetic nerve fibres? (other than the 4 CNs)
sacral spinal nerves
169
what do parasympathetic nerves not innervate that the sympathetic do?
the smooth muscle/glands if the body wall
170
how do parasympathetic fibres reach the smooth muscle/glands of the head and body?
via cranial nerves
171
parasympathetic fibres reach the smooth muscle/glands of the hindgut and pelvic organs via what?
pelvic splanchnic nerves
172
what are the parasympathetic fibres leaving the sacral spinal nerves known as?
pelvic splanchnic nerves
173
what nerve carries the parasympathetic fibres to the kidneys and ureter?
within the vagus nerve
174
where are nerve fibres that supply the bladder carried within?
the pelvic splanchnic nerves
175
how does the vagus nerve enter the abdomen?
through oesophageal hiatus with the oesophagus
176
what spinal nerves make up the pelvic splanchnic nerves?
S2, S3, S4
177
what are the only parts of the renal system that somatic nerve fibres go to?
those within the perineum eg distal urethra and its sphincter and levator ani
178
what spinal nerve form the pudental nerve?
S2, 3 and 4
179
what part of the renal system does the pudental nerve supply?
external urethral sphincter
180
what stimulates the detrusor muscle to contract?
parasympathetic fibres (from S2, S3, S4) via pelvic splanchnic nerves
181
what type of fibres stimulate the internal urethral sphincter (in males) to contract and when does this happen?
sympathetic fibres, during ejaculation
182
what stimulates the external urethral sphincter muscle to contract?
somatic motor fibres within the pudental nerve
183
where is pain from the kidney itself felt?
posterior aspect of the flank region on affected side
184
where is pain often felt from a calculus obstructing the ureter?
radiating from the loin to groin on affected side
185
where is pain from the bladder usually felt?
in suprapubic region (midline)
186
where is pain from the perineal part of the urethra usually felt?
quite localised in the perineum
187
where do visceral afferents from the kidneys run?
alongside the sympathetic fibres back to the spinal cord
188
where do visceral afferents from the kidneys enter the spinal cord?
between T11 and L1
189
where do visceral afferents from the ureters enter the spinal cord ?
between T11 and L2
190
what do visceral afferents carrying pain from the part of the bladder which touches the peritoneum run alongside?
sympathetic fibres
191
at what level do the visceral afferents carrying pain from the part of the bladder which touches the peritoneum enter the spinal cord at?
T11-L2
192
where do visceral afferents from the rest of the bladder (not superior part) run alongside and where do they enter the spinal cord?
run alongside the parasympathetic nerve fibres back to spinal cord levels S2, S3, S4
193
where do visceral afferents from the proximal urethra run and to where?
alongside parasympathetic nerve fibres back to spinal cord levels S2, S3, S4
194
what type of nerve fibres carry pain sensation from the distal urethra and to where?
somatic sensory nerve fibres within the pudental nerve. back to spinal cord levels S2, S3, S4.
195
where do the visceral afferent fibres from the testis enter the spinal cord and what do they run alongside?
run alongside sympathetic fibres back to spinal cord to levels T10-11
196
where else can testis pain be felt due to their close relation with the scrotal wall?
localised to the scrotum and/or groin (L1 region)
197
nerve fibres entering and leaving spinal cord at what levels are key in control of micturition?
levels S2-S4
198
what senses the bladder being stretched?
visceral afferent nerve fibres
199
where does the pudental nerve arrise from?
the sacral plexus
200
what nerve roots of the sacral plexus does the sciatic nerve arise from?
L4-S3
201
what named nerved does the lumbar plexus give rise to?
- iliohypogastric
- ilioinguinal
- lateral cutaneous nerve of thigh
- genitofemoral nerve
- femoral nerve
- obturator nerve
202
nerve root(s) of iliohypogastric nerve?
L1
203
nerve root(s) of ilioinguinal nerve?
L1
204
nerve root(s) of lateral cutaneous nerve of thigh?
L2, L3
205
nerve root(s) of genitofemoral nerve?
L1, L2
206
nerve root(s) of femoral nerve?
L2-L4
207
nerve root(s) of obturator nerve?
L2-L4
208
what nerve supplies the lateral compartment of the leg?
superficial fibular
209
what nerve supplies the anterior compartment of the leg?
deep fibular
210
what nerve supplies the muscles of posterior compartment of leg and intrinsic muscles of the foot?
tibial nerve
211
what does the femoral nerve become inferior to the knee?
the saphenous nerve
212
what supplies sensation to plantar aspect of foot?
tibial nerve
213
what supplies sensation to the lateral aspect of the foot?
sural nerves
