Flashcards in Anatomy Deck (146):
What parts of the urinary tract are in the retroperitoneum?
What parts of the urinary tract are in the pelvis?
What part of the urinary tract is in the perineum?
What is the kidney enclosed in (from superficial to deep)?
- Paranephric fat
- Renal/Deep fascia
- Perinephric fat
- Renal capsule
What muscles surround the kidney?
Posterior abdominal walls:
- Quadratus lumborum
Anterolateral abdominal wall:
- Transverse abdominis
What muscle is the kidney anterior to?
What muscle is the kidney lateral to?
What vertebral levels is the right kidney at?
What vertebral levels is the left kidney at?
What ribs protect the kidneys?
11 + 12
What effects can rib fractures have on the kidneys?
Contusion and Laceration
What are the dimensions of a normal kidney?
How does a usual kidney feel?
What does the right kidney lie posterior to?
2nd part of duodenum
Right colic flexure
What sac does the hepatorenal recess lie in?
What does the left kidney lie posterior to?
Tail of pancreas
Hilum of spleen
Which is more anterior, the renal arteries or veins?
Which is more anterior, common iliac arteries or veins?
What lymph nodes does renal lymph flow to?
Where are the lumbar lymph nodes?
Around abdominal aorta and IVC
Where does ureteric lymph flow to?
Lumbar and iliac nodes
Where are the iliac lymph nodes located?
Around the common, internal and external iliac vessels
Which of the following blood vessels doesn't supply the ureter:
- Renal artery
- Abdominal artery
- Common and iliac arteries
- Superior mesenteric artery
- Vesical artery
Superior mesenteric artery
What does the vesical artery supply?
What tends to be the cause of an infra-renal AAA and renal artery stenosis?
What tends to cause renal artery stenosis by occlusion?
What is the most common anatomical variation in the renal system? What is its incidence?
Bifid renal pelvis -> 1:10
What renal anatomical variation has an incidence of 1:25?
Bifid ureter and unilateral duplicated ureter
What are three less common anatomical variations of the renal and urinary systems? What are their incidences?
Horseshoe kidney -> 1:500
Retro-caval (behind IVC) ureter -> 1:1500
Ectopic pelvic kidney -> 1:2500
What can cause a solitary kidney?
How many pyramids are in each renal medulla?
Approximately how many nephrons are in each renal pyramid?
What direction do nephrons run? How does this make the pyramids appear?
Axially to the apex:
- Striped appearance
Where does the collecting duct drain the filtrate into?
Where is the first constriction do urine flow and what does this junction indicate?
- Renal pelvis becomes ureter
Where are the anatomical sites of ureteric constriction?
1. Pelviureteric junction
2. Ureter crossing anterior aspect of common iliac artery (often at the bifurcation)
3. Ureteric orifice
Where does the ureter open into?
One corner of the trigone on the bladder floor
What imaging modalities can show renal calculi?
IV urogram (shows ureteric narrowing)
What compound makes up the majority of renal calculi?
Where do 'staghorn' calculi tend to form?
Pelvis and major calyces
What can internally obstruct the ureter?
What can externally obstruct the ureter?
Expanding mass (eg. Tumour)
What muscle is in the walls of the ureter?
When the ureter is obstructed, what is its response?
Increased peristalsis proximal to obstruction:
- In waves -> 'Colicky' pain
What type of obstructions can cause a unilateral back pressure up to the kidney?
What type of obstructions can cause a bilateral back pressure up to the kidney?
In ureteric obstruction, when will urine production stop?
When urinary tract pressure > Glomerular filtration pressure
How does hydronephrosis result in renal failure?
Urine backs up into calyces -> Nephrone compression -> Renal failure
What kidney, when enlarged, is easier to feel on palpation?
Where is the false pelvis?
From iliac crests to the pelvic inlet
What is the false pelvis a part of?
Where is the true pelvis?
From pelvic inlet to the pelvic floor
What forms the pelvic floor?
Pelvic diaphragm (mainly levator ani)
What are the openings in the pelvic floor?
Distal parts of the following tracts:
Where is the perineum?
Between pelvic floor and skin
Where do the ureters lie in relation to the common iliac vessels?
Where do the ureters run along?
Lateral pelvic walls
Where do the ureters turn medially?
At the level of the ischial spine
On what surface of the bladder do the ureters enter?
What direction do the ureters enter the bladder? What does this prevent?
- Prevents vesicouretal reflux upon bladder contraction
What is the route the ureters take?
In relation to the uterine tubes and uterine artery, where do the ureters lie?
Inferiorly ('Water under the bridge')
In relation to the vas deferens, where do the ureters lie?
What forms the trigone?
2 ureteric orifices
1 internal urethral orifice
Where does the prostate lie in relation to the bladder?
The detrusor muscle forms the main bulk of what?
The detrusor mucle has fibres which encircle the ureteric orifices. What function does this have?
Tighten on bladder contraction -> Prevents vesicouretal reflux
What structure does the detrusor muscle form in men? What function does this have?
Internal urethral sphincter:
- Prevents retrograde ejaculation
Where does the bladder lie when empty?
Just posterior to the pubic bone
Where does the uterus lie in relation to the bladder?
What position does the uterus lie?
What separates the uterus and the bladder?
Where does the rectum lie in relation to the bladder?
The peritoneum covers what surface of the bladder?
What is the approximate length of the female urethra?
What is the approximate length of the male urethra?
What are the four parts of the male urethra from internal to external?
Spongy part (In corpus spongiosum)
Where do the testes originally lie?
What route do the testes take to reach the scrotum?
Move through inguinal canal to scrotum
What is contained in the spermatic cord?
Testicular artery and vein
- ANS for vas deferens smooth muscle
- Somatic for cremaster muscle
What are the testicular veins part of?
What sac do the testes lie in?
What embryological remnant of the testes can become twisted?
What is a hydrocele?
Excess fluid in tunica vaginalis
What can testicular torsion result in?
Disruption of blood supply:
- Severe pain
- Testicular torsion
Where can the epididymis be palpated?
What part of the prostate is in contact with the levator ani?
What do the prostatic drains do?
Allow glandular secretions to drain into the prostatic urethra
What forms the ejaculatory duct?
Vas deferens and seminal gland duct
What part of the prostate is felt on PR exam?
What part of the prostate do most malignant cancers arise from?
Where does the penis lie?
What is the anatomical position of the penis?
What is the structure of the corpus cavernosum and what does it do?
Transmits deep penile arteries
What does the spongy urethra lie deep to and what is this structure a continuation of?
- Continuation of the scrotal raphe
What is the blood supply to the penis?
Deep arteries of the penis:
- Branches of internal pudendal artery
-> From internal iliac artery
What is the blood supply to the scrotum?
Via internal pudendal
Via branches of the external iliac artery
Where does lymph from the scrotum and penis (excluding the glans) drain to?
Superficial inguinal LNs (in groin superficial fascia)
Where does lymph from the testes drain to?
Lumbar nodes (around abdominal aorta)
What nerve fibres provide motor control for ureteric peristalsis and bladder contraction?
SNS and PSN
What nerve fibres provide motor control to the urethral sphincters?
- SNS and PNS
External sphincter (and levator ani):
- Somatic motor
What nerve fibres carry renal system pain from the kidneys, ureters, bladder and testes?
What nerve fibres carry renal system pain from the urethra?
Visceral afferents in the pelvis
Somatic sensory in the perineum
Where do SNS nerve fibres leave the spinal cord?
In spinal nerves T1-L2
How do SNS nerve fibres get to the body wall?
In spinal nerves
What part of the body do SNS fibres not supply via spinal nerves? How do these fibres reach this body part?
- Follow arteries supplying same head structures
How do SNS fibres supply muscles/glands of organs? What are the two main kinds of these nerves?
The SNS nerves supply the renal and urinary system leave at what spinal levels?
What route do SNS fibres take to reach the end organ?
1. Leave spinal cord
2. Enter bilateral sympathetic chains
3. Leave chains in abdominopelvic splanchnic nerves
4. Synapse at abdominal sympathetic ganglia around the abdominal aorta
5. Post-synpatic fibres pass from ganglia onto surface of arteries (periarterial plexus)
What do the periarterial plexuses contain?
Visceral afferent fibres
Where do PNS fibres leave the CNS?
Four CNs (III, VII, IX and X)
Sacral spinal nerves
What do PNS fibres not supply?
Smooth muscles and glands of the body wall
How do PNS fibres reach the hindgut and pelvic organs?
Via pelvic splanchnic nerves (carried in sacral spinal nerves only briefly)
What parts of the renal and urinary system does the vagus nerve supply?
What parts of the renal and urinary system do the pelvic splanchnic nerves innervate?
What parts of the renal and urinary system do the somatic motor nerves supply?
- Distal urethra
- Urethral sphincter (external)
- Levator ani
What initiates and propagates ureteric peristalsis?
- Built in auto-rhymicity
How does the bladder contract?
- S2, S3 + S4
- Via pelvic splanchnic nerves
-> Stimulate detrusor to contract
What controls the internal urethral sphincter (in males only)?
SNS -> Cause contraction during ejaculation
PNS -> Relax it to allow urination
What stimulates the contraction of external urethral sphincter?
Somatic motor fibres:
- Within pudendal nerve (S2, S3 + S4)
What stimulates the contraction of the levator ani?
Somatic motor fibres:
- Within nerve to levator ani (S3 + S4)
Where is kidney pain typically felt?
Where is ureteric pain typically felt?
'Loin to groin'
Where is bladder pain typically felt?
Suprapubic region (midline)
Where is perineal urethra pain typically felt?
Where do visceral afferent nerves from the kidney enter the spinal cord?
Where do visceral afferent nerves from the ureters enter the spinal cord?
Visceral afferent nerves either run alongside SNS fibres or PNS fibres. From what parts of the bladder do they run alongside the above fibres?
- Bladder touching peritoneum
- From rest of bladder
Where do visceral afferent nerves from the bladder touching the peritoneum enter the spinal cord? Where is this pain perceived?
Midline, suprapubic pain
Where do visceral afferent nerves from the rest of the bladder enter the spinal cord?
What fibres do visceral afferents from the proximal urethra run alongside and where do they enter the spinal cord?
Enter between T2 + T4
What fibres supply the rest of the urethra?
The fibres that supply the rest of the urethra are contained in what nerve?
Pudendal nerve (S2-S4)
What can cause localised perineal pain?
Anal canal fissure
Perineal genital ulcers (eg. Herpes)
The visceral afferents leaving the testes are carried alongside what fibres and enter the spinal cord at what levels?
Due to the close relationship with the scrotal wall, where can testes pain be felt?
L1 region (scrotum)
Nerves entering and leaving the spinal cord at what levels control micturition?
S2, S3 and S4
What nerves fibres control micturition?
PNS fibres (in pelvic splanchnic nerves)
Pudendal nerve (somatic motor)
Put the following steps in the micturition reflex in order:
- Detrusor muscle stimulation
- Bladder fills
- Stretch receptors in visceral afferent stimulated
- Inhibition of internal urethral sphincter (males)
- Bladder stretching
- Relayed to spinal cord between S2-S4
1. Bladder fills
2. Bladder stretching
3. Stretch receptors in visceral afferent stimulated
4. Relayed to spinal cord between S2-S4
5. Detrusor muscle stimulation
6. Inhibition of internal urethral sphincter (males)
How can the brain overide the micturition reflex?
APs from inhibitory nerves from cortex pass inferiorly
How else can we voluntarily prevent micturition?
Contract external urethral sphincter and levator ani by crossing our legs
When it is appropriate to urinate, what series of contractions and relaxations occur? What nerve fibres carry out these functions?
1. Detrusor contracts (PNS)
2. Internal urethral sphincter (PNS), external ureathral sphincter and levator ani relax (somatic motor)
3. Anterolateral abdominal wall muscles contract (somatic motor)
4. Intra-abdominal pressure increased
5. Urine forces out of EUS (somatic motor)
Which of the following nerves does not arise from the lumbar plexus:
- Iliohypogastric (L1)
- Ilioinguinal (L1)
- Lateral cutaneous nerve of thigh (L2 + L3)
- Genitofemoral (L1 + L2)
- Femoral (L2-L4)
- Medial cutaneous nerve of thigh (L2)
- Obturator (L2-L4)
Medial cutaneous nerve of thigh (it is a branch of the femoral nerve)
What does the femoral nerve lie under?
Inguinal ligament (into anterior thigh compartment)
What compartment does the obturator nerve lie in?
Medial thigh compartment