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Year 2 - Renal (DP) > Anatomy > Flashcards

Flashcards in Anatomy Deck (146):
1

What parts of the urinary tract are in the retroperitoneum?

Kidneys
Proximal ureters

2

What parts of the urinary tract are in the pelvis?

Distal ureters
Bladder
Proximal urethra

3

What part of the urinary tract is in the perineum?

Distal urethra

4

What is the kidney enclosed in (from superficial to deep)?

(Visceral peritoneum)
- Paranephric fat
- Renal/Deep fascia
- Perinephric fat
- Renal capsule

5

What muscles surround the kidney?

Posterior abdominal walls:
- Quadratus lumborum
Anterolateral abdominal wall:
- Obliques
- Transverse abdominis
Back

6

What muscle is the kidney anterior to?

Quadratus lumborum

7

What muscle is the kidney lateral to?

Psoas major

8

What vertebral levels is the right kidney at?

L1-L3

9

What vertebral levels is the left kidney at?

T12-L2

10

What ribs protect the kidneys?

11 + 12

11

What effects can rib fractures have on the kidneys?

Contusion and Laceration

12

What are the dimensions of a normal kidney?

Length ~12cm
Width ~6cm

13

How does a usual kidney feel?

Smooth
Regular
Firm

14

What does the right kidney lie posterior to?

Liver
2nd part of duodenum
Ascending colon
Right colic flexure

15

What sac does the hepatorenal recess lie in?

Greater sac

16

What does the left kidney lie posterior to?

Stomach
Tail of pancreas
Hilum of spleen
Splenic vessels

17

Which is more anterior, the renal arteries or veins?

Veins

18

Which is more anterior, common iliac arteries or veins?

Arteries

19

What lymph nodes does renal lymph flow to?

Lumbar nodes

20

Where are the lumbar lymph nodes?

Around abdominal aorta and IVC

21

Where does ureteric lymph flow to?

Lumbar and iliac nodes

22

Where are the iliac lymph nodes located?

Around the common, internal and external iliac vessels

23

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

24

What does the vesical artery supply?

Bladder

25

What tends to be the cause of an infra-renal AAA and renal artery stenosis?

Atherosclerosis

26

What tends to cause renal artery stenosis by occlusion?

Suprarenal AAA

27

What is the most common anatomical variation in the renal system? What is its incidence?

Bifid renal pelvis -> 1:10

28

What renal anatomical variation has an incidence of 1:25?

Bifid ureter and unilateral duplicated ureter

29

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

30

What can cause a solitary kidney?

Agenesis
Neophrectomy

31

How many pyramids are in each renal medulla?

27

32

Approximately how many nephrons are in each renal pyramid?

~50000

33

What direction do nephrons run? How does this make the pyramids appear?

Axially to the apex:
- Striped appearance

34

Where does the collecting duct drain the filtrate into?

Minor calyx

35

Where is the first constriction do urine flow and what does this junction indicate?

Pelviureteric junction:
- Renal pelvis becomes ureter

36

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

37

Where does the ureter open into?

One corner of the trigone on the bladder floor

38

What imaging modalities can show renal calculi?

X-rays
IV urogram (shows ureteric narrowing)

39

What compound makes up the majority of renal calculi?

Calcium oxalate

40

Where do 'staghorn' calculi tend to form?

Pelvis and major calyces

41

What can internally obstruct the ureter?

Impacted calculus
Blood clot

42

What can externally obstruct the ureter?

Expanding mass (eg. Tumour)

43

What muscle is in the walls of the ureter?

Smooth muscle

44

When the ureter is obstructed, what is its response?

Increased peristalsis proximal to obstruction:
- In waves -> 'Colicky' pain

45

What type of obstructions can cause a unilateral back pressure up to the kidney?

Ureteric blockage
Bladder blockage

46

What type of obstructions can cause a bilateral back pressure up to the kidney?

Bladder blockage
Urethra blockage

47

In ureteric obstruction, when will urine production stop?

When urinary tract pressure > Glomerular filtration pressure

48

How does hydronephrosis result in renal failure?

Urine backs up into calyces -> Nephrone compression -> Renal failure

49

What kidney, when enlarged, is easier to feel on palpation?

Right kidney

50

Where is the false pelvis?

From iliac crests to the pelvic inlet

51

What is the false pelvis a part of?

Abdominal cavity

52

Where is the true pelvis?

From pelvic inlet to the pelvic floor

53

What forms the pelvic floor?

Pelvic diaphragm (mainly levator ani)

54

What are the openings in the pelvic floor?

Distal parts of the following tracts:
- GI
- Renal
- Reproductive

55

Where is the perineum?

Between pelvic floor and skin

56

Where do the ureters lie in relation to the common iliac vessels?

Anteriorly

57

Where do the ureters run along?

Lateral pelvic walls

58

Where do the ureters turn medially?

At the level of the ischial spine

59

On what surface of the bladder do the ureters enter?

Posterior aspect

60

What direction do the ureters enter the bladder? What does this prevent?

Inferomedial:
- Prevents vesicouretal reflux upon bladder contraction

61

What is the route the ureters take?

Sub-peritoneal

62

In relation to the uterine tubes and uterine artery, where do the ureters lie?

Inferiorly ('Water under the bridge')

63

In relation to the vas deferens, where do the ureters lie?

Inferiorly

64

What forms the trigone?

2 ureteric orifices
1 internal urethral orifice

65

Where does the prostate lie in relation to the bladder?

Inferiorly

66

The detrusor muscle forms the main bulk of what?

Bladder walls

67

The detrusor mucle has fibres which encircle the ureteric orifices. What function does this have?

Tighten on bladder contraction -> Prevents vesicouretal reflux

68

What structure does the detrusor muscle form in men? What function does this have?

Internal urethral sphincter:
- Prevents retrograde ejaculation

69

Where does the bladder lie when empty?

Just posterior to the pubic bone

70

Where does the uterus lie in relation to the bladder?

Superior

71

What position does the uterus lie?

Anteflexed

72

What separates the uterus and the bladder?

Uterovesical pouch

73

Where does the rectum lie in relation to the bladder?

Posterior

74

The peritoneum covers what surface of the bladder?

Superior surface

75

What is the approximate length of the female urethra?

4cm

76

What is the approximate length of the male urethra?

20cm

77

What are the four parts of the male urethra from internal to external?

Intramural/Preprostatic part
Prostatic part
Intermediate/Membranous part
Spongy part (In corpus spongiosum)

78

Where do the testes originally lie?

Posterior abdomen

79

What route do the testes take to reach the scrotum?

Move through inguinal canal to scrotum

80

What is contained in the spermatic cord?

Testicular artery and vein
Vas deferens
Lymphatics
Nerves:
- ANS for vas deferens smooth muscle
- Somatic for cremaster muscle

81

What are the testicular veins part of?

Pampiniform plexus

82

What sac do the testes lie in?

Tunica vaginalis

83

What embryological remnant of the testes can become twisted?

Appendix testis

84

What is a hydrocele?

Excess fluid in tunica vaginalis

85

What can testicular torsion result in?

Disruption of blood supply:
- Severe pain
- Testicular torsion

86

Where can the epididymis be palpated?

Posteriorly

87

What part of the prostate is in contact with the levator ani?

Inferior

88

What do the prostatic drains do?

Allow glandular secretions to drain into the prostatic urethra

89

What forms the ejaculatory duct?

Vas deferens and seminal gland duct

90

What part of the prostate is felt on PR exam?

Peripheral zone

91

What part of the prostate do most malignant cancers arise from?

Peripheral zone

92

Where does the penis lie?

Within perineum

93

What is the anatomical position of the penis?

Erect

94

What is the structure of the corpus cavernosum and what does it do?

Paired posteriorly
Transmits deep penile arteries

95

What does the spongy urethra lie deep to and what is this structure a continuation of?

Penile raphe:
- Continuation of the scrotal raphe

96

What is the blood supply to the penis?

Deep arteries of the penis:
- Branches of internal pudendal artery
-> From internal iliac artery

97

What is the blood supply to the scrotum?

Via internal pudendal
Via branches of the external iliac artery

98

Where does lymph from the scrotum and penis (excluding the glans) drain to?

Superficial inguinal LNs (in groin superficial fascia)

99

Where does lymph from the testes drain to?

Lumbar nodes (around abdominal aorta)

100

What nerve fibres provide motor control for ureteric peristalsis and bladder contraction?

SNS and PSN

101

What nerve fibres provide motor control to the urethral sphincters?

Internal sphincter:
- SNS and PNS
External sphincter (and levator ani):
- Somatic motor

102

What nerve fibres carry renal system pain from the kidneys, ureters, bladder and testes?

Visceral afferents

103

What nerve fibres carry renal system pain from the urethra?

Visceral afferents in the pelvis
Somatic sensory in the perineum

104

Where do SNS nerve fibres leave the spinal cord?

In spinal nerves T1-L2

105

How do SNS nerve fibres get to the body wall?

In spinal nerves

106

What part of the body do SNS fibres not supply via spinal nerves? How do these fibres reach this body part?

Head:
- Follow arteries supplying same head structures

107

How do SNS fibres supply muscles/glands of organs? What are the two main kinds of these nerves?

Splanchnic nerves:
- Cardiopulmonary
- Abdominopelvic

108

The SNS nerves supply the renal and urinary system leave at what spinal levels?

T10-L2

109

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)

110

What do the periarterial plexuses contain?

SNS fibres
PNS fibres
Visceral afferent fibres

111

Where do PNS fibres leave the CNS?

Four CNs (III, VII, IX and X)
Sacral spinal nerves

112

What do PNS fibres not supply?

Smooth muscles and glands of the body wall

113

How do PNS fibres reach the hindgut and pelvic organs?

Via pelvic splanchnic nerves (carried in sacral spinal nerves only briefly)

114

What parts of the renal and urinary system does the vagus nerve supply?

Kidney
Ureter

115

What parts of the renal and urinary system do the pelvic splanchnic nerves innervate?

Bladder

116

What parts of the renal and urinary system do the somatic motor nerves supply?

Perineum:
- Distal urethra
- Urethral sphincter (external)
- Levator ani

117

What initiates and propagates ureteric peristalsis?

Uteric cells:
- Built in auto-rhymicity

118

How does the bladder contract?

PNS fibres:
- S2, S3 + S4
- Via pelvic splanchnic nerves
-> Stimulate detrusor to contract

119

What controls the internal urethral sphincter (in males only)?

SNS -> Cause contraction during ejaculation
PNS -> Relax it to allow urination

120

What stimulates the contraction of external urethral sphincter?

Somatic motor fibres:
- Within pudendal nerve (S2, S3 + S4)

121

What stimulates the contraction of the levator ani?

Somatic motor fibres:
- Within nerve to levator ani (S3 + S4)

122

Where is kidney pain typically felt?

Flank

123

Where is ureteric pain typically felt?

'Loin to groin'

124

Where is bladder pain typically felt?

Suprapubic region (midline)

125

Where is perineal urethra pain typically felt?

Localised perineum

126

Where do visceral afferent nerves from the kidney enter the spinal cord?

T11-L2

127

Where do visceral afferent nerves from the ureters enter the spinal cord?

T11-L2

128

Visceral afferent nerves either run alongside SNS fibres or PNS fibres. From what parts of the bladder do they run alongside the above fibres?

Alongside SNS:
- Bladder touching peritoneum
Alongside PNS:
- From rest of bladder

129

Where do visceral afferent nerves from the bladder touching the peritoneum enter the spinal cord? Where is this pain perceived?

T11-L2
Midline, suprapubic pain

130

Where do visceral afferent nerves from the rest of the bladder enter the spinal cord?

S2-S4

131

What fibres do visceral afferents from the proximal urethra run alongside and where do they enter the spinal cord?

PNS fibres
Enter between T2 + T4

132

What fibres supply the rest of the urethra?

Somatic sensory

133

The fibres that supply the rest of the urethra are contained in what nerve?

Pudendal nerve (S2-S4)

134

What can cause localised perineal pain?

Vaginal tear
Anal canal fissure
Perineal genital ulcers (eg. Herpes)

135

The visceral afferents leaving the testes are carried alongside what fibres and enter the spinal cord at what levels?

SNS fibres
T10-T11

136

Due to the close relationship with the scrotal wall, where can testes pain be felt?

L1 region (scrotum)

137

Nerves entering and leaving the spinal cord at what levels control micturition?

S2, S3 and S4

138

What nerves fibres control micturition?

PNS fibres (in pelvic splanchnic nerves)
Visceral afferents
Pudendal nerve (somatic motor)

139

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)

140

How can the brain overide the micturition reflex?

APs from inhibitory nerves from cortex pass inferiorly

141

How else can we voluntarily prevent micturition?

Contract external urethral sphincter and levator ani by crossing our legs

142

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)

143

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)

144

What does the femoral nerve lie under?

Inguinal ligament (into anterior thigh compartment)

145

What compartment does the obturator nerve lie in?

Medial thigh compartment

146

What does the femoral nerve become and what does this nerve supply?

Saphenous nerve:
- Anteromedial leg and ankle