Anatomy Flashcards
(146 cards)
1
Q
What parts of the urinary tract are in the retroperitoneum?
A
Kidneys
Proximal ureters
2
Q
What parts of the urinary tract are in the pelvis?
A
Distal ureters
Bladder
Proximal urethra
3
Q
What part of the urinary tract is in the perineum?
A
Distal urethra
4
Q
What is the kidney enclosed in (from superficial to deep)?
A
(Visceral peritoneum)
- Paranephric fat
- Renal/Deep fascia
- Perinephric fat
- Renal capsule
5
Q
What muscles surround the kidney?
A
Posterior abdominal walls:
- Quadratus lumborum
Anterolateral abdominal wall:
- Obliques
- Transverse abdominis
Back
6
Q
What muscle is the kidney anterior to?
A
Quadratus lumborum
7
Q
What muscle is the kidney lateral to?
A
Psoas major
8
Q
What vertebral levels is the right kidney at?
A
L1-L3
9
Q
What vertebral levels is the left kidney at?
A
T12-L2
10
Q
What ribs protect the kidneys?
A
11 + 12
11
Q
What effects can rib fractures have on the kidneys?
A
Contusion and Laceration
12
Q
What are the dimensions of a normal kidney?
A
Length ~12cm
Width ~6cm
13
Q
How does a usual kidney feel?
A
Smooth
Regular
Firm
14
Q
What does the right kidney lie posterior to?
A
Liver
2nd part of duodenum
Ascending colon
Right colic flexure
15
Q
What sac does the hepatorenal recess lie in?
A
Greater sac
16
Q
What does the left kidney lie posterior to?
A
Stomach
Tail of pancreas
Hilum of spleen
Splenic vessels
17
Q
Which is more anterior, the renal arteries or veins?
A
Veins
18
Q
Which is more anterior, common iliac arteries or veins?
A
Arteries
19
Q
What lymph nodes does renal lymph flow to?
A
Lumbar nodes
20
Q
Where are the lumbar lymph nodes?
A
Around abdominal aorta and IVC
21
Q
Where does ureteric lymph flow to?
A
Lumbar and iliac nodes
22
Q
Where are the iliac lymph nodes located?
A
Around the common, internal and external iliac vessels
23
Q
Which of the following blood vessels doesn’t supply the ureter:
- Renal artery
- Abdominal artery
- Common and iliac arteries
- Superior mesenteric artery
- Vesical artery
A
Superior mesenteric artery
24
Q
What does the vesical artery supply?
A
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
