Anatomy Flashcards
(158 cards)
1
Q
What does the urinary tract consist of?
A
The anatomical structures through which urine passes from its production to its excretion.
2
Q
What is the function of the detrusor muscle?
A
Contracts to empty the contents of the bladder when full.
3
Q
Which structures are involved in a lower UTI?
A
Urethra and bladder.
4
Q
Which structures are involved in an upper UTI?
A
Kidneys.
5
Q
What structures are found in the upper urinary tract?
A
Kidneys (left and right).
Ureters (left and right).
6
Q
What structures are found in the lower urinary tract?
A
The bladder.
The urethra.
7
Q
Which body cavities does the urinary tract pass through?
A
Abdomen.
Pelvis.
Perineum.
8
Q
What structures of the urinary tract are found in the abdomen?
A
Kidneys.
Proximal ureters.
In the retroperitoneum.
9
Q
What structures of the urinary tract are found in the perineum?
A
Distal urethra.
10
Q
What structures of the urinary tract are found in the pelvis?
A
Distal ureters.
Bladder.
Proximal urethra.
11
Q
What structure is in contact with the anterior surface of the kidneys?
A
Visceral peritoneum.
12
Q
What is the renal hilum?
A
Root of the kidney (arteries, veins and urinary structures entering and exiting the kidney).
13
Q
Where are the kidneys located?
A
Posterior to their own visceral peritoneum.
Enclosed within the renal fat/fascia/capsule.
Surrounded by skeletal muscles:
- Muscles of the posterior abdominal wall.
- Muscles of the antero-lateral abdominal wall.
- Muscles of the back.
- Muscle guarding can protect the kidneys from trauma.
14
Q
Where do the kidneys lie exactly?
A
Anterior to the quadratus lumborum.
Lateral to psoas major and lower thoracic/upper lumbar vertebral bodies.
15
Q
What vertebral bodies is the left kidney in line with?
A
T12-L2.
16
Q
What vertebral bodies is the left kidney in line with and why?
A
L1-L3.
Liver pushes kidney inferiorly.
17
Q
Which ribs can lacerate the kidneys in trauma?
A
Floating ribs 11 and 12.
18
Q
Where do the renal veins lie in relation to the renal arteries?
A
The renal veins are anterior to the renal arteries.
19
Q
Where does lymph drain to from the kidneys?
A
The lymph from the ureters drains to the lumbar nodes & the iliac nodes.
The iliac nodes are located around the common, internal & external iliac vessels.
20
Q
Where does the abdominal aorta bifurcate?
A
At the level of the umbilicus.
21
Q
Where does the ureteric arterial blood supply come from?
A
Branches of the following:
- Renal artery.
- Abdominal aorta.
- Common iliac artery.
- Internal iliac artery.
- Vesical (bladder) artery.
22
Q
Where does lymph from the kidney drain to?
A
The lumbar nodes located around the abdominal aorta and inferior vena cava.
23
Q
Where do the common iliac arteries lie in relation to the common iliac veins?
A
The common iliac arteries are anterior to the common iliac veins.
24
Q
What is the pathway of urine drainage from the kidney?
A
25
What is the largest tube of the kidney drainage pathway?
The renal pelvis.
26
What are the anatomical sites of ureteric constriction?
The pelviuteric junction - *cl**inically important as kidney stones can get stuck here.*
Ureter crossing the aspect of the common iliac artery (often crosses the bifurcation).
Ureteric orifice.
27
What can cause ureteric obstruction?
**Internal obstruction** - an impacted renal calculus or a blood clot.
**External compression** - an expanding mass (e.g. a tumour).
28
What is hydronephrosis?
Water inside the kidney due to urine back pressure into the calyces compressing the nephrons within the medullary pyramids leading to renal failure.
## Footnote
*Very painful due to the renal capsule stretching.*
29
What is the false pelvis?
The area from the iliac crests to the pelvic inlet.
## Footnote
* It is part of the abdominal cavity.*
* Light green on image.*
30
What is the true pelvis?
The pelvic inlet to the pelvic floor.
## Footnote
*Dark green on image.*
31
What are the pelvic floor muscles?
Levator ani (pelvic diaphragm).
32
Which cavity is the bladder found in?
Pelvic cavity.
33
What forms the pelvic floor?
Formed by the shape of the pelvic diaphragm and is made up of muscles including the levator ani.
34
What is the function of the openings in the pelvic floor?
To allow the distal parts of alimentary, renal and reproductive tracts to pass through from the pelvic cavity into the perineum.
35
What is the course of the ureters?
The ureters pass **anterior** to the common iliac vessels to enter the pelvis.
They run anteriorly (along the lateral walls of the pelvis),
At the level of the **ischial spine**, they turn medially to enter the **posterior aspect** of the bladder.
This route is completely **“sub” peritoneal**.
The ureters enter the posterior bladder wall in an **inferomedial** direction.
Helps prevent **reflux of urine** back into the ureters when the bladder contracts.
36
What is the rectovesicle pouch?
In the male peritoneal cavity, it is the deepest part of the peritoneal cavity.
37
What is the vesico-uterine pouch?
Pouch between the bladder (vesical) and uterus.
38
What is the deepest peritoneal space in the female body, when standing upright?
Vesico-uterine pouch.
Rectouterine pouch (of Douglas).
39
What is the deepest peritoneal space in the male body, when standing upright?
The rectovesicle pouch.
40
In the female, where does the ureter run?
The ureter runs inferiorly to the uterine tubes and the uterine artery.
## Footnote
*Water under the bridge.*
41
In the male, where does the ureter run?
The ureter runs inferiorly to the vas deferens.
42
Need to know the arterial supply of the vesicle.
43
What does the uterine artery supply?
Uterus.
44
What does the middle rectal artery supply?
Rectum.
45
What does the vaginal artery supply?
Vagina.
46
What does the vesical artery supply?
Bladder.
47
What forms the corners of the triangular shape of the internal aspect of the bladder called the trigone?
2 ureteric orifices.
Internal urethral opening (where the bladder empties).
48
What is the purpose the fibres of the detrusor muscles encircling the ureteric orifices?
Ensures no urine reflux into ureter as these fibres also contract when detrusor contracts for the bladder to empty.
49
What is the internal urethral sphincter?
Only present in the male.
Sits at the opening of the internal urethral orifice around the neck of the male bladder.
Contracts during ejaculation to prevent retrograde ejaculation of semen back into the bladder.
50
What is the position of the bladder in the female?
In the female, the body of the uterus usually lies superior to the bladder (in an “anteflexed” position), it is separated from the bladder by the uterovesical pouch.
As a result, most of the weight of the uterus is borne by the bladder.
51
What is the position of the bladder in the male?
The prostate gland lies inferior to the bladder and the rectum.
52
Where does an empty bladder lie?
WIthin the pelvis.
## Footnote
*Peritoneum covers its superior surface only.*
53
Why can't you perform a suprapubic catheterisation of an empty bladder?
Can risk piercing the peritoneal cavities.
54
Where does a full bladder lie?
A full bladder can extend out of the pelvis: its superior part lies superior to the pubic bone.
## Footnote
*Peritoneum still only covers its superior surface.*
55
What are the 2 routes of catheterising a patient's bladder?
Urethral.
Suprapubic (must not be done on an empty bladder).
56
What is the control of the internal urethral sphincter?
Involuntary control so it contracts at the point of ejaculation.
57
What is the spongy urethra?
The part of the urethra sitting within the corpus spongiosum.
58
Where are sperm stored?
In the epididymis.
59
Where does the testis sit within the scrotum?
The testis sits within a sac called the tunica vaginalis.
60
What is a hydrocele?
Where excess fluid (abnormal) sits within the tunica vaginalis.
61
What is the main arterial supply of the testis?
The testicular artery.
62
What surrounds the kidney?
A fibrous capsule.
63
What is a papilla in a kidney?
The round apex of the medullary pyramids.
64
What is a nephron?
A functional unit of the kidney.
It is composed of a renal corpuscle and a renal tubule.
The renal corpuscle consists of a tuft of capillaries called a glomerulus and an encompassing Bowman's capsule.
65
What is the vertebral level of the left renal hilum?
L1.
66
What is the vertebral level of the right renal hilum?
L1/2.
67
What are the contents of the renal hilum?
Renal pelvis (posterior).
Renal artery (middle).
Renal vein (anterior).
Lymphatics.
Nerves.
Renal sinus fat.
68
Why is the left renal vein longer than the right?
The left renal vain passes across the aorta anteriorly to join the right-sided IVC.
69
What are the 3 fundamental spaces in the retroperitoneum?
Anterior pararenal.
Perirenal (enclosed by renal fascia).
Posterior pararenal.
70
What is the pathway for urine excretion from the papilla?
1. Excretion of urine from papilla into a minor calyx.
2. Minor calyces join to major calyx.
3. Major calyces empty into renal pelvis.
4. Pelvi-ureteric junction.
5. Ureter empties into bladder at vesico-ureteric junction.
71
What are the portions of a ureter?
Abdominal ureter.
Pelvic ureter.
Intravesical ureter.
72
What are the 3 anatomical locations where the ureters narrow in diameter?
1. Pelvi-ureteric junction.
2. Pelvic brim.
3. Vesico-ureteric junction.
73
What is the course of the abdominal ureter?
Courses along the medial aspect of the psoas muscle.
74
What is the course of the pelvic ureter?
Enters pelvis at the bifurcation of the common iliac artery.
Anterior and medial to SI joint.
Turns medially at the level of ischial spines.
Enters the posterolateral bladder.
75
What ureter abnormalities can be seen on imaging?
Bifid renal pelvis and upper ureter.
Duplex system.
Ectopic ureter.
Retrocaval ureter.
76
Where does the urethra exit the bladder?
Inferiorly at the narrow neck of the bladder.
77
Where do the ureters enter the bladder?
The 2 posterolateral walls of the bladder.
78
What is the trigone?
The triangular smooth area of bladder between the ureters and urethra.
79
What covers the superior surface of the bladder?
Loosely covered by peritoneum.
80
Which muscles lie inferolaterally to the bladder?
Obturator internus and levator muscles.
81
Where does the pubic symphysis lie in relation to the bladder?
Pubic symphysis lies anteriorly.
82
What is the anatomical relationship between the bladder in females and the vagina and cervix?
Posterior wall of the bladder loosely attaches to the anterior vagina and cervix.
83
What is the pathway of the urethra in males?
1. Male urethra starts at the bladder neck.
2. Prostatic urethra.
3. Membranous urethra.
4. Bulbous urethra.
5. Penile urethra.
84
What is the anatomical relationship between the bladder in males and the prostate?
The bladder neck is fused with the inferior prostate.
85
Is the urethra shorter in males or females?
Females.
86
Within which regions/quadrants are the kidneys found?
Both upper quadrants/lumbar regions.
87
What is the normal size of a kidney?
~12cm long.
6cm wide.
Smooth, regular and firm.
88
Why do the kidneys move inferiorly on inspiration and superiorly on expiration?
The liver and spleen lie in contact with the diaphragm superiorly and the superior poles of the kidneys inferiorly.
As the patient breathes in the kidneys descend and may be 'trapped' for examination between the palpating hands.
89
Where do you palpate a kidney?
Palpate posteriorly within the right flank just inferior to the 12th rib and anteriorly within the RUQ.
90
What is the right kidney posterior to?
The liver.
Hepatorenal recess.
The (2nd part of the) duodenum.
Ascending colon.
Right colonic flexure.
91
What is the left kidney posterior to?
Stomach.
Tail of the pancreas.
Hilum of the spleen.
Splenic vessels.
92
What is the hepatorenal recess?
Deepest part of the abdomen when the patient is in the supine position.
93
What 2 abdominal aortic aneurysms are associated with the renal arteries?
Infra-renal AAA (below the renal arteries).
Suprarenal AAA (above the renal arteries).
94
What is the relationship of renal artery stenosis with an abdominal aortic aneurysm?
Renal artery stenosis may be combined with an infra-renal AAA (both are caused by atherosclerosis).
Renal artery stenosis may be due to supra-renal AAA causing occlusion of the proximal renal artery by the aneurysm.
95
Why may a person have 1 kidney?
Agenesis.
Nephrectomy (pathology).
Nephrectomy (donation).
96
What are the different anatomical variants of kidneys?
Bifid renal pelvis.
Bifid ureter and unilateral duplicated ureter.
Retrocaval ureter.
Horseshoe kidney.
Ectopic pelvic kidney.
97
What is the composition of a kidney?
Outer cortex.
Inner medulla.
98
What does the renal medulla contain?
Renal pyramids which contain nephrons.
99
What gives the renal pyramids their striped appearance?
The regularly arranged nephrons running axially towards the apex of each pyramid.
100
What are renal calculi?
Renal stones that form from urine calcium salts and obstruct the urinary tract from within.
They tend to visible on xray.
101
What is the urinary tract's response to obstruction of the ureter?
Increased peristalsis proximal to the site of the obstruction in an attempt to remove it (flush it into the bladder).
As peristalsis comes in waves, a patient with a ureteric obstruction tends to experience pain that “comes and goes” (“colicky”).
102
What are the consequences of urinary tract obstruction in relation to urine?
Obstructions cause urine to 'back up' in the tract towards the kidneys.
103
What are the consequences of urinary tract obstruction in relation to calyces?
Obstructions within the calyces or ureter cause unilateral or bilateral kidney problems.
104
What are the consequences of urinary tract obstruction in relation to urethra?
Obstructions to the urethra cause bilateral kidney problems.
105
Review this image.
106
Review this image.
107
Which part of the inguinal canal does the vas deferens pass through?
The deep ring.
108
What is the course of semen through the male reproductive system?
1. Scrotum.
2. Testis.
3. Epididymis.
4. Vas deferens.
5. Posterior to the bladder, the vas deferens joins with the seminal gland to produce the ejaculatory duct.
6. The ejaculatory duct joins with the prostate gland to form the prostatic urethra.
7. Spongy urethra.
8. External urethral orifice.
109
What happens to the scrotum during development?
During embryological and fetal development the testes move from their original position in the posterior abdomen, through the inguinal canal to the scrotum.
110
What structures are found within the spermatic cord?
Testicular artery.
Testicular vein.
Vas deferens.
Lymphatic vessels draining the testis.
Nerves.
111
What is testicular torsion?
Twisting of the spermatic cord which can disrupt the blood supply to the testis causing severe pain and danger of testicular necrosis (cell death).
112
What drains deoxygenated blood from the testis?
The pampiniform plexus.
113
What is the venous drainage from the left testis?
Left testicular vein -\> left renal vein -\> IVC.
114
What is the venous drainage from the right testis?
Right testicular vein -\> IVC.
115
Where is sperm produced?
Seminiferous tubules.
116
Where can the epididymis be palpated?
Posterior aspect of the testis.
117
Where can the vas deferens be palpated?
Within the spermatic cord.
118
Where is the prostate gland located?
Between the bladder and levator ani sphincter.
119
Within which part of the prostate does prostate cancer tend to develop?
Within the peripheral zone.
120
What are the 3 erectile tissues of the penis?
Right and left corpus cavernosum.
Corpus spongiosum.
121
What is the blood supply of the penis?
Deep arteries of the penis.
Branches of the internal pudendal artery (from the internal iliac).
122
What is the blood supply of the scrotum?
Internal pudendal artery.
Branches from the external iliac artery.
123
What is the lymph drainage of the scrotum and most of the penis (not the glans)?
Drains to the superficial inguinal lymph nodes found in the superficial fascia in the groin.
124
What is the lymph drainage of the testis?
Drains to the lumbar nodes around the abdominal aorta.
125
What parts of the renal system are innervated by motor control?
Ureteric peristalsis.
Bladder contraction.
Urethral sphincter control (internal and external urethral sphincters).
126
What parts of the renal system have sensory innervation?
Pain from:
* Kidneys.
* Ureters.
* Bladder.
* Urethra.
* Testis.
127
What parts of the renal system have both sensory and motor innervation?
The voluntary control of the elimination of urine from the bladder.
Perineum (distal part of the renal system) and lower limbs.
128
What are the 5 modalities (types) of nerve fibre?
Somatic sensory (sensory).
Somatic motor (motor).
Visceral afferent (sensory).
Parasympathetic (motor).
Sympathetic (motor).
129
What aspects of the renal system are under sympathetic and parasympathetic control?
Ureteric peristalsis.
Bladder contraction.
Urethral sphincter control, specifically the internal sphincter (also somatic motor to the external sphincter & levator ani).
The voluntary control of the elimination of urine from the bladder (also somatic motor and visceral afferent).
130
What aspects of the renal system are under somatic motor control?
Urethral sphincter control, specifically the external sphincter and levator ani (sympathetic and parasympathetic control to internal sphincter).
The voluntary control of the elimination of urine from the bladder (also controlled by sympathetic, parasympathetic and visceral afferent).
Perineum and lower limbs (also controlled by somatic sensory).
131
What aspects of the renal system are under somatic sensory control?
Pain from the urethra in the perineum (also visceral afferent controls pain from the urethra in the pelvis).
Perineum and lower limbs (also controlled by somatic motor).
132
What aspects of the renal system are under visceral afferent control?
Pain from the pelvic urethra (somatic sensory provides pain from perineal urethra), kidneys, ureters, bladder and testis.
The voluntary control of the elimination of urine from the bladder (also somatic motor, parasympathetic and sympathetic control).
133
How do sympathetic nerve fibres get from the CNS to the kidneys, ureters & bladder?
Leave the spinal cord approx. between levels T10 and L2.
Enter the sympathetic chains (bilaterally) but do not synapse.
Leave the sympathetic chains within abdominopelvic splanchnic nerves.
Synapse at the abdominal sympathetic ganglia which are located around the abdominal aorta.
Postsynaptic sympathetic nerve fibres pass from the ganglia onto the surface of the arteries which are heading towards the organs they need to innervate.
The collection of nerve fibres found on the outside of the arteries is called a “periarterial plexus”.
Other nerve fibre types also take part in such plexuses are parasympathetic and visceral afferent nerve fibres (as they are all going to coming from (sensory) the same organs).
134
How do parasympathetic nerve fibres get from the CNS to the kidneys, ureters & bladder?
Parasympathetic fibres innervating the kidneys and ureter are carried within the vagus nerve (CN X).
Parasympathetic fibres innervating the bladder are carried within the pelvic splanchnic nerves (S2-4).
All parasympathetic fibres supplying the renal system reach the organs via the periarterial plexus, like sympathetics.
135
How do somatic motor nerve fibres get from the CNS to the kidneys, ureters & bladder?
Somatic fibres only go to body wall structures.
The only parts of the renal system that somatic fibres go to are those within the perineum, e.g the distal urethra, external urethral sphincter and levator ani muscles.
136
Where is pain from the kidney itself felt?
In the loin on the affected side: posterior aspect of the flank region.
137
Where is pain from the bladder felt?
Usually in the suprapubic region (midline).
138
Where is pain from calculus obstructing the ureter felt?
Radiating from the loin to the groin on the affected side.
139
Where is pain from the perineal part of the urethra felt?
Localised to the perineum.
140
How do visceral afferent nerve fibres get from the kidneys to the CNS?
Visceral afferents from the kidneys run alongside sympathetic fibres back to the spinal cord.
They enter the spinal cord approx. between levels T11 and L1.
The patient feels this pain in these dermatomes, posteriorly (i.e. the “loin”).
141
What are the differential diagnoses for loin pain?
Skin origin (e.g. herpes zoster).
Muscular - most common.
Vertebrae.
Spinal nerve root compression.
Lower lobe pneumonia.
142
How do visceral afferent nerve fibres get from the ureters to the CNS?
Visceral afferents from the ureters run alongside sympathetic fibres back to the spinal cord.
They enter the spinal cord between levels T11 and L2.
Pain from these structures tends to be perceived by the patient anywhere along this path.
143
What are the differential diagnoses for groin pain?
Hernias (inguinal or femoral).
Lymphadenopathy.
Testicular pathology.
144
How do visceral afferent nerve fibres get from the bladder to the CNS?
Visceral afferents carrying pain from that part of the bladder which touches the peritoneum (superior part) run alongside sympathetic fibres back to the spinal cord.
They enter the spinal cord between levels T11 – L2 and the pain is perceived by the patient as suprapubic pain (midline).
Visceral afferent fibres from the rest of the bladder (that not touching the peritoneum) run alongside the parasympathetic nerve fibres back to spinal cord levels S2, S3, S4.
145
What are the differential diagnoses for suprapubic pain?
Hindgut organs e.g. sigmoid diverticula.
Other single, midline pelvic organs whose superior aspect touches the peritoneum e.g. uterus.
*Can sometimes result in referred pain to* *buttocks* *and gluteal region.*
146
How do visceral afferent & somatic sensory nerve fibres get from the urethra to the CNS?
Visceral afferents from the proximal urethra (i.e. above the levator ani and in the pelvis) run alongside the parasympathetic nerve fibres back to spinal cords levels S2, S3, S4.
Somatic sensory nerve fibres from the remaining urethra are carried within the pudendal nerve also back to spinal cord levels S2, S3, S4. Pain from this part of the urethra will present as a localised pain within the perineum.
147
What are the differential diagnoses for perineal pain?
Vaginal tear.
Anal canal fissure.
Perineal genital ulcers (e.g. herpes).
148
How do pain fibres get from the testis to the CNS?
Due to its embryological descent, visceral afferents run alongside sympathetic fibres back to the spinal cord to levels T10-11.
However, due to its close relationship to the scrotal wall (body wall), pain from the testis can also present localised to the scrotum and/or groin (L1 region).
149
What are the differential diagnoses of scrotal pain?
Skin lesions.
Strangulated inguinal hernia.
150
What is pain from the kidneys felt as and where?
Dull, achy type pain in the loin (posterior flank region).
151
Where is pain from ureteric obstruction felt?
Loin to groin pain.
152
What is pain from the bladder felt as and where?
Usually dull, achy suprapubic pain.
153
Where is pain from the urethra felt?
Distal urethra (that within the perineum) is felt localised and is a relatively sharp pain within the perineum.
154
Where is pain from the testis felt?
Often felt in the scrotum but can radiate to the groin and the anterior lower abdomen (can also initially present in one of the latter 2).
155
How is urine flow controlled?
The nerve fibres (visceral afferents, pelvic splanchnic nerves and pudendal nerve) entering and leaving spinal cord levels **S2-S4** are key in the control of micturition (**urine flow**).
1. As the bladder fills, this is sensed by stretch receptors at the end of visceral afferent nerve fibres.
2. This information is relayed to the CNS via S2, S3, S4 spinal cord levels.
3. There is a reflex at this point to empty the bladder by stimulation of the detrusor muscle and inhibition of the internal sphincter muscle (only in males).
4. However, in those infants who have been “potty trained” along with children and adults, the brain overrides this reflex; action potentials within inhibitory nerve fibres from the cortex pass inferiorly and inhibit this reflex. We can also voluntarily contract the external sphincter and levator ani muscles.
5. Once it is appropriate to micturate, the cerebral inhibition of this reflex is lifted and there is a co-ordinated contraction/relaxation of various muscles:
* The detrusor muscle contracts (parasympathetic)
* The internal urethral sphincter (parasympathetic), external urethral sphincter and levator ani muscles relax (somatic motor).
* The anterolateral abdominal wall muscles contract to increase intra-abdominal pressure and force urine out of the external urethral orifice (somatic motor nerve fibres).
156
Where does the pudendal nerve arise from?
Sacral plexus (S2-4).
157
Where does the sciatic nerve arise from?
**Sacral plexus (L4-S3)** and travels into the posterior compartment of the thigh via the gluteal region.
158
What nerves arise from the lumbar plexus?
**Iliohypogastric (L1)**.
**Ilioinguinal (L1)**.
**Genitofemoral nerve (L1-2)**.
**Lateral** **cutaneous nerve of the thigh (L2-3)**.
**Femoral nerve (L2-4)** - passes under the inguinal ligament into the anterior compartment of the thigh.
**Obturator nerve (L2-4)** - passes through the obturator foramen (pelvis) into the medial compartment of the thigh.
