Anatomy and Embryology Hi Res Flashcards
(117 cards)
1
Q
25% of adults have 2-4 renal arteries usually arising from the aorta superior or inferior to the main renal artery. May enter kidneys directly, usually into the superior or inferior poles. Those to the inferior pole may cross anterior to the ureter & obstruct it, causing hydronephrosis. Accessory arteries are twice as common as accessory veins.
A
Accessory Renal Arteries
2
Q
during their “ascent” to their final location, embryonic kidneys receive their blood supply from progressively superior vessels. Usually the inferior vessels degenerate as the superior ones take over. Failure of the inferior vessels to degenerate results in accessory vessels.
A
Accessory Renal Vessels
3
Q
appears at approximately day 16 as a small diverticulum from the caudal wall of the umbilical vesicle that extends into the connecting stalk. The intraembryonic part of the XXX passes from the umbilicus to the urinary bladder. As the bladder enlarges the XXX forms a thick tube, the urachus. After birth the urachus becomes a fibrous cord, the median umbilical ligament, that extends from the urinary bladder to the umbilicus.
A
Allantois
4
Q
is the benign hypertrophy of the prostate gland. It is common after middle age, affecting virtually every male who lives long enough. An enlarged prostate projects into urinary bladder and impedes urination by distorting prostatic urethra. The middle lobule usually enlarges the most and obstructs the internal urethral orifice.
A
Benign prostatic hyperplasia/hypertrophy
5
Q
relatively common, results from incomplete division of ureteric bud (metanephric diverticulum), primordium of renal pelvis, may be unilateral or bilateral.
A
Bifid renal pelvis (congenital anomaly of the kidney)
6
Q
relatively common, results from incomplete division of ureteric bud (metanephric diverticulum), primordium of ureter, may be unilateral or bilateral, but separate openings into urinary bladder are uncommon.
A
Bifid ureter (congenital anomaly of the ureter)
7
Q
– Failure of urogenital ridge to form bilaterally. Associated with mutations in Wilms tumor suppressor (WT1), steroidogenic factor 1, and DAX1 genes. Presents as a stillborn with pulmonary hypoplasia, widely separated eyes with epicanthic folds, low set ears, a broad flat nose, a receding chin, limb defects, and a pregnancy complicated with oligohydramnios. Diagnosis: Potter syndrome.
A
Bilateral Renal Agenesis
8
Q
composed of salts of inorganic or organic acids or other minerals. Most common are calcium- or uric acid-containing.
A
Calculi / Calculus – (L. pebbles)
9
Q
endodermaly-lined chamber in which the hindgut and allantois (urinary bladder) empty. It is in contact with the surface ectoderm at the cloacal membrane. It is divided into two parts, rectum and urogenital sinus, by the urorectal septum
A
Cloaca –
10
Q
– superficial fascia of the lower abdominal wall and perineum.
A
Colles’ fascia
11
Q
– A pathological large bladder from a congenital disorder of the ureteric bud; may be associated with dilation of renal pelvis & blunting of calices. May result from post urethral valves. Absolute renal failure & pulmonary hypoplasia of lethal degree are consequences unless treated intrauterinely.
A
Congenital Megacystis
12
Q
– Sometimes a kidney crosses to the other side with or without fusion, with both kidneys on the same side of the abdomen.
A
Crossed Renal Ectopia
13
Q
– kidneys contain cysts (see polycystic kidney disease and multicystic dysplastic kidney)
A
Cystic kidney
14
Q
Cystitis – urinary bladder infections
A
Cystitis
15
Q
hernia of the bladder
A
Cystocele
16
Q
visualization of the interior of the bladder and its three orifices (2 x ureteral and urethral) with a cystoscope
A
Cystoscopy
17
Q
suprapubic extraperitoneal incision
A
Cystotomy
18
Q
the dermis of the scrotum.
A
Dartos fascia
19
Q
Dermatomal Innervation: level of nipples (in male)
A
T4
20
Q
Dermatomal Innervation: level of Xiphoid
A
T5 – T6
21
Q
Dermatomal Innervation: area above the umbilicus (epigastrium)
A
T7 – T9
22
Q
Dermatomal Innervation: area around umbilicus
A
T10
23
Q
Dermatomal Innervation: area below umbilicus (hypogastrium)
A
T11 – L1
Subcostal (T12) [back (loin) region]
Iliohypogastric (L1) [groin region]
Ilioinguinal (L1) [groin region]
24
Q
Dermatomal Innervation: scrotum
A
S3
25
Dermatomal Innervation: penis
S4
26
Diaphragm: aponeurotic center of diaphragm
| – distal attachment of all muscular parts
Central tendon
27
Diaphragm: two small bundles of muscle fibers that attach to posterior surface of xiphoid process
Sternal part –
28
Diaphragm: – muscle fibers that attach to inferior six ribs & their costal cartilages
Costal part
29
Diaphragm: – formed by right & left crura
| – muscle fibers arise from medial and lateral arcuate ligaments
Lumbar part
30
Diaphragm: – right and left halves of diaphragm
Hemidiaphragm(s)
31
Diaphragm: opening in right crus at T10
Esophageal Hiatus
32
Diaphragm: – thickenings of fascia acting as proximal attachment sites for some muscle fibers of diaphragm
Arcuate ligaments
33
Diaphragm: – passes through central tendon at vertebral level T8
Vena caval foramen
34
Diaphragm: – passes through right crus at vertebral level T10
Esophageal hiatus
35
Diaphragm: – passes behind diaphragm at vertebral level T12
Aortic hiatus
36
Diaphragm: supply sensory innervation to
– thoracic parietal pleura (superior surface diaphragm)
– abdominal parietal peritoneum (inferior surface of diaphragm)
Phrenic nerves
| – contribution of cervical roots 3, 4, & 5
37
Diaphragm: – sensory innervation to peripheral thoracic and peritoneal surfaces
Intercostal nerves (T5 – T11) & Subcostal nerve (T12)
38
Diaphragm: – penetrates crura to enter abdominal cavity
| – distributes to celiac ganglia (either side of celiac trunk)
Greater splanchnic nerve
39
– a type of ectopic kidney located in the pelvis. Pelvic kidneys are close to each other and usually fuse to form
Discoid kidneys (pancake kidneys)
40
Congenitally misplaced kidney. Usually they are more inferior than usual & have not rotated; hilum faces anteriorly. Most located in pelvis; some lie in inferior part of abdomen. Results from failure of kidneys to ascend. Receives blood from vessels near them & often by multiple ones.
1) Pelvic kidneys - close together, may fuse to form discoid or pancake kidney.
2) Crossed renal ectopia - kidney crosses to other side with or without fusion.
3) Unilateral fused kidney - fuse while in pelvis. One ascends to the normal position, dragging other kidney with it.
Ectopic Kidneys –
41
– Duplication of the abdominal part of ureter & renal pelvis common; supernumerary kidney is rare. Result from division of the metanephric diverticulum (ureteric bud). Complete division results in double kidney with bifid ureter or separate one; incomplete division results in divided kidney with bifid ureter.
Duplication of Urinary Tract
42
hallow tube emanating from the testes in the scrotum, transmits sperm to ejaculatory ducts
Ductus (Vas) deferens
43
failure of embryonic kidney to enter abdomen. Can be mistaken for pelvic tumor. In females pelvic kidney can be injured or cause obstruction during childbirth.
Ectopic pelvic Kidney –
44
Opens anywhere except into bladder. In males, usually into the neck of the bladder or prostatic part of the urethra; but may enter the ductus deferens, prostatic utricle, or seminal vesicle. In females, may open into bladder neck, urethra, vagina, or vestibule of vagina. Incontinence is common due to continuous dribble.
Ectopic Ureter –
45
- when ureter is not incorporated into post part of bladder; instead it is incorporated into the caudal portion of the vesical part of the urogenital sinus.
1) Ureteric ectopia
46
– empties into prostatic urethra on seminal colliculus. Formed by fusion of duct of seminal vesicle with ductus deferens.
Ejaculatory duct
47
– the external urethral orifice opens on the dorsum of the penis
Epispadias
48
Severe anomaly that occurs 1/10000-40000 births. Chiefly in males. Results from incomplete median closure of the inferior part of the anterior abdominal wall. In some cases the penis is divided into 2 parts & the halves of the scrotum are widely separated. Involves the anterior abdominal wall & anterior wall of urinary bladder. Result of failure of mesenchyme to migrate beneath ectoderm of abdomen & cloaca during the 4th week. Therefore abdominal muscles & connective tissue are absent. Later the thin epidermis & anterior wall of bladder rupture causing wide communication beneath the exterior & mucus membrane of the bladder. Exposure & protrusion of the post wall of the bladder characterizes the anomaly. Trigone of the bladder & ureteric orifices are exposed & urine dribbles off & on from the everted bladder. Epispadias & wide separation of the pubic bones are associated with complete exstrophy of the bladder.
Exstrophy of Bladder –
49
is distensible because it contains considerable elastic tissue and smooth muscle. It is easily dilated without injury. Passage of catheters or cystoscopies is easier in females than males. Infections in urethra and especially bladder in females is common because female urethra is short, ore distensible, and open to the exterior through the vestibule of the vagina.
Female Urethra –
50
– apparent space between the right superior pole of kidney and the right hepatic lobe of the liver, located only on the right side of the body.
Hepatorenal pouch (of Morrison)
51
– loss of bladder support in females by damage to pelvic floor during childbirth or lesion of the nerves supplying the muscles of the pelvic floor or rupture of the fascia support of the vagina. It can result in collapse of the bladder onto the anterior vaginal wall, which may protrude through the vaginal orifice into the vestibule.
Hernia of the bladder (cystocele)
52
inferior poles of kidneys fuse in embryonic pelvis, occurs in 1/500 people (1/600 fetuses). 7% of people with Turner’s syndrome have a horseshoe kidney. Large U-shaped kidney lies in pelvis (hypogastrium), anterior to the inferior lumbar vertebrae. Normal ascent is prevented by the inferior mesenteric artery (lies at level of L3 – L5). Usually produces no symptoms because everything else is normal. However, associated abnormalities of kidney and renal pelvis may be present, obstructing the ureter. Wilms tumor is 2-8 times more frequent in kids with horseshoe kidney than general population.
Horseshoe kidney –
53
– distention of the renal pelvis and calices with urine.
Hydronephrosis
54
– fused aponeurosis of the external abdominal oblique muscle running from anterior superior iliac spine to pubic tubercle
Inguinal ligament
55
– The ureters are vulnerable to injury when the ovaian vessels are ligated during an ovariectomy (excision of ovary) because the structures are close to each other as they pass over the pelvic brim.
Injury during ligation of ovarian artery
56
– The ureter is in danger of being inadvertently clamped (crushed), ligated or transected during a hysterectomy (excision of uterus). The point at which the uterine artery and ureter cross each other lies ~ 2 cm superior to the ischial spine.
Injury during ligation of uterine artery
57
– formed by the confluence of the common iliac veins,
– runs superiorly,
– located on right side of body lateral to abdominal aorta
– drains left and right renal veins & right gonadal veins directly
Inferior vena cava
58
Iatrogenic compromise of the ureteric blood supply
Ureters may be injured during abdominal, retroperitoneal, pelvic, or gynecological operations.
59
– is the benign hyperplasia/hypertrophy of the prostate gland. It is common after middle age, affecting virtually every male who lives long enough. An enlarged prostate projects into urinary bladder and impedes urination by distorting prostatic urethra. The middle (central) lobule usually enlarges the most and obstructs the internal urethral orifice.
Hyperplasia/hypertrophy of the prostate
60
– the external urethral orifice opens on the ventral aspect of the glans penis
Hypospadias
61
Kidneys & Suprarenal glands – lateral to the vertebral column between
T12 and L3
62
Loin
– lumbar region of the back
(Seriously? I've been led to believe by several romance authors that loins are the jiggly parts of your inner thighs. Talking about your quivering lumbar back is really kind of a let down.)
63
Kidneys are normally lobulated until
the end of the first postnatal year.
64
– focused shockwave sent through body that breaks renal calculus into small fragments that pass in the urine.
Lithotripsy
65
– omental bursa within abdomen
Lesser sac
66
– drains directly into left renal vein, passes inferior to superior mesenteric artery, crosses midline and drains into inferior vena cava
Left testicular (or ovarian) vein
67
– leaves left kidney at hilum, passes inferior to superior mesenteric artery, crosses midline and drains into inferior vena cava
Left renal vein
68
– If kidneys fail to rotate, hilum faces anteriorly & fetal kidney retains embryonic position. If rotated too far, hilum faces posteriorly. Often associated with ectopic kidneys.
Malrotation of Kidneys
69
– extends from the prostate gland to the perineal membrane in males. It is the shortest (~1 cm), thinnest, narrowest and least distensible portion of the urethra.
Membranous urethra
70
In crossing the midline to reach the inferior vena cava (IVC) the left renal vein passes underneath the superior mesenteric artery (SMA), between it and the descending abdominal aorta. Downward traction on the SMA may compress the left renal vein. May include hematuria or proteinuria (blood or protein in urine), abdominal (left flank) pain, nausea, vomiting (indicating compression of the duodenum), and in males, left testicular pain (related to let testicular vein draining into left renal vein between the left kidney and the site of compression.
Mesoaortic compression of the left renal vein – a.k.a., renal vein entrapment syndrome (“nutcracker syndrome”).
71
– Relatively common. Death usually occurs shortly after birth. In 75% of cases disease is unilateral. Increased numbers survive owing to hemodialysis & kidney transplants. Kidneys contain large to small cysts. About 90% result from urinary tract obstruction during kidney formation. Cyst formations are wide dilations of parts of otherwise continuous nephrons, particularly loop of Henle.
Multicystic Dysplastic Kidney (MCDK)
72
– dropped kidney, distinguished from ectopic kidney by a ureter of normal length that has loose coiling or kinks because the distance to the bladder has been reduced.
Nephrotosis
73
Pain in pararenal region: why may extension of hip joints increase pain?
close relationship of kidneys to psoas major muscle
Psoas major muscle flexes thigh at hip joints.
74
Parietal peritoneum is derived from
LP somatic mesoderm
75
– inflammation of the renal parenchyma, calyces, and pelvis, particularly due to local bacterial infection
Pyelonephritis
76
– any disease of the pelvis of the kidney
Pyelonephrosis
77
Posterior Abdominal Wall Muscles:
– strong flexor of thigh and vertebral column
– proximal attachments to lumbar vertebrae (bodies, discs, & transverse processes)
– distal attachment at lesser trochanter of femur
Psoas major muscle
78
Posterior Abdominal Wall Muscles:
– variable presence
– has a long flat tendon that passes along the psoas major muscle
– distal attachment to iliopublic eminence & arcuate line of ilium
– joins with Iliacus muscle to form iliopsoas muscle
Psoas minor muscle
79
Posterior Abdominal Wall Muscles:
– strong flexor of thigh
– proximal attachment is iliac fossa
– distal attachment is lesser trochanter of femur
– joins with psoas major muscle to form Iliopsoas muscle
Iliacus muscle
80
Posterior Abdominal Wall Muscles:
– formed by Iliacus muscle and psoas major muscle
– distal attachment is lesser trochanter of femur
– powerful flexor of thigh on hip
Iliopsoas muscle
81
Posterior Abdominal Wall Muscles:
– flexes vertebral column laterally
– anchors inferior rib cage during respiration
– proximal attachment are 12th rib and lumbar transverse processes
– distal attachment to iliolumbar ligament and iliac crest
Quadratus lumborum muscle
82
Posterior Abdominal Wall Muscles:
– forms lateral part of posterior abdominal wall
– lies posterior to quadratus lumborum muscle
Transversus abdominis muscle
83
– caused by bilateral renal agenesis. Infants have characteristic facial appearance: the eyes are widely separated and have palpebronasal (epicanthal) folds, the ears are low set, the nose is broad and flat, the chin is receding, and there are limb and respiratory anomalies. Infants with bilateral renal agenesis usually die shortly after birth.
Potter Syndrome
84
– the groove on either side of the seminal colliculus
Prostatic sinus
85
– about 3 cm in length and is the portion of the male urethra passing between the lobes of the prostate.
Prostatic urethra
86
– a small opening on the midline of the seminal colliculus
Prostatic utricle
87
– fossa located in the area between the anal canal and the ischium (ischial spine)
Ischioanal fossa
88
– the entire prostate is removed along with the seminal glands, ejaculatory ducts, and terminal parts of the ductus deferens.
Radical Prostatectomy
89
– (normal female only) pouch bounded by the base of the uterus (anteriorly) and the rectum (posteriorly)
Rectouterine pouch (of Douglas)
90
– (normal male only) pouch bounded by urinary bladder (anteriorly) and rectum (posteriorly)
Rectovesical pouch
91
– Endopelvic fascia between rectum and urinary bladder
Rectovesical septum
92
– Results when metanephritic diverticula fail to develop or the ureteric primordia degenerate. Failure of the metanephric diverticulum to penetrate the metanephritic mesoderm results in the absence of kidney development because no nephrons are induced by the collecting tubules to develop from the metanephritic mass of mesoderm. Has a multifactorial etiology.
Renal Agenesis
93
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relatively common (1/1000 newborns); males more often. Left kidney
usually absent. Often causes no symptoms as remaining kidney often undergoes hypertrophic & assumes functions of missing kidney. It should be suspected in infants with a single umbilical artery.
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Unilateral Renal Agenesis
94
- associated w/ oligohydraminos b/c no urine excreted into amniotic cavity.
Occurs 1/3000 births & incompatible w/ postnatal life. Have characteristic facial appearance: eyes widely separated w/ epicanthic folds, low-set ears, broad/flat nose, receding chin & limb defects. They die shortly after birth or during first months of life.
Bilateral Renal Agenesis
95
– a thin capsule of connective tissue separating pararenal fat (superficial) within the retroperitoneal space from perirenal fat (internal to the fascial capsule) surrounding the kidney proper and within the hilum of the kidney surrounding ureter, renal pelvis, etc.
Renal fascial capsule (of Gerota)
96
– uncommon, ureter leaves kidney and passes posterior to inferior vena cava (IVC).
Retrocaval ureter
97
During surgery ureters are avoided and left undisturbed when possible. If necessary, traction is applied gently and only (direction)
toward the blood supply (i.e., laterally) to avoid disruption of the small branches.
****
98
– when ureter is not incorporated into posterior part of bladder; instead it is incorporated into the caudal portion of the vesical part of the urogenital sinus.
Ureteric ectopia
99
– a longitudinal ridge along the posterior wall of the prostatic urethra
Urethral crest
100
Afflicts 1:10,000 children in US. It is associated with mutations in WT1 and PAX6 genes, located on chromosome 11p13. The WT1 protein is critical for normal renal and gonadal development, such as development of the urogenital ridge. It is the most common primary renal tumor in childhood and 4th most common pediatric malignancy in US. Peak incidence is between 2-5 years of age. Children present with a large abdominal mass that may be unilateral or, when very large, may extend across midline & down into pelvis. Most patients can expect to be cured of their malignancy.
Wilm’s tumor
101
Teratogen: cause oligohydramnios, fetal death, hypoplasia of the bones of the calvaria, IUGR and renal dysfunction
ACE- (Angiotensin-converting enzyme) inhibitors.
102
Teratogen: causes spontaneous abortion, prematurity, IUGR, microcephaly, cerebral infarction, urogenital anomalies, neurobehavioral disturbances, and neurological abnormalities.
Cocaine
103
Teratogen: may cause masculinization of female external genitalia, increased prevalence of cardiovascular defects and an increased incidence of hypospadias in males.
Progestin
104
Teratogen: causes abnormal development of the limbs (meromelia [partial absence], amelia [complete absence]), facial defects, and systemic anomalies, e.g., cardiac, kidney and ocular defects.
Thalidomide
***
105
Teratogen: causes cutaneous scars (dermatomal distribution), neurologic defects (limb paresis [incomplete paralysis], hydrocephaly, seizures), cataracts, microphthalmia, Horner syndrome, optic atrophy, nystagmus, chorioretinitis, microcephaly, mental deficiency, skeletal anomalies (hypoplasia of limbs, fingers, toes), urogenital anomalies.
Varicella virus
106
What nerve(s)?
– L1,2
– motor nerve to the cremasteric muscle
– supplies small area of skin inferior & medial to inguinal ligament
Genitofemoral nerve
107
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What nerve(s)?
– T12
– passes along inferior border of 12th rib
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subcostal
108
What nerve(s)?
– L1
– descend across anterior surface of quadratus lumborum muscle – arise from common trunk
Iliohypogastric & Ilioinguinal nerves
109
What nerve(s)?
– L2,3
– passes deep to inguinal ligament
– supplies skin on lateral aspect of thigh
Lateral cutaneous nerve of the thigh
110
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What nerve(s)?
– L2-4
– lies lateral to psoas major muscle in groove between psoas major & iliacus
– innervates Iliacus muscle
– innervates anterior thigh musculature
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Femoral nerve
111
What nerve(s)?
– L2-4
– located between psoas major and common iliac vessels
– supplies motor innervation to medial thigh
Obturator nerve
112
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What nerve(s)?
– L4-5
– deep to obturator nerve – passes into pelvis to join sacral plexus
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Lumbosacral trunk
113
What nerve(s)?
– L1,2
– passes through the deep inguinal ring and down the inguinal canal
– motor nerve to the cremasteric muscle
Genital branch of Genitofemoral nerve
114
What nerve(s)?
– L1,2
– passes under the inguinal ligament on the external surface of the external iliac artery
– supplies small area of skin inferior & medial to inguinal ligament
Femoral branch of genitofemoral nerve
115
Rupture of XXX part of urethra – often caused by fractures of the pelvic girdle – allows extravasation of the urine into the deep renal pouch; the fluid may also pass superiorly through the urogenital hiatis and distribute extraperitoneally around the prostate and bladder.
intermediate
116
Rupture of the XXX urethra – common site is in the bulb of the penis; caused by forceful blow to perineum (straddle injury), i.e., riding a bicycle and hitting an object, falling on a metal beam, incorrect placement of a transurethral catheter or device that fails to negotiate the angle of the urethra in the bulb of the penis; resulting in extravasation of urine into superficial perineal space. The swelling disappears about an inch below the inguinal ligament, with no swelling in the buttocks region.
spongy
117
– an enlargement of the urethral crest
Seminal colliculus
