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CPR 2 > Clinical Anatomy Of The Urinary System > Flashcards

Clinical Anatomy Of The Urinary System Flashcards

1
Q

Describe the landmarks of an abdominal X-ray

A

Not all abdominal organs can be clearly identified on x-ray imaging

  • Just like thoracic imaging, using a systematic approach will aid in in assessment of visible structures
  • Assess the image quality
-Examine the bones and identify bones landmarks
Rib 12
Vertebrae
Pelvic bones
  -Iliac crest 
  -Pelvic crest
  -Acetabulum

Bowel gas pattern

Soft tissue structures

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2
Q

What is a urteogram?

A

Ureters are not usually clearly visible with plain X-rays

Introducing a contrast material allows for visibility

Look for:

  • narrowing of lumen
  • Variations of pathways
  • Duplication
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3
Q

What is the main demographic of urinary tract stones?

A

More common in men

Age range 20-60 years

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4
Q

Explain urinate tract stones

A

-Aggregates of calcium, phosphate, oxalate, urate and other soluble salts

Urine becomes saturated and a small change in pH can cause precipitation of these salts

Pain usually radiates from the infra-scapular region into the groin, may even radiate into the scrotum

There may be hematuria

Stones may also be caused by bacteria

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5
Q

What are the complications of urinary tract stones?

A
  • infection
  • urinary obstruction
  • Renal failure
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6
Q

What causes pain from kidneys and ureters?

A

Pain from kidney stones, (pain from ureters mainly) is commonly reffered to the flanks, inguinal region, groin, scrotum/labia majora and/or upper thigh; the classic loin to groin type dustribution

Rationale:
Sympathetics are supplied from about T11-L2 (carries visceral afferents fibers going back to spinal cord )

Higher levels of these fibers will radiate near the UPJ

Lower levels near the UVJ

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7
Q

What causes reffered pain along kidney and ureters?

A

Ilioinguinal nerve- (skin over upper medial thigh, upper scrotal and labial areas)

Iliohypogastric nerve- (skin over the anterior abdominal muscles, pubic symphysis) or Subcostal nerves depending on the location of the kidney stone

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8
Q

What is the urinary bladder? Where is it found?

A

Muscular organ for collection for urine

Located just posterior to the pubic symphysis area

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9
Q

Contrast the bladder empty and full

A

Empty-4 sided pyramid; resides in true pelvis

Full- ovoid; protrudes anteriorly & superiorly into abdominal cavity

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10
Q

What is the blood supply of the urinary bladder?

A

Superior and inferior vesicle artery

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11
Q

What is the lymphatic drainage of the bladder?

A

Internal and external iliac nodes

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12
Q

What are the relationships if the urinary bladder?

A

The apex is attached to the umbilicus by the median umbilical fold (remnant if the uracus)

  • The base is located posterioinferiorly.
    • Ureters enter at the posterior superior edges
    • Urethra exits inferiorly
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13
Q

What are the internal structures of the urinary bladder?

A

Bladder trigone

Detrusor muscle

Internal urethral sphincter

Sphincter urethrae(external sphincter)

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14
Q

What is the bladder trigone?

A

Smooth area of the bladder in the non-distended state-bounded by:
- Urethral orifices- open into the posterior lateral aspect of the bladder

-Urethra-commences at the neck of the bladder as the internal urethral orifices

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15
Q

What is the detrusor muscle?

A
  • Smooth muscle of bladder wall
  • Relaxes to allow filling
  • Contracts to empty
  • Autonomic innervation
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16
Q

What is the internal urethral sphincter?

A
  • located at the neck of the bladder
  • continuation of detrusor muscle
  • autonomic innervation
17
Q

What is the sphincter urethrae (external urethral sphincter)?

A
  • located in deep perineal space
  • skeletal muscle
  • somatic innervation (pudendal nerve)
18
Q

Explain ligamentius support of the bladder?

A

Condensations of tendinitis arch of pelvic fascia/loose connective tissue

  • Pubovesicle (dudes) or pubrostatic (duddetes) ligaments
  • Perineal membrane and associated muscles, levator ani of the pelvic floor
  • Together they hold the neck of the bladder in place and help support /suspend
19
Q

Explain the innervation of bladder

A

Dense autonomic plexus around the bladder

  • Parasympathetic from S2-4 (pelvic splachni), then through the inferior hypo gastric to the bladder
  • Sympathetic T10-12 (lesser and Least splachnic) and L1 & 2 (lumbar splachnics) reach the vesical plexus via hypogastric nerves (only to very superior aspect of bladder)

Visceral afferents for pain travels with the Sympathetic/parasympathetic nerves

Pudendal (S2-4) somatic motor to the external urethral sphincter

20
Q

Where dies pain in the bladder refer from?

A

Pain from the bladder refers to the perineum (area between the vagina and anus in women and between the penis and scrotum in men)

May also involve an increase in urinary urge

21
Q

Summarize innervation to the contractile parts of the urinary bladder

A

Detrusor muscle during mictruition

  • sympathetic- relaxation
  • parasympathetic- contraction

Internal urethral sphincter

  • sympathetic- contract
  • parasympathetic- relax

External urethral sphincter (pudendal nerve-somatic)

22
Q

Explain the innervation of the bladder when there is a feeling of fullness

A

Stretch- visceral afferents accompanying parasympathetic (pelvic splachnic / sympathetics)/sympathetics

23
Q

Explain the innervation of the (detrusor muscle) smooth muscle organs of the wall

A

Parasympathetics (pelvic splachnic)

24
Q

What is the innervation of the internal sphincter (s moth muscle)?

A

sympathetics contracts parasympathetics rekaxes

25
Q

What is external anal sphincter Innervated by?

A

Skeketal muscle- somatic efferent control (voluntary- oudedpndal nerve)

26
Q

Explain urinary control in infants

A

Infants have no cortical control of the external sphincters organs of the voiding reflex(automatic voiding)

Conscious control of both of these are learned over time

Adults have cortical control of external sphincters and voiding reflex can be c8ntroled (continence of bladder and bowel)

27
Q

Describe the urethra in females

A
  • approx. 4cm In length
  • external urethral orifice opens into vestibule of the vagina

Ascending UTI more common because:
-short urethra

  • proximity to vagina and anus
  • intercourse
28
Q

Describe female urethral sphincters

A

Internal urethra sphincter
-under sympathetics- contracts

-under parasympathetic- relaxes

External urethral sphincters
Under somatic efferent-pudendal n.

29
Q

Describe the make urethra

A

Prostatic urethra- situated within anterior half of prostate

Me,brownouts urethra-located within the deep perineal pouch - ass. With sphincter urethrae

Penile/spongy urethra- it’s proximal portion contains openings fir the bulbourethral glands

30
Q

What is the use of urethral cathererization?

A

Insertion of a flexible tube through the urethra

In the male the shape of the urethra has 2 bends

  • 1st bend is in the spongy urethra and can easily be manipulated
  • 2nd bend is located at the membranous urethra and is fixed

If not inserted carefully the catheter may damage the bulb of penis- just deep to the first bed

31
Q

What is a suprapubic catheterization ?

A

A urinary bladder catheterization inserted through the skin about 1 inch above the symphysis pubis

It is inserted under a general or local anesthetic

-Used for closed drainage and May be left in place of a time, sutured to the abdominal skin

32
Q

What are the pros of suprapubic catheterization?

A

Lower incidence of urinary tract infection, ease of voiding of naturally when the catheter is clamped, and ease of ambukation

33
Q

What are the cons of suprapubic catheterization?

A

Must initially be inserted through the abdominal wall by a physician and the insertion site must be cleaned daily using sterile technique if the patient is in the hospital

34
Q

When inserting a catheter the penis…

A

Must be manipulated to “straighten out” the bends in the penile urethra

35
Q

Outline changes in the pelvic floor during delivery

A
  • Causes weakness of the pelvic muscles

- Muscle weakness in reduced support to pelvic organs

36
Q

Explain stress incontinence of the urinary bladder

A

Pelvic floor and perineal muscles are important fir stability of pelvic organs and to maintain continence

External sphincters and pelvic floor muscles are voluntary muscles

Coughing and laughing increases the intra-abdominal muscles

Sphincters are weak and therefore doesn’t close of the urethra and urine leaks out

37
Q

What is cystocele?

A

Prolapse of the bladder inti the vaginal canal

38
Q

What are the common causes of cystocele?

A
  • repetitive straining for bowel movements
  • Constipation
  • Chronic or violent coughing
  • Heavy lifting
  • Being overweight or obese

CPR 2 (32 decks)

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