Genitourinary Anatomy Flashcards
The kidney lie infront of which ribs?
11th and 12th ribs
which kidney is slightly lower
right kidney slightly lower
the right adrenal gland lies behind which structures?
liver and IVC
the left adrenal gland lies behind which structures?
stomach and pancreas
which three arteries supply to the adrenal glands?
Superior adrenal artery (from inferior phrenic)
Middle adrenal artery (from abdominal aorta)
INferior adrenal artery (from renal artery)
venous drainage of adrenal glands?
right adrenal vein –> IVC
left adrenal vein –>left renal —> IVC
what does the cortect of the adrenal gland produce?
cortisol, aldosterone, testosterone
what does the medulla of the adrenal glands produce?
adrenaline
are the kidneys intraperitoneal?
no - retroperitoneal
what is each kidney embedded in?
perinephric fat and renal fascia and paranephric fat
the renal arteries are branches from?
the renal veins drain into?
aorta
IVC
what are the functional unit of the kidneys? what are they responsible for?
nephrons.
- filter blood, reabsorbing water and solutes, secreting and excreting waste products as urine
what structures are found withing the cortex of the kidney?
glomerulo, Bowman’s capsule, proximal and distal tubules, part of collecting ducts
what are found in the renal pyramids?
nephron loop of Henle
rest of collecting ducts
From the collecting ducts, urine travels down the pyramid towards the [a] (the apex of the pyramid) where it enters a [b]. [b]s merge with other [b]s to
form a [c]. [c] merge to form the [d] which is continuous with the [e].
From the collecting ducts, urine travels down the pyramid towards the renal papilla (the apex of
the pyramid) where it enters a minor calyx. Minor calyces merge with other minor calyces to
form a major calyx. Major calyces merge to form the renal pelvis which is continuous with the
ureter.
the ureters run anterior to which muscle on the posterior abdominal wall.
what do they cross to to enter the pelvis?
run anterior to psoas major.
cross the pelvic brim to enter pelvis
where is the bladder located?
below the peritoneum ∴ infra-peritoneal organ
posterior to pubic symphasis
anterior to vagina and rectum
what is the smooth muscle in the bladder wall called?
detusor - contracts to forcibly expel urine
the ureters join the bladder at which part of the bladder
the trigone - smooth internal wall.
how is reflux of urine prevented when the bladder is full?
the ureters enter the trigone of the bladder at an angle, forming a rudimentary valve.
name of the folds inside the bladder? function?
ruggae.
allow the bladder to stretch without tearing when it fills.
how much urine can the the bladder hold in an adult?
400-600ml
blood supply to bladder?
vesical arteries - from internal ileac artery.
vesical veins - to the internal iliac vein
the release of bladder in controlled by?
internal sphincter - smooth muscle (involuntary)
external sphincter - skeletal muscle (voluntary)
where is the internal sphincter located?
base of bladder where it opens into the urethra
where is the external sphincter found?
inferior to prostate in males.
deep perineal pouch in females
somatic control of urinary bladder and sphincters:
pudendal nerve S2-S4
- concsious control of external sphincter
sypmathetic innervation of the Urinary Bladder and Urethral Sphincters
- Via branches of the hypogastric nerve (sympathetic chain, T12-L2)
- Causes relaxation of the detrusor and contraction of the internal urethral sphincter, allowing storage of urine.
Parasympathetc Innervation of the Urinary Bladder and Urethral Sphincters
- Via the pelvic splanchnic nerves (S2-S4)
- Causes contraction of the detrusor and relaxation of the internal urethral sphincter, allowing initiation of micturition.
how long is the female urethra?
3-4cm
the posterior abdominal wall extends from where to where
from the attachments of the diaphram
to the
pelvic brim inferiorly
which nerves supply the anterior abdominal wall muscles
and skin of the external genitalia.
iliohypogastric and ilioinguinal
which nerve supplies the skin of the external genitalia.
genitofemoral
which nerve supplies the skin over the lateral thigh.
Lateral femoral cutaneous nerve - also known as the ‘lateral cutaneous nerve of the thigh’
which nerve supplies the muscles and skin of the anterior thigh
Femoral nerve - often target for nerve blocks for pain releif in lower limb fractures. easy to locate with ultrasound
which supplies the muscles and skin of the medial thigh.
obturator nerve
the thoracic abdomen pierces abdomen at which level?
t12 —abdominal aorta
where does the abdominal aorta bifurcate?
bifourcates at L4
into the left and right common iliac arteries
what are the paired branches of the abdominal aorta?
renal, adrenal, gonadal, lumbar
what are the unpaired branches of the abdominal aorta?
coeliac trunk, SMA, IMA
where is the IVC formed, from what?
L5 - from union of left and right common iliac veins.
the IVC is to the left/right of midline in abdoman?
IVC to the right
Aorta to the left
where does the left gonadal vein typically drain into?
left renal
at what level does the IVC pass through the diaphram?
T8
what is it called when a UTI spreads to the kidney?
pyelonephritis
requires IV antibiotics
where do:
- Renal cell carninomas
- transitional cell carcinomas
- wilms tumours
orginate from?
Renal cell carninomas - lining og nephron
transitional cell carcinomas - epithelial lining in kidney
wilms tumours - renal stem cells
triad of renal cancer symptoms?
pain in the flank
palpable mass in the abdomen
haematuria
As the kidneys are encased in a renal capsule, perinephric fat, renal fascia and paranephric fat, a renal cancer must grow very large and penetrate these layers before it is able to invade adjacent organs and structures.
risk factors for AAA?
smoking, alcohol,
hypertension, and atherosclerosis.
AAAs are diagnoses if?
dfiameter of aorta wider than 3cm
risk factors for kidney stones?
high urine-calcium levels, dehydration, obesity, and certain medications
typical kidney stone presentation?
The typical presentation of an obstructing stone in the ureter is
excruciating, pulsatile pain felt from ‘loin to groin’.
This is because the pain fibres supplying
the ureters originate from the T12 to L2 nerves, so pain is referred and felt in the T12 - L2
dermatomes
where are kidney stones most likey to get stuck?
3 places where the ureter narrows:
- Pelvi-ureteric junction (PUJ) – between the renal pelvis and ureter.
- Pelvic brim - where the ureter runs over the pelvic brim, anterior to the iliac artery.
- Vesico-ureteric junction (VUJ) - where the ureter joins the bladder.
what is a phaeochromocytoma?
This is a rare hormone-producing tumour of the adrenal medulla.
Secretion of excess adrenaline causes symptoms and signs related to hyperactivity of the sympathetic nervous
system which are typically hypertension, tachycardia, and excessive sweating.
where is the sacral micturition centre found?
sacral spinal chord:
what is the reflect arc involved in urination?
As the bladder fills, stretch of the bladder wall is detected and this is relayed to the sacral spinal cord via visceral afferent fibres.
In the sacral spinal cord these fibres synapse directly onto motor neurons.
= reflex arc = inhibited by inputs from cerebral cortex in adults who have developed descening inhibitory pathways that inhibit reflex = potty training
what is the pattern of bladder dysfunction in someone with injury to spinal chord above the sacral level.
- X ascending pathways conveying the sensation of bladder filling to the brain (so the patient is no longer aware of bladder filling).
- X descending pathways that exert voluntary, inhibitory control over the external urethral sphincter (so the external sphincter is permanently relaxed).
The reflex arc still functions below the injury, but the patient does not have any inhibitory control over it. The patient does not realise they need to pass urine and the bladder automatically empties as it fills, so the patient is incontinent of urine.
what happends to urination in a person with spinal injury at or below sacral micturation centre?
- overflow incontinence: reflex arc disrupted, bladder fills without emptying, internal sphincter permanently contracted until pressure in bladder exceeds sphincter strength.
- urinary retention - if pressure does not exceed sphincter strength, back up of urine to ureters and kidneys.
what bones make up the hip bone?
ilium, ischium, pubis –> fuse at the acetabulum of pelvis
what are the five articulations of the bony pelvis?
- hip joint
- Sacroiliac joint
- pubic symphasis
- lumbosacral joint
- sacrococcygeal joint
three differences beetween male and femal bony pelves?
- Wider, circular pelvic inlet in females (for childbirth) and narrower, heart-shaped pelvic
inlet in males. - Obtuse (>90˚) angle formed by the inferior pubic rami in females, acute angle (<90˚) in
males. - Wider and shorter sacrum in females; a narrower, longer sacrum in males.
landmark for eipdural and lumbar puncture?
iliac crest - L4/L5 disc space
where can the femoral artery be palpated?
mid-inguinal point
three functions of the pelvic floor muscles?
- Prevent herniation of the pelvic organs inferiorly, out of the pelvis.
- Control continence of urine and faeces by providing a sphincter action on the urethra
and rectum respectively. - Aid in increasing intra-abdominal pressure.
what TWO mucles is the pelvic floor made up from?
levator ani and coccygeus
what THREE muscles make up the levator ani?
- puborectalis (sling)
- Pubococcygeus
- Iliococcygeus (ischium and coccyx)
innervation of levator ani?
branch of S4 and branches of pudenal (S2-S4)
which artery supplies the bladder in both sexes, and the prostate and seminal vesicles
in males?
vesical
label these key branches of the internal iliac artery
- Vesical arteries - supply the bladder in both sexes, and the prostate and seminal vesicles
in males. - Uterine and vaginal arteries in females.
- Middle rectal artery - supplies the rectum.
- Internal pudendal artery - exits the pelvis to supply the perineum.
- Superior and inferior gluteal arteries - exit the pelvis to supply the gluteal region.
- Obturator artery – exits the pelvis to supply the lower limb.
what is the major nerve of the perineum?
Pudendal nerve - S2-S4, somatic
which nerves exit the pelvis and innervate the
gluteal region.
superior and inferior gluteal nerves
nerves carry parasympathetic fibres from the S2 - S4
spinal cord segments to the pelvic viscera.
pelvic splanchnic
Sympathetic fibres that innervate the pelvic viscera are derived from the?
lumbar splanchnic nerve.
what are the two flextures of the rectum?
the sacral flexure anteriorly and the anorectal flexure posteriorly.
what can be found within each of the layers of the urogenital triangle?
what divides the anal canal into superior and inferior parts?
pectinate(/dentate) line
What makes up the borders of the inguinal canal?
Anterior -
Posterior
Roof -
Floor -
Anterior
- External oblique aponeurosis
- Laterally only - internal oblique aponeurosis
Posterior
- Transversalis Fascia
- Medially only - medial fibres of the aponeurosis of internal oblique and transversus abdominis (conjoint tendon)
Roof
- Transversalis fascia
- arching fibres of internal oblique and transversus abdominis
Floor
- inguinal ligament
testicular arteries are direct branches of?
abdominal aorta
venous blood from the testis and epidymis enter the [a]
the [a] forms the [b]
the right [b] drains into the [c]
the left [b] drains into the [d]
[a] pampiniform venous plexus
[b] testicular vein
[c] IVC
[d] left renal vein
what are the three cylinders of erectile tissue that compose the penis?
2 x corpora cavernosa dorsally (top)
1 x corpus spongiosum ventrally (bottom)
The corpora cavernosa and corpus spongiosum are enclosed within?
the deep fascia of the penis = Buck’s fascia
The end of the penis is called the [a] and is an expansion of the [b]. The circular base of the glans is called the [c].
[a] glans
[b] corpus spongiosum
[c] corona
what are the crura of the penis?
symetricsl parts of the corpora cavernosa that are attached to the left and right ischial rami
what is the bulb of the penis?
the part of the corpus spongiosum that, proximally, rests on the perineal membrane.
the corpa cavernosa are covered by which muscles?
the corpus spongiosum is covered by which muscles?
corpa cavernosa = ischiocavernous muscles
corpus spongiosum - blubospongious muscle
what is the route of the vas deferens?
include what the ampulla is.
tube that carries sperm from the epidymis up the spermatic chord through the inguinal canal into the pelvis.
from the deep inguinal ring it passes across the side wall of the pelvis and tuns medially into the back of the bladder. Here it has a dilated portion, the ampulla, which lies medially to the seminal vesivle. It terminated by joining the duct of the seminal vesicle to form the ejactulatory duct.
what is a BPH or BPE. what can it cause?
benign prostatic hyperplasia/enlargement
common with age.
prostate completely encircles the urethra, so enlargement can lead to urinary retention = requires catherterisation.
what is a clinician feeling for in a DRE?
size, contour and frimness.
hard and craggy = concerning.
what is the hymen?
thin membrane that partially covers the vaginal opening
the crura of the clitoris refers to?
the parts of the corpora cavernosa that are attached to the ischial rami
in females, the corpus spongiosum lies in the midline on the perineal membrane (as in males) but it [?].
this makes the [a] of the vestibule
the anterior part of the [a] from the [?]
but is split into ttwo parts that flank that vaginal opening.
this makes the bluble of the vestibule/bulb of the clitoris
the anterior part of the bulb form the glans clitoris
