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Medicine Phase 1 > Genitourinary and renal system ANATOMY > Flashcards

Genitourinary and renal system ANATOMY Flashcards

1
Q

What are the functions of the kidneys?

A

They act to filter and excrete waste products from the blood. They are also responsible for H2O and electrolyte balance.

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2
Q

What are the posterior relations to the kidneys?

A

Diaphragm, psoas major, quadratus lumborum and transversus abdominis.

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3
Q

What are the anterior relations to the right kidney?

A

Liver and duodenum, coils of intestine.

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4
Q

What are the anterior relations to the left kidney?

A

Stomach, spleen, pancreas, coils of intestine.

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5
Q

What is found at the renal hilum?

A

Renal arteries and veins, ureter, nerves and lymphatics.

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6
Q

Which kidney is often positioned lower in the abdomen and why?

A

The right kidney, this is due to the presence of the liver.

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7
Q

What are the renal arteries a branch of?

A

The abdominal aorta just below the SMA.

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8
Q

Which renal artery is longer?

A

The right renal artery, this is due to the position of the aorta being slightly to the left.

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9
Q

Which artery crosses the IVC posteriorly?

A

The right renal artery.

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10
Q

Describe the branching of the renal artery.

A

Renal artery -> interlobar artery -> arcuate artery -> interlobular artery -> afferent arteriole.

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11
Q

Where do the renal veins drain?

A

Into the IVC.

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12
Q

How would you describe the shape of the:
a) right adrenal gland?
b) left adrenal gland?

A

a) Tetrahedral.
b) Crescent-shaped.

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13
Q

Which adrenal gland does the IVC lie anteriorly to?

A

The right adrenal gland.

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14
Q

What are the 3 main layers of an adrenal gland?

A
  1. An outer connective tissue capsule.
  2. A cortex.
  3. A medulla at the centre.
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15
Q

Adrenal glands: What are the 3 layers of the cortex?

A
  1. Zona glomerulus.
  2. Zona fasciculata.
  3. Zona reticularis.
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16
Q

Adrenal glands: What cells are contained within the medulla and what do they secrete?

A

Chromaffin cells - they secrete catecholamines e.g. adrenaline. This is a ‘fight or flight’ response.

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17
Q

What are the 3 arteries that supply the adrenal glands?

A
  1. Superior adrenal artery.
  2. Middle adrenal artery.
  3. Inferior adrenal artery.
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18
Q

What is the superior adrenal artery a branch of?

A

The inferior phrenic artery.

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19
Q

What is the middle adrenal artery a branch of?

A

The abdominal aorta.

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20
Q

What is the inferior adrenal artery a branch of?

A

The renal arteries.

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21
Q

What does the right adrenal vein drain into?

A

The IVC.

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22
Q

What does the left adrenal vein drain into?

A

The left renal vein (and then into the IVC).

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23
Q

What section of the spine is found in the posterior abdominal wall?

A

The lumbar section.

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24
Q

What muscle lies superficially to psoas major?

A

Quadratus lumborum.

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25
Q

What is the origin of quadratus lumborum?

A

Iliac crest and the iliolumbar ligament.

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26
Q

What is the insertion of quadratus lumborum?

A

The transverse processes of L1 to L4 and the 12th rib.

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27
Q

What is the action of quadratus lumborum?

A

Extension and flexion of the vertebral column.

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28
Q

What is the innervation of quadratus lumborum?

A

T12-L4 nerves.

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29
Q

What is the origin of psoas major?

A

T12-L5 vertebrae.

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30
Q

What is the insertion of psoas major?

A

The lesser trochanter of the femus.

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31
Q

What is the action of psoas major?

A

Flexion of the hip.

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32
Q

What is the innervation of psoas major?

A

L1-3 nerves.

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33
Q

What nerves lies on the anterior surface of psoas major?

A

The genitofemoral nerve.

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34
Q

Where does the femoral branch of the genitofemoral nerve go?

A

It passes under the inguinal ligament and supplies sensory innervation to the inner thigh.

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35
Q

Where does the genital branch of the genitofemoral nerve go?

A

It passes through the deep inguinal ring to enter the inguinal canal. It supplies the cremaster muscle.

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36
Q

Why can renal tumours become very large before invading adjacent structures?

A

The tumour has to grow through multiple tough layers: fibrous capsule, perirenal fat, renal fascia and pararenal fat.

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37
Q

What vein does the right gonadal vein drain into?

A

The IVC.

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38
Q

What vein does the left gonadal vein drain into?

A

The left renal vein (and then the IVC).

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39
Q

Where would you palpate an abdominal aortic aneurysm?

A

In the epigastrium, above the umbilicus.

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40
Q

What is the origin of psoas major?

A

T12-L5.

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41
Q

What is the insertion of psoas major and iliacus muscles?

A

Lesser trochanter of femur.

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42
Q

What is the origin of iliacus muscle?

A

Iliac fossa and anterior inferior iliac spine.

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43
Q

What is the innervation of iliacus muscle?

A

Femoral nerve (L2-4).

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44
Q

What nerve lies in the groove between the iliacus and psoas major?

A

The femoral nerve.

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45
Q

What nerve emerges from psoas major medially?

A

Obturator nerve.

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46
Q

What does the femoral nerve give motor innervation to?

A

The anterior thigh muscles that flex the hip and extend the knee.

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47
Q

What is the action of iliacus?

A

Flexion of the hip.

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48
Q

What does the femoral nerve give sensory innervation to?

A

Cutaneous branches pass to the antero-medial thigh. The terminal branch, saphenous nerve, supplies the medial side of the leg and foot.

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49
Q

What are the nerve roots for the femoral and obtruator nerves?

A

L2-L4.

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50
Q

What does the obtruator nerve give motor innervation to?

A

The medial thigh muscles inolved in adduction.

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51
Q

What does the obtruator nerve give sensory innervation to?

A

The skin of the medial thigh.

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52
Q

What are the sciatic nerve roots?

A

L4 - S3 (lumbosacral plexus).

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53
Q

What is the largest nerve in the body?

A

The sciatic nerve.

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54
Q

What does the sciatic nerve give motor innervation to?

A

Muscles of the posterior thigh and hamstring of adductor magnus.

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55
Q

When the sciatic nerve terminates it bifurcates into 2 nerves. What are they?

A
  • Tibial.
  • Common fibular.
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56
Q

What are the walls of ureters composed of and why?

A

Smooth muscle walls. When the muscle contracts it produces peristaltic waves that propels the urine into the bladder.

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57
Q

What is the name of the point at which the renal pelvis narrows?

A

The ureteropelvic junction.

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58
Q

What is the significance of the ureters piercing the bladder obliquely?

A

It creates a physiological valve that acts to prevent the back flow of urine.

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59
Q

Do the ureters cross the ovarian arteries and the ductus deferens anteriorly or posteriorly?

A

Posteriorly. (Water (ureters) under the bridge (artery)).

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60
Q

What is the function of the bladder?

A

Collection, temporary storage and expulsion of urine.

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61
Q

Give 3 ways in which the bladder is specialised for storage.

A
  1. Rugae give the bladder a great capacity to expand.
  2. Detrusor muscle relaxes in storage, increasing bladder volume.
  3. Urethral sphincters contract.
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62
Q

What is the interureteric bar?

A

A ridge of muscle between the two ureteric orficies.

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63
Q

What is the significance of the trigone?

A

It marks the two ureteric orifices and the urethral orifice. It is located in the fundus and it has a smooth wall in contrast to the rest of the bladder.

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64
Q

Which urethral sphincter is composed of skeletal muscle?

A

The external urethral sphincter.

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65
Q

Which urethral sphincter is under voluntary control?

A

The external urethral sphincter.

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66
Q

Which urethral sphincter is composed of smooth muscle?

A

The internal urethral sphincter.

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67
Q

Which urethral sphincter is under autonomic control?

A

The internal urethral sphincter.

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68
Q

What is the specialised smooth muscle of the bladder wall called?

A

The detrusor muscle.

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69
Q

What is the blood supply to the bladder?

A

The internal iliac arteries.

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70
Q

What nerve provides sympathetic innervation to the bladder?

A

The hypogastric nerve (T12-L2).

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71
Q

What is the affect of sympathetic innervation on the bladder?

A

Relaxation of the detrusor muscle and constriction of the internal urethral sphincters - this promotes urine retention.

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72
Q

What is the affect of parasympathetic innervation on the bladder?

A

Contraction of the detrusor muscle and relaxation of the internal urethral sphincters - this promotes micturition.

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73
Q

What is the role of the sensory nerves in the bladder wall?

A

They signal the need to urinate to the brain when the bladder becomes full.

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74
Q

Name 3 locations where the ureter narrows and renal stones may be present.

A
  1. Ureteropelvic junction.
  2. As the ureter passes the pelvic brim.
  3. Where the ureters enter the bladder.
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75
Q

Why is the ureter at danger of being damaged in a hysterectomy?

A

The uterine artery is ligated in a hysterectomy. The ureter passes immediately posteriorly to the uterine artery and so may be damaged.

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76
Q

What two lumbar plexus nerves have the same nerve roots?

A

Femoral and Obtruator - L2,3,4.

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77
Q

What 3 bones make up the hip bone?

A
  1. Ilium.
  2. Pubis.
  3. Ischium.
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78
Q

What is the socket called formed from the fusion of the ilium, pubis and ischium?

A

The acetabulum.

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79
Q

What bone articulates with the acetabulum?

A

The head of the femur.

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80
Q

Name 2 important ligaments that attach from the sacrum to the ischium.

A
  1. sacrospinous ligament.
  2. sacrotuberous ligament.
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81
Q

Where does the sacrospinous ligament run between?

A

The sacrum to the ischial spine.

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82
Q

Where does the sacrotuberous ligament run between?

A

The sacrum to the ischial tuberosity.

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83
Q

Why are female pelvis’ different to males?

A

Female pelvis’ have special adaptations for childbirth.

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84
Q

What are the 3 main differences between male and female pelvis’?

A
  1. The female has a larger angled sub-pubic arch.
  2. The pelvic outlet is rounder in females.
  3. The ischial spine projects further into the male pelvic cavity.
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85
Q

What do the left gonadal veins (ovarian and testicular) drain into?

A

The left renal vein!

86
Q

What forms the floor of the inguinal canal?

A

The inguinal ligament.

87
Q

What does the inguinal canal transmit in males?

A

The spermatic cord.

88
Q

What does the inguinal canal transmit in females?

A

The round ligament of the uterus.

89
Q

The round ligament of the uterus.

A

L1.

90
Q

What does the ilio-inguinal nerve give sensory innervation to?

A
  • Skin on the upper middle thigh.
  • In males it supplies the skin over the penis and scrotum.
  • In females it supplies the skin over the mons pubis and labium majora.
91
Q

How do the testes move from the posterior abdominal wall to the scrotum?

A

The paired gubernacula aid in the descent of the testes. The testes are guided through the inguinal canal and then into the scrotum.

92
Q

Define hernia.

A

Protusion of an organ through the wall of cavity that normally contains it.

93
Q

What type of hernia is lateral to the inferior epigastric artery?

A

An indirect hernia.

94
Q

Where does the inferior epigastric artery lie?

A

Immediately medial to the deep inguinal ring.

95
Q

What are the 3 layers of tissue surrounding the spermatic cord?

A
  1. External spermatic fasica.
  2. Cremaster muscle and fascia.
  3. Internal spermatic fascia.
96
Q

What layer of the abdominal wall is the external spermatic fascia derived?

A

Derived from the aponeurosis of external oblique.

97
Q

What layer of the abdominal wall is the internal spermatic fascia derived?

A

Transversalis fascia.

98
Q

What layer of the abdominal wall is the cremaster muscle and fascia derived?

A

Internal oblique.

99
Q

What is the function of the cremaster muscle?

A

To raise and lower the testes in order to regulate scrotal temperature for optimum spermatogenesis.

100
Q

What is the vas deferens?

A

The duct that transports sperm from the epididymis to the ejaculatory ducts.

101
Q

What 3 arteries are contained within the spermatic cord?

A
  1. Testicular artery.
  2. Cremasteric artery.
  3. Artery of the vas.
102
Q

What 3 veins are contained within the spermatic cord?

A
  1. Testicular vein.
  2. Cremasteric vein.
  3. Vein of the vas.
103
Q

What 3 nerves are contained within the spermatic cord?

A
  1. Ilio-inguinal nerve.
  2. Genitofemoral nerve.
  3. Sympathetic plexus.
104
Q

What are ‘3 others’ contained within the spermatic cord?

A
  1. Vas deferens.
  2. Lymphatics.
  3. Tunica vaginalis.
105
Q

What is the midline fusion of the scrotum called?

A

The midline raphe.

106
Q

Where is the dartos muscle located?

A

Immediately underneath the scrotal skin.

107
Q

What is the function of the dartos muscle?

A

It helps to regulate temperature by wrinkling the skin of the scrotum - this decreases SA and reduces heat loss.

108
Q

What are the 3 erectile tissues contianed within the root of the penis?

A
  1. 2x Crura (form corpus cavernosum in body).
  2. 1x Bulb (forms corpus spongiosum in body).
109
Q

What is the glans of the penis?

A

The most distal part of the penis formed by the expansion of the corpus spongiosum. It contains the urethral orifice.

110
Q

Is ejaculation caused by parasympathetic or sympathetic innervation?

A

Sympathetic.

111
Q

What is a varicocele?

A

Pampiniform plexus of veins has dilated in the testicle.

112
Q

Where will inguinal hernias lie in relation to the pubic tubercle?

A

Superiorly and medially.

113
Q

What is a hydrocele?

A

Swelling of the scrotum caused by distension of the tunica vaginalis.

114
Q

Which nerves provide sensory innervation to the scrotal skin?

A
  • Ilio-inguinal.
  • Genital branch of genitofemoral.
  • Branches from the perineal nerve.
115
Q

Give 3 functions of the pelvis.

A
  1. Transfers weight.
  2. Provides attachment for muscles and ligaments.
  3. Contains and protects pelvic viscera.
116
Q

What are the two hiatuses of the pelvic floor?

A
  1. Urogenital hiatus.
  2. Rectal hiatus.
117
Q

What passes through the urogenital hiatus of the pelvic floor?

A

The urethra and the vagina.

118
Q

What passes through the rectal hiatus of the pelvic floor?

A

The anal canal.

119
Q

Give 3 functions of the pelvic floor muscles.

A
  1. They support abdomino-pelvic viscera.
  2. They resist increases in intra pelvic pressures.
  3. They maintain urinary and faecal continence.
120
Q

What are the 2 main muscles of the pelvic floor?

A
  1. Levator ani muscles.
  2. Coccygeus muscle.
121
Q

What is the innervation to the levator ani muscles?

A

Branches of the pudendal nerve, S2, 3, 4 roots.

122
Q

What is the function of levator ani?

A

Maintains faecal continence, during defecation this muscle relaxes.

123
Q

Which muscles of levator ani are prone to injury in childbirth?

A

Pubococcygeus and puborectalis due to their medial position.

124
Q

What is the innervation of coccygeus?

A

Ventral rami of S4 and 5.

125
Q

Ventral rami of S4 and 5.

A

You may get prolapse of pelvic viscera.

126
Q

What risk factors can increase the chance of prolapse?

A
  1. Increasing age.
  2. Number of vaginal deliveries.
  3. Family history.
  4. Being overweight.
  5. Chronic coughing e.g. a lung disorder.
127
Q

What is the perineum?

A

An anaotmical space located below the pelvic diaphragm; it is diamond shaped and contains urinary, GI and reproductive viscera.

128
Q

What divides the perineum into anterior and posterior triangles?

A

An imaginary line drawn between the ischial tuberosities.

129
Q

An imaginary line drawn between the ischial tuberosities.

A
  1. The posterior anal triangle.
  2. The anterior urogenital triangle.
130
Q

What line separates the deep and superficial perineal pouches in the urogenital triangle?

A

The perineal membrane - a sheet of fibrous tissue.

131
Q

Where will urine accumulate if the male urethra is ruptured?

A

In the superficial perineal pouch.

132
Q

What does the superficial perineal pouch contain?

A

Erectile tissue that forms the penis and the clitoris.

133
Q

What is the deep perineal pouch?

A

A space deep to the perineal membrane. It contains part of the urethra.

134
Q

What is the deep perineal pouch?

A

A space deep to the perineal membrane. It contains part of the urethra.

135
Q

A space deep to the perineal membrane. It contains part of the urethra.

A

An area superficial to the urogenital diaphragm.

136
Q

True or False: the perineal membrane covers the urogenital diaphragm?

A

True.

137
Q

What perforates the perineal membrane?

A

The urethra and the vagina.

138
Q

What is the perineal body?

A

The centre of the perineum located at the junction between the urogenital and anal triangles.

139
Q

Why does the uterus need to be capable of expansion?

A

So it can accommodate the growth of a foetus.

140
Q

What are the 3 sub-divisions of the uterus?

A
  1. Fundus.
  2. Body.
  3. Cervix.
141
Q

What is a fornix?

A

A space between the vagina and the cervix.

142
Q

What are the 2 orifices of the cervix?

A
  1. The internal orifice - communicates with the uterus.
  2. The external orifice - communicates with the vagina.
143
Q

The uterus is described as anteverted with respect to the vagina, what does this mean?

A

It is rotated towards the anterior surface of the body.

144
Q

How does the uterus lie with respect to the bladder?

A

Posterior-superior.

145
Q

What are the three tissue layers that make up the uterus?

A
  1. Peritoneum.
  2. Myometrium: smooth muscle layer.
  3. Endometrium: inner mucous membrane lining.
146
Q

What are the two divisions of the endometrium?

A
  1. Stratum basalis.
  2. Stratum functionalis.
147
Q

Which layer of the endometrium is shred in menstruation?

A

The stratum functionalis.

148
Q

What is the broad ligament?

A

A double peritoneum layer that attaches the uterus to the pelvis; it acts a mesentery.

149
Q

What is the round ligament and what is its function?

A

A remnant of the gubernaculum.
Its function is to maintain the anteverted position of the uterus.

150
Q

What does the cardinal ligament contain?

A

The uterine artery and vein.

151
Q

What is the uterine artery a branch of?

A

The internal iliac artery.

152
Q

What ligament do the uterine tubes lie in?

A

The broad ligament.

153
Q

What is the function of the uterine tubes?

A

They assist in the transport and transfer of ovum from the ovary to the uterus.

154
Q

Give 2 ways in which the uterine tube is adapted for the transport of ovum to the uterus.

A
  1. Ciliated columnar epithelium wafts the ovum to the uterus.
  2. Contraction of the smooth muscle layer
155
Q

What is the most medial part of the uterine tube?

A

The isthmus.

156
Q

Where in the uterine tube does fertilisation normally occur?

A

In the ampulla, this is the widest part of the tube and is lateral to the isthmus.

157
Q

What is the final part of the uterine tube?

A

The fimbriae, finger-like projections coming off the infundibulum.

158
Q

What is the function of the fimbriae?

A

To capture the ovum.

159
Q

What is the blood supply to the uterine tubes?

A

The ovarian and uterine arteries.

160
Q

What is the ovarian artery a branch of?

A

The abdominal aorta.

161
Q

What forms the ovarian fossa?

A

The angle between the internal and external iliac arteries.

162
Q

What are the female gonads?

A

The ovaries.

163
Q

Where do the ovaries lie in relation to the broad ligament?

A

Posterior.

164
Q

Give 2 functions of the ovaries.

A
  1. To produce oocytes.
  2. To produce oestrogen and progesterone.
165
Q
  1. To produce oocytes.
  2. To produce oestrogen and progesterone.
A

In the cortex.

166
Q

What is the epithelium surface of the ovary?

A

Simple cuboidal epithelium.

167
Q

What area of the ovary contains the neurovascular tissues?

A

The medulla.

168
Q

What does the ovarian ligament connect?

A

The ovary to the uterus.

169
Q

What is the blood supply to the ovaries?

A

Ovarian arteries (branch of the abdominal aorta).

170
Q

What does the left ovarian vein drain into?

A

The left renal vein.

171
Q

What ligament does the neurovasculature tissue travel through to reach the hilum of the ovary?

A

The suspensory ligament of the ovary.

172
Q

Give 3 functions of the vagina.

A
  1. It receives the penis in sexual intercourse.
  2. It expands providing a delivery channel in childbirth.
  3. It serves as a canal for menstrual fluid to leave the body.
173
Q

What 2 things comprise the vaginal mucosa?

A
  1. Stratified squamous epithelium.
  2. Elastic lamina propria.
174
Q

What is the blood supply to the vagina?

A

Uterine and vaginal arteries (branches of the internal iliac artery).

175
Q

What are female external genitalia collectively known as?

A

Vulva.

176
Q

Give 3 functions of the vulva.

A
  1. Sensory tissue in sexual intercourse.
  2. Assist in micturition.
  3. Defend the internal female reproductive tract from infection.
177
Q

What is the mons pubis?

A

A mass of fatty tissue lying over the pubis symphysis.

178
Q

What are the labia majora?

A

Hair bearing external folds that fuse posteriorly and extend anteriorly to the mons pubis.

179
Q

What are the labia minora?

A

Hairless folds that lie within the labia majora. They fuse anteriorly to form the prepuce (hood) of the clitoris.

180
Q

Hairless folds that lie within the labia majora. They fuse anteriorly to form the prepuce (hood) of the clitoris.

A

An area between the labia, the external vagina and urethral orifice are found here.

181
Q

Where are the great vestibular glands located and what is their function?

A

Glands located either side of the vaginal orifice, they secrete mucous during sexual arousal.

182
Q

What is the clitoris derived from embryologically?

A

The genital tubercle.

183
Q

What is the main blood supply to the vulva?

A

Pudendal arteries.

184
Q

What 2 structures combine to form the ejaculatory ducts?

A

The vas deferens and the seminal vesicle.

185
Q

List in sequence the tubular structures along with spermatozoa pass to the exterior?

A

Testes -> epididymis -> vas deferens (goes through inguinal canal and along the lateral pelvic wall to the posterior bladder) -> seminal vesicle -> ejaculatory duct -> prostate gland -> prostatic urethra -> membranous urethra -> penile urethra.

186
Q

What is the ampulla of vas?

A

A large dilation of the vas deferens on the posterior aspect of the bladder.

187
Q

True or False: the seminal vesicles store spermatozoa.

A

False - they do NOT store spermatozoa.

188
Q

What is the function of the prostate glands?

A

They secrete proteolytic enzymes which break down clotting factors in the ejaculate and so allowing the semen to remain fluid.

189
Q

What does the prostate lie inferior to?

A

The neck of the bladder.

190
Q

What does the prostate lie superior to?

A

The external urethral sphincter.

191
Q

What is the blood supply to the prostate?

A

Prostatic arteries (derived from internal iliac arteries).

192
Q

Name 2 vessels that pierce the prostate.

A

The urethra and the ejaculatory ducts.

193
Q

How long is the male urethra?

A

15-20cm.

194
Q

How long is the female urethra?

A

4cm.

195
Q

What is the prostatic part of the male urethra?

A

Where the urethra descends through the prostate (3cm).

196
Q

What is the membranous part of the male urethra?

A

Where the urethra transverses the urogenital diaphragm (1cm).

197
Q

What is the penile part of the male urethra?

A

Where the urethra travels through the bulb, corpus spongiosum and glans of the penis (15cm).

198
Q

What dilation in the glans may impede a urethral catheter?

A

The navicular fossa.

199
Q

Why might inflammation of the ovary cause medial thigh pain?

A

Inflammation may irritate the obtruator nerve causing medial thigh pain - REFERRED PAIN!

200
Q

What is a retroverted uterus?

A

One that is rotated towards the posterior abdominal wall, it would lie on the rectum.

201
Q

Give some signs and symptoms of an enlarged prostate gland.

A

An enlarged prostate would press on the bladder and so cause an increase in urinary frequency, urinary urgency, dribbling, and difficulty initiating micturition.

202
Q

Why might a malignant tumour of the prostate spread to the vertebral column?

A

The prostatic venous plexus of veins is in direct continuation with the venous plexus of the vertebra and so this represents a possible route of tumour spread.

203
Q

What does the ectoderm form?

A

Skin, CNS, PNS, teeth, sweat glands, pituitary gland.

204
Q

What are the divisions of the mesoderm?

A
  • Lateral plate - Splanchnic and somatic.
  • Paraxial plate.
  • Intermediate plate.
205
Q

What does the intermediate plate of mesoderm form?

A

The UG system - kidneys, gonads etc.

206
Q

What does the paraxial plate of mesoderm form?

A

Somites.

207
Q

What does the paraxial plate of mesoderm form?

A
  • Splanchnic: circulatory system, muscle and connective tissue.
  • Somatic: the body wall.
208
Q

What does the endoderm form?

A

GI tract, respiratory tract, urinary tract, liver, pancreas, auditory tube, thyroid and parathyroid gland.

209
Q

What is the dermatome of the nipple?

A

T4.

210
Q

What is the dermatome of the inguinal region?

A

T12.

Medicine Phase 1 (16 decks)

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