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Genitourinary system Flashcards

(94 cards)

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1
Q

Describe the peritoneum

A

Continuous membrane which lines the abdominal cavity and covers the abdominal organs. It acts to support the viscera and provides pathways for blood vessels and lymph to travel to and from the viscera

Two types: Parietal and Visceral

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2
Q

Describe the parietal peritoneum

A

Lines the internal surface of the abdominopelvic wall. Derived from somatic mesoderm in the embryo.
Recives the same somatic nerve supply as the region of the abdo wall it lines and yjerefore pain from the parietal peritoneum is well localised.
Sensitive to pressure, pain, laceration and temperature

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3
Q

Describe the visceral peritoneum

A

Invaginates to cover the majority of the abdominal viscera. Derived from splanchnic mesoderm in the embryo. Has the same autonomic nerve supply as the viscera it covers. Unlike the parietal peritoneum, pain from the visceral peritoneum is poorly localised and is only sensitive to stretch and chemical irritation. Pain from here is reffered to dermatomes

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4
Q

What are retroperitoneal organs

A

Not related to visceral peritoneum and the peritoneum only covers them anteriorly. the oesophagus, rectum and kidneys are the main ones but there are also structures which were initially within the peritoneum but through the twists and turns of the embryo became retro

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5
Q

3 intraperitoneal organs

A

spleen, stomach, and liver

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6
Q

Where are the kidneys found

A

T12-L3
ribs 11 and 12
right kidney is slightly lower due to the liver

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7
Q

Function of the kidneys

A

Filter waste
produce urine
regulate blood: pressure, ions, pH, osmolarity, volume, glucose level
hormone production: calcitriol, erythropoietin

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8
Q

function of calcitriol

A

raises blood calcium levels by increasinf absorbtion from the gut, kidney and stimulation of release from bones

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9
Q

2 broad areas of kidney anatomy

A

superficial: cortex
- aka body
- supporting tissue
- contains glomeruli, Bowman’s capsule, and convoluted tubules

deep: medulla
- the functional tissue
- organised into renal pyramids

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10
Q

what are renal tubules composed of

A

proximal convoluted tubule
loop of henle
distal convoluted tubule

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11
Q

fucntion of loop of henle

A

concentration gradient for fluids and electrolytes

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12
Q

hopw do diuretics work

A

promotion of urination
sodium linked
excretion of water

used to treat conditions like heart failure, cirrhosis, hypertension

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13
Q

gateway into kidney

A

The renal hilum

includes the renal vein, renal artery and renal nerve

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14
Q

describe horseshoe

A

kidney where the two kidneys fuse at the lower end of the abdomen
occurs in utero
more common in boys
most cases asymptomatic
can lead to UTIs
1 in 500 people

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15
Q

what surrounds and protects the kidneys

A

perinephric fat (closely surrounds)
paranephric fat (second layer)

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16
Q

describe a FAST scan

A

Focused assessment with sonography for trauma
bedside ultrasound
identifies blood or fluid around abdominal organs

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17
Q

where do the phrenic veins drain

A

under the diaphragm

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18
Q

where does the gonadal vein drain

A

left - into left renal vein
right - directly into vena cava

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19
Q

what supplies the foregut with blood

A

coeliac trunk and the superior mesenteric arteries

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20
Q

where doe each of the surparenal arteries lead

A

superior - inferior phrenic artery
middle - abdominal aorta
inferior - renal artery

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21
Q

describe polycystic kidney disease

A

autosomal (can be dominant or recessive)
common cause of renal failure
high levels of parenchymal loss
raised bp
headaches
abdo pain

ADPKD: 1 in 500
ARPKD: 1 in 20

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22
Q

examples of retroperitoneal organs

A

oesophagus, kidneys and rectum

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23
Q

function of the ureter

A

transports urine to urinary bladder via peristalsis

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24
Q

where can the ureter be blocked by kidney stones

A

pelvoureteric junction
pelvic brim
trigone

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25
describe the urinary bladder
muscular organ - smooth muscle called the detrusor stores urin and aids urine removal expands and shrinks
26
4 layers of the bladder wall
superficila to deep: - detrusor muscle - submucosa (lamina propria) - mucosa - transitional epithelium
27
describe the male reproductive tract
gonads (testes) are external - temperature sensitive vas deferens in spermatic corde connects testes to urethra - prostate and other glands must contribute to ejaculate
28
layers of testes from deep to superficial
visceral layer of tunica vaginalis parietal layer of tunica vaginalis internal spermatic fascia cremaster muscle and fascia external spermatic fascia superficial fascia skin
29
describe the testes
begin development in abdomen descend into scrotum around 7th month in utero exocrine (sperm) and endocrine gland (testosterone) two tunics: tunica vaginalis (outer) tnuica albuginea (inner)
30
describe order sperm transit
seminiferous tubules straight tubules (tubulus rectus) rete testes efferent ductules epididymis
31
describe cryptorchidism
maldescent of testes incidence - 3% of full-term and 90% of premature infants bilaterally can result in infertility spontaneous descent in 80% of cases during the first year
32
describe testicular cancer
germ cell tumours (95%) sex cord stromal tumours (5%) more prevalent in men in 20s than in 60s
33
describe varicocoele
dilation of pampiniform venous plexus may be due to obstruction of testicular vein characterised by 'bag of worms' appearance
34
describe hydrocoele
accumulation of fluid within tunica vaginalis penligtht examination reveals a translucent scrotum
35
3 stages in passage of male urethra
prostatic membranous pendulous (penile)
36
describe the prostatic urethra
continues at the bladder neck uvula consists of: urethral crest prostatic ultricle sphincter urethrae
37
what is the urethral crest
long fold in the posterior wall of the urethra can stop passage of sperm into bladder when distended
38
what is the prostatic ultricle
blind ended structure and represents the origin of where the vagina and uterus would have developed from
39
what is the sphincter urethrae
external sphincter to control urine expulsion and is a second sphincter as well as the internal urethral sphincter. internal - involuntary control external - voluntary
40
describe the membranous urethra
cowper glands - secrete glycoproteins in mucous during sexual arousal. This fluid produced by the gland lubricates the urethra and penis helps remove debris and dead cells and neutralises the activity within the urethra
41
describe the prostate gland
biggest of the accessory glands and produces enzymes which break down proteins and maintains the semen in a fluid state and stops clotting here found inferior to the bladder neck and above the external urethral sphincter. Can be felt when performing a rectal examination.
42
describe the femal reproductive tract
gonads (ovaries) are internal - not in direct contact with rest of tract uterus (including uterine tubes) and vagina form seperate reproductive tract - increased risk on infection
43
possible positions of uterus
- Normal Anteverted, anteflexed - Retroflexed, anteverted - Retroverted, anteflexed - Retroverted retroflexed
44
round ligament function
maintains anteflexion of uterus
45
fucntion of broad ligament
acts as a mesentery and has a minor role in keeping the uterus forward
46
describe the suspensory ligament of the ovary
not a functioning ligament but contains the blood supply of the ovaries. It connects to the anterior abdominal wall
47
fucntion of the ovarian ligament
connects ovary and lateral aspect of the uterus
48
describe the rectouterine pouch
double fold of peritoneum between rectume and back wall of uterus. It is a point most inferior where infection and fluids can accumulate.
49
describe etopic pregnancy
1 in every 80-90 pregancies 12000 in the UK ampulla is the most common form can lead to rupture with blood and fluid in pouch of douglas ampulla - in fallopian tube cervical - in cervix ovarian - in ovaries cornual/interstitial - end of fallopian tube/start of uterus
50
3 main stages of life before birth
Week 1 - Preimplantation stage Weeks 2-8 - Embryonic stage (Organogenesis) Weeks 9-38 - Fetal stage (growth and development)
51
Describe cleavage in embryo
Mitotic divsions of the fertilised oocyte (egg) Overall size of zygote remains the same - Allows passage down the narrowest part of the uterine tube (ISTHMUS) - Surrounded by tough glycoprotein coat (ZONA PELLUCIDA) to prevent premature implantation
52
Describe Morula formation
Around day 4 after fertilisation cells maximise contact with each other forming a cluster of cells held together by tight junctions This Morula enters the uterus
53
Developmental regulation
When individual cells within the zygote compensate for others that are damaged or have been taken for sampling. They can do this at this stage as all the cells are the same.
54
Describe blastocyst formation
Day 5 or 6 of deveopment first signs of cellular differentiation - Inner cell mass: goes on to form the embryo and extraembryonic tissues - Outer cells trophoblasts: contributes to the placenta As the embryo entes the uterine cavity fluid enters via the zona pellucide into the spaces of the inner cell mass A fluid filled blastocyst cavity forms
55
Describe hatching
"ICM calls undergo proliferation and the fluid builds up in the cavity eventually resulting in the blastocyst ""hatching"" from the zona pellucida to facilitate implantation"
56
What is decidualosation
A process that results in several changes in the endometrium to prepare it for pregnancy. Occurs in the stromal cells of the uterus when the blastocyst makes contact with en endometrium. The process triggers the production of several molecules and promotes the trophoblast cells to become invasive.
57
What two layers does the trophoblast differentiate into
Cells closest to the inside of the cell become one layer called the cytotrophoblast. The outer layer is much more extensive and invasive. Its called the syncytiotrophoblast
58
2 layers of the inner cell mass
The epiblast and the hypoblast. Together these are known as the bilaminar disk.
59
What happens in week 2 of development
The implanting synctiotrophoblast cells start to communicate with the maternal side of the placenta and begin to establish a connection to enable diffusion of oxygen, waste and nutrients via the blood supply. It also produces a hormone called human chorionic gonadotrophin. This is secreted in the urine and is identified in pregnany kits.
60
4 fetal membranes
Amnion Chorion Yolk Sac Allantois
61
Describe the amnion
Continuous with the epiblast of the bilamniar disc Lines a structure called the amniotic cavity which is filled with fluid and acts to protect the developing embryo Present up until birth
62
Describe the chorion
Double layered membrane formed from the trophoblast and the extra embryonic membranes Lines a structure called the chorionic cavity which is seen in early pregnancy but dissapears due to the extesnion of the amniotic cavity Forms the fetal component of the placenta
63
Describe the yolk sac
Continuous with the hypoblast of the bilaminar disk Important in nutrient transfer in weeks 2-3 but dissapears completely by week 20 Important in blood cell formation and formation of the gut
64
Describe the allantois
Forms as an outgrowth of the yolk sac Contributes to the umbilical arteries and connects to the fetal bladder In non-human mammals acts as a reservoir for fetal urine.
65
Describe gastrulation
A process of cell division and migration resulting in the formation of the three germ layers - Ectoderm - Mesoderm - Endoderm Occurs in week 3 Formation of the trilaminar embryo from the bilaminar epiblast
66
3 important structures of trilaminar embryo
Primitive streak Notochord Neural tube
67
what is insensible loss
approx. 700ml water that comes out through skin but not by sweat. Can also be released in respiration.
68
How much blood supply does the kidneys recieve
about 625ml/100g/min thats approx. 25% of cardiac output
69
blood pressure in glomerular capillaries
50-60mmHg (double the pressure in other capillaries?)
70
what are the Two types of nephron
superficial = short ones juxtamedullary = longer ones
71
4 sections of nephrons
1. proximal convoluted tubule 2. loop 3. distal convoluted tubule 4. collecting duct
72
describe ultrafiltration
driven by blood pressure in glomerular capillaries - high renal blood flow (1.25L/min blood, 650ml/min plasma) - High filtration rate (90-140 ml/min) filtration of water and small molecules through slits between podocytes
73
describe reabsorption
active pumping from filtrate in tubules. for substances to be retained: water, glucose, amino acids, electrolytes brush broder of proximal convoluted tubule
74
describe secretion
active pumping into tubules. for substances to be eliminated faster than filtration alone allows; H+, ammonia, uric acid, some drugs
75
how are pumping rates of kidneys controlled
by hormones eg aldosterone can adjust the rates of Na+ and K+ excretion
76
describe the counter current concentration of the loop of henle
thinner wall in descent into medulla, thicker wall during ascent - active pumping out of tubule Solute diffuses into descending tubule: counter-current mechanism 'recycles' solutes ion pumping develops high osmotic pressure but still no net re-absorption
77
describe the distal convoluted tubule
similar structure and function to proximal tubule light reabsorption and fine-tuning of urine composition controlled by horomes like aldosterone
78
describe the collecting duct
CDs pass close to the tips of the loop; flows past high osmotic pressure section of loop of henle If they are permeable to water then moves out of the duct to concentrate filtrate duct permeability set by ADH/AVP
79
what is ADH
anti-diuretic hormone promotes water absorbtion by letting it leave the collecting duct to concentrate urine when ADH is present aquaporins are inserted into the luminal membrane to allow water movement.
80
describe how blood/filtration pressure is controlled
1. Hypo-filtration initiates secretion of renin by the juxtaglomerular apparatus 2. renin splits angiotensinogen to make angiotensin I 3. AI converted to angiotensine II (powerful vasoconstrictor) Enhanced by sympathetic nerves system regulates renal blood flow and glomerular filtration rate
81
What does a cystometrogram measure
bladder behaviour and compliance
82
Technique for bladder investigation
Multi-barrel catheter allows fluid to fill the bladder at a controlled rate Allows pressure to be measured at several sites simultaneously; bladder, sphincter, etc.
83
name of muscle of bladder
Detrusor muscle
84
Decsribe the storage pahse of bladder filling
1. Early filling phase: low pressure in bladder, bladder wall and external sphincter relaxed. 2. No flow in urethra: urethral pressure > bladder pressure 3. Sensations develop then sphincter contracts to maintain continence.
85
Describe the voiding phase
1. 'Urge' then 'Voluntary voiding' 2. Bladder contracts, urethra and sphincter relaxes. Flow in urethra: bladder pressure > urethral pressure. 3. 'Voluntary' stop flow then a 2nd voiding phase
86
Describe innervation of the bladder and sphincters
Sympathetic: from L1, L2 - Bladder wall and internal sphincter Parasympathetic: From S2, S3 and S4 - Bladder wall Somatic: From S2, S3 and S4 - Sensory and motor to external sphincter
87
Afferent bladder control pathway
1. Sensory fibres sense the stretch of the bladder wall. These afferents run in the hypogastric nerve and enter the cord in the upper lumbar roots. 2. Other sensors near the urethra sense flow of urine. 3. Skeletal muscle sensors in the external sphincter
88
Efferent bladder control pathway
1. Parasympathetic to detrusor 2. Sympathetic to internal sohincter 3. Somatic to external sphincter
89
Reflex control of bladder
Via centres in the sacral cord and in the pons. Pontine centre coordinates with the higher centres.
90
Describe link between micturation and myelinated fibres
Sensations are supported by larger and small myelinated fibres Small fibres are linked to unpleasant sensations while larger ones are linked to a more organised desire of micturation
91
neurogenic bladder
contraction starts at lower volume. reflexes are very active and bladder is very stiff.
92
atonic bladder
pressure rises slowly as bladder fills. they struggle to contract bowel and hence empty it
93
how to calculate the likeliehood ratio of a negative result
(1- sensitivity) / specificity
94
how to calculate the likelihood ratio of a positive result
sensitivity / ( 1 - specificity)

Biochemistry (11 decks)

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