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Flashcards in Kidneys and Urinary System Deck (40):
1

What organs are in the urinary system?

Kidneys
adrenal glands
ureters
urinary bladder
urethra

2

Where is the renal angle?

Junction of the 12th rib and lateral border of erector spinae

3

When would the kidneys be palpable?

If enlarged or very low body fat

4

Where do the kidneys sit?

In the paravertebral gutters
On the posterior abdominal wall
Extend below inferior ribs

5

What are the right anterior relations of the kidneys?

Liver - pushes right kidney down
Duodenum/small intestine - above right kidney
Right hepatic flexure

6

What are the left anterior relations of the kidneys?

Spleen
Stomach
Pancreas
Left hepatic flexure
Small intestine

7

What is another name for the hepatorenal recess?

Morrison's pouch

8

What is the hepatorenal recess?

separates the liver from the right kidney
fluid can collect here in pathologies

9

What are the posterior relations of the kidneys?

Diaphragm
Psoas major
Quadratus lumborum
Transversus abdominis
T12 - subcostal nerve
L1 - iliohypogastric and iligoinguinal nerve

10

Where are the renal arteries?

- Arise at L1/L2
- right renal artery passes posterior to IVC

11

Where are the renal veins?

- Arise at L2 vertebral level
- anterior to aorta

12

What are the differences between the left and right renal veins?

- left renal vein is longer than right due to right's lateral position near iVC
- left is longer and receives suprarenal and gonadal veins whilst right drains to IVC

13

How much CO does the renal artery supply to the kidneys?

1/4 - 1200ml/min

14

What does the renal artery divide the hilum into?

4/5 segmental arteries supplying discrete renal segments

15

What is the nerve supply to the kidneys?

- renal plexus
MOTOR
- sympathetic (thoracic and lumbar splanchnic nerves) and PS (vagus)
SENSORY
- afferent fibres enter T10-T12

16

What are the ureters?

Retroperitoneal
SM tubes
Pass over pelvic brim at common iliac artery bifurcation
Run on lateral pelvis walls
Opposite ischial spine, curve anteromedially
Oblique entrance into bladder via one flap valve
Propel urine to bladder via response to SM stretch

17

What is the wall of ureters like?

Tri-layered wall:
- transitional epithelial mucosa
- SM muscularis
- fibrous CT adventitia

18

What is the nerve supply to the ureters?

- visceral afferents enter at spinal levels T11-L1/2
- loin pain referred along ilioinguinal and iliohypogastric nerves (L1)
- pain can change and be referred to genitofemoral nerve if kidney stone descends (L1,2) so pain over groin and scrotum/labia majora

19

Where is the urinary bladder?

Retroperitoneally lies on pelvic floor posterior to pubic symphysis
- connected anteriorly to umbilicus via median umbilical ligament (urachus)

20

What is the wall of the bladder like?

- transitional epithelial mucosa
- thick muscular layer
- fibrous adventitia

21

What is the trigone?

Triangular area between ureters and urethra
Clinically important for infection

22

What is the urethra?

Muscular tube that drains urine from bladder conveying it out of the body
Has sphincters keeping urethra closed when urine is not being passed

23

What are the urethral sphincters?

- internal (males have anatomical, woman is physiological): involuntary at bladder-urethra junction preventing retrograde ejaculation
- external voluntary sphincter surrounding urethra passing through urogenital diaphragm
- levator ani muscle: voluntary

24

What is the female urethra like? Where is it?

Tightly bound to anterior vaginal wall
External opening lies anterior to vaginal opening and posterior to clitoris

25

What is the male urethra like?

double curvature
divided into 4 sections as it passes through pelvic structures

26

What are the 4 structures of the male urethra?

- intramural (pre-prostatic): length varies on bladder filling
- prostatic: contains ejaculatory ducts
- intermediate (membranous): penetrates perineal membrane, surrounded by external urethral sphincter
- spongy: final part in corpus spongiosum of penis

27

What is micturition?

Urination
Emptying bladder

28

How is micturition controlled?

- Distension of bladder walls initiates sympathetic reflexes (visceral afferents)
- symp (hypogastric nerve) stimulates contraction to close internal urethral sphincter inhibiting detrusor muscle preventing contraction and bladder emptying
- PS: stimulates detrusor muscle to contract, inhibits and opens internal urethral sphincters
- somatic: external urethral sphincter via pudendal

29

What muscles are posterior to the kidney?

- transversus abdominis
- quadratus lumborum

30

What nerves are posterior to the kidney?

T12 - subcostal nerve
L1 - iliohypogastric and ilioinguinal nerves

31

What surrounds the kidneys?

Fat and fascia
Muscles of the back

32

What are the layers of fat and fascia surrounding the kidneys?

(outer)
pararenal fat
renal fascia/Gerota's fascia
perirenal fat
renal capsule
(inner)

33

What are the parts of the kidney?

Inner medullary pyramids
Outer cortical region (cortex)
Minor calyx
Major calyx
Pelvis
ureter

34

What is the drainage of the urine?

Collecting ducts -> renal papilla -> minor calyx -> major calyx -> renal pelvis -> ureter

35

What is the blood supply to the kidneys?

Renal artery -> 5 segmental arteries -> interlobar arteries -> arcuate -> interlobar arteries -> afferent arterioles -> glomerular capillaries

36

What is the venous drainage of the kidneys?

Capillaries -> interlobular veins -> arcuate veins -> interlobar veins -> renal veins

37

What is the lymph drainage of the kidneys?

To the lateral aortic lymph nodes

38

Where is pain felt from the kidneys?

- direct = kidney region
- referred = groin

39

What is the blood supply to the ureters?

From renal arteries, testicular arteries and common iliac arteries

40

What is the voiding reflex?

PS action to permit pee
Opposite to bladder distension where symp stops pee