Flashcards in L16 – Anatomy of the Kidneys, Ureters and Urinary Bladder Deck (81):
Where are the kidneys located?
Retroperitoneum= posterior to parietal peritoneum
Upper border= T12
Lower border = L3
What 2 types of nodes are for draining the posterior abdominal wall?
Lateral aortic nodes
Which nodes drain lymph from kidneys, supraadrenal glands, testes, ovaries? What does the efferent lymph of these nodes form?
Lateral aortic nodes: common iliac nodes
Efferent lymph forms right and left lumbar trunk
What does the lateral lumbar trunk drain into until BCV?
lumbar/ para-aortic nodes+ lateral Aortic nodes > cisterna chyli > thoracic duct > BCV
Where does the blood supply of kidney comes from?
Renal A/V arise from abdominal aorta
What is the consequence of the location of the inferior vena cava on the length of renal veins?
Left renal vein is longer than right renal vein because inferior VC is located off to the right
What is the nerve supply of the kidney?
Renal plexus, autonomic nerves
Consists of T12 (sympathetic) and Vagus (parasympathetic)
Why is the right kidney at a slightly different level to the Left?
Due to right lobe of liver being lower
Right kidney is lower than left
What is the order of the coverings of the kidney?
(From most outer)
What is the role of kidney coverings?
Hold in position, structure
Where are renal tubules located (Loop of Henle and Collecting duct)? (not including juxtamedullary nephrons)
In the pyramids in renal medulla
What are the two layers of the kidney responsible for filtration?
Cortex and Medulla
How do the pyramids connect to major calyxes?
Pyramid > Renal papilla > minor calyx > major calyx
What structures are found in the hilum of kidney?
How does the minor calyx connect with the bladder?
Minor calyx > Major calyx > Renal pelvis > Uroteropelvic junction > ureter
What are the two parts of the gland over the kidneys?
Adrenal cortex (outer) and Adrenal medulla (inner)
What are the functional role differences between renal medulla and renal cortex?
Cortex = filtration role
Medulla = urine concentration role
What structures are found in the renal cortex?
parts of juxtamedullary nephron and cortical nephron
Where do renal veins drain?
At level of L2, drain into Inferior VC
What is located anterior to right kidney?
2nd descending part of duodenum
What is antero-lateral to right kidney?
Right Colic Fissure
What is inferior to right kidney?
Inferior to L. kidney?
What is anterolateral to left kidney?
What is anterior to left kidney? (4)
Left colic fissure
What muscle is posterior to kidney?
Quadratus Lumborum muscle
Suprarenal glands. Artery supplies?
3 artery supplies:
Superior: Branch of Inferior phrenic artery (from abdominal aorta)
Middle: Branch of abdominal aorta
Inferior: Branch of Renal artery
Veins of suprarenal glands?
Right= inferior VC
Left = Left renal vein
Nerves of suprarenal glands?
Lymphatic drainage of suprarenal glands?
Lateral aortic/ lumbar nodes
Ureter has three physiological narrowings. Name each in sequence.
Uretopelvic junction (where renal pelvis joins ureter)
When ureters cross pelvic inlet
Uretovesical junction/ entrance to bladder
Why condition is common at the physiological narrowings of the ureter?
obstruction due to uretero stones
Severe nonspecific pain when ureter smooth muscle contracts
Ureter blood supply divided into three parts. Name each?
Upper = renal A/V
Middle= Gonadal A/V
Pelvic= Vesical A/V
What are the nerve supplies of ureter?
Renal, testicular and hypogastric plexuses
What is the lymphatic drainage of ureters?
Lateral Aortic/ lumbar nodes
What is the difference in the gonadal A/V supplying middle ureter between two genders?
Male = testicular A/V
Female= ovarian A/V
Where does vescial A/V supplying pelvic (lower) ureter come from?
From internal iliac artery branching from aorta
What structure lies adjacent to ureter in male and female?
Male = Ductus deferens anterior to ureter
Female = uterine arteries is anterior
During a surgical removal of uterus, what may be accidentally ligated?
The ureter instead of the uterine artery
Cause no renal output and enlargement of abdomen
What are the three components to the pelvic inlet?
Margin of Ala -formed by S1 bone, up to sarco-iliac joint
Promontory (body) -formed by protrusion of S1 bone
What forms Linea terminalis ? (3) (PPA)
From medial to lateral:
What is the clinical significance of the Pelvic inlet?
Important for determining the first stage of labour
Fetal distress if inlet is too small and fetus forces into pelvis
What are the three bones that form the Pelvis?
Where do the three pelvic bones join?
Acetabulum, head of femur is located there
Diagonal conjugate vs Obstetrical conjugate
How are they measured?
Obstetrical conjugate / true conjugate only measured by X-ray = 11.5cm
Diagonal conjugate > 11.5cm, indirect measurement, ultrasound
Which two muscles are attached to the lateral rotator of hip joint?
Piriformis muscle on lateral wall
Obturtator intermus muscle
What VAN supplies the adductor muscles of the thigh?
Obturator VAN that passes through obturator canal at the medial side of thigh
What two ligaments attached to the lateral rotator of hip joint?
Sacrospinous and Sacrotuberous ligaments
What are the components of the Pelvic outlet?
How is diagonal conjugate measured?
Mesaure tip of S1 to lower border of pubic bone
How is Obstetrical/ True conjugate measured?
Only by X-ray
Actural Anterior-Posterior diameter
How does common iliac artery branch?
Into internal and external iliac arteries
How does Internal iliac artery further subdivide?
posterior ll ls sg
Anterior and Posterior divisions
Posterior is closer to spine, further divides into:
Iliolumbar, Lateral sacral and superior gluteal arteries
How does sacral arteries differ in origin?
Lateral sacral artery is from:
Posterior division on internal iliac artery from common iliac artery
Medial sacral artery is from: Abdominal aorta
What are the three divisions of one of the branches of posterior division of internal iliac artery?
Iliolumbar artery branches into iliac, lumbar and spinal branch
The ANTERIOR division of internal iliac artery branches into which arteries?
Umb Ob Ves IG MR IP V Uter
MR IP V V U U IG Ob
MR. IP's VERY, VERY OBSESSED with Ur 2 IGs
Superior and Inferior vesical artery
Inferior gluteal (vs superior gluteal in POSTERIOR)
Middle Rectal artery
Internal Pudendal artery
What does the umbilical artery supply?
What artery supplies the external genitalia?
Internal pudendal artery
Male= dorsal artery of penis
Female = clitoris
What does the inferior vesical artery supply?
Ureter and bladder
same as supeior vesical artery
What is anterior to the bladder?
What procedure is done to drain the bladder?
Puncture needle above symphysis pubis to drain the bladder
What things are posterior to the bladder?
Female= rectum and uterus
What is in the wall of the bladder?
What is the difference in epithelium in the bladder wall?
Internal = transitional epithelium
External, superior outer portion = serous (parietal) peritoneal layer
What part of he bladder is covered by peritoneum?
Only superior portion
The peritoneum can reflect/fold in two ways in male and female. How?
Female= Vesico-uterine pouch, space between bladder and uterus
Male= Recto-vesical pouch, space between bladder and rectum
What is the sphincter on bladder and what nerve supplies this sphincter?
Supplied by autonomic NS
How is the sphincter fixed in male and female?
Male= Pubo-prostatic ligament
Female= Pubo-vesical ligament
What supports the bladder? ***
Urogenital diaphragm (perineal muscle)
Pelvic fascia (inferior)
Medial umbilical ligament (posterior)
Median umblilical ligament (from Urachus, anterior)
Trigone is where in bladder?
Triangular area at base of bladder
Lies between urethral orifice and 2 ureteric orifices
How is the lining of the Trigone different?
Where is the ureteral fold?
on the superior border of trigone
What is the blood supply off the bladder?
Superior and inferior vesical A/V
What is the nerve supply of the bladder?
What procedure is done to extract urethral stone?
Bladder lymphatic drainage?
Internal and external iliac nodes
What structure is found anterior to bladder in male and female?
Male = ductus deferens, seminal vesicle
Female= uterine artery
What is the urogenital diaphragm formed by?
Deep transverse perineal body
Supports bladder and prostate
How can the male urethra be divided anatomically? (not like in embryology)
Which of the two umbilical ligaments attached to the bladder is more anterior?