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LSS2: urinary > The Kidney system > Flashcards

The Kidney system Flashcards

1
Q

What does the kidney compromise of?

A
  • Kidneys
  • Ureters
  • Urinary bladder
  • Urethra
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2
Q

describe the features of the kidneys?

A
  • Retroperitoneal in upper abdomen
  • Surrounded by dense fibrous capsule
  • Outside the capsule is a fascial pouch (renal fascia) containing the peri-renal adipose tissue
  • Overlapped postero-superiorly by the diaphragm and pleural cavity
  • Right kidney is usually slightly lower than the left
  • Superior pole of the R kidney lies at the level of the 11th intercostal space and that of the L at the 11th rib
  • Hilum lies at about the level of L1 (R & L)
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3
Q

what are the 3 types of muscles in the kidneys?

A

Posterior to anterior.

  • Transversus abdominis muscle
  • Quadratus lumborum muscle
  • Psoas major muscle
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4
Q

Describe the nerves in the kidneys?

A
  • Subcostal nerve
  • Right kidney
  • iliohypogastric nerve
  • ilioinguinal nerve
  • ureter
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5
Q

what anterior relations does the kidney have?

A

Right: liver, hepatic flexure; hilus lies behind 2nd part of duodenum

Left: stomach, pancreas, spleen and splenic flexure

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6
Q

Describe the blood vessels of the kidneys?

A

-Left midline: aorta
Right midline: IVC

-Aorta emerging from the crura of the diaphragm.

Blood vessels of the kidneys:

  • Veins lie in front of the artery
  • left renal vein crosses in front of the aorta, just below the origin of the superior mesenteric artery and is very long
  • right renal vein which is much shorter passes steeply backwards to reach the right kidney.
  • renal arteries arise just below the superior mesenteric arteries.
  • renal arteries pass quite sharply backwards to reach the kidneys.

Renal arteries and renal veins enter the kidney at the hilum of the kidney.
-renal pelvis emerges from the hilum of the kidney, behind the blood vessels, narrows to become the ureter.

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7
Q

what is the structure of the kidney?

A
  • Cortex granular-looking because of random organisation
  • Medulla striated because of radial arrangement of tubules and micro-vessels
  • Human kidney is multilobar – like a lot of simple kidneys stuck together
  • Each lobe drains through its own papilla and calyx
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8
Q

Describe the structure of the ureters?

A
  • emerges from the hilum of the kidney
  • The ureter runs almost straight towards to pelvic brim
  • Behind the ureter is the psoas major muscle
  • Testicular vessels/ ovarian vessels run in front of the ureter
  • As the ureter runs over the pelvic brim and into the pelvis, it passes in front of the common iiliac artery, just as it divides into the internal and external iliac artery.
  • Run vertically down posterior abdominal wall in the vertical plane of the tips of the transverse processes of the lumbar vertebrae
  • Cross the pelvic brim anterior to the sacro-iliac joint bifurcation of the common iliac arteries
  • Descend anteromedially to enter bladder at the level of the ischial spine
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9
Q

Describe how urine is transported?

A
  • Urine transported by peristalsis of their smooth muscle walls
  • Open obliquely through bladder wall
  • Constrictions are sites of renal colic caused by kidney stones attempting to pass
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10
Q

what are the 3 sites of ureteric constricitons and which site is most likely to have kidney stones?

A

3 sites of ureteric constriction:

1. pelviureteric junction: junction between the ureter and renal pelvis
2. Pelvic inlet: where ureter crosses pelvic brim
3. where ureter traverses bladder wall.

The first constriction is the most likely.

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11
Q

describe the features of the bladder?

A

Adult: pelvic organ
Children: abdominal organ
-The ureter passes downwards and forwards along the pelvic wall towards the bladder.
-It passes medial to the internal iliac vessels
-Pelvic organ
-Triangular pyramid with apex pointing anteriorly and base posteriorly
-Lined by urothelium (transitional epithelium)
-3-layered epithelium with very slow cell turnover
-Large luminal cells have highly specialised low-permeability luminal membrane
-Prevents dissipation of urine-plasma gradients

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12
Q

Describe the urinary sphincters?

A
  • Sphincter vesicae (internal sphincter – smooth muscle)
  • At neck of bladder
  • Reflex opening
  • In response to bladder wall tension
  • Relaxed by parasympathetic NS
  • Contracts by sympathetic NS

-Sphincter urethrae (external sphincter – striated muscle)
-In perineum
-Tone maintained by somatic nerves in pudendal nerve (S2, 3, 4)
Opened by voluntary inhibition of nerves.
-children can’t use this

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13
Q

Describe the male urethra?

A 
-Internal urethral orifice
Bladder neck, Bladder outlet
-Prostatic urethra
-Membranous urethra 
-Bulbar urethra
-Penile urethra 
-Navicular Fossa 
-External urethral meatus

-The ductus deferens crosses the ureter medially

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14
Q

What drives ultrafiltration?

A

Blood pressure

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15
Q

What are the kidneys encased in?

A

Capsule

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16
Q

Where does each lobe of the kidney drain to?

A

Minor Calyx

17
Q

What do minor calyces form?

A

Major Calyx

18
Q

What do major calyces enter into?

A

Renal Pelvis

19
Q

How is the kidney formed embryologically?

A

It is formed from 10 or so kidney like units

20
Q

How does fluid move through the ureters?

A

Peristalsis

21
Q

Describe the epithelium in the kidneys and state its functions.

A

Urothelium/Transitional Epithelium
It has three layers of epithelium with the epithelial layer facing the urine having high-resistance tight junctions so you minimise trans-epithelial exchange (so you don’t undo the work of the kidneys).
The pleated borders of the urothelial cells allow extensive unfolding when the bladder fills with urine.

22
Q

Where is the bladder located and what happens when it is full?

A

Below the pelvic peritoneum and it doesn’t usually rise much above the pubic symphysis.

When the bladder is full it rises up into the lower abdomen and the ureters close to prevent backflow.
When empty it flattens out.
The bladder has a covering of the peritoneum only on its upper surface
Behind the bladder is the rectum
Wall of the bladder is lined with smooth muscle with mucosa
On each side the ureter opens into the bladder obliquely at the urinary ostium.
Urine leaves the bladder through the internal urethral meatus to enter the urethra.
The projection just above the urethra is the uvula.
The mucosal lining is thrown into irregular folds which flatten out as the bladder fills.

23
Q

What latin word describes things related to the urinary bladder?

A

Vesical

24
Q

How is the urethra different in males compared to females?

A

The urethra in males is much longer. In females the urethra opens in the vestibule of the vagina (the space between the labia minora).

Urethra in males

  • passes down the prostate
  • prostate/prostate gland consists of smooth muscle interlaced with glandular tissue which secrete seminal fluid
  • Urethra emerges

Urethra in females:

  • Just below the pelvic diaphragm, the urethra passes through the perineuronal membrane
  • urethra is very short approx 4cm
25
Q

What is the reflex that leads to contraction of the bladder smooth muscle and relaxation of the bladder’s smooth muscle sphincter?

A

Sacral Parasympathetic Reflex

26
Q

If we decide to urinate, it leads to voluntary relaxation via the reduced stimulation of which nerves?

A

Pudendal Nerve

27
Q

where are the kidneys located?

A
  • Located high in the posterior abdominal wall, behind the peritoneum.
  • Located in front of the 11th and 12th rib.
  • Right kidney is slightly lower than the left one.
  • Kidney is surrounded by a layer of fat.
28
Q

Describe the blood supply of the kidneys?

A
  • Abundant blood supply via renal arteries - short direct branches from abdominal aorta
  • Renal veins drain into the IVC
29
Q

Describe the structure surrounding the hilum of the kidneys?

A
  • At the hilum, the surface of the kidney are rolled inwards, creating the renal sinus.
  • In the renal sinus, the arteries and veins divide into numerous branches.
  • Renal pelvis is formed by the joining of various drainage channels
  • Usually 3-4 calyces drain into the pelvis
  • Each major calyx branches into many minor ones
  • Each minor clayx ends up in a trumpet like widening
  • At the end of each calyx, the solid tissue of the kidney projects inwards into the papilla.
  • Medulla is continuous with the papilla
30
Q

Describe the location of the suprarenal glands/adrenal glands and their function?

A
  • lies superior to the kidney
  • Emedded in the same layer of fat as the kidney
  • IVC is superior to the suprarenal glands
  • Left suprarenal gland, lies in the front of the upper part of the kidney close to the crus of the diaphragm
  • Pale outer cortex secretes corticosteroids
  • Darker inner layer is the medulla and secretes epinephrine and norepinephrine
31
Q

Describe the blood supply of the ureters?

A
  • Renal artery
  • Gonadal artery
  • Common illiac artery
  • internal artery
  • few from the aorta

If you lose one part of the blood supply, then you damage the system.

32
Q

Describe the voluntary and reflex control of the bladder?

A

Reflex control:

  1. Bladder fills
  2. This activates stretch receptors
  3. This activates parasympathetic nerve
  4. causing bladder to contract
  5. internal urethral sphincter mechanically opens when bladder contracts.

Voluntary control:
1. Cerebral cortex
In order to suppress the release:
2. Stretch receptors inhibit the motor neuron
4. External urethral sphincter opens when motor neuron is inhibited

OR
In order to stimulate the release:
2. Stretch receptors activate the motor neuron
3. This causes external urethral sphincter remains closed when motor neuron is stimulated

The stretch receptors on the bladder wall run to the spinal cord which therefore allows inhibition.

33
Q

Describe the lymphatic drainage

A

Lymph is parallel but opposite of blood supply due to supply drives the lymph.
-Lymph drainage follows the arterial supply but in opposite direction

  1. Nodes in internal ilia
  2. Common illiac
  3. Nodes not of gonadal arteries—-> inferior mesentry—-> superior mesentry—> renal artery.

All of these nodes are known as the paraaortic lymph node.

34
Q

which sex is more likely to suffer from a bladder infection/

A

Females:

  • because urethra is very short for bacteria
  • environment is very warm and moist of the vagina

Males:

  • Long
  • Dry

LSS2: urinary (9 decks)

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