The Urinary System Flashcards by Rosemarie Stringfellow

What vertebral levels do the kidneys lie at?

T12-L3

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Which kidney lies slightly lower and why?

The right one, due to the presence of the liver

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What are the anterior relations of the right kidney?

Suprarenal Gland 
Liver
Duodenum (2nd part)
Right colic flexure 
Small intestine

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What are the anterior relations of the left kidney?

Suprarenal Gland
Spleen
Stomach 
Pancreas 
Left colic flexure 
Descending colon 
Jejunum

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What are the posterior relations of the left and right kidney?

Diaphragm
Psoas major, quadratus lumborum, transversus abdominus
Ribs (right 12th) (left 11-12th)
Sub costal, iliohypogastric and ilioinguinal nerves

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What are the kidneys surrounded by (from internal to external)?

Renal capsule
Perirenal (periphrenic fat)
Renal fascia
Pararenal (paraphrenic fat)

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What are the structures that enter at the hilum of the kidney (from front to back)?

Renal vein
Renal artery
Ureter

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Describe the passage of drainage from the renal pyramid to the ureter?

Renal papilla
Minor calyx
Major calyx
Renal pelvis

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What are renal columns?

They separate each renal pyramid

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What is a renal lobe?

An area of the kidney consisting of a renal pyramid and its overlying renal cortex

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What vertebral level do the renal arteries arise at?

Between L1 and L2

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Which renal artery is longer and why?

Right renal artery, because the abdominal aorta lies slightly to the left of the midline

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Which of the renal veins is longer?

The left renal vein, because the IVC lies slightly to the right of the midline

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Does the right renal artery pass the IVC anteriorly or posteriorly?

Posteriorly

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What are the 5 segmental branches of the renal artery?

Apical (superior)
Anterosuperior
Anteroinferor 
Inferior 
Posterior

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Describe the pathway of arterial supply once it enters the kidney

Segmental arteries > Interlobar arteries > arcuate arteries > interlobular arteries > afferent arterioles >glomerulus > efferent arterioles > vasa reta/peritubular capillaries

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What is the difference in the blood supply in the cortical nephron compared to that of the juxtamedullary nephron?

Cortical nephron - peritibular capillaries

Juxtamedullary nephron - vasa recta

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What is the venous drainage of the kidney?

The vasa recta and peritubular capillaries both drain into:

Interlobular vein
arcuate vein
Interlobar vein
Renal veins

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What is the lymphatic drainage of the kidneys?

They drain into the para-aortic lymph nodes (located around the renal artery)

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What is the sympathetic innervation of the kidney?

What does it cause?

Least splanchnic nerve
Aorticorenal ganglion

Sympathetic stimulation leads to constriction of the vessels

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How long are the ureters?

25cm

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What are the three most likely points for kidney stones to become lodged and why?

Uteropelvic junction
Pelvic inlet - As the ureters cross the common iliac vessels
Ureter entrance to bladder

These are the 3 constriction points along the course of the ureters

How much urine can the bladder hold?

Up to 600mL

How is the bladder connected to the umbilicus?

From the median umbilical ligament by the apex

How is the neck of the bladder fixed in place in males and females?

Males: puboprostatic ligament Females: pubovesical ligament

Which relations to the bladder are the same in both males and females?

Anterior and lateral relations

What is the area called on the bladder which has smooth walls? Where is it located on the bladder

The trigone On the fundas/base

What are the three openings of the trigone

Two superior - right and left ureters | One inferior - exit of urethra

What is the muscle of the bladder called? What kind of muscle is this?

Detrusor muscle Specialised smooth muscle

How does the internal urethral sphincter differ in males and females?

Males - smooth muscle fibres under autonomic control | Female - functional sphincter with no muscle present, formed by the anatomy of the bladder neck

What kind of control is the external urethral sphincter under?

Voluntary control

What is the arterial supply to the bladder?

Internal iliac artery branches: - superior vesicular - inferior vesicular (males only) - vaginal arteries (females only)

What is the venous plexus called that drains the bladder?

Vesical venous plexus

Where does the sympathetic nerve supply to the bladder come from?

Preganglionic fibres arise from spinal cord T10-L2 Fibres are transmitted in the lumber splanchnic nerves Preganglionic fibres terminate in the hypogastric ganglion Postganglionic fibres arise from the nerve cell bodies in the hypogastric plexus

What does sympathetic innervation do to the bladder?

Relaxes the detrusor muscle Closes the internal sphincter Promotes urine retention

Where does the parasympathetic supply to the bladder arise?

From spinal cord segments S2-S4 Fibres are transmitted in the pelvic splanchnic nerve Fibres pass through the inferior hypogastric plexus without synapsing

What does parasympathetic supply to the bladder result in?

Contraction of the detrusor muscle Inhibition of internal sphincter - causes it to open This stimulates micturition

Which nerve supplies somatic innervation to the bladder? Which part does it innervate?

``` Pudendal nerve (S2-S4) Innervates the external urethral sphincter ```

What is the pelvic pain line? What kind of pain afferents come from above and below?

Above the pelvic pain line - pelvic organs in contact with peritoneum, pain follows sympathetic fibres Below the pelvic pain line - pelvic organs that do not contact the peritoneum, pain follows parasympathetic fibres

How long is the female urethra?

4cm

What are skene's glands?

Two small paraurethral mucous glands associated with the lower end of the female urethra

How many times does the male urethra bend along its course?

Twice

How long is the male urethra?

20cm

What are the 4 parts of the male urethra?

Preprostatic Prostatic Membranous Spongy

In which part of the male urethra is the internal urethral sphincter?

Preprostatic part

In which part of the male urethra is the seminal colliculus located?

The prostatic part

Where do the prostatic glands drain into the urethra?

At the prostatic sinuses in the prostatic part of the urethra lateral to the urethral crest

Which part of the male urethra contains the external urethra sphincter?

Membranous part

Which part of the male urethra do the bulbourethral glands open into?

The spongy part

What are the four histological zones of the prostate?

Central zone Transitional zone Peripheral zone Fibromuscular structure

Which zone of the prostate is prostate carcinoma most likely to occur?

The peripheral zone

In which zone of the prostate would you most likely get benign hyperplasia (BPH)?

Transitional zone

Which zone of the prostate is felt on a DRE through the rectum?

The peripheral zone