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Anatomy Y1 > Unit 8 - Urinary system > Flashcards

Unit 8 - Urinary system Flashcards

1
Q

1- What kind of organ is the kidney?
2- What vertebral level does it sit at?
3- Which kidney is lower than the other/why?
4- Where do kidneys sit in relation to the posterior abdominal wall?

A

1- Retroperitoneal
2- T12- L3
3- 1 side of diaphragm us higher due to liver > right kidney is 1/2 vertebral level Lower than left
4- Anterior

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2
Q

Examine a specimen with accessory renal vessels.
* How does this relate to the embryology of the kidney?

A
  • Understanding the embryology of the kidney helps explain the development of these accessory vessels.
  • Sometimes, when the blood vessels are forming, there can be extra ones
    > these bonus blood vessels don’t cause any problems.
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3
Q

Label the transverse section showing the layers surrounding the kidney.

A
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4
Q

Label the parts of the urinary system.

A
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5
Q

Label the internal structures of the kidney.
What 2 structures make up the Renal medulla?

A
  • Renal pyramids and renal columns.
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6
Q

Label the following labels of the bladder?

A
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7
Q

What are the 3 constriction points of the ureter? What is the clinical significance of these areas?

A
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8
Q

From where does the blood supply to the ureter arise in:
- The upper abdomen
- The middle
- The lower pelvis

  • What direction do these vessels arise from in the pelvis and abdomen?
  • What is the clinical significance of this?
A
  • Blood supply LONGITUDINALLY
    > If carrying out surgery disrupting 1 area can cause ischaemia in another area.
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9
Q

Complete the flow chart regarding renal blood flow?

A
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10
Q

Label the posterior abdominal wall. What movements to they provide?

What muscles are closely related to each kidney?

A
  • Provide protection for retroperitoneal organs.
  • Kidneys lie anterior to the psoas major muscles.
  • Posterior portion of the kidneys is in close proximity to the quadratus lumborum.
  • Transversus abdominis is located superficial to the kidneys.
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11
Q

Label the branches of the Aorta.

A

Prostitutes- Phrenic (inferior) - T12
Causes- Coeliac trunk - T12
Swollen- Supra-renal (middle)
Saggy- SMA - L1
Red- Renal - L2
Testicles- Testicular (gonadal) - L2
In men- IMA - L3
Living- Lumbar
In- Iliac (common)
Sin- Sacral (median)

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12
Q

Blood supply to suprarenal glands
Where do the following arteries originate:
- Superior suprarenal
- Middle suprarenal
- Inferior suprarenal

A
  • Superior suprarenal > Inferior phrenic artery
  • Middle suprarenal > Lateral aspect of abdominal aorta
  • Inferior suprarenal > Renal artery
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13
Q

What is the venous drainage of suprarenal glands?

A
  • Right suprarenal vein > IVC
  • Left suprarenal vein joins with left inferior phrenic vein > left renal vein > IVC
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14
Q

What separates the suprarenal glands from the kidneys?

A
  • The kidneys and suprarenal glands are separated by a layer of connective tissue and fat known as the renal fascia.
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15
Q

What is unique about the innervation of the suprarenal glands?

A
  • Primary mode of innervation for the suprarenal glands is sympathetic.
    > Preganglionic sympathetic fibers originate in the spinal cord’s thoracic region (specifically T10–L1 levels). These fibers pass through the sympathetic chain ganglia without synapsing in ganglia and reach the adrenal medulla directly.
    > Upon reaching the adrenal medulla, the preganglionic fibers synapse with chromaffin cells, which are specialized cells in the medulla.
    > The stimulation of chromaffin cells leads to the release of hormones, primarily epinephrine (adrenaline) and norepinephrine, into the bloodstream.
  • Unlike many other organs, the suprarenal glands receive minimal parasympathetic innervation.
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16
Q

1- What are the effects of of sympathetic and parasympathetic innervation of the bladder?
2- Somatic innervation to the bladder?

A

1-
Sympathetic = Storage
- Hypogastric plexus T12-L2
Parasympathetic = Peeing
- Pelvic splanchnic S2-S4

2-
Somatic = Voluntary micturition via external urethral sphincter
- Pudendal S2-S4

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17
Q

1- What is the blood supply to the bladder?
- The bladder is supplemented by different arteries in males and females name these too!

2- Venous drainage of bladder

A

1- Superior vesical arteries> branch of internal iliac
- Males: Inferior vesical artery
- Females: Uterine artery

2- Vesical venous plexus > Internal iliac veins

18
Q

What muscle completes the posterior abdominal wall posteriorly? What is the blood supply to this muscle?

A
  • Quadratus Lumborum
    > Lumbar, median sacral , illiolumbar , subcostal arteries
19
Q

In males, what is the innervation and function of the internal urethral sphincter?

A
  • Regulates involuntary control of urine flow of urine to bladder
    > Males use urethra for urination and ejaculation
    » Prevents seminal regurgitation during ejaculation
20
Q

What tributaries do the following veins receive?
1- Left renal vein
2- Right renal vein

A

1- Left renal vein
- Left suprarenal vein
- Left gonadal vein
- Vein from left kidney

2- Right renal vein
- Vein from right kidney

21
Q

Discuss the clinical implications of Renal vein entrapment
syndrome (“Nutcracker syndrome”). How might this present?

A
  • Compression or entrapment of the left renal vein between the abdominal aorta and the superior mesenteric artery.

> Blood flows back into gonadal veins > pampiform plexus = swollen

22
Q

What is the relationship between the bladder and peritoneum?

A

Bladder = Retroperitoneal
> Peritoneum covers the posterosuperior surface
> HOWEVER the anterior, lateral and lower parts of the posterior surface are devoid of peritoneum.

23
Q

What kind of hernia is more prominent in males vs females?

A

Males: Inguinal
Females: Femoral

24
Q

How can you orientate whether u have right or left kidney using the hilum?

A
  • Renal vein most superficial > Artery > Ureter
25
By which process does urine pass through ureters?
- Peristalsis of muscular tube
26
In the radiograph above what is the name generally given to this type of large renal calculus, which ureter has likely been blocked as a consequence?
- **Staghorn calculi** > renal calculi that obtain their characteristic shape by forming a cast of the renal pelvis and calyces, thus resembling the horns of a stag. > seen in the setting of recurrent urinary tract infection with urease-producing bacteria - Left
27
Where does ureteric pain typically refer?
- The upper part of the ureter, close to the kidney, is associated with pain in the flank region. - As the ureter goes down, the pain might be felt in the lower abdomen. - Ureteric pain can also extend to the groin, the area where your upper thigh meets your abdomen.
28
What happens during "storage" of urine?
- Detrusor muscle relaxes (autonomics) - Internal urethral sphincter contracts (involuntary control)
29
What is the structural difference between male and female urethra?
- Female > shorter + wider
30
Where are the internal and external urethral sphincter's found in mens prostate?
- Internal: Pre prostatic urethra (involuntary- Autonomic) - External: Membranous urethra (voluntary - Somatic)
31
Which space is kidney transplanted into? What artery and vein would the renal vessels of the new kidney be attached to?
- **Iliac fossa** - Renal artery > Common iliac Or External iliac - Renal vein > Common iliac or External iliac - Ureter > Recipients bladder
32
Name the condition presented in the image. - What vessel prevented the kidney from ascending?
- Horseshoe kidney (Renal fusion) - Kidney starts in pelvis gets trapped by **Inferior mesenteric artery** and we get fusion of inferior poles of kidneys.
33
What complications are associated with horseshoe kidney (kidney fusion)?
- Asymptomatic BUT rinary Tract Infections - (UTIs) - Kidney Stones - Renal Dysfunction - Abdominal Pain
34
The ureter is at risk of being confused with the uterine artery during a hysterectomy. What is the relationship between these two vessels?
The relationship between the ureters and uterine arteries is anatomically close in the pelvic region. During a hysterectomy, surgeons must be vigilant to avoid inadvertent injury to these structures, taking measures to identify, protect, and preserve the integrity of the ureters and uterine arteries.
35
What commonly causes older men to experience problems when urinating?
1- Benign Prostatic Hyperplasia (BPH): BPH is a non-cancerous enlargement of the prostate gland, which surrounds the prostatic urethra.> As the prostate enlarges, it can squeeze the urethra, leading to urinary symptoms.
36
How can the bladder be drained if it is not possible to insert a catheter through the urethra?
1- Suprapubic Catheterization: This involves inserting a catheter directly into the bladder through a small incision made in the lower abdomen, just above the pubic bone. 2- Surgical Creation of a Urostomy: In some cases, when other options are not suitable, a surgeon may create a urostomy. This involves rerouting the ureters to a stoma (an opening) in the abdominal wall, where urine can be collected in an external pouch.
37
When does the common iliac artery divide into internal/external?
- L5–S1 When ureter crosses anteriorly
38
What are the tributaries of the IVC? (4)
- 3 formative veins: 2 common iliac veins and the median sacral vein. The latter may join the left common iliac vein. Every common iliac vein gets an iliolumbar vein. - 3 abdominal wall tributaries: inferior phrenic vein and third and fourth lumbar veins. The very first and 2nd lumbar veins finish in the ascending lumbar vein. - 3 Lateral visceral tributaries: right suprarenal vein, renal veins, and right testicular/ovarian vein. The left suprarenal vein and left gonadal veins drain into the left renal vein. - 3 anterior visceral tributaries: right, middle, and left hepatic veins
39
Lymphatic drainage of kidneys
- Renal Lymph Nodes: Lymphatic vessels from the kidneys carry lymph, a clear fluid, to the renal lymph nodes. These nodes are located near the renal arteries and veins, close to the kidney's hilum (the indented area where blood vessels and the ureter enter and exit). - Para-Aortic Lymph Nodes: From the renal lymph nodes, lymphatic vessels continue their course and may connect with the para-aortic lymph nodes. The para-aortic nodes are situated along the abdominal aorta. - Cisterna Chyli: The cisterna chyli is a dilated part of the thoracic duct, a major lymphatic vessel. It serves as a collecting point for lymph from the lower half of the body, including the renal and para-aortic lymphatic drainage.
40
What happens in? - Nephroptosis - Ectopic kidney - Renal agenesis
- Nephroptosis (Floating Kidney): > abnormal downward displacement or "dropping" of the kidney. This can occur when the kidney descends more than usual, leading to excessive mobility. = Kidney is held in place by a layer of perirenal fat and the renal fascia, which are connective tissue structures. In nephroptosis, the supportive structures are insufficient, allowing the kidney to descend more than usual. - Ectopic Kidney: > Abnormal Position: An ectopic kidney is one that is located in an abnormal position. This can occur due to developmental anomalies during fetal development. - Renal Agenesis: > Renal agenesis is the congenital absence of one or both kidneys. In unilateral renal agenesis, one kidney is entirely absent, and in bilateral agenesis, both kidneys are absent. Developmental Issues: During fetal development, the kidneys fail to form properly or do not develop at all.
41
Discuss the clinical significance of peritoneal reflections associated with: Kidneys - Hepatorenal recess Bladder - Vesicouterine pouch
- Hepatorenal recess is a peritoneal space located between the liver and the right kidney. - Vesicouterine pouch is the peritoneal space between the bladder and the uterus in females. In males, it's referred to as the vesicorectal pouch. > Both pouches can serve as areas where fluid may collect.

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