Urinary

Question 1

what vertebral levels can the left kidney be found between?

Answer 1

T11-L2

Question 2

what vertebral levels can the right kidney be found between?

Answer 2

T12-L3

Question 3

why is the right kidney lower than the left?

Answer 3

the lived displaces it inferiorly

Question 4

what are the layers of facia/fat which surround the kidney? (4)

Answer 4

deep to superficial

• renal capsule
• perirenal fat
• renal fascia
• pararenal fat (mainly on the posteriolateral aspect of the kidney)

Question 5

describe the path of urine from the renal pyramid to the ureter

Answer 5

renal pyramid-minor calyx-major calyx-renal pelvis- ureter

Question 6

which vessel is more anterior, the renal veins or renal arteries?

Answer 6

renal veins

Question 7

describe the vessels which blood must pass through to get into the renal vein from the renal artery.

Answer 7

renal artery-segmented-lobar- interlobular- arcuate artery- arcuate vein- interlobular- lobar- segmented- renal vein

Question 8

where do interloper arteries become afferent arterioles?

Answer 8

through the cortex

Question 9

What is pelvic kidney?

Answer 9

failing of a kidney to ascend. it remains in the pelvis at the level of the common iliac artery.

Question 10

What is horseshoe kidney?

Answer 10

the kidneys are fused and situated in the pelvis. The kidneys become too close during their ascent, fuse, and become stuck underneath the IMA

Question 11

What problems can arise from a horse shoe kidney?

Answer 11

not much really, slightly more prone to obstruction.

Question 12

what is renal agenisis?

Answer 12

complete failure of one or both kidneys to develop, it’s most commonly unilateral

Question 13

what is renal hypoplasia?

Answer 13

the kidneys develop with normal architecture, but are of smaller size than normal.

Question 14

In an adult, how long are ureters?

Answer 14

25cm

Question 15

what type of muscle can be found in the wall of the ureters?

Answer 15

smooth muscle

Question 16

where do the ureters fun in relation to psoas major?

Answer 16

they run anteriorly

Question 17

where do the ureters cross the pelvic brim?

Answer 17

at the sacroiliac joint

Question 18

what vessels do the ureters cross at the pelvic brim?

Answer 18

bifurcation of the common iliac arteries.

Question 19

at what level do the ureters move anteriorly?

Answer 19

the level of the ischial spines

Question 20

what’s the significance of the oblique manner at which the ureters enter the bladder?

Answer 20

it creates a one-way valve, where high intramural pressure collapses the ureters, preventing the back-flow of urine.

Question 21

which arteries supplies the abdominal part of the ureter?

Answer 21

renal arteries and gonadal

Question 22

which arteries supply the pelvic part of the ureter?

Answer 22

superior and inferior vesical arteries

Question 23

venous drainage of the ureters is carried out by which vessels?

Answer 23

they match the corresponding arteries

Question 24

what delivers the nervous control of the ureters?

Answer 24

renal, testicular/ovarian and hypogastric plexuses

Question 25

what vertebral levels is the ureteric nervous supply via? so what dermatome is ureteric pain referred?

Answer 25

T11-T12 | -flank, loin and groin

Question 26

what vessel is at risk during a hysterectomy and why?

Answer 26

ureters | -2cm above the ischial spine the ureters run under the uterine artery (water under the bridge)

Question 27

what three locations along the ureter are narrowest and therefore at risk of a renal stone being stuck.

Answer 27

- uretopelvic junction - pelvic brim - where the ureter enters the bladder

Question 28

what is the bladder an embryological derivative of?

Answer 28

the hind gut

Question 29

what are the two main functions of the bladder?

Answer 29

- temporary storage of urine | - assists in the expulsion of urine

Question 30

what's the largest volume of urine a bladder can hold?

Answer 30

600ml (or 20ml if alcohol is involved ;) )

Question 31

What is the trigone int he bladder?

Answer 31

a triangular area in the funds, marked by the ureters and urethra. it's a smooth walled area.

Question 32

what sphincters control the outflow of urine, and how do they differ between men and women?

Answer 32

internal and external sphincter | the internal sphincter is only present in men

Question 33

what is the specialised muscle of the bladder wall called?

Answer 33

detruser muscle

Question 34

is the internal sphincter under somatic or autonomic control?

Answer 34

autonomic, and is thought to prevent seminal regurgitation during ejaculation

Question 35

what muscle makes up the external sphincter?

Answer 35

skeletal, so it's under voluntary control

Question 36

how is arterial supply to the bladder deliverd?

Answer 36

superior and inferior vesical arteries, via the internal iliac. the obturator, inferior gluteal and vaginal arteries also contribute small branches.

Question 37

how is venous drainage of the bladder achieved?

Answer 37

vesical venous plexus

Question 38

what nerve delivers sympathetic innervation to the bladder? and what are it's nerve roots?

Answer 38

hypogastric nerve | T12-L2

Question 39

what nerve delivers parasympathetic innervation to the bladder? and what are it's nerve roots?

Answer 39

pelvic nerve | S2-S4

Question 40

what nerve delivers somatic innervation to the bladder? and what are it's nerve roots?

Answer 40

pudendal nerve | S2-S4

Question 41

What is the bladder stretch reflex?

Answer 41

it's a primitive spinal reflex, where micturition is stimulated in response to stretch.

Question 42

what is the reflex arc which causes the bladder stretch reflex?

Answer 42

- bladder fills with urine and the sensory nerves detect this and transmit it to the spinal chord - interneurones within the spinal cord relay the signal to the parasympathetic efferents - the pelvic nerve acts to contract the detrusor muscle and stimulates micturition.

Question 43

The bladder stretch reflex is not functional in adults (thank goodness), but when do we still need to consider it?

Answer 43

- childhood - spinal injuries - neurodegenerative diseases

Question 44

where does a spinal cord transection occur if it produces 'reflex bladder' and why?

Answer 44

above S2 -afferent signals are unable to reach the brain, and there will be no awareness of the bladder filling. there is also no control over the external urethral sphincter, so it is constantly relaxed !

Question 45

where does a spinal cord transection occur if it produces 'flaccid bladder' and why?

Answer 45

S2-S4 damages the parasympathetic outflow to the bladder. the detrusor muscle will be paralysed. the bladder will fill uncontrollably until overflow incontinece occurs.

Question 46

what epithelia lines the urethra?

Answer 46

stratified columnar

Question 47

how long (on average) is the male urethra?

Answer 47

15-20cm

Question 48

what for sections can the male urethra be separated into?

Answer 48

pre-prostatic, prostatic, membranous and spongy

Question 49

what two angles make male catheterisation difficult?

Answer 49

prepubic angle and the infrapubic angle

Question 50

how can the prepubic angle be overcome during catheterisation?

Answer 50

holding the penis upwards

Question 51

what three constrictions does the male urethra have?

Answer 51

- internal urethral sphincter - external urethral sphincter - external urethral orifice

Question 52

how long is a female urethra?

Answer 52

4cm

Question 53

what is the clinical significance of the short female urethra?

Answer 53

it predisposes women to urinary tract infections

Question 54

what epithelia is found in the ureters?

Answer 54

urothelium- transitional epithelium

Question 55

what epithelia can be found in the bladder?

Answer 55

bladder