Urinary S1 (Needs Imaging) Flashcards by Callum Mackay

How many Kidneys are found in the human body?

Where are they located?

How much does each kidney weigh?

2 kidneys

Retroperitoneal organs

Lateral to vertebrae (T11 to L3)

Left higher than right

150g each

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What structures immediately surround each kidney?

Enclosed by a capsule (which also encloses the suprarenal glands)

Suprarenal glands separated from kidneys by a septum

All enclosed in perirenal fat and pararenal fascia

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Label the lines according to the structures that overly the kidneys at each point

From top left anticlockwise:

Right suprarenal gland

Liver

Desc. Duodenum

R. Colic flexure

Small intestine

Jejunum

Desc. Colon

Left colic flexure

Pancreas

Spleen

Stomach

Left suprarenal gland

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What are the posterior relations of the kidneys?

Left kidney

Top 1/3:

Rib XI and XII
Diaphragm

Lower 2/3 (From medial to laterally)

Psoas major
Quadratus lumborum
Transversus abdominis

Right Kidney:

As above but excluding Rib XI (R. Kidney lower)

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Describe the Hilum of the Kidneys

Vertical clefts in the medial margins

Renal arteries, Veins and the ureters enter/leave here

VAU (vein, artery, ureter) Anterior to posterior

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Describe the Venous drainage of the kidneys

What is the clinical relevance?

Renal veins drain both kidneys into the IVC

Left renal vein must cross the midline, lies between Superior mesenteric artery and the aorta

Clinical:

Aneurysm in the abdominal aorta could compress left renal vein

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Describe the Renal arteries

What is the most common anomaly and the clinical significance of this anomaly?

Normally one renal artery to each kidney supplied by the Abdominal aorta

Right renal artery passes inferior to IVC

Multiple renal arteries to one kidney is a common anomaly

These multiple arteries are end arteries that do not anastomose and so occlusion of one will lead to kidney tissue ischaemia/necrosis

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Label the black boxes

From top left anticlockwise:

Pyramid in renal medulla

Renal cortex

Renal papilla

Renal sinus

Minor calyx

Ureter

Renal Pelvis

Renal vein

Renal artery

Major Calyx

Renal Column

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Through which structures does filtrate/urine pass in kidneys before reaching the bladder?

Filtrate in the cortex is filtered throught the nephrons to the collecting ducts in the medulla

Urine passes throught collecting ducts in the renal pyramids to the papillae at the apex of each pyramid

Papillae drain into minor calyx, which in turn drains into the major calyx

Major calices drain to the renal pelvis, then through the ureters to the bladder

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Follow the course of a red blood cell from the left renal artery to the left renal vein

Hint: Make sure to go into detail of vasculature surrounding each nephron

Arterial:

Renal Vein

Segmental artery

Interlobar artery

Arcuate artery

Interlobular artery

Afferent arterioles

Glomerulur tuft

Efferent arteriole

THEN EITHER

Peritubular capillaries which drain into cortical venules

Vasa recta, which drain into the venae recta

Venous:

Cortical venules or venae recta

Interlobular vein

Arcuate vein

Interlobar vein

Segmental vein

Renal vein

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Where can the kidney recieve abberant blood supply from?

Extra renal arteries

Superior mesenteric artery

Suprarenal artery

Testicular or ovarian arteries

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What 3 constrictions are present in the ureters as they travel from kidney to bladder?

The Junction of the renal pelvis
At pelvic brim
Where it pierces the bladder wall

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At what level do the ureters cross the pelvic brim?

What is the closest major vasculare structure at this level?

At the level of the sacro-iliac joint

The ureter pasess anterior to the bifurcation of the common iliac artery at this level

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Describe the course of the ureters from Hilum to Bladder

Descends anterior to psoas major

crosses pelvic brim at level of sacro-iliac joint

**In Women: **

Uterine artery passes over the ureter (water under the bridge)

In Men:

Ureter passes under the vas deferens

Then:

Ureters enter the posterolateral aspect of the bladder and run obliquely throught the bladder wall

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Given the most likely cause of trauma to the ureters

During hysterectomy or oophorectomy in women damage to the ureters can occur

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Apart from trauma, what is the other major clinical aspect of ureters? Explain in detail

Uretic stones can be passed from kidney

Can get caught at uretic constrictions causing renal colic

Smooth muscle spasms that are normally a function of peristalsis try to clear the stone

This can cause pain from visceral sensory nerves T11 to L2

This presents as groin, loin and flank pain

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Givea a very brief description of bladder structure (3 points)

Hollow

Distensible (transitional epithelium)

Muscular walls

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Where is the bladder found and how is it shaped?

Hint: Different states

Empty:

Lies in the lesser pelvis inferior to the peritoneum

It is a tetrahedron

Posterior base, superior side and two inferolateral sides

Full:

Rises into the greater pelvis and above the pubic bone, may reach as high as the umbilicus. Still lies inferior to peritoneum

Spherical in shape

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Give short descriptions of the specific regions/structures of interest within the bladder (5 points)

Apex (anterior angle):

Connection here to urachus, seen as the median umbilical ligament

Trigone:

Defines posterior wall, oblique openings to the ureters and internal urethral opening in a triangle shape, smooth walled

Interureteric fold:

Ridge between two ureter openings

Neck:

Where base and inferolateral sides meet

Involuntary internal sphincter:

Circular region of detrusor muscle at neck acting as sphincter

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Describe the bladder walls (3 points)

Rugae in mucosa except within trigone

Transitional epithelium

Detrusor muscle is the muscularis propria, formed of longitudinal, circular and oblique fibres

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How is the prostate involved in urination?

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Can occlude urethra preventing urination

Enlargement normal with age in response to male hormones

How long is the urethra?

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Females:

4-5cm

Males:

~20cm

Describe the course of the male urethra

Include notes on structure in each section

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Preprostatic:

Small section of urethral between bladder and prostate

Transitional epithelium

Prostatic:

Section of the urethra that passes through the prostate, ejaculatory duct and prostatic ducts drain into urethra here

Transitional epithelium

Membranous:

Small section of urethra passing through the external urethral sphincter and the deep peritoneal pouch

Stratified columnar epithelium

Spongy (Penile):

Longest section passes through the penis (corpus spongosium)

Stratified columnar proximally

Stratified squamous distally

What is the clinical significance of the Membranous section of the male urethra

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Can be damaged during catheterisation

Describe the course of the female urethra

Passes between the glans clitoris and the vaginal opening Passes through the deep perenial pouch first, this is where the external urethral sphincter resides Then passes straight to the external urethral orifice

What is the clincial relevance of the female urethra?

Greater chance of UTIs than men due to closeness to the anal orifice and short length

What are the general functions of the kidneys? (4 points)

**Regulation:** Controls concentrations og key substances (ions and small organic molecules) in ECF **Excretion:** Filters waste products from blood **Endocrine:** Synthesis of renin, erythropoietin, prostaglandins **Metabolism:** Produce active Vit. D Catabolism of Insulin, PTH, calcitonin

Describe the water content of a 70Kg Medical student

**40L total** **ICF:** 25L **ECF:** Interstitial fluid - 12L Intravascular - 3L Lymph Synovial, intestinal, CSF, Sweat, Urine, Pleural, Peritoneal, Pericardial, Intraocular

Describe what is meant by the terms: Osmolality Osmolarity Oncotic

**Osmolality:** Solute per Kg of solvent **Osmolarity:** Number of osmoles (ions and organic molecules) of solute per litre measured in milli-osmoles **Oncotic:** Osmotic force due to proteins

How do you make water cross a cell membrane?

Have differnt osmolarities across the membrane Water moves from areas of low to high osmolarity

Compare the ICF and ECF in terms of relative amounts of electrolytes Why are they different? What can happen in the case of disturbance to this balance?

**ECF:** High Na+ and low K+ Many large organic anions **ICF:** High K+ and low Na+ Main anions Cl- and HCO3- **Difference:** Maintained by active transport mechanisms (E.g. Na+/K+ATPase) **Disturbance:** Failure to control electrolyte balance will affect transport and electrical functions

How do the Kidney interact with bodily fluid?

Affects ECF directly by changing volume and compostion This has indirect effect on the ICF

How does failure of the kidney to regulate ECF volume and composition affect the body? Hint: Keep it general

**Volume:** Changes in BP, Tissue fluid and cell function **Composition:** Changes in osmolarity cause cells to shrink or swell

What 2 major factors affect homeostatic regulation of ECF/ICF in a normal physiological state?

Variable ingestion of water and salts Loss of water and salts

How do the kidneys affect the acid/base balance of the body?

Control concentration of Bicarbonate in plasma

How much does the kidney filter every minute/day and what is this called? What is the general composition of this filtrate? How much ends up being excreted?

125ml/min or 180L/day - Glomerular filtration rate Produces an ultrafiltrate of water, ions and small molecules Leaves on average 1.5L or urine a day

What is the functional unit of the kidney? How many are found in each kidney?

Nephron 1.5 million

Give the basic areas of the nephron and where they are found

**Cortex:** Glomerulus, PCT, DCT **Medulla:** Loop of Henle Collecting duct (passes into pelvis)

What is the function of epithelium in the nephron?

Filtration of plasma Excrete waste produces Reabsorb needed materials from ultrafiltrate

**1. **Give a list of normal substances the kidney will reabsorb and proportions of that material that are reabsorbed from ultrafiltrate **2. **Give an example of a substance that is actively excreted

**1.** Water - 99% reabsorbed Na+ and Cl- 99% Bicarbonate - 100% Gucose and amino acids -100% **2.** H+ actively excreted by epithelium (lose more than is filtered)

What is the blood flow required by the kidney? What proprtion of cardiac output does this represent?

4ml/g/min 25%

Decribe in general terms how the kidney produces ultrafiltrate

Glomerulus filters water, ions and small molecules by constant filtration pressure in capillaries Specialised circulation (affernet and efferent arterioles) maintains filtration pressure

Describe the functions of the PCT

**Major site of reabsorbtion:** 60-70% water 80-90% Na+ and K+ 90% Bicarbonate 100% glucose and AAs Reabsorbed materials then leave via peritubular capillaries

Is the fluid in the PCT hypotonic, isotonic or hypertonic? Explain

**Isotonic** Water follows osmotic gradient produces by reabsorbtion

What is meant by 'Kidney epithelia are polarised' Why is this important

**Polarisation:** Differnt membrane transporters on luminal and basolateral membranes This allows transport across the epithelium

Explain how Na+/K+ATPase transporters are involved in reabsorbtion at the PCT

Na+/K+ATPase extrudes Na+ across basolateral membrane Na+ enters cells from lumen down conc gradient Energy from soudium movement used to drive reabsorbtion of other sultutes such as glucose Water follows osmotically

What are the functions of the Loop of Henle?

**Reabsorbtion:** Further reabsorption occurs **Counter current multiplication:** Creates a gradient of increasing osmolarity in the medulla Allows formation of concentrated urine to conserve water

Describe the modification of urine in the DCT

Site of variable reabsorbtion of electrolytes and water Takes hypotonic fluid leaving LoH and removes yet more Na+ and Cl- Actively secretes H+ Water can move into or out of lumen If net movement is into the lumen then large volumes of dilute urine formed (Diuresis)

Describe how the collecting duct affects urine production

Collecting duct passes through high osmolarity medulla If CD is water permeable, water moves out and concentrated urine is produced If CD not permeable to water, urine remains dilute

Describe the hormonal basis of variable reabsorption in the distal nephron

**Renin angiotensin system:** Controls sodium recovery and hence controls ECF volume/amount of water reabsorbed **Anti-Diuretic hormone:** Controls permeability of the DCT and collecting ducts This controls ECF osmolarity

Urinary S1 (Needs Imaging) Flashcards

(50 cards)