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Abdomin And Superficial Structures > Urinary System > Flashcards

Urinary System Flashcards

1
Q

What layer does the kidney arise from?

A

Mesoderm

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2
Q

How many stages of kidney development are there?

A

3

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3
Q

What are the 3 stages of kidney development?

A
  1. Pronephros
  2. Mesonephros
  3. Metanephros
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4
Q

When does the pronephros development take place?

A

4th embryological week

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5
Q

Is the pronephros a functioning unit?

A

No

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6
Q

When does the meonephros develop?

A

Late in the 4th embryologic week

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7
Q

Which stage of development function as the interim kidney?

A

Mesonephros

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8
Q

What does the mesonehros develop into?

A

Mesonephric duct

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9
Q

Explain the development of the mesonephric duct in male development

A

Epididymis, vas deferns, ED

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10
Q

Explain the development of the mesonephric duct in female development

A

Mullarian duct > ureter, vagina

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11
Q

What stage of kidney development becomes the permanent kidney?

A

metanephros

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12
Q

When does the metanephros form?

A

End of the 5th week embryological development

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13
Q

When does the metanephros begin to function?

A

8 weeks gestation

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14
Q

What does the ureteric bud form? (4)

A

Ureters
Renal pelvis
Calyces
Collecting ducts

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15
Q

Where does the ureteric bud form from?

A

Mesonephric duct

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16
Q

What is the functional unit of the kidney?

A

Nephrons

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17
Q

Where do the nephrons arise from?

A

Intermediate mesoderm

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18
Q

During fetal growth where do the kidneys migrate to?

A

Migrate from the pelvis to the abdomen

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19
Q

At what week do the kidneys migrate during fetal development?

A

12-15 weeks gestation

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20
Q

What causes the kidney to migrate?

A

Result of rapid caudal growth (so they don’t really migrate)

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21
Q

When are where do the ureters develop?

A

Mesonephric duct (wolffian duct) at 4 weeks gestation

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22
Q

Where does the urinary bladder develop from?

A

Urogenital sinus

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23
Q

Is the urinary bladder continuous with the allantois?

A

Yes

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24
Q

Where does the allantois form?

A

Yolk sac

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25
Q

What does the allantois become?

A

Urachus

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26
Q

What is the urachus?

A

Median umbilical ligament

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27
Q

What is the purpose of the medial umbilical ligament?

A

Pathway the bladder takes from the abdomen to the pelvis

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28
Q

When does the bladder become a true pelvic structure in infants and children?

A

After puberty

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29
Q

In what retroperitoneal space does the kidneys and ureters lie in?

A

Perirenal space

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30
Q

In what gutter do the kidneys obliquely lie?

A

Paravertebral gutters

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31
Q

What muscle runs parallel to the kidneys?

A

Psoas muscle

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32
Q

The upper poles are located more what to the inferior poles?

A

Medial and posterior

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33
Q

Where do the IVC and aorta lie in relation to the kidneys?

A

Anterior

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34
Q

Where do the ureters enter the bladder?

A

Posterolateral aspect of the bladder

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35
Q

What is the relation of the ureters to the iliac vessels?

A

Anterior

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36
Q

How long are the ureters?

A

30cm

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37
Q

What is the diameter of the ureters?

A

2-8cm

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38
Q

What vertebral level does the upper and lower poles the kidneys sit?

A

T12 and L3

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39
Q

At what vertebral level is the hilum?

A

L1

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40
Q

What cavity does the bladder lie in?

A

Retroperitoneal

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41
Q

Where does the bladder sit in an empty state?

A

True pelvis

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42
Q

Where does the bladder sit in a distended state?

A

False pelvis/abdominal cavity

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43
Q

Where is the bladder in relation to the prostate?

A

Superior

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44
Q

What shape is the kidney?

A

Bean-shaped AKA reniform shaped

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45
Q

How are the medial and lateral aspects of the kidneys shaped?

A

Medial- concave

Lateral- convex

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46
Q

What are the dimensions of the adult kidney?

A

Length- 9-12cm
Width- 4-5cm
AP- 3cm

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47
Q

Which kidney is usually longer?

A

Left

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48
Q

The lengths of the adult kidney should be within how many cm of each other?

A

1.5-2cm

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49
Q

What is the size of a child’s kidneys?

A

Size will vary with age- charts generally available within department

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50
Q

What are the 4 layers if tissue that protects the kidneys?

A
  1. Thin fibrous capsule
  2. Perirenal fat
  3. Renal fascia
  4. Pararenal fat
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51
Q

Describe how the thin fibrous capsule that surrounds the kidney appears on US

A

Specular reflector that appears bright on US (echogenic)

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52
Q

What is the perirenal fat continuous with?

A

Renal sinus

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53
Q

What is another name for the renal fascia?

A

Gerota’s fascia

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54
Q

What is the purpose of the renal fascia?

A

Anchors the kidney to the posterior abdominal wall

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55
Q

What spaces does the renal fascia separate?

A

Separates the perirenal space from the pararenal space

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56
Q

What is ptosis?

A

A kidney that falls when fascia tears

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57
Q

What are the 2 distinct areas of the kidney?

A

Parenchyma and Sinus

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58
Q

What area of the kidney is the functional layer?

A

Parenchyma

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59
Q

What is the parenchyma divided into?

A

Cortex and Medulla

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60
Q

What portion of the kidney is the renal capsule?

A

Outer portion

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61
Q

Where is the site of urine production?

A

Renal cortex

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62
Q

What area of the kidney contains the functional units?

A

Cortex

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63
Q

What is the parenchyma that arches over the renal pyramids and extends between pyramids known as?

A

Columns of Bertin

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64
Q

What artery and vein does each column of Bertin contain?

A

Interlobular artery and vein

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65
Q

What is the medulla?

A

Inner portion of the parenchyma

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66
Q

What does the medulla consist of?

A

Pyramids

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67
Q

How many triangular structured pyramids are there?

A

8-18

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68
Q

What does the base of the pyramid point to?

A

Pointed toward the cortex

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69
Q

What does the apex of the pyramid point to?

A

Renal sinus (minor calyces)

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70
Q

When is a pyramid considered enlarged?

A

If they are thicker then the cortex

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71
Q

What is the fatty central portion of the kidney?

A

Renal sinus

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72
Q

What structures does the renal sinus contain?

A

Minor and major calyces, renal pelvis, vessels and nerves

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73
Q

How many minor calyces are there?

A

8-18

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74
Q

Does the minor or major calyce receive urine from the pyramids?

A

Minor calyce

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75
Q

How many major calyces are there?

A

2-3

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76
Q

What is another name for the major calyces?

A

Infundibula

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77
Q

What portion of the kidney does the major calyces join to?

A

Renal pelvis

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78
Q

What is the order from anterior to posterior are the vessels positioned in the renal hilum?

A

Renal vein
Renal artery
Ureter
Third branch of the renal artery

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79
Q

Which ureter is shorter? Right or Left?

A

Right

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80
Q

How does the ureter transport urine?

A

Peristalsis and gravity

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81
Q

What are the 3 natural points of narrowing?

A
  1. Ureteropelvic junction
  2. Pelvic brim (anterior to iliac vessels)
  3. Ureterovesical junction
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82
Q

What does bladder size and shape depend on?

A

Urine volume

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83
Q

What lines the inner walls of the bladder?

A

Inner muscos membrane containing rugae

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84
Q

What happens to the rugae of the bladder in an extended state?

A

Outline becomes smoother and distends with urine

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85
Q

What happens to the rugae when the bladder is in an empty state?

A

Membrane is wrinkled

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86
Q

What is the bladder capacity?

A

300-500ml

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87
Q

What is the volume measurement of the bladder?

A

AP X L X W X 0.52

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88
Q

Is a post void of < 100ml significant?

A

No

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89
Q

Does the trigone of the bladder change shape?

A

No, remains constant

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90
Q

What is the trigone?

A

Triangular area b/w the openings of the ureters and the urethra

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91
Q

Where is the trigone located?

A

Base/posterior surface of the bladder

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92
Q

What is the bladder neck?

A

Urethral opening

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93
Q

Does the bladder neck remain a content size ad shape?

A

Yes

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94
Q

Where is the apex of the bladder located?

A

Anterior and superior surface of the bladder

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95
Q

What attaches to the apex of the bladder?

A

Median umbilical ligament

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96
Q

What are the 4 layers of the bladder?

A
  1. Mucosa- inner layer containing rugae
  2. Sub-mucosa- connective tissue
  3. Muscle
  4. Serosa- peritoneum covering superior surface
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97
Q

What is the muscle layer of bladder?

A

Detrusor muscle

98
Q

How many muscle layers of the bladder is there?

A

3

99
Q

What does the muscle layer of the bladder form?

A

Sphincter muscle

100
Q

What is the measurements for the distended state of the bladder wall?

A

3mm

101
Q

What is the measurements for the non-distended state of the bladder wall?

A

6mm

102
Q

What does the female urethra pierce to exist the bladder?

A

Urogenital diaphragm

103
Q

What are the 3 areas of the male urethra?

A
  1. Prostatic
  2. Membranous
  3. Penile
104
Q

What structures are anterior to the right kidney? (5)

A
  1. Right adrenal
  2. Right lobe of the liver
  3. 2nd part of to duodenum
  4. Right colic flexure
  5. Morrisons pouch
105
Q

What structures are posterior to the right kidney? (4)

A
  1. Diaphragm (superiorly)
  2. Psoas muscle (posteriomedial)
  3. Quadratus lumborum muscle
  4. Costodiaphragmatic recess
106
Q

What structures are anterior to the left kidney? (6)

A
  1. Left adrenal gland
  2. Body and tail of pancreas
  3. Spleen
  4. Stomach
  5. Jejunum
  6. Left colic flexure
107
Q

What structures are posterior to the left kidney? (4)

A
  1. Diaphragm
  2. Psoas muscle (posteriomedial)
  3. Quadratus lumborum muscle
  4. Costodiaphragmatic recess
108
Q

What structures is the right ureter posterior to?

A

Duodenum and terminal ilium

109
Q

What structures is the left ureter posterior to?

A

Colon and left gonadal vessels

110
Q

In males the pelvic portion of the ureter pass what to the ductus deferens?

A

Posteriorly

111
Q

What is anatomical order of structures from anterior to posterior in the female pelvis, relating to the ureter?

A

Ovary > ureter > internal iliac artery > vein

112
Q

What is anterior to the male and female bladders?

A

Space of Retizus

113
Q

What structures are posterior to the male bladder? (3)

A

Rectum, vas deferens, seminal vesicles

114
Q

What muscles are lateral to the male and female bladder?

A

Iliopsoas and obturator internus muscles

115
Q

What is the relationship of the bladder to the prostate?

A

Posterioinferior

116
Q

Are the levator ani muscles inferior to the male bladder?

A

Yes

117
Q

What structures are posterior to the female bladder? (3)

A

Uterus, vagina, anterior-cul-de-sac

118
Q

How is the adnexa positioned in relation to the bladder?

A

Posteroinferior

119
Q

What is the total cardiac output to the kidneys?

A

1/4 of the cardiac output

120
Q

Approximately how much blood passes through the kidneys (blood volume) per minute?

A

1200ml/min

121
Q

What do the renal arteries branch into?

A

Interlobar arteries

122
Q

What do the lobular arteries branch into?

A

Arcuate arteries

123
Q

Where are the arcuate arteries located?

A

At the base of the pyramids

124
Q

What do the arcuate arteries branch into?

A

Interlobular arteries

125
Q

What arteries travel into the renal cortex?

A

Interlobular arteries

126
Q

What do interlobular arteries branch into?

A

Afferent arterioles

127
Q

Where do the afferent arteries travel?

A

Into the glomerulus of the nephron

128
Q

How is the lymph fluid drained?

A

Para-aortic nodes

129
Q

What is the ultrasonic appearance of a sagittal adult kidney?

A

Smooth, contoured, elliptical shape

130
Q

What is the ultrasonic appearance of a transverse adult kidney?

A

Rounded and boken medially by the hilum

131
Q

How does the capsule present on US?

A

Echogenic line bordering cortex

132
Q

Describe the US appearance of the cortex

A

Extends from the sinus to the outer surface
Homogenous
Even thickness
Echogenicity equal to or slightly less echogenic than the liver

133
Q

At what level do you assess and compare the kidney to the liver?

A

Assess and compare at the same level

134
Q

Describe the US appearance of the medulla

A

Triangular rounded or blunted hypoechoic (anechoic) areas

Equidistant

135
Q

What is the corticomedullary junction (CM junction)?

A

A marker used for measuring the cortical thickness

136
Q

How does the corticomedullary junction appear as on US?

A

Pulsation and bright reflection of arcuate arteries

137
Q

Describe the US appearance of the renal sinus?

A

Homogenous highly echogenic central area

138
Q

What does the renal sinus appear as in a non hydride state?

A

Renal pelvis and infundibulum not well seen (collapsed)

139
Q

What does the renal sinus appear as when over hydrated?

A

Small echo lucent areas within the sinus

140
Q

What do the renal arteries appear as in US?

A

Linear anechoic tubes

141
Q

What plane are the renal vessels best assessed in?

A

Transverse (long axis)

142
Q

What structure can be mistaken for the renal arteries?

A

Crura

143
Q

What is the US appearance of the cortex in infants and children?

A

Isoechoic or MORE ECHOGENIC compared to the liver
Thin compared to pyramids
Lobular contour (should disappear by age 6)

144
Q

What is the US appearance of the pyramids in infants and children?

A

Hypoechoic and large

Ratio of the cortex to the medulla 1.64:1 (adult 2.59:1)

145
Q

What is the US appearance of the sinus in infants and children?

A

Indistinct, hypoechoic due to very little fat

146
Q

How is the paediatric kidney position different then an adult within the body?

A

Positioned lower in the abdomen

147
Q

By what age do infants demonstrate an adult echo pattern?

A

6 months

148
Q

When are ureters best visualized?

A

When dilated

149
Q

What will the ureters appear like when dilated?

A

Anechoic tubular structure in sagittal

150
Q

When is the distal ureter be assessed?

A

When there is a full bladder

151
Q

Describe the ureteral jets

A

1-3sec stream of urine entering bladder from ureter

152
Q

What does flow from the ureteral jets indicate?

A

Flow of urine not obstructed

153
Q

How does the bladder appear on US?

A

cystic and anechoic

154
Q

How does the bladder appear on US in a transverse plane with superior angulation?

A

Rounded

155
Q

How does the bladder appear on US in a transverse plane with inferior angulation?

A

Squared

156
Q

What are we checking for when scanning the bladder?

A

Wall irregularities/ shape

157
Q

What transducer frequency would you use when scanning the kidneys?

A

3-5 MHz

158
Q

What are the potential patient positions when scanning the kidneys?

A

Supine, decubitus or oblique

159
Q

What planes are the kidneys assessed in?

A

Sagittal, coronal or transverse

160
Q

What structure is used to help assess the right kidney?

A

Liver

161
Q

What structure is used to assess the left kidney?

A

Spleen

162
Q

What are some things you could do to optimize the image?

A

Breathing technique
Change pt position
Change windows

163
Q

How are the ureters best visualized?

A

In long axis

164
Q

How is the proximal ureter best visualized?

A

Coronal oblique plane using kidney as a window

165
Q

How is the mid ureter best visualized?

A

Using grated compression to move bowel gas out of the way

166
Q

What are the scanning techniques used for the bladder? (3)

A
  1. 3-5MHz transducer
  2. Sagittal and transverse planes
  3. Full bladder required
167
Q

What are you supposed to check for when the dilated ureters or hydronephrosis?

A

Check for “jets”

168
Q

What are you supposed to look for when there is a lesion noted in the bladder?

A

Check the kidneys for hydronephrosis

169
Q

Are you supposed to do a post void image when a mass or fluid is collected within the space of Retzius?

A

Yes

170
Q

What is the modality of choice to evaluate the bladder?

A

Cystoscopy

171
Q

What do the kidneys regulate? (3)

A
  1. Osmotic pressure and volume of extracellular fluids by regulating the amount of sodium and water excreted
  2. Total concentration of water and electrolytes
  3. pH
172
Q

What product is excreted by the kidneys?

A

Metabolic waste

173
Q

What enzyme is secreted by the kidney?

A

Renin

174
Q

What does renin affect?

A

Blood pressure

175
Q

Can a person function with only 1 kidney? How?

A

Yes, because they function independently

176
Q

How much urine is excreted daily?

A

1.2-1.5L - variable

177
Q

What are the metabolic wastes excreted by the kidneys?

A

CO2, urea, uric acid, creatinine

178
Q

How much fluid do the kidneys produce daily?

A

180L

179
Q

What % of the processed fluid is retained from the kidneys and how much is excreted?

A

99% filtered and recirculated

1% excreted

180
Q

What does the nephron do? (2)

A

Filter blood and produce urine

181
Q

What are the 2 types of nephrons?

A
  1. Cortical (superficial)

2. Juxtamedullary (deep)

182
Q

What are the 2 main components of the nephrons?

A
  1. Renal corpuscle

2. Renal tubule

183
Q

What makes up the renal corpuscle? (2)

A
  1. Network of porous capillaries (glomerulus)

2. Membrane with filtration slits (Bowman’s capsule)

184
Q

What makes up the renal tubule? (4)

A
  1. Proximal convoluted tube
  2. Distal convoluted tube
  3. Loop of henle
  4. Collecting duct
185
Q

What is the function of the nephrons?

A
  1. Control blood concentrations and volume
  2. Helps regulate blood pH
  3. Removes toxins from blood
186
Q

How are toxins removed from the blood?

A

Through osmosis and active transport

187
Q

What path does the blood take to reach the nephrons?

A

Renal artery > interlobar artery > arcuate artery > interlobular arteries > interlobular artery > afferent artery > glomerulus

188
Q

What are the 3 stages of urine formation?

A
  1. Glomerular formation
  2. Tubular reabsorption
  3. Tubular secretion
189
Q

Describe the process of glomerular formation

A
  • Afferent artery brought blood to the glomerulus
  • An increase in BP forces water and dissolved substances through a membrane
  • The combo of water and dissolved substances filters into bowman’s capsule producing filtrate
  • Filtrate enters renal tubule
190
Q

What does not pass through the membranes of the bowman’s capsule?

A

RBC

191
Q

How do RBCs leave the glomerulus?

A

Efferent arteriole

192
Q

Describe the process of tubular reabsorption

A

Nutrients in the filtrate are reabsorbed back into the bloodstream

193
Q

What are the substances reabsorbed back into the bloodstream?

A

Water, glucose, vitamins and nutrients

194
Q

What causes reabsorption to occur?

A

Peritubular capillaries at the PCT, ascending and descending loop of henle

195
Q

Describe the process of tubular secretion

A
  • Waste is secreted into the DCT

- Rids the body of certain substances and controls the blood pH

196
Q

What is the bloods normal pH?

A

7.35 to 7.45

197
Q

Where is the juxtaglomerular apparatus located?

A

The point where the DCT, afferent and efferent arterioles come into contact

198
Q

What cells release renin?

A

Granular cells (afferent arterioles)

199
Q

What cells inhibit renin release?

A

Macular cells (DCT)

200
Q

What is the main function of the juxtaglomerular apparatus?

A

Regulate BP

201
Q

What are the influencing factors that act on the kidney to help regulate BP? (3)

A
  1. ADH (antidiuretic hormone)
  2. Aldosterone
  3. Renin
202
Q

What secretes ADH?

A

Posterior Pituitary

203
Q

What is the function of ADH?

A

Aids in retaining water in the body

204
Q

What stimulates the production of ADH?

A

Decrease in blood volume

205
Q

What structure secretes Aldosterone?

A

Adrenal cortex

206
Q

What does aldosterone act on?

A

PCT

207
Q

What does aldosterone control?

A

Sodium reabsorption

208
Q

What stimulates the production of aldosterone?

A

Increased blood volume

209
Q

What system is aldosterone influenced by?

A

Renin-angiotension system

210
Q

What secretes renin?

A

juxtaglomerular apparatus

211
Q

What influencing factor in the kidney acts as a catalyst?

A

Renin

212
Q

What does renin stimulate the formation of ?

A

Angiotensin

213
Q

Angiotensin stimulates the release of what?

A

Aldosterone

214
Q

Does renin respond to the stimulation of decreased or increases BP?

A

Decreased

215
Q

How much loss of function can there be in the kidney before blood tests are elevated?

A

60%

216
Q

What are the 3 blood tests that assessed for kidney function?

A
  1. Serum creatinine
  2. Blood urea nitrogen (BUN)
  3. Serum electrolytes
217
Q

What is serum creatinine?

A

End product of muscle creatine phosphate metabolism that is filtered out of the kidneys

Easily excreted by kidneys and directly related to glomerular filtration rate

218
Q

How much serum creatinine is in the blood?

A

Amount proportional to the body’s muscle mass (levels remain constant)

219
Q

Which test is more sensitive? Serum creatinine or BUN

A

Serum creatinine

220
Q

What do increased level of creatinine suggest?

A

Renal failure, chronic nephritis and urinary tract obstruction

221
Q

What is BUN?

A

End product of protein metabolism

222
Q

How is BUN formed?

A

In the liver from ammonia and readily excreted by the kidneys

223
Q

What does BUN reflect? (2)

A

Protein intake and renal excretory capacity

224
Q

What does increased levels of BUN suggest? (3)

A

Renal dysfunction, dehydration (reduced renal blood flow) and increased protein metabolism

225
Q

What do decreased levels of BUN suggest?

A

Severe hepatic dx, malnutrition and over hydration

226
Q

What are the serum electrolytes?

A

Chloride (CI), Potassium (K), sodium (Na) and bicarbonate (HCO3)

227
Q

What do increased levels of serum electrolytes indicate?

A

Acute renal failure, glomerulonephritis and renal tubular acidosis

228
Q

What do decreased levels of serum electrolytes indicate?

A

Chronic and acute renal failure

229
Q

What is tested for in urine tests? (6)

A
  1. RBC
  2. WBC
  3. Pyuria
  4. Proteinuria
  5. pH
  6. Specific gravity
230
Q

Is hematuria normal?

A

Any amount of blood in urine is abnormal

231
Q

What does hematuria detect?

A

Inflammation, tumors, pyelonephritis and calculi

232
Q

What does WBCs in the urine indicate?

A

Inflammation, infection and tissue necrosis

233
Q

What is pyuria? What does it indicate?

A

Pus in the urine and indicates infection

234
Q

What is proteinuria?

A

Protein in the urine

235
Q

When is proteinuria seen?

A

In nephritis, polycystic dx, stones and carcinoma

236
Q

What does the pH refer to in the urine?

A

Abundance of hydrogen atoms

Acidic if levels increased
Alkaline if levels decreased

237
Q

What does the formation of stones depend on?

A

Urine pH - important in pt with calculi

238
Q

What does specific gravity measure?

A

Kidneys ability to concentrate urine

239
Q

When is there low levels of specific gravity?

A

Renal failure and pyelonephritis

240
Q

When are there increased levels of specific gravity?

A

Urine output (dehydration)

Abdomin And Superficial Structures (12 decks)

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