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Anatomy: Urinary System
Cole 4/21/11 lecture 1.5 hr
63
Anatomy
04/20/2011

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Term
none! kidneys have no mesentery
Definition
what is the relationship between the kidneys and the peritoneum of the abdominal cavity?
Term
primary
Definition
what kind of ----peritoneal are the kidneys and most of the ureters?
Term
subperitoneal (beneath the peritoneum)
Definition
what kind of ---peritoneal are the lower portion of the ureters and urinary bladder?
Term
renal vein, renal artery, renal pelvis
+ lymph & nerves

there is NO collateral circulation to the kidney
Definition
what structures are found in the hilum of the kidney? (anterior to posterior
Term
renal pyramids, the tissue is called "renal medulla" fail pronounced by Cole
Definition
where is the first place fully processed urine is? what is the name of this tissue type?
Term
renal papilla
Definition
what is the tip of a renal pyramid called that faces the hilum?
Term
the renal capsule
Definition
what is the most external part of the kidney?
Term
renal cortex
Definition
what tissue is the outer 1/3 of the kidney?
Term
minor calyx
Definition
what ducts start at renal papilla?
Term
no, there is a potential space underneath it
Definition
is the renal capsule connected to the kidney?
Term
not chemotherapy it doesn't seem to help.
instead they just remove the whole kidney (guess you are screwed if you have a horseshoe kidney)

Definition
what is done about renal cancer?
Term
if the cancer is contained within the capsule and the kidney is removed, the patient has a good chance to live for a while, but if the cancer is outside the capsule the survival rate decreases a LOT
Definition
what is the relationship between renal cancer and the renal capsule?
Term
yes, it is divided into lobes based on blood supply and calyxes
Definition
can part of the kidney be removed instead of the whole thing?
Term
on top of the superior pole of the kidney
Definition
where do the suprarenal/adrenal glands sit in relation to the kidney? (be specific)
Term
the left adrenal gland is larger and crescent shaped
Definition
which adrenal gland is larger? describe its shape
Term
the right is smaller, and triangle shaped
Definition
which adrenal gland is smaller? what shape is it?
Term
the left side drains to the left renal vein

the right side contacts the inferior vena cava and drains directly into it
Definition
where do each of the suprarenal glands veins drain?
Term
a layer of fascia separates the two so the adrenal gland can be pushed up off the kidney with your finger
Definition
what connects/separates the kidney and the suprarenal glands?
Term
they are tethered by their vessels floating in fat which is surrounded by a layer of renal fascia in front and back with more fat around it
Definition
what supports the kidneys since they have no mesentery (what keeps them in place?)
Term
paranephric fat
Definition
what is the name of the fat between the renal fascia and the transversalis fascia
Term
perinephric fat
Definition
what is the name of the fat right around the kidney contained within the renal fascia?
Term
the right kidney is 0.5-1 inches BELOW the left because when the right migrates up it smacks into the liver
Definition
which kidney is higher? how much? why?
Term
the right suprarenal gland and top of the right kidney are found in the bare area
Definition
what kidney parts are found underneath the bare area of the liver?
Term
the tail of the pancreas is anterior to the hilum of the left kidney
Definition
where is the tail of the pancreas in relation to the kidneys?
Term
the head of the pancreas (in the curvature of the duodenum) is in front of the hilum of the right kidney
Definition
where is the head of the pancreas in relation to the kidneys?
Term
stomach, spleen, pancreas, left colic flexure, descending colon, jejunum
Definition
what organs sit anterior to the left kidney?
Term
liver, descending part of duodenum, right colic flexure, small intestine?
Definition
what organs are anterior to the right kidney?
Term
1) the ureter is resting against a structure
2) the ureter just walls in on its own
Definition
describe the natural causes of a ureter to have a constriction?
Term
1) proximal ureter at the uretopelvic junction

2) the middle portion of the ureter where it goes in the pelvic inlet crossing the common iliac and external iliac
3) the entrance to the bladder in the distal ureter
Definition
where are three natural sites of constriction in the ureter(specific)? how are they clinically significant?
Term
1) proximal part supplied by renal arteries
2) middle gets blood from the gonadal vessels
3) distal part from internal iliac
Definition
describe the blood supply to the ureters
Term
smooth muscle -contracts in peristaltic waves to keep urine from backing up into the bladder
Definition
what kind of muscle lines the ureter? how does it contract? why?
Term
where it crosses the pelvic brim it angles forward and down
Definition
what part of the ureter is not vertical?
Term
they pass anterior to the psoas muscles and the common iliac vessels
Definition
where are the ureters in relation to the psoas muscle? the common iliac A & V?
Term
the right ureter
Definition
what urinary structure is at risk during an appendectomy?
Term
the left ureter which is crossed by the sigmoid colon
Definition
what urinary structure is at risk during a surgery of the sigmoid colon and rectum?
Term
secondarily retroperitoneal
Definition
what kind of ----peritoneal are the IMA and IMV?
Term
water under the bridge, the ureters go BEHIND the gonadal vessels

this is due to the gonads migrating down out of the body wall over the kidneys ascending from the pelvis
Definition
where do the ureters pass in relation to the gonadal vessels? why?
Term
they get their blood supply from the vessels they contact: the renal arteries, gonadal, and inernal iliac
Definition
where do the ureters get their blood supply? why?
Term
it collapses
Definition
what happens to the bladder when it empties?
Term
the pubic symphysis
Definition
what structure does the bladder sit directly behind?
Term
female: smaller bladder with a short, straight urethra

male: larger but has the prostate around the neck
Definition
compare the male and femal bladder in terms of size, and the urethra
Term
the external sphincter is BELOW the prostate gland (bad news for old guys with prostate cancer)

the internal is above the prostate
Definition
where is the external urethral sphincter in relation to the prostate gland? the internal?
Term
the name given to the smooth muscle with its fibers in different orientations all around the urinary bladder
Definition
what is the detrusor muscle?
Term
the allantois -I think, kind of lost my train of thought in the notes here. some one figure it out and let me know.
Definition
what is the strand of CT connecting the bladder to the umbillicus?
Term
a valve where the ureter enters the urinary bladder
Definition
in addition to peristaltic movements, what prevents urine from flowing back into the kidney?
Term
females have short, straight urethras which makes them easier to colonize

males are harder to catheterize
Definition
why are women more likely to get a urinary tract infection even though their urethra is not continuous with their reproductive tract (like males)? what disadvantage do males have?
Term
in the deep perineal pouch, deep to perineal membrane
Definition
where is the external urethral sphincter located in both males and females?
Term
1) preprostatic urethra
2) prostatic urethra
3) membranous part of urethra
4) spongy part of urethra
Definition
what are the 3 parts of the male urethra? (proximal to distal)
Term
the aorticorenal ganglion lateral to the celiac ganglia
Definition
where do the nerves supplying the kidney synapse?
Term
from both directions (from above and below) "probably" the vagus(renal plexus) and pelvic splanchnic nerves dragged with kidneys when they migrate
Definition
where do the parasympathetics coming to the kidneys come from?
Term
T1-L2 from greater and lesser splanchnic nerves
Definition
what are the sympathetics supplying the kidney and ureters (what spinal level, what nerves?)
Term
sympathetics decrease urine productions through vasoconstriction of the kidney's blood supply

parasympathetics have no apparent function (except to carry visceral afferents back to the brain)

basically sympathetics are on/off switches to the blood flow
Definition
how does the ANS control urine production at the kidneys?
Term
in the proximal ureter (closer to renal pelvis) peristalsis is myogenic-a response to stretching when filled with urine

in the lower ureter, parsympathetics increase peristalsis , and sympathetics actively inhibit peristalsis
Definition
how do ureters contract? how does the ANS regulate them?
Term
parasympathetics from pelvic splanchnic nerves (S2-S4) cause the detrusor to contract and inhibit the internal urinary sphincter (relaxing/opening it)
Definition
what nerves help to eliminate urine? how?
Term
sympathetics(mostly L1)cause the detrusor to relax and cause the internal sphincter to constrict also somatic motor (pudendal nerve S2-S4) in the external urinary sphincter can contract voluntarily to prevent urination
Definition
what nerves help to retain urine? how?
Term
the urine is blocked and forced out into the interstitium (increased hydrostatic pressure?)
Definition
why does the area around a kidney stone look blobby on a CT?
Term
stenosis of the junction between the renal pelvis and the ureter
Definition
what is an often congenital cause for pressure to build in the kidney that causes the calyx to bulge out and possibly cut off/compress kidney circulation?
Term
through the lumbar region, on the back, below the 12th rib parallel to the ribs and abdominal muscle fibers

-this prevents nerve damage to subcostal and ileohypogastric/ileoinguinal that lie below the rib
Definition
how is the kidney accessed surgically? why?
Term
horeshoe kidney, this happens when the kidneys migrate up and get stuck under the IMA

note: the blood supply moves up the great vessels with the kidneys, so as they migrate new vessels form, and old ones close up
Definition
what is the congenital anomaly in which the kidneys are connected at the lower poles? why does this happen?
Term
pelvic kidney
Definition
abnormally positioned kidney that can compress vasculature, especially bad in pregnancy
Term
1) sometimes R renal art passes in front of IVC
2) sometimes renal arteries split around the IVC
3) sometimes there is a retroaortic renal vein instead of in front
Definition
describe some vasculature abnormalities to the kidney
Term
the blood supply
Definition
where is the most variation in terms of kidney anatomy?
Term
1) duplicate ureters (2 major calyx that don't make a renal pelvis-usually blood supply is duplicated too)
2) retrocaval ureter (wraps around behind the IVC and stones can get caught there)
Definition
what are the 2 major ureter anatomical anomalies?