1
Q
What are the pelvic urinary organs?
- describe general function
A
- distal ureter: muscular tube, transmits urine by peristaltic waves
- bladder: temporary reservoir, strong muscular walls (detrusor m)
- urethra: passage for urine from bladder to exterior (also passage for semen in men)
2
Q
Why would there be dilated and contracted segments in a ureter in an xray?
A
- peristaltic contraction
3
Q
Explain relationship of pelvic portion of ureters to the peritoneum
A
- retroperitoneal, runs on lateral walls of pelvis, parallel to anterior margin of greater sciatic notch, between parietal pelvic peritoneum and internal illiac aa
4
Q
What structure demarcates the beginning of the pelvis?
A
pelvic brim: promontory and ala of sacrum and terminal lines
5
Q
In males what structure passes between the ureters and the peritoneum?
A
Ductus deferens
6
Q
In females the ureter passes medial to what structure?
A
origin of the uterine a
7
Q
3 primary sources of arterial blood to the pelvic portion of the ureters
- differences between males and females
A
- males and females: common iliac and internal iliac
- females: ovarian a (off of aorta) and uterine a (off of internal iliac)
Males: inferior vesicle a (off of inernal iliac)
8
Q
Describe iatrogenic compromise of ureteric blood supply.
- above common iliac
- below common iliac
A
- arteries are very sensitive to damage/movement
- ureters supplied medially
- ureters supplied laterally
9
Q
Venous drainage of pelvic part of the ureters
A
- parallels to the arterial supply
10
Q
Where does lymph drain in the area of the pelvic portion of ureters
A
- common and internal iliac nodes
11
Q
Innervation of the ureters
- autonomic plexuses that innervate the ureters
A
- aortic, renal. superior and inferior hypogastric
12
Q
Pathway of afferent innervation of the ureters
- afferent superior to pelvic line
- afferent inferior to pelvic line
- where is ureteric pain usually felt?
A
- follows sympathetics: aortic, renal and superior hypogastric plexuses –> aorticorenal and renal pre-vertebral ganglion –> lesser, least, or lumbar splanchnic –> paravertebral sympathetic ganglion –> white rami communicans –> anterior primary rami –> spinal n –> dorsal root –> DRG –> dorsal root –> dorsal rootlets –> T10-L2 dorsal horn
- follows parasympathetic: inferior hypogastric plexus –> pelvic splanchnic nn (s2-4) –> sacral plexus –> anterior primary rami –> spinal n –> ventral root –> ventral rootlet –S2-S4 lateral horn
- ipsilateral lower quadrant of abdomen, close to the groin
13
Q
3 locations most often occluded with kidney stone
- how do you confirm?
A
- junction of ureters and renal pelvis
- where the ureters cross the external iliac a and pelvic brim
- during the passage through the wall of the urinary bladder
- CT
14
Q
How does the position of the bladder change when empty vs full in and adult
A
- empty: within the true pelvis
- full: extends up towards the umbilicus, more into the false pelvis
15
Q
Components of the urinary bladder
A
- apex: points toward superior edge of pubic symphysis
- fundus:opposite the apex, formed by convex posterior wall
- body: major portion, between apex and fundus
- neck: where fundus and inferolateral surfaces meet inferiorly
16
Q
What muscle composes the walls of the urinary bladder?
A
detrusor m
17
Q
what is the function of the internal urethral sphincter in the male?
A
- contracts during ejaculation to prevent retrograde flow of semen into the bladder (ejaculatory reflux)
18
Q
Trigone of the bladder
- what is it?
- sensitive to?
- made of?
A
- triangular area of smooth muscle inside the dorsal wall of the bladder neck
- very sensitive to expansion
- ureteric orfices (opening in bladder where ureters insert to drop urine into bladder); and internal urethral orfice (where urethera inserts into the bladder to drain urine from bladder to outside world)
19
Q
Blood supply of the urinary bladder
- main art supplying bladder
- art supplying the antero-superior parts of the bladder
- differences in females vs males in supply to inferior bladder
A
- internal iliac a
- superior vesical
- male: inferior vesical aa, females: vaginal aa
20
Q
Venous drainage of the urinary bladder
- veins that drain the urinary bladder are tributaries of the ..?
- venous plexus most directly associated w/ bladder?
- what does it drain through to reach the main v?
A
- internal iliac vv
- vesical venous plexus
- drains through inferior vesical vv into internal iliac v
21
Q
Innervation of the bladder: where are they from, what v used to deliver fibers, function?
- sympathetics
- parasympathetics
A
- from inferior thoracic and upper lumbar spinal levela to vesical plexuses through hypogastric plexuses; prevents voiding of urine due to contraction of internal sphincter
- from sacral spinal cord, conveyed by the pelvic splanchnic and inferior hypogastric plexus; motor to detrusor m and inhibitory to internal urethral sphincter
22
Q
Four parts of male urethra
A
- intramural part
- prostatic arethra
- intermediate part of urethra
- spongy urethra
23
Q
Blood supply to the urethra in males and females
A
- males: prostatic branches of inferior vesical and middle rectal aa
- females: pudendal and vaginal aa
24
Q
Urethral innervation male
- nerve fibers in prostatic plexus
- where does prostatic plexus come from
A
- mixed sympathetic, parasympathetic and visceral afferent fibers
- pelvic plexus arising as organ-specific extensions of the inferior hypogastric plexus
25
Urethral innervation in females
- what nerves supply the female urethra?
- afferent
- termination afferent
- where are cell bodies
- vesical nerve plexus and pudendal nerve
- visceral afferent from most of urethra run in pelvic splanchnic nn
- from pudendal n
- s2-s4 spinal ganglia
26
1. trace path of blood from renal a to renal v
- renal a -> segmental a -> interlobar a -> arcuate a -> interlobular a -> afferent arteriole -> glomerulus -> efferent arteriole -> peritubular capillaries (for convoluted tubules) or vasa recta (for loop of henle) -> interloular v -> arcuate v -> interlobar v -> renal v
27
2. - What is renal lobe?
- what is renal lobule?
- What is renal column?
- What is renal pyramid?
- pyramid and cortical tissue at its base and extending along side
- medullary ray and its cortical tissue
- medullary extension of renal cortex in between renal pyramids
- conical region of medulla
28
What is major solute in the renal pyramid?
| - how does this relate to concentrating urine?
- urea
| - secreted or reabsorbed to increase/decrease urine concentration
29
2. - what is a medullary ray?
- descending and ascending segments of cortical nephrons and a collecting tubule/duct, closely aggregated at the middle of the renal lobule, axis of the lobule
30
What is a uriniferous tubule?
- nephron and collecting tubule
31
What does nephron consist of
renal corpuscle, proximal convoluted tubule, loop of henle and distal convoluted tubule
32
Where do you find the renal corpuscle?
- throughout the cortex
33
3. What is the vascular pole?
| What is the urinary pole?
- where the afferent and efferent arterioles enter and exit the glomerulus
- where the ultrafiltrate exits the bowmans space and proximal convoluted tubule begins
34
what cells make up the visceral vs parietal layer of the renal corpuscle?
- visceral: podocytes over glomerular capillaries
| - parietal: simple squamous epithelium, lines outer wall of bowmans capsule
35
What cells do we find associated w. renal corpuscle?
- podocytes, medangial cells, fenestrated endothelial cells, JG cells, macula densa and extraglomerular mesangial cells
36
4. Function of
- podocyte
- mesangial cell
- fenestrated endothelial cells
- which cells form filtration barrier?
- JG cells: type of cell, found, release?
- Macula densa: what do they do, function, where are they found
- extraglomerular mesangial cells
- which cells have role in maintaining blood vol/pressure
- make up epithelial lining of bowmans capsule, foot processes wrap around capillaries and form filtration slits which acts as a sieve and control what gets into bowmans space
- contractile, phagocytic and produce components of external lamina
- block blood cells and platelets from entering bowmans capsule
- podocytes and fenestrated endothelial cells
- modified secretory smooth muscle cells. found on arteriole walls and release renin
- sense concentration of NaCl in the DCT, part of the DCT and function to regulate glomerular blood flow to keep GFR constant and increase renin release
- supportive
- JG cells, macula densa, and extraglomerular mesangial cells
37
5. PCT and DCT
- where are the convoluted tubules found?
- where is majorities of filtrate reabsorbed? adaptations for reabsorption
- cortex
| - PCT; long microvilli, simple cuboidal epithelial cells. increased mitochondria
38
Compare and contract appearance of PCT and DVT
- cells
- nuclei
- brush border
- length
- P: eosinophilic and large; D: smaller, flatter, lighter
- P: less apparent; D: more apparent
- P: apical; D: none
- P: takes up more space; D: shorter, less convoluted
39
6. LOH
- blood vessels found here
- limbs
- where are these found
- appearance of cells in ascending and descending?
- thin limb found? appearance?
- vasa recta
- descending (thin descending limb) and ascending (thick ascending limb)
- medulla
- simple squamous epithelial cells with few organelles
- medulla, simple cuboidal epithelium w/ many mito
40
7. Collecting Tubule
- trace the path of urine from DCT to ureter
- where are they found?
- kinds of cells
- DCT -> CD-> minor calyx -> major calyx -> renal pevlic -> ureter
- medullary rays and medulla
- principal and intercalated
41
Principal vs Intercalated Cells in CT
- organelles
- folds
- location
- function
- P: few; I: abundant mito
- P: BM infoldings; I: apical folds
- P: medullarys rays and medulla; I: medullary rays
- P: Regulates reabsorption of H2O and electrolytes and secretion of K+; I: Reabsorption of K+ and helps maintain acid-base balance
42
Mechanisms or properties by which antigens might become planted in the glomerulus providing surfaces for antibody attachment
any antigen that is small and + will get filtered and planted into the glomerulus because the cationic charge will be attracted to the anionic charge of the BM and then bind to antibody
43
Common sources of antigen contributing to circulating immune complexes
- endogenous
- exogenous
- DNA, tumor antigens, SLE or IgA nephropathy
| - Infectious products strep proteins, Hep B/C, T pallidum, P. falciparum
44
Neutrophils and monocyte causing glomerular injury
- what do they do?
- caused by?
- results in?
- pathway
- infiltrate glomerulus in certain types of glomerulonephritis
- usually because of activation of complement
- results in generation of chemotactic agents but can also be mediated by Fc adherence and activation
- neutrophils release protesases which cause GBM degradation -> free radicals from oxygen cause cell damage -> arachadonic acid metabolites reduce GFR
45
Macrophages and t lymphocytes causing glomerular injury
- when does this occur?
- what happens?
- infiltrate glomerulus in antibody and cell mediated reactions
- release vast number of biologically active molecules
46
Platelets causing glomerular injury
- what happens?
- what do they release?
- treatment
- aggregate in glomerulus during immune-mediated injury
- release eicosanoids, growth factors, and other mediators may contribute to vascular injury and proliferation of glomerular clls
- antiplatelet agents have beneficial effects
47
Mesangial cells causing glomerular injury
- what is produced?
-
- stimulated to produce several inflammatory mediators, including ROS, cytokines, chemokines, growth factors, eicanoids, NO, and endothelin- initiate inflammatory responses in glomerulus even in absence of leukocytic infiltration
48
8. Etiology of glomerulopathy based on IF
- GVHD
| - antibodies against PLA2, infection, post-infection- autoimmune
49
9. Etiology of glomerulopathy based on IF
Goodpasture
50
10. Predict characteristics of the deposit and consequences of them
10. a
51
Cycle that leads to progressive glomerular injury
what happens with podocytes
Injury -> loss of nephron -> unable to efficiently regenerate nephrons -> decrease functional renal mass -> remaining nephrons have to function receiving same blood flow and filtering the same amount of vol -> increased pressure per nephron -> increase BP -> increase stress on nephrons -> endothelial damage -> inflammation and proliferation
damage to podocytes -> increased production of ECM (collagen) -> fibrosis of BM
52
11 exam and body part? what can you see? can you see adrenal glands or kidneys?
- Normal AP/Frontal abdominal x-ray
- Vertebra, pelvis, air in stomach and bowel
- No
53
12
What happens after injection of non-ionic iodinated contrast?
What is this called?
12 a
| - Intravenous urogram and intravenous pyelogram
54
What relativelt inexpensive and commonly available imaging test can we use to evaluate kidneys
- renal ultrasound
55
13
What is this?
- characteristics
- Normal Renal ultrasound
| - normal liver is more echogenis then normal renal cortex but renal fat is more echogenic than renal cortex and liver
56
14
| Imaging modality and body part depicted? Abnormality?
- Renal US; polycystic kidney
57
15
Imaging modality, body region, orientation and window?
Abnormality?
characteristics
- Non contrast abdominal/pelvic CT, soft tissue window
- polycystic kidneys
- normal renal cortices are obscured by innumerable cysts
58
16
Imaging modality, body region, orientation, window?
- abnormality
- IV and oral contrast enhanced abdominal/pelvic CT, soft tissue window
- cysts in kidneys
59
Imaging modality also used that does not employ ionizing radiation?
- MRI of abdomen
60
17
Imaging modality, body region, and orientation
dx?
- non-contrast MRI abdomen/ axial/ T2 fat sat
| - Polycystic kidneys
61
18
imaging modality, body region, and orientation are depicted?
dx?
- Non-contrast MRI abdomen/pelvis, coronal, T2
| - Polycystic Kidneys
62
19
| What is this?
- polycystic kidney
63
```
20
Imaging modality and organs depicted?
- abnormality
- dx?
- next stop
```
- renal US
- dilated renal calyces and renal pelvis
- hydronephrosis -> likely urinary obstruction more distal in urinary tract than can be assessed with US
- order non contrast CT abdomen/pelvis
64
21
imaging modality and part of the body
-abnormalities?
- dx?
- Non contrast CT abdomen/pelvis/coronal/ soft tissue window
- hydronephrosis, hydroureter, obstruction
- obstructing L ureteral calculus w/ ipsilateral hydronephrosis and hydroureter
65
```
22
imaging modality and body part depicted?
abnormalities
dx
causes
```
- RUQ US
- echogenic, atrophic kidney
- chronic renal failure
- HTN, DM
66
```
23
Imaging modality, body part, orientation and window?
how old is this patient?
abnormalities?
dx?
```
- IV and enteric C+ CT abdomen and pelvis, coronal, soft tissue
- relatively elderly
- expansile mass in the upper pole of r kidney
- renal cell carcinoma
67
24
imaging examination?
structures being pointed at?
- non-contrast CT abdomen, axial, soft tissue window
| - normal adrenal glands
68
25
what imaging exam is this?
- structures being pointed at
- contrast enhanced CT abdomen, coronal, soft tissue window
| - normal adrenal glands
69
26
Medical imaging examination is this?
- abnormality
- Contrast enhanced CT abdomen, axial, soft tissue window
| - right adrenal mass
70
Are kidneys, suprarenal glands, urter and vessels intraperitoneal or retroperitoneal?
- primarily retroperitoneal; originall formed as and remained retropertioneal viscera
71
Function of kidney
| Function of suprarenal glands
- removes excess water, salts, and wastes
| - part of endocrine system
72
External and internal features of the kidney
- E: hilum-> entrance to renal sinus
- I: renal sinus -> occupied by renal pelvis, calices, vessels, nn and variable fat; renal pelvis -> flattened funnel-shaped expansion of superior end of ureter
73
Pathway of urine flow
- glomerulus -> PCT -> LOH -> DCT -> CD -> minor calyx -> renal pelvis -> ureter -> bladder
74
Outcome in patient with urinary calculus
- what happens to ureter?
- sxs?
- urine flow
- If the stone is larger than normal lumen of the ureter it causes excessive distention of muscular tube
- Causes severe intermittent pain as it is forced down ureter by waves of contraction
- May cause complete or intermittent obstruction of urinary flow
75
Vasculature of ureter
- art
- vein
- supplied y branches from renal artery, testicular/ovarian aa, abdominal aorta, and common illiac
- drain abdominal portion of ureters into renal and gonadal vv
76
Suprarenal glands
- art
- vein
- superior suprarenal a (off of inferior phrenic), middle suprarenal a (aorta), inferior suprarenal a (renal a)
- r suprarenal v-> IVC; left suprarenal v -> left renal v -> IVC
77
Renal vein entrapment syndrome
- where does l renal v pass?
- other name for this
- sxs
- In crossing the midline to reach the IVC the longer left renal v traverses an acute angle between the superior mesenteric artery anteriorly and the abdominal aorta posteriorly
- downward traction of the SMA may compress the left renal v resulting in entrapment
- nut cracker syndrome because appearance of the vein in the acute arterial angle in saggital view
- hematuria, proteinuria, abdominal/flank pain, testicular pain
78
Innervation of the kidney
- sympathetics and para
- afferent
- renal plexus: SNS and PSNS fibers supplied by the abdominopelvic splanchnic nn
- pain sensation follos sympathetic fibers retrograde to spinal ganglia and cord segments T11-12
79
Innervation of the suprarenal glands
| - sympathetic fibers
- abdominal splanchnic nerves to celiac plexus
- come from lateral horn from T10-L1 and go through paravertebral and preverterbral ganglia but do not synapse until they reach the chromaffin cells in the suprarenal medulla
80
Innervation of the ureter to explain referred pain as result of kidney stone
visceral afferent fiber in kidney/ureter -> prevertebral ganglion -> abdominal splanchnic ganglion -> sympathetic trunk -> white rami -> primary anterior rami -> spinal n -> dorsal root -> dorsal root ganglion -> dorsal root -> dorsal rootlets -> dorsal horn (T11-L2)
Unit 6: SXS
flashcards
Decks in class (6)
# Cards
