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55 Cards in this Set

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Obj.
1.Identify the parts of the urinary system and state the function of each part.
-kidneys: filtration of blood & formation of urine, hormone filtration & release

-ureters: connects kidneys to bladder

-bladder
-urethra
Obj.
2.Locate the kidneys and describe their anatomical relations.
-retroperitoneal
-in extraperitoneal CT on post. abdomen @ level of T12-L3

Ureters run inferiorly from kidneys
*L kidney higher than R
Obj.
3.Name the coverings of the kidney.
innermost--> outermost)
Fibrous capsule-->
PERIrenal/PERInephric Fat-->
Renal Fascia (of Gerota)-->
PARArenal/PARAnephric Fat
Obj.
4.Identify the parts of the kidney as seen in a sagittal section.
2 main portions: cortex (outer) & medulla (inner)

Hilum continuous w/ renal sinus--->
Renal sinus continuous w/ renal pelvis (into ureter)

(cortex/outer--->medulla/inner)
renal columns, project to inward creating renal pyramids--->
pyrami...
2 main portions: cortex (outer) & medulla (inner)

Hilum continuous w/ renal sinus--->
Renal sinus continuous w/ renal pelvis (into ureter)

(cortex/outer--->medulla/inner)
renal columns, project to inward creating renal pyramids--->
pyramid apex, renal papilla point inward & are surrounded by minor calyx--->
multiple minor clayx converge to form major calyx--->
several major calyx form renal pelvis-->
renal pelvis funnels downward as ureter
Obj.
5.Describe the blood supply, lymph drainage, and nerve supply of the kidneys.
blood supply: R & L renal arteries & veins (veins anterior)

lymph drainage: paraaortic nodes

nerve supply:
GVE
sympathetic- T10-12, splanchnic nerve & aorticorenal ganglion
parasympathetic- vagus nerve
GVA
splanchnic nerves to spinal sensory ganglia & spinal cord T10-L2
Obj.
6.Locate the ureters and describe their anatomical relations.
-run inferiorly from kidneys
-along psoas major, pass over pelvic brim @ bifurcation of common illiac arteries
-lower 1/2 in pelvis ant. to internal illiac arteries to ischial spine, then to post bladder
-adheres to peritoneum
Obj.
7.Identify the (3) areas of normal constrictions of the ureter and the clinical significance of these.
1. Ureteropelvic junction- where renal pelvis joins ureter
2. Pelvic brim- ureter crosses brim at bifurcation of common iliac arteries
3. Ureterovesical junction- where ureter pierces wall of urinary bladder
*significant sites of urinary tract stone (caliculi) impaction
Obj.
8.Describe the blood supply, lymph drainage, and nerve supply of the ureters.
blood supply:
longitudional anastomoses (upper-->pelvic)
renal a, testicular/ovarian a, abdominal aorta, branches of internal iliac a.
venous drainage (upper-->pelvic)
renal v, gonadal v, branches of internal iliac

lymph drainage:
upper- paraaortic nodes
middle- common iliac nodes
inferior- external or internal nodes

nerve supply:
GVE
sympathetic- T11-12
parasympathetic- vagus & pelvice splanchnic nerves, S2-4
GVA
splanchnic nerves to spinal sensory ganglia & spinal cord T10-L2
Obj.
9.Identify the kidneys and their excretory portions on retrograde pyelograms.
*numbers indicate ureter constrictions
1. ureteropelvic junction
2. pelvic brin
3. ureterovesicular junction
*numbers indicate ureter constrictions
1. ureteropelvic junction
2. pelvic brin
3. ureterovesicular junction
Obj.
10.Locate the suprarenal glands and describe their anatomical relations.
-associated w/ the superior pole of each kidney
-separated from each kidney by thin septum
-located in the perirenal fat & fascia
Obj.
11.Differentiate the right from the left suprarenal gland.
Right-
pyramidal
behind R lobe of liver & IVC
Lert
semilunar
behind stomach, spleen, & pancreas
Obj.
12.Describe the blood supply, lymph drainage, and nerve supply of the suprarenal glands.
blood supply-
sup, mid, & inf suprarenal arteries
R & L suprarenal veins

lymph drainage-
nerve supply-
lesser & least splanchnic nerves (*primarily sympathetic supply) (T10-T12)
Obj.
13.Name the hormones secreted by the adrenal glands and the action of each hormone.
(outermost-->innermost)
Cortex:
zona glomerulosa- mineralcorticoids, fluid & electrolyte balance
zona fasiculata- glucocorticoids, fat, carb, protein metabolism
zona reticularis- androgens, sex organ development
Medulla:
chromaffin cells- catecholamines, flight or fight response
Obj.
14.Describe the effects of hyper- and hyposecretion of the hormones of the adrenal glands.
hyper-
Cushing's syndrome ( excessive cortisol)
Pheochromocytoma (catecholamine, medulla tumor)

hypo-
Addison's disease (adrenal insufficiency)
Obj.
15.Define the role of the intermediate mesoderm in the development of the urinary system.
-most of urinary system forms from intermediate mesoderm
-during embryonic folding, intermediate mesoderm forms buldge--> urogenital ridges
-nephronic portion of ridge, gives rise to most of urinary system
(gonadal ridge--> genital system)
Obj.
16.Discuss the development of the embryonic excretory organs and their role in the formation of the permanent kidneys.
3 overlapping kidneys develop in a cranial-caudal sequence (as the next one develops, the previous one disappears)
1. Pronephros
4th week, nephrotomes form
2. Mesonephros
4th week- middle 2nd month, mesonephric ducts
3. Metanephros
5th week-birth, ureteric bud, permanent kidney
Obj.
17.List the derivatives of the ureteric bud and the metanephric mesoderm.
Ureteric bud-
ureter, renal pelvis, major & minor calyces, renal pyramids, collecting tubules (collecting system)

metanephric mesoderm-
glomeruli, nephrons, bowmans capsule, proximal & distal convoluted tubules, loop of henle (excretory portion)
Obj.
18.Describe the positional changes of the kidney during development and associated position of the renal vessels.
-initially, kidneys (metanephros) in pelvis, supplied by pelvic branches of aorta
-ascent into abdomen, becomes vascularized by arteries at higher levels
-by week 9, retroperitoneal on post. abdomen wall
-lower vessels degenerate, may persist as accessory renal arteries
Obj.
19.List and describe most common congenital anomalies of the kidneys
Renal agenesis-
metanephric diverticulum fails to develop or degenerates early-->unilateral of bilateral absence
bilateral-> oligohydramnios, Potter sequence (flat face, hypoplastic lungs, deformed limbs)

Renal ectopia
failure of one or both to ascend-->
abnormal position or fusion (discoid, pancake)
crossed--> both kidneys on one side
horseshoe kidney--> fusion of poles (normal ascent prevented by inf. mesenteric artery)

Malrotated kidney-
no rotation, or incorrectly rotated

Cystic Kidney disease-
polycystic--> multiple cysts (renal insufficiency)
autosomal recessive (childhood)- collecting duct cysts
autosomal dominant (adult)- nephron cysts
multicystic--> fewer cysts, nephrons
What structures enter the kidneys at the medially located hilums?
renal vein
renal artery
ureter
(ant. V-->A-->U post.)

*lymphatics & nerve plexuses also transmitted through hilum
What structures run posteriorly to BOTH kidneys? (same)
-diaphram (superior-most)
-psoas major-->quadratus lumborum-->transversus abdominis (medial-->lateral)

*pleural sacs & costodiaphragmatic recesses also posterior to both
What structures run anteriorly to EACH kidney? (differs)
(listed superior-->inferior)
Right: liver, descending duodenum, R colic flexure, small intestine (intraperitoneal part)

Left: stomach, spleen, pancreas, L colic flexure, descending colon, jejunum
The _______________ lie superior-most and anterior to each kidney
suprarenal glands
(R & L respectively)
The (Right/Left) kidney is anterior to ribs 11 & 12.

The (Right/Left) kidney is anterior to 12 only.
Left

Right
What nerves run posterior to both kidneys?
subcostal nerves (& vessels)
iliohypogastric nerve
ilioinguinal nerve
The renal fascia encloses both the ________ & _________, which are separated by a thin septum
kidneys & suprarenal glands
The renal fascia encloses the ureter inferiorly & directs perinephric infections where?
inferiorly into the pelvis
What is the renal fascia continuous w/ laterally?
medially?
posteriorly?
laterally- fascia transversalis

medially- sheath of renal vessels, aorta & inferior vena cava

posteriorly- fascia of psoas major
The (cortex/medulla) contains the following:
-renal corpuscles (glomerulus & Bowman's capsule)
-PROXIMAL parts of proximal & distal convoluted tubules & distal collecting ducts
cortex
The (cortex/medulla) contains the following:
-thick & thin limbs of loops of Henle
-DISTAL parts of proximal & distal convoluted tubules & distal collecting ducts
medulla
Describe the functional subdivisions of the kidneys (largest-->smallest divsions)
Segments (5), each supplied by own segmental artery-->
Lobe, cortical tissue around each pyramid, includes renal column-->
Lobule, cortical tissue w/ medullay ray in middle-->
Uriniferous tubule, nephron + collecting duct (functional unit of kidney**^)
What are the 5 segments of the kidney
Superior
Inferior
Posterior
Anterosuperior
Anteroinferior
The renal artery arises from the abdominal aorta at what spinal level?
arises below superior mesenteric btwn L1 & 2
The (right/left) renal vein is longer

The (right/left) renal artery is longer
left vein longer

right artery longer
T/F

Accessory renal arteries are common & enter the kidney at the hilum
FALSE

do NOT enter at hilum (extra hilar arteries)
Before the R & L renal veins drain into the IVC, the L vein crosses the midline btwn what two structures, where it may become compressed?
aorta & superior mesenteric
(compressed by aneurysm of either^)
Describe the vascular divisions of the R & L renal arteries
R & L renal arteries-->
Ant & Post branches-->
5 segmental end arteries-->
interlobar arteries-->
arcuate arteries-->
interlobular arteries-->
afferent arterioles-->
glomerulus-->
efferent arteriole-->
cortical peritubular capillaries (cortex) or
rectae spuriae (medulla)
What is the main advantage & disadvantage of the segmental END arteries
advantage- segments can be surgically resected individually, leaving rest of kidney functional & intact

disadvantage- no collateral circulation, if artery becomes occluded the entire segment infarcts (dies)
What causes nutcracker syndrome?

What may male patients develop as a result?
compressed L renal vein btwn SMA & aorta

may develop varicocele & left testicular pain
In females only, the ureters are crossed by _________________
uterine artery
Describe symptoms & treatments for caliculi (UT stones)
symptoms:
-ureteric colic (intermittent pain)
-loin to groin pain (T11-L2)
-hematuria (bloody urine)
treatments:
-lithotripsy (laser shock waves, break stones to pass)
Why is renal cell carcinomas is especially dangerous when it invades the renal vein?
Spreads from the renal vein to inferior vena cava, will then be able to travel into right atrium, across tricuspid valve into pulmonary artery
During renal transplant, where is the new kidney placed and why?
in the illiac fossa

-doesn't compromise existing structures & extraperitoneal approach provides swift recovery
The (cortex/medulla) of the suprarenal gland has a mesoderm origin

The (cortex/medulla) has a neural crest cell origin
cortex (mesoderm)


medulla (neural crest)
What do each of the following arteries branch from?
Superior suprarenal artery
Middle suprarenal artery
Inferior suprarenal artery
Superior suprarenal artery- inf. phrenic artery
Middle suprarenal artery- abdominal aorta
Inferior suprarenal artery- renal artery
The (left/right) suprarenal vein drains into the left renal v, while the other drains directly into the IVC
left

(drains into L renal, which then drains into IVC)
Preganglionic fibers (T10-T12) pass through the paravertebral _______ ganglia & plexus, joining the _________ plexus, & ending on the postganglionic chromafin cells
celiac ganglia
(joining)
periarterial plexus
The mesonephros & mesonephric duct are derived from intermediate mesoderm in the __________________ segments

What does the mesonephros form?
upper thoracic to upper lumbar (L3) segments


forms glomerulus, Bowman's capsule, renal corpuscle, mesonephric/wolffian duct
The ridge between the mesonephros & primary gonads, formed in the middle of the 2nd month is the ____________________
urogenital ridge
The mesonephric duct persists in (males/females) & contributes to the formation of what?
males

genital system
The definitive kidney becomes functional near the ___ week.
12th
Each developing collecting tubule is covered distally be a ________________
metanephric tissue cap
Prior to birth, the _____________ is the primary remover of nitrogenous wastes from fetus. After birth, the ______________ takes on this role
placenta

kidney
Obj.
19.List and describe most common congenital anomalies of the ureters.
Duplication of Urinary tract-
division of metanephric diverticulum-->
incomplete-> divided kidney w/ bifid ureter
complete- >double kidney w/ bifid ureter
formation of 2 metanephric diverticula-> supernumerary kidney (3rd) w/ own ureter

Ectopic Ureteral orifices-
ureter is not incorporated into post urinary bladder-->ureters open somewhere besides into urinary bladder--> incontinence
What syndrome are horseshoe kidneys associated with?
Turner's syndrome (45, XO)
women