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Lecture Urinary Anatomy Naravane

Narration/notes
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homeostasis; transportation systems; reservoirs
The urinary system is an important homeostatic system. The kidneys play an important role in _______ and the rest of the organs of this system act as either _________ or _________ for storage of urine.
• excretion
• regulation of volume and chemical composition of blood
• gluconeogenesis
• endocrine functions
The main functions of the urinary system and the kidneys, in particular are:
1/5th; liver
• gluconeogenesis: the kidneys reabsorb glucose and in times of need, can furnish _____ as much glucose as the ______.
renin; erythropoietin; D
• endocrine functions; the kidneys secrete the hormones, ______, ________ and also metabolize Vitamin ____ to it's active state
Kidneys, Ureter, Urinary Bladder, & Urethra.
Organs of the urinary system include:
lumbar; T12 -L3; obliquely
Kidneys are located in the ______ region between ______ vertebra, by the side close to the vertebral column. They are ______ placed in the body.
right; left

because of the presence of the liver on the right side.
The _____ kidney is slightly lower than _____ kidney.
12cm 6cm. 3cm.; 5 oz.
K:

Dimensions of the kidney are ___ x _____ x _____ and the weight is __oz.
convex; concave
K:

The kidney has a _______ lateral surface and a _______ medial surface.
concave; enter; exit
K:

The ______ medial surface has the Hilum (gateway). The hilum is where structures _____ or _____.
renal artery; renal vein; ureter
The _______, the ______, and the _______ are present in the hilum.
Anterior; posterior

The renal vein is placed anteriorly because it is always going to be in a position where it wont be compressed by any other structure.
The renal vein is the most _______ structure and the ureta is the most __________ structure.
The renal sinus

So the renal artery; renal vein; ureta enter at the renal sinus
K:

The hilum leads into a space inside the kidney known as the ______ sinus. It is the space within the kidney on the medial side.
capsule;
K:

The kidney has a ______ covering it intimately and normally can be stripped off easily.
perirenal fat
K:

Outside the capsule is a layer of _____ fat which supports and protects the kidney and holds it in places.
depleted; iliac fossa; 'ptosis'; hydronephrosis
K:

During starvation perirenal fat may be ______ because its utilized to make glucose so the kidney drops from it's usual position in the lumbar region, into the _____ a condition known as _______.

When this happens the ureter gets kinked and may cause someone to be prone to a condition called ______. This is where the kidney becomes extremely dilated because the urine cannot pass out due to the ureter being kinked.
renal fascia
K:

The ________ is the outermost capsule and forms another protective layer. So the kidney has a total of __ capsules.
cortex; medulla
K:

Coronal section of the kidney reveals the outermost layer which is lighter and granular is known as the ______ of the kidney. Then much of the rest of the kidney, the darker, larger part, is known as the ______ of the kidney.
pyramids; cortex; hilum; minor calyces; renal column.
K:

The medulla consists of triangular structures called ________, which have their bases facing the _______ and their apices called papilla, facing the _______ and the papilla open up into the ________. A portion of the cortex passes in between the pyramids which is part of the medulla, and this area is called a ________.
cortical tissue; 8 or more
K:

Each pyramid along with the _________ above it is called a lobe of the kidney. There are usually _______ lobes
renal arteries
The Kidneys:

The renal blood supply is by the __________.
abdominal aorta
K:

The renal arteries are branches of the _______.
segmental arteries; lobar arteries; interlobar arteries; arcuate arteries; interlobular arteries
(SLIAI) for arteries
(IAILS) for veins
K:

Renal arteries divide into 5 arteries and each artery supplies an independant area of the kidney. In order starting from the renal artery you have the _______ , _____, ______, _______, ________. The veins come back in the opposite direction to finally form the renal vein.
Afferent
The interlobular arteries gie rise to the _____ arteriole.
cortical radiate arteries; glomerulus
K:

The interlobular arteries are also called the _______ arteries and it give rise to the afferent artery of the ________.
renal veins; Inferior vena cava.
K:

The _______ drain the kidneys and they drain into the _______.
Right; Left

This is the case in the renal arteries because the abdominal aorta lies on the left side of the body so the left renal artery is shorter.
This is the case for the veins because both veins drain into the inferior vena cava which is present on the right side the right renal vein is shorter.
K:

The _____ renal artery is longer than the other renal artery and the ____ renal vein is longer than the other renal vein.
sympathetic; blood vessel
K:

The nerve supply of the kidneys is mainly _______ which acts on the _______.
nephron
K:

The functional unit of the kidney is the ______.
collecting ducts; ureter (or kidney)
K:

The urine from the nephrons is collected by _______ which convey it to the pelvis of the _____.
Glomerulus; Renal tubule
K:

The nephron consists of ____ & ______.
tuft of capillaries; fenestrated

The interlobular artery gives off the afferent arterioles which goes inside the renal tubules where it breaks up into a bunch of capillaries and from these capillaries another artery comes out which is known as the efferent arterioles. The efferent arterioles form a whole network of capillaries. From these capillaries a vein starts out which joins a major vein and thats how the blood is drained out of the kidney.
K:

Glomerulus is a _______. These are formed by the afferent arterioles and leads to the efferent arterioles. The endothelium is ______ (which means it has pores.
renal tubules
K:

The fenestrated epithelium allows for filtrate to pass from blood to the ______.
Bowman's, Proximal convoluted tubule (PCT), Loop of Henle, Distal convoluted tubule (DCT);

Collecting duct; Minor calyces.
K:


The renal tubule consists of the ______ capsule and the ________ tubule, then the _________ which has an descending limb (thin) and then an ascending (thick) limb, and the ascending limb continues fowards as the __________ tubule.

The DCT opens into the ________ which open up into the _______.
glomerulus; blind

The bowman's capsule is like a baseball glove and the glomerulus is like the baseball. The part of the glove that holds the ball, think of that as the visceral layer of the capsule. The part of the glove that covers the dorsal layer of your hand is the parietal layer. So visceral layer is in close contact with the capillaries and the parietal layer is not and in between the two you have a space which is known as the glomerular space.
K:

The ______ fits into the Bowman's capsule which is the ____ expanded end.
glomerular space
There's a membrane resent that is called the filtration membrane and this is what the blood has to filter through. The blood passing into the capillaries has to pass through the endothelium of the capillaries along with the basement membrane and then it passes through that visceral layer of the Bowman's capsule which also rests on a basement membrane. So the two basement membranes are fused together.

Therefore the filtration membrane consists of endothelium of the capillaries, the fused basement membranes and the visceral layer of the Bowman's capsule. Once having passed that it enters into the capsular space, also known as the ______ and then it passes into the rest of the renal tubule.
renal corpuscle
K:
Secretory structure:
The bowman's capsule and the glomerulus together form the ________.
capsular space
K:

The Bowman's capsule has a parietal and a visceral layer and the space in between is called the _______.
visceral;

porous capillary endothelium; glomerulus
K:

The ______ layer of the capsule has special cells which also have pores allowing the filtrate to pass through.

The filtration membrane consists of the __________ endothelium of the ________, the fused basement membranes and the visceral layer of the glomerular capsule which also rests on a basement membrane which fuses together.
thin; thick
K:

Loop of Henle has a descending ____ segment and ascending ____ segment
afferent; Juxtaglomerular cells (JG cells)
K:

Distal convoluted tubule (DCT) is important as it lies very close to the ______ arteriole. At the point of contact the smooth muscle cells of the arteriole are enlarged and granular (contain renin) and are called _______ cells.
blood pressure; renin; tall columnar; Macula Densa.

When blood pressure is low in the affarent arteroile, the granules are stimulated to produce renin.
K:

The Juxtaglomerular cells (JG cells) sense the ______ in the afferent arteriole. They have granules inside them which produce _____. The cells of the DCT at that point change and they become ________ and are called _______.
solute or electrolyte

So if the electrolyte is low then it gets stimultaed because the body needs to absorb more electrolytes.
K:

The Macula Densa sense the _____ content of the filtrate in the tubule.
JG apparatus
K:

Together, Juxtaglomerular cells (JG cells) and Macula Densa form the __________.
JG apparatus
K:

This plays a role in rate of filtrate formation and blood pressure regulation.
nephrons; papillary ducts
K:

The collecting ducts have many ______ opening into them and they in turn join to form the ________.
papillary ducts
K:

This delivers urine into the pelvis of the ureter:
erythropoeitin; anemia
One of the functions of the kidney is to produce _______ which is needed for erythropoeisis. What would be the effect in a person with kidney damage?
True
True or false: The afferent and efferent arterioles both break up into capillaries.
glomerulus
K Histologically:

◦ ________ is a mass of branching capillaries with scanty, very little, connective tissue.
Simple squamous; space
K Histologically:

The Bowman's capsule, consists of ______ epithelium, with a _____ between the visceral and parietal layers.
Proximal convoluted tubule (PCT)

Because the cuboidal cells have microvilli on them it often gives them a fringed appearance.
K Histologically:
▪ ___________ are numerous, have a relatively small lumen and have large cuboidal cells lining the tubule.
pink; eosin

They look this way because they have a great deal of mitochondria on them
K Histologically:
▪ Proximal convoluted tubule (PCT) are stained deep _____ with ____.
Distal convoluted tubule (DCT)

They have less mitochondria so the cells do not stain as deeply.
K Histologically:
▪ __________ are fewer, have a larger regular lumen, and cells are smaller. The cytoplasm is not as deeply staining.
loop of Henle
K Histologically:

The ________ has thick and thin segments.
squamous; Distal convoluted tubule (DCT)
K Histologically:

The loop of Henle has thick and thin segments. The thin segments have a _______ cell lining while the thick segments are similar to _______.
large; wide; clear columnar

Lecture notes say cuboidal to low columnar cells.
K Histologically:

Collecting ducts have _____ diameters, a _____ lumen and are lined by _______ cells.
L2; ureteropelvic junction; pelvic brim; entry of the bladder (it is narrowed as it goes through the wall of the bladder).
The Ureter lies both in the abdomen and the pelvis. It begins at the level of __ at the lower end of the pelvis; this area is called _________ and there is a slight narrowing there.
The second area where the ureter narrows is called the _____ and then the third area that the ureter narrows is at the ______.

A kidney stone can get blocked at any of these three narrowing sites.
3-4; minor calyces

So the major calyces join up to form the pelvis and then the pelvis continues down as the ureter.

The pelvis is part of the ureter because both the ureter and the pelvis developed from the same structure.
The pelvis divides into ______ major calyces which in turn divide into _______.
minor calyces
Ureter:

The papilla of the pyramids open into the _______.
urinary bladder; back pressure; filling of the bladder
Ureter:

The ureter descends by the side of the vertebral column retroperitoneally and crosses the pelvic brim, to open into the __________. The opening is oblique, and the ureter runs through the bladder wall for a distance; this prevents ________ into the ureter during __________.
uterine artery; ligature; renal shut down
The ureter is closely related to the ________ in females, and during hysterectomies, can be caught in the _______, around the uterine artery, leading to ________.
regional; ureter
Ureter:

The blood supply is from ______ arteries and and arteries or veins that cross, or are crossed by the ______ supply it.
transitional; star; muscle; peristalsis
Transitional epithelium has stetchibilty and does not allow urine to pass into the cells. Hence the urinary bladder is also lined by this type of epithelium.
Histologically, the ureter is lined by _______ epithelium. The lumen is ____ shaped, due to the ______ layer being so thick and contracted due to _______.
longitudinal; circular; longitudinal; adventitia
Histologically, the ureters The muscular layer consists of inner ______ and outer _______, with an additional ______ layer in the lower third. The outermost layer is _______ for most part.
peristalsis

This is a wave of contraction that causes urine to dribble into the bladder drop by drop. This is how the bladder fills up.
This is seen in the ureter and passage of urine is dependant on this:
Urinary Bladder

Muscles are not in any particular arrangement. They are interlacing fibers going in all different directions and its smooth muscle
This is an extremely muscular organ that lies in the pelvis behind the symphisis pubis:
Detrusor muscle; internal urinary meatus; involuntary sphincter
The muscle of the urinary bladder is smooth and is called the ________, which is thickened at the _________ to form an _________.
3; trigone; ureteral; internal urinary meatus; smooth; not distended
The urinary bladder has __ orifices seen at the apices of a triangular area in the interior of the bladder known as the ______. It also has 2 ______ openings and a single urethral opening also called the _________. This triangular zone is in the center of the urinary bladder is ______ unlike the rest of the bladder, which is folded when _______.
vesical
Blood supply for the urinary bladder is from ______ arteries and veins.
3; transitional epithelium; muscle fibers; different; thick adventitia

Transitional which allows stretchability so the bladder can distend and fill to 500 ml of urine before pain is actually felt.
Urinary bladder histologically: It has __ layers; is lined by ________ epithelium. The muscular layer consists of ______ running in ______ directions. The outermost layer is _____________.
abdominal
The urinary bladder is an _______ organ only in children, and when distended
500; 1000; incontinence; stress incontinence.
When the urinary bladder fills beyond ___ml, pain is felt. It can hold more than ______ml. if necessary, but over distention leads to _______ and this is when you cannot hold your urine and it passes out known as _______.
cystoscope; cystoscopy; urethra; interior.

This helps to see if their is any carcinoma, or to see if the trigone is ok and if the 3 orfices are working properly and to look at all of the structures in the bladder.
The urinary bladder can be visualized by using an instrument called a _____ and the procedure is called _____. A scope is introduced into the bladder through the _____, and the _______ portion of the bladder can be seen.
Cystoscopy
This helps to see if their is any carcinoma, or to see if the trigone is ok and if the 3 orfices are working properly and to look at all of the structures in the bladder.
micturition
The process of passing urine is called ______.
brain, bladder, sphincters
Micturition involves the _____, ____, and the _____.
bladder neck; external urinary meatus
The Urethra begins at the ______ and opens at the _______.
Internal (Detrusor muscle-sphincter vesicae) which is involuntary smooth muscle
and the external (sphincter urethrae)
The Urethra has 2 Sphinters which are known as:
skeletal; voluntary
The external sphincter of the urethra is ______ muscle and under _____ control.
longer; 20;
The urethra is ______ (___ cm) in the males.
prostatic portion, a membranous portion and a penile portion
The male urethra has 3 portions known as:
short; 3-4cm.;
The urethra is _____ (__-___ cm) in females.
short
Females are more prone to urinary infections because the urethra is so ____ and close to the anal canal.
perineum
The urethra blood supply is from the arteries and veins in the _____.
transitional, pseudostratified and stratified squamous; skeletal; not clearly
Histologically, the urethra is lined by _______, _______ and ________epithelium. Muscle is ______ and layers are clearly or not clearly demarcated.
Sympathetic and parasympathetic.
Nerve supply to the urinary organs is _______ and _______.
detrusor muscle; sphincters (internal, involuntary sphincter)
Nerve supply to the urinary organs:

The parasympathetic system causes the ______ muscle to contract and it causes the _______ to relax thus causing urination.
sphincters (internal, involuntary sphincter); inhibitory to the muscle.

This is important during sexual activity because of this contraction of the sphincter is why you have semen passing out and not urine.
Nerve supply to the urinary organs:

The sympathetic system causes the ______ to contract and is ______ to the muscle stopping urine from passing out.
spinal nerves, pudendal nerve.
Nerve supply to the urinary organs:

The skeletal components are supplied by _______.
• UTI

Common in women, and in people that hold their bladder (which causes stasis of bacteria multiplying), a person with prostatic hypertrophy (prostate enlargement), and if you catheterize a patient you may induce this infection if you don't observe absolute sterile conditions.
Clinical conditions:

A symptom of this condition is frequency in urination, burning, and they may also have hematuria (blood in the urine). Hematuria especially if you have statisis (inflammation of the bladder which may cause a lot of blood in the urine).
Glomerulonephritis; antigen-antibodies; protein; hematuria
_______ is a renal disease that usually of both kidneys. It is an autoimmune infection which affects the glomeruli (the small blood vessels in the kidneys). Here ______ complexes are deposited on the glomeruli so the filtration membrane is damaged so because its damaged the proteins and blood cells which are normally not filtered now can pass through and a person will show _____ in the urine and _____.
• Pyelonephritis
_____ is inflammation of the pelvis of the ureter and other structures. This is due to repeated urinary tract infections (UTI) and hematuria may also be one of the symptoms seen.
• Wilm's tumor also called nephroblastoma
_______ also called ________ is a primitive tumor seen in young children and it presents with a huge mass in the abdomen. If caught early prognosis is good, you would remove the tumor with the kidney. You have to remove the kidney sometimes.
Renal Calculi; vesical calculi; stone aka calculus; L1 nerve

Note: hematuria is also seen in bladder cancer.
This condition is called ______ in the kidney and ______ in the bladder. This may form because of a small infection which leaves a little nidus (cavity) and then there's a deposit of salts, calcium or oxalate salts around it and that becomes a ______. When it tries to pass down from the kidney through the ureter it causes severe pain which has been compared to the pains of labor. This type of pain is usually felt from the back to the front (loin to the groin) and thats because of the nerve supply, the _____ nerve travels in that direction. These people also have hematuria (because the stone irritates the lining and causes erosion), people also have nausea, vomitting, and since they also have UTI this also causes a fever.
urine; transporters; storage sites
Discussion forum info;

The kidneys are the producers of ____ while the ureters, bladder and urethra are ______ and or _______.
Blood; glomerulus; renal tubule
Since the kidneys produce urine, it has to be made from something, this something is _______. Therefore in the nephron, you have to have something that brings in blood which is the _______ and something that filters it and transports it out of the kidney, in order to make urine which is known as the ________.
transitional; urothelium
The collecting ducts are not part of the renal tubule, as they develop separately. The epithelium in the urinary tract, ureter, bladder and proximal part of urethra, is _______. It is also called _______ because it allows stretch and is also impervious to urine. On account of being multilayered it is protective in function.
glomerular capillaries
You must understand the layers of the Bowman's capsule. The visceral layer of the bowman's capsule is intimately attached to the ________, and hence in an image or model you will not be able to see it separately.
filtration/glomerular; Bowman's space.
The parietal layer of the Bowman's capsule which you can see is in between the two and this is called the ______ or the ______.
Cortex; medulla
The proximal convoluted tubule, the glomerulus, bowmans capsule and the distal convoluted tubules are found in the _____ of the kidney. The collecting ducts and the loops of henle are found in the _____.
Horseshoe kidney; inferior mesenteric artery
A congenital anomaly called ______ is where the two kidneys fuse in the center. This is seen fairly often and usually you will find that the kidneys are prevented from going up due to the presence of the _______.
pelvic; lumbar
The kidneys develop in the _____ region and in the fetus, as the body is growing, it grows away from the kidneys so it looks as though the kidneys have ascended to the lumbar region. But they haven't ascended, the body has actually grows away from it so what was the pelvic becomes the _____ region. So in a horseshoe kidney they cannot go up to the lumbar region because they are blocked by the inferior mesenteric artery.
Intravenous pyelogram
A method used to see the functioning of the kidney and to see if the rest of the urinary tract is ok.
A dye is injected into the vein and the dye passes out into the blood stream and then it is filered by the kidney and then when it passes through you take xrays at various intervals, at 5 min. 10 min. and so on. You will be able to see the calyces, and the bladder filling up, and you can see the ureters, but in some areas you don't see the ureters because that area would be where peristalsis and going on.
Explain the method of Intravenous pyelogram:
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