Lecture 5: Urinary System and Inguinal Canal

Label structure 1-6

ala of sacrum, pelvic inlet, ischial spine, pubic tubercule, ischiopubic ramus

Label structures 7-12

sacroiliac joint, anterior superior iliac spine, coccyx, obturator foreman, ischial tuberosity, pubic symphysis

Label structures 1-5

liver, adrenal gland, stomach, left kidney, 12th rib

Label structures 6-10

renal artery, renal vein, ureter, bladder, urethra

Label structures 1-4

renal pelvis, urinary flow, medulla, cortex

Label structures 1-5

renal vein, renal hilum, renal nerve, renal artery, renal medulla

Label structures 6-10

ureter, capsule, minor calyx, major calyx, renal pelvis

label structures 11-14

pyramid, papilla, renal column, renal cortex

Whats an important distinction between the drainage from the left and right suprarenal glands?

 R suprarenal vein into IVC, L suprarenal vein into left renal vein

Label structures 1-3

adrenal gland, adrenal medulla, adrenal cortex

Label structures 1-5

right cupola of diaphragm, right suprarenal gland, right kidney, hepatic flexure, duodenum

Label structures 6-9

stomach (fundus), IVC, oesophagus, right crus of diaphragm

Label structures 1-5

kidneys, ureters, bladder, prostate, urthera

Label structures 1-6

ureter, external iliac artery, kidney, testicular artery, posts major, bladder

Label 1-4

inferior vena cava, common iliac artery, bifurcation of common iliac artery, internal iliac artery

Label structures 5-8

external iliac artery, urethra, left suprarenal gland, uretopelvic junction

Label structures 9-13

abdominal aorta, ureter, crossing iliac vessels and pelvic brim. urinary bladder, transversing bladder wall

Label structures 1-4

ureter, ureteric orifices, detrusor muscle, trigone

Label structures 5-8

bladder neck, urethra, external urethral orifice, internal urethral sphincter

Label structures 1-4

ureters, fundus (base), superior, inferolateral

label structures 5-7

median umbilical ligament, apex, neck

Label structures 1-4

external oblique muscle, skin, peritoneum, internal spermatic fascia

label structures 6-9

external spermatic fascia, skin, cord and vessels, testicle

fill in blanks 1-5

renal pelvis, uretopelvic junction, uretopelvic junction, ureters, abdomen

Fill in blanks 6-10

sacroiliac joints, pelvic brim, iliac vessels, pelvic cavity, lateral pelvic walls

Fill in blanks 10-13

lateral pelvic walls, ischial spines, anteromedially, bladder wall

Label structures 1-3

spermatic cord, pampiniform plexus, cremaster muscle

Label structures 4-6

testicular artery, vas deferns, testicle

Label strucutres 1-4

inferior vena cava, right kidney, right renal artery, right renal vein

Label structures 5-9

superior mesenteric artery, left kidney, left renal artery, left renal vein, abdominal aorta

Which anatomical landmark forms the anterior (front) boundary of the pelvic inlet?

superior margin of the pubic symphysis

Which bony landmark constitutes the posterior (back) boundary of the pelvic inlet?

Anterior sacrum

Along the sides, the pelvic brim demarcates the pelvic inlet along which specific surface of the left and right hip bones?

Medial (inner) surface

Where are the kidneys located?

On posterior abdominal wall, either side T12 to L3

Which regions of the abdomen do the kidneys occupy?

Hypochondriac and lumbar regions

What’s the venous drainage of the kidneys?

left and right renal vein

What’s the blood supply to the kidneys?

left and right renal artery

Where does the renal artery come from?

the aorta (L1/l2)

Where do the renal veins join?

inferior vena cava

How do the left and right kidneys relate to each other?

same for posterior and superior, different for anterior

Where are the suprarenal glands located?

Sit on top of each kidney, inferior to the diaphragm

What is the blood supply to the suprarenal glands?

superior, middle and inferior suprarenal arteries

What is anterior to the right suprarenal duct?

IVC and liver

What is anterior to the left suprarenal duct?

stomach, pancreas and spleen

What is posterior to the suprarenal glands?

crura of the diaphragm.

What are the ureters?

Muscular tubes that convey urine from kidney (renal pelvis) to urinary bladder

Where are the ureters?

half in abdomen, half in pelvis

What muscle does the ureter travel on?

Travel on psoas major muscle

What are the potential sites of constriction?

Uretopelvic junction, Pelvic brim anterior to iliac vessels, Entrance to urinary bladder wall

What is the key difference between the left and right suprarenal glands?

The right suprarenal gland is triangular whereas the left gland is semi-lunar (crescent) shaped.

What’s a difference between the left and right kidneys?

the right kidney is usually slightly lower than the left due to the liver's size and position within the abdomen.

What is the urinary bladder?

Muscular sac on floor of pelvic cavity, posterior to pubic bone

What’s the trigone?

triangular region between openings of the ureters and the urethra

What makes up the urinary bladder?

Five parts (apex, body, fundus, trigone and neck) + umbilical ligament

What is superior to both kidneys?

a suprarenal gland.

What is posterior to both kidneys?

posterior abdominal wall, the diaphragm, and ribs 11th and 12th.

What’s anterior on the right kidney?

the liver, duodenum and hepatic flexure of the ascending colon.

What’s anterior on the left kidney?

stomach, jejunum, pancreas, spleen and descending colon.

What’s the inguinal canal?

Short oblique passageway formed from anterolateral abdominal wall muscles and their aponeuroses

What does the inguinal canal follow?

part of the inguinal ligament

What’s the entrance to the inguinal canal?

deep inguinal ring (around midpoint inguinal ligament)

What’s the exit of the inguinal canal?

superficial inguinal ring (above pubic tubercle)

What are the contents of the inguinal canal?

ilioinguinal nerve + either the spermatic cord or the round ligament of the uterus

What’s the roof of the inguinal canal formed by?

Internal oblique and transversus abdominis muscles

What’s the anterior wall of the inguinal canal formed by?

Aponeurosis of internal and external oblique muscles

What’s the floor of the inguinal canal formed by?

Inguinal and lacunar ligament

What’s the posterior wall of the inguinal canal formed by?

Conjoint tendon and transversalis fascia

Describe the ovaries descent and what it means for the inguinal canal

pelvic cavity to become associated with uterus. Only remaining structure passing through the inguinal canal is the round ligament of the uterus.

Describe the testes descent and what it means for the inguinal canal

through inguinal canal, surrounded by the same fascial layers of the abdominal wall. This completes the formation of the spermatic cord.

What is the trigone defined by?

the openings of the two ureters and the internal urethral sphincter

What does the trigone do?

plays a crucial role in preventing urine reflux.

What does the detrusor muscle do?

contracts when the bladder is full to release the urine into the urethra.

What’s anterior to the bladder?

the pubic symphysis of the hip bones.

What’s posterior to the bladder in males?

vas deferens, anterior wall of the rectum

What’s posterior to the bladder in females?

the anterior wall of the vagina.

What’s inferior to the bladder?

the internal urethral sphincter. In addition, the bladder neck lies inferior and it is continuous with the urethra.

What are the boundaries of the inguinal canal?

 MALT:

• The roof is formed by Muscles (internal oblique and transversus abdominis).

• The anterior wall is derived from Aponeuroses (internal and external oblique aponeuroses).

• The floor is formed by Ligaments (inguinal and lacunar ligaments).

• The posterior wall is formed by the conjoint Tendon and Transversalis fascia.

Fill in blanks 1-5

anterior superior iliac spine (ASIS), inguinal ligament, pubic tubercule, deep, superficial

Where is the deep inguinal ring found?

midway between the anterior superior iliac spine (ASIS) and pubic tubercle

Where is the superficial inguinal ring found?

above the pubic tubercle

Fill in blanks 1-5

ilioinguinal nerve, round ligament of the uterus, genital branch of the genitofemoral nerve, ilioinguinal nerve, spermatic cord

Whats the spermatic cord?

collection of vessels, nerves and ducts that run to and from the testes

Overview of the descent of the testes (you won’t be able to write this one out)

during development the testes are inside the abdominal cavity; the spermatic cord is formed from the descent of the testes from the inside of the abdominal cavity through the abdominal wall. As the testes descend, they drag along the layers of the anterior abdominal wall which forms the layers of the spermatic cord. Hence, the spermatic cord has three layers derived from the layers of the anterior abdominal wall,

What derives from the external oblique aponeurosis?

external spermatic fascia

What derives from the Cremasteric muscle and fascia?

Internal oblique muscle and aponeurosis

What derives from the Transversalis fascia?

Internal spermatic fascia

What are the blood vessels of the spermatic cord?

• Pampiniform plexus of testicular veins 

• Testicular artery 

• Artery to the vas deferens

• Cremasteric artery and vein

What are the nerves of the spermatic cord?

Genital branch of the genitofemoral nerve, Autonomic nerves