B5: Anatomy Exam 2 (THE LAST MELON)

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647 Terms

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intraperitoneal

(intraperitoneal/retroperitoneal) structures are completely covered by visceral peritoneum

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retroperitoneal

(intraperitoneal/retroperitoneal) structures are behind the peritoneal cavity, external to parietal peritoneum (covered only on anterior surface w/ parietal peritoneum)

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1. surparenal glands

2. abdominal aorta (+ IVC)

3. duodenum

4. pancreas head + body

5. ureters

6. colon

7. kidneys

8. esophagus

9. rectum

What are the retroperitoneal (SADPUCKER) structures?

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subperitoneal

What type of structures are found below the peritoneal cavity, external to the parietal peritoneum and covered only on their superior surface w/ parietal peritoneum?

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adrenal glands

What organ:

-retroperitoneal endocrine organs

-superior pole of kidneys (between kidney + diaphragm)

-surrounded by perinephric fat + enclosed by renal fascia (separated from kidney by thin fascial septum)

-R = more pyramidal, partially posterior to IVC

-L = crescent-shaped, extends medial from superior half of kidney

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cortex

What part of the adrenal gland:

-outer portion

-derived from MESODERM

-secretes HORMONES --> corticosteroids, androgens

-disorders of excess or deficient secretion of above hormones can occur

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medulla

What part of the adrenal gland:

-inner part

-derived from neural crest cells

-secretes catecholamines --> epinephrine + norepinephrine

-some adrenal tumors secrete catecholamines

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catecholamines epinephrine and norepinephrine

What does the medulla of the adrenal gland secrete?

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neural crest cells

What is the medulla of the adrenal gland derived from?

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hormones corticosteroids and androgens

What does the cortex of the adrenal gland secrete?

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mesoderm

What is the cortex of the adrenal gland derived from?

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1. superior suprarenal a.

2. middle suprarenal a.

3. inferior suprarenal a.

What are the arteries that supply the adrenal glands?

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1. R suprarenal v.

2. L suprarenal v.

What is the venous drainage from the adrenal glands?

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inferior phrenic a.

What is the origin of superior suprarenal a.?

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abdominal aorta

What is the origin of middle suprarenal a.?

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renal a.

What is the origin of inferior suprarenal a.?

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IVC

What does the R suprarenal v. drain into?

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L. renal v.

What does the L suprarenal v. drain into?

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greater (majority) and lesser splanchnic nn. (thoracic splachnic nn.)

What supplies sympathetic innervation to the adrenal gland?

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adrenal glands

Pre-synaptic sympathetic fibers to the _________ pass through both paravertebral and prevertebral ganglia WITHOUT synapsing. They end DIRECTLY ON THE CHROMAFFIN CELLS in the adrenal medulla (which act like post-synaptic sympathetic neurons), stimulating them to release catecholamines

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chromaffin cells

What act like post-synaptic sympathetic neurons in the adrenal gland?

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1. suprarenal lymphatic vessels

2. R and L lumbar lymph nodes (R = caval lymph nodes, L = aortic lymph nodes)

3. cisterna chyli

Describe the lymphatic drainage of the adrenal glands.

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kidney

What organ:

-retroperitoneal

-capsule, cortex, medulla, and collecting system

-functions to filter blood + produce urine, regulate BP via renin, role in RBC production via erythropoietin, vitamin D activation

-often impalpable!!!!!! may feel lower pole of R kidney in lean adults, L kidney ONLY if enlarged or displaced by retroperitoneal mass

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T12-L3 levels

At what spinal levels are the kidneys found within the superior posterior abdominal wall?

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right

The (right/left) kidney is slightly more inferior w/ its lower pole just superior to iliac crest

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costovertebral angle

Tenderness at the _____________ is associated w/ renal pathology

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anterior

R lobe of the liver is ____________ to the R kidney, thus free fluid collects within the heptorenal recess. Duodenum and ascending colon also has the same relation to the kidney as the R lobe of the liver.

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anterior

Spleen is ________ to the superior pole of the L kidney (as well as pancreas, jejunum, descending colon, and stomach)

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posteromedial

Where is the psoas mm. in relation to the kidney?

Hint: has similar vertical axis to kidneys

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cortex

What part of the kidney parenchyma:

-periphery of kidneys

-extends centrally as renal columns

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medulla

What part of the kidney parenchyma:

-multiple fan-shaped medullary (renal) pyramids

-apex of pyramid = renal papilla

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minor calyx

What collects urine from a SINGLE renal papilla?

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major calyx

2-3 minor calyces come together to form a(n) __________

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renal pelvis

What is a funnel-shaped structure hat receives urine from major calyces and continues w/ the ureter?

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renal hilum

What is the medial cleft where structures enter/exit the renal sinus?

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renal sinus

What is the space in the kidney containing fat (perinephric fat), neurovasculature, and collecting system?

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perirenal space

What is the space containing perinephrix fat around kidneys and adrenals, is enclosed by renal fascia (other than the inferior surface)?

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perinephrix abscess or hematoma

What can extend inferiorly into the pelvis through the inferior opening in the perirenal space?

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nephroptosis

What is abnormal drooping of the kidney, even very low into the abdominal cavity causing a very long ureter that is coiled?

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pararenal space + fat

What is the space containing paranephric fat superficial to renal fascia?

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R and L renal aa.

What supplies blood to the kidneys?

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L1/L2

At what spinal levels are the renal aa. found?

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right

The (right/left) renal a. travels posterior to IVC

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left

The (right/left) renal a. is shorter b/c it does not have to run behind the IVC

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both

_____ renal aa. travel posterior to renal vv.

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left

the (right/left) renal v. is longer because the IVC is on the R side of the body

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hilum

Where do the renal aa. divide into 5 segmental aa. to supply non-overlapping areas of the kidneys?

Note: they segments are surgically resectable! :)

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left

the (right/left) renal v. receives infow from L adrenal v. & gondal v.

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left

the (right/left) renal v. courses over the aorta, under the SMA and is vulnerable to entrapment ("nutcracker" syndrome)

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vagal trunks

What supplies parasympathetic innervation to the kidneys?

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thoracic splanchnic nn.

What supplies sympathetic innervation to the kidneys?

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T10-L1

Pain fibers (visceral afferents) travel to ________ spinal levels and are sensitive to over -distension of the ureter

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1. lumbar lymph nodes

2. cisterna chyli

Describe the lymphatic flow from the kidneys.

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horseshoe kidney

What kidney pathology:

-lower poles fused or connected by fibrous bridge

-usually ~L3-L5 b/c of IMA root

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ectopic kidney

What kidney pathology:

-kidney located outside of renal fossa

-usually in pelvis

-SHORT ureter (diff from nephroptosis)

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UL renal agenesis

What kidney pathology:

-one kidney congenitally absent

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renal transplantation

What is the preferred treatment for selected cases of chronic renal failure in which the kidney is removed from the donor WITHOUT the adrenal gland and a new kidney is placed into the iliac fossa (provides support and ease of access to anastomosis for grafting to external iliac vessels and bladder)?

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renal v. entrapment ("nutcracker") syndrome

What disorder:

-L renal v. traverses midline to reach IVC crossing under acute angle between SMA and aorta

-traction on SMA can compress L renal v.

-Sx = hematuria or proteinuria, abdominal (L flank) pain, n/v, and L testicular pain in men (L-sided varicocele may occur in rare cases)

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costodiaphragmatic recess

What recess is located posterior to the superior poles of the kidneys?

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iliohypogastric and inguinal nn.

What nerves can become injured because they cross the lower poles of the kidneys?

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renal and uretic calculi

What disorder:

-stones of slats of inorganic/organic acids or of other materials

-may pass from kidney into renal pelvis then into ureter

-ureteric may cause over-distension of the tube --> severe intermittent pain ("ureteric colic") w/ peristalsis as moved

-partial or complete obstruction of urinary flow

-level = level of referred pain in lumbar/inguinal regions (T11-L2)

-pain passes inferioanteriorly from loin to groin

-pain accompanied by digestive upset and generalized sympathetic response that can mask specific Sx

-hydronephrosis can also occur if blood supply to ureter disturbed

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ureters

What are muscular tubes coursing from the renal pelvis to the urinary bladder, located proximal to the retroperitoneal abdomen and distal to the subperitoneal pelvis?

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ureter

What function to propel urine to the bladder from the kidney?

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intrinsic pacemakers

What regulate peristalsis within the ureter?

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1. ureteropelvic junction

2. crossing iliac vessels/pelvic brim

3. ureterovesicle junction

What are the 3 anatomic constrictions of the ureter (common sites for stones to lodge)?

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-anterior part of psoas mm.

-close to gonadal vessels

-same sagittal plane as tips of lumbar transverse processes

Describe the relations of the ureter in the abdomen.

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ductus deferens

The ureter crosses inferior to the __________ in males

Hint: on posterior portion of the bladder

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uterine a.

The ureter crosses inferior to the __________ in females

Hint: "water under the bridge", possible injury during hysterectomy

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ureter

What runs with the ovarian a. at the pelvic brim in females?

Hint: possible injury during ophorectomy

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renal aa., gonadal aa., abdominal aorta, common iliac aa.

What supplies blood to the ureter in the abdomen?

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renal and gonadal vv.

What drains the ureter in the abdomen?

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internal iliac aa. and their branches

What supplies blood to the ureter in the pelvis?

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internal iliac vv.

What drains the ureter in the pelvis?

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renal, abdominal aortic, and superior hypogastric plexusees

What innervates the ureters?

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T11-L2

What spinal levels does pain from the ureters travel to?

Hint: dermatomes overlying loin + groin, sensitive to overdistension

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back, flank, or groin

Where is pain referred to when pts have a ureteral stone?

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1. Depends on specific level:

-proximal --> lumbar nodes

-mid --> common iliac nodes

-distal --> internal and external iliac nodes

2. then all to cisterna chyli

Describe the lymphatic drainage of the ureter.

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bifid ureter

What disorder:

-2 proximal ureters on same side that converge before the bladder

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duplicated ureter

What disorder:

-2 ureters on same side remaining separate the entire way to the bladder

-upper pole prone to obstruction

-lower pole prone to reflux

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retrocaval ureter

What disorder:

-R ureter courses posterior to IVC then descends along its medial and anterior aspect

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subperitoneal

The bladder is a(n) __________ organ, stores urine prior to micturition, and is made up of the apex, body, fundus, and neck

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trigone

What is a triangular area between the ureteric orifices and the internal urethra orifice formed by the incorporation of mesonephrix ducts into the bladder wall?

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ureteric orifices

What are openings of the ureters that is encircled by detrusor mm. which acts as a sphincter?

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hydronephrosis

occlusion of the ureteric orifices leads to ___________

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intramural part

What part of the distal ureters courses obliquely to the ureteric orifice (through wall that acts as a one-way valve)?

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intermediate mesoderm

What does the urinary system develop from?

Hint: during folding, it moves ventrally and forms the urogenital ridge

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urogenital ridge

What part of the intermediate mesoderm is a longitudinal elevation of mesoderm on either side of the dorsal aorta + forms the nephrogenic cord?

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pronephros

What set of kidneys during development:

-regresses, non-functional

-first kidney to form (early week 4)

-tubes are rudimentary and non-functional around the cervical region

-degenerates late week 4

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mesonephros

What set of kidneys during development:

-functional in embryo

-does NOT give rise to adult kidney

-second kidney to form (late week 4)

-functions starting week 5

-regresses week 9/10

-glomeruli, mesonephric tubules, mesonephric duct (10-50 glomeruli per kidney)

-after it regresses, some components will be incorporated into structures of reproductive system

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metanephros

What set of kidneys during development:

-functional in embryo

-gives rise to adult kidney

-develops from the outgrowth of the mesonephric duct to the ureteric bud

-condensation of mesoderm within nephrogenic cord (metanephric mesoderm)

-begins to form week 5, functional in fetus ~week 10

-fetal kidney is divided into lobes (adult kidney has a smooth contour)

-2 parts: collecting + filtration system

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week 4

During what week of development:

-urogenital ridge differentiates into nephrogenic cord (urinary system) and gonadal ridge

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week 5

During what week of development:

-medial portion of undifferentiated cells will form gonadal ridge (forms gonads)

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pronephric duct

what runs from the pronephros to the cloaca and becomes the mesonephric duct?

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collecting

The (collecting/filtration) system of the metanephros:

-ureteric bud widens to form renal pelvis

-1st gen = major calyces

-buds continues to subdivide until 12 or more generation of tubules formed

-collecting tubules will eventualyl fuse to metanephric tubules

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filtration

The (collecting/filtration) system of the metanephros:

Week 8:

-metanephric diverticulum induces formation of small nephrogenic vesicles in nephrogenic cord from metanephric blastema

-nephrogenic vesicles --> metanephric tubules

-metanephric tubules fuse w/ arached collecting ducts

Week 10-18:

-glomeruli increase gradually

Week 18-36:

-glomeuli increase rapidly

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near cloaca (S1/S2)

Around week 6, where are the kidneys located?

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mid abdomen (T12-L3)

around week 9, where are the kidneys located?

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bladder

What structure (in the adult) is developed from the allantois and cloaca?

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bladder

What structure:

-adult structure formed from allantois and cloaca

-urorectal septum separates cloaca into urogenital sinus + rectum

Three Parts:

1. Vesical part -- continuous w/ allantois, becomes adult bladder

2. pelvic part -- entire urethra in FEMALES, Prostatic urethra in MALES

3. phallic part -- vestibule in females and majority of penile urethra in males

-allantois --> urachus

-Trigone: as bladder enlarges, distal portion of ureters & mesonephric ducts gets pulled into bladder wall

Layers:

-epithelial lining = endoderm from urogenital sinus

-muscular layers = adjacent mesenchyme (mesoderm, splanchnic)

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adult bladder

What does the vesical part of the embryonic bladder become?

Hint: continuous w/ allantois