L2 Anatomy of Ureter (P2 Hard)

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Questions and Answers

What is the approximate length of the ureter?

  • 15-20 cm
  • 25-30 cm (correct)
  • 30-35 cm
  • 20-25 cm

Which vessel is a medial relation of the left ureter?

  • Renal artery
  • Inferior mesenteric vein (correct)
  • Common iliac artery
  • Inferior vena cava

Which artery does the ureter cross in the pelvic part for both sexes?

  • Popliteal artery
  • External iliac artery (correct)
  • Brachial artery
  • Femoral artery

What structure does the ureter cross in males but not in females?

<p>Vas deferens (C)</p> Signup and view all the answers

Which of the following best describes the abdominal part of the ureter?

<p>It has different relations for right and left ureters. (A)</p> Signup and view all the answers

What role do the ovarian and uterine blood vessels play concerning the female ureter?

<p>Their relation is crucial during oophorectomy and hysterectomy. (A)</p> Signup and view all the answers

Which organs or structures are located in proximity to the right ureter?

<p>Duodenum and right mesenteric structures (C)</p> Signup and view all the answers

Which of the following lymphatic drainage options is true regarding the ureter?

<p>It has a complex drainage system involving multiple node groups. (A)</p> Signup and view all the answers

What is the main significance of the arterial supply of the ureter?

<p>It supports the structural integrity of the ureter. (A)</p> Signup and view all the answers

What anatomical feature helps prevent reflux of urine into the ureter during bladder fullness?

<p>The intramural part of the ureters (B)</p> Signup and view all the answers

Which area of the ureter is considered the narrowest part?

<p>Within the wall of the urinary bladder (A)</p> Signup and view all the answers

During which surgical procedure is the ureter most commonly at risk of accidental ligation?

<p>Oophorectomy or hysterectomy (D)</p> Signup and view all the answers

Which arteries primarily supply the abdominal part of the ureter?

<p>Medial to the ureter arteries (B)</p> Signup and view all the answers

Which part of the ureters receives its blood supply from the lateral aspect?

<p>Pelvic part (D)</p> Signup and view all the answers

What does the anatomical location of ureteric constrictions mainly represent?

<p>Common sites for renal stones impaction (C)</p> Signup and view all the answers

Which nerves contribute to the sympathetic innervation of the ureters?

<p>T12, L1, and L2 segments (C)</p> Signup and view all the answers

Where do the lymph vessels from the upper abdominal part of the ureters typically drain?

<p>To the renal collecting vessels (B)</p> Signup and view all the answers

Which structure does the ureter cross at the brim of the lesser pelvis?

<p>Common iliac artery bifurcation (C)</p> Signup and view all the answers

What allows the ureter to be safely transected at any level during surgery?

<p>Presence of longitudinal anastomosis (D)</p> Signup and view all the answers

Flashcards

What is the ureter?

The ureter is a muscular tube that carries urine from the kidneys to the bladder.

How long is the ureter and what is its structure?

The ureter is about 25-30 cm long and has a thick wall and narrow lumen.

What are the different parts of the ureter?

The ureter has three parts: abdominal, pelvic, and intra-mural.

Describe the location of the abdominal part of the ureter.

The abdominal part of the ureter sits near the psoas muscles, the transverse processes of L2-L5, the genito-femoral nerve, and the bifurcation of the common iliac artery.

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What are the differences between the right and left ureters in the abdominal part?

The right ureter is different from the left because it's closer to the duodenum, right colic vessels, ileocolic vessels, gonadal vessels, mesentery, and small intestine.

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Where does the pelvic part of the ureter pass?

The pelvic part of the ureter crosses the external iliac artery and vein, obturator nerve, artery, and vein. It's also near the vas deferens in males and the lateral fornix of the vagina in females.

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How does the ureter get blood?

The ureter has its own blood supply coming from the renal, gonadal, and common iliac arteries.

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Where does the lymph from the ureter go?

The lymphatic drainage of the ureter follows the path of the blood supply. It drains into the lumbar and common iliac nodes.

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What kind of nerves innervate the ureter?

The renal plexus is a network of nerves that supplies the ureter. It carries both sympathetic and parasympathetic fibers.

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What is the role of the renal nerve plexus?

The renal nerve plexus regulates the flow of urine and the smooth muscle contractions within the ureter. It's important for maintaining the normal function of the urinary system.

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Where is the narrowest part of the ureter located?

The narrowest part of the ureter is located within the wall of the urinary bladder during its passage.

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How does the intramural ureter prevent reflux?

The ureter runs obliquely through the bladder wall, preventing urine backflow.

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What are the three constrictions of the ureter?

The ureter's journey from the kidney to the bladder has 3 points of narrowing, increasing the risk of stone impaction.

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Where is the first constriction of the ureter?

The ureter's junction with the renal pelvis, at the tip of the transverse process of L2.

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Where is the second constriction of the ureter?

The point where the ureter crosses the bifurcation of the common iliac artery.

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Where is the third constriction of the ureter?

The ureter's intramural part, where it runs within the wall of the bladder.

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How is the ureter's blood supply organized?

The ureter's blood supply varies throughout its length, but good longitudinal anastomosis allows for safe surgical transection.

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Where does the upper abdominal ureter drain its lymph?

The upper portion of the ureter drains to the renal collecting vessels or to the lateral aortic nodes.

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Where does the lower portion of the ureter drain its lymph?

The lower abdominal portion of the ureter drains to the common iliac nodes.

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Where does the pelvic portion of the ureter drain its lymph?

The pelvic portion of the ureter drains to the common, external, or internal iliac nodes.

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Study Notes

Quranic Verse

  • A verse from Surah Al-Dhariyat (21) is quoted: "And in the earth are signs for those who have firm belief. And in yourselves, then why do you not see?" (translation approximate).

Renal Module

  • Course code: IMP/07/20318
  • Phase I
  • Second year/semester 3
  • Course duration: 5 weeks

Anatomy of the Ureter

  • The ureters are two muscular tubes.
  • Peristaltic contractions convey urine from kidneys to the urinary bladder.
  • Length: 25-30cm
  • Thickness: thick-walled & narrow lumen
  • Diameter: 3mm

Learning Objectives

  • Describe ureter anatomy (shape, length, and parts).
  • State normal ureter locations and constrictions.
  • Differentiate between right and left ureter relations.
  • List ureter arterial supply and significance.
  • Describe ureter lymphatic drainage.
  • Describe renal nerve plexus and innervations.

Ureter Course

  • Each ureter descends behind the peritoneum, opposite transverse processes of L2,3,4,5, in front of psoas major muscle.
  • Enters pelvis by crossing the bifurcation of the common iliac artery at the sacroiliac joint.
  • Passes downward and backward along the internal iliac artery.
  • At the level of the ischial spine, it curves medially to open into the postero-superior angle of the urinary bladder.

Ureter Parts

  • Abdominal part
  • Pelvic part
  • Intramural part

Ureter Constrictions

  • Three normal constrictions during the ureter's course:
    • At the junction with the renal pelvis (L2).
    • At the brim of the lesser pelvis (bifurcation of the common iliac artery at the sacroiliac joint).
    • Within the wall of the urinary bladder (ischial spine)

Ureter Relations

  • Medial and lateral relations of ureter are mentioned.
  • Importance of relation between the ureter, psoas major muscle, and vas deferens/uterine artery.
  • Ureter's relation to the pelvic brim (pelvic inlet).
  • In females, the ureter passes above the lateral fornix of the vagina.

Ureter Blood Supply

  • Abdominal part: supplied by medial arteries (renal, gonadal, branches of abdominal aorta).
  • Pelvic Part: supplied by lateral arteries (common iliac, internal iliac, vesical, uterine arteries).
  • Venous drainage generally follows arterial supply.

Ureter Lymphatic Drainage

  • Upper abdominal ureter: collects with renal vessels and passes directly to lateral aortic nodes near the gonadal artery.
  • Lower abdominal ureter:drains to the common iliac nodes.
  • Pelvic ureter: drains to common, external, or internal iliac nodes.

Ureter Nerve Supply

  • Supplied via renal, testicular/ovarian, and hypogastric plexuses.
  • Sympathetic plexus: nerves in T12, L1,2.
  • Parasympathetic plexus: nerves in S2,3,4.

Additional Notes

  • Location of normal ureter constrictions and their possible clinical significance (e.g., renal stone impaction) are mentioned.
  • The importance of the ureter's anatomy to proper organ removal (e.g., oophorectomy, hysterectomy) in females is detailed.

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