11/15 Pelvic Viscera Flashcards
What does the pelvic viscera include?
Distal parts of the urinary system
Distal parts of the gastrointestinal tract
Reproductive system
What are the urinary system pelvic viscera?
Ureters, bladder, urethra
What do the ureters connect?
The kidneys to the urinary bladder
Are the ureters intraperitoneal or retroperitoneal?
Retroperitoneal in abdomen
Where are the ureters oriented in comparison to other structures (arteries, pelvis)?
At the bifurcation of the common iliac artery, pass over the pelvic brim, entering the lesser pelvis
After the ureters enter the lesser pelvis, how do they run?
along lateral wall, between the parietal pelvic peritoneum and internal iliac arteries
How do the ureters pass through the urinary bladder? What is contained in the ureters distally?
Pass obliquely through the urinary bladder
Connection is “flap valve”- one way valve
How does the pressure of the bladder affect the tissues?
The internal pressure from the filling of the bladder causes the intramural passage to collapse
How do the contractions of bladder musculature help?
act like a sphincter preventing the reflux of urine into the ureters when the bladder contracts
How does urine pass down the ureters?
via peristaltic contractions
How does the path of the female ureters differ from the males?
Female: Ureter passes medial to the origin of the uterine artery. At the ischial spine the ureter passes inferior to the uterine artery
Male: Ductus deferens passes between the ureter and peritoneum
What makes up the arterial supply of the ureters?
Ureteric branches are highly variable (common iliac a., internal iliac a., ovarian a.)
Ureteric branches form an anastomosis along the ureter
Uterine a./ inferior vesical a, supply terminal parts of the ureter
What is the venous supply of the ureters in comparison to the arterial supply?
Venous drainage parallels the arterial supply, draining to corresponding venous names
What is the urinary bladder and what is it like/made of?
Reservoir for urine
Hollow structure with muscular walls (detrusor muscle) and distensible.
What do the apex, fundus, body, and neck of the urinary bladder correspond with?
Apex-points toward superior edge of pubic symphysis.
Fundus- convex posterior wall
Body-area between the apex and the fundus
Neck- where fundus and inferolateral surfaces meet
What is the trigone of the urinary bladder?
area bounded by the ureteric orifices and internal urethral orifice
Where is the empty urinary bladder found in adults and infants/children?
Adults: lesser pelvis
Infants/Children: almost entirely in the abdomen, even when empty
What is the relationship between the urinary bladder and peritoneum? Where does the urinary bladder rest?
Inferior to the peritoneum, rests on pubic symphysis and prostate or vagina
What anchors the neck of the bladder?
lateral ligaments of the bladder and the tendinous arch of the pelvic fascia
What are the anterior urinary bladder supports in the male and female?
Male: Puboprostatic ligament
Female: Pubovesical ligament
What makes up the arterial supply of the urinary bladder?
Superior vesical a. - Anterosuperior part of bladder
Male: Inferior vesical a. - Fundus and neck of bladder
Female: Vaginal a. - Postero-inferior bladder
Obturator and inferior gluteal a.
What makes up the venous drainage of the urinary bladder?
Form a complicated plexus on its inferolateral surface and pass backwards in the lateral ligaments of the bladder to end in the internal iliac veins
Is this male or female? What are the structures?
Male
A: obturator artery
B: superior vesical arteries
C: inferior gluteal artery
D: inferior vesical artery* (male structure)
Is this male or female? What are the structures?
Female
A: obturator artery
B: superior vesical arteries
C: inferior gluteal artery
D: vaginal artery* (female structure)
What are the functions of the proximal male urethra?
Provides an exit for urine and semen
What are the divisions for the proximal male urethra?
Intramural- pre-prostatic
Prostatic
Membranous
Spongy
What are the sphincters for the proximal male urethra?
Internal urethral sphincter
External urethral sphincter
What are the divisions (left) and sphincters (right) of the proximal male urethra?
A: intramural
B: prostatic
C: membranous
D: spongy
E: internal urethral sphincter
F: external urethral sphincter
What is the female urethra like in comparison to the male?
Shorter (1/5 of the length)
What is the musculature of the female urethra?
musculature surrounding the internal urethral orifice of the female bladder has incomplete fibers that form an internal urethra sphincter (not able to see grossly)
Where is the external urethra sphincter in the female?
In the vestibule of the vagina
What is the rectum to the digestive tract?
Rectum is the pelvic portion of the digestive tract
Where does the rectum end?
Ends antero-inferior to the tip of coccyx
What artery supplies the anterosuperior part of the bladder?
Superior vesical artery
What artery supplies the fundus and neck of bladder in the male?
Inferior vesical artery
What supplies the postero-inferior bladder in the female?
Vaginal artery
What does the anorectal flexure do as part of the rectum? What muscle?
mechanism for fecal continence, maintained by tonus of puborectalis muscle
What does the ampulla of the rectum do?
Receives and holds fecal mass until expulsion
Ampulla needs to relax to accommodate the initial and subsequent arrival of fecal material.
What is the arterial supply of the rectum?
Superior rectal artery, middle rectal artery, inferior rectal artery
What is the arterial supply of the proximal rectum?
Superior rectal artery
What is the arterial supply of the middle and inferior rectum?
Middle rectal artery
What is the arterial supply of the anorectal junction?
Inferior rectal artery
What does the male pelvic viscera consist of?
Testes*
Epididymis*
Ductus deferens
Seminal glands
Ejaculatory ducts
Prostate
Bulbo-urethral glands
Where does the ductus deferens begin, where does it travel, and where does it end?
Begins at the epididymis
Passes through the inguinal canal, enters the pelvis.
Ends by joining the duct of the seminal gland to form the ejaculatory duct.
Where are the seminal glands? In comparison to prostate?
Between the bladder and rectum.
Oblique and superior to prostate gland
What do the seminal glands do?
Secrete alkaline fluid with fructose and coagulating agent that mixes with sperm
Largest accessory gland of the male reproductive system
Prostate
What is the size of the prostate and what does it surround?
Size of a walnut
surrounds the prostatic urethra.
Where is the prostate?
Just inferior to the neck of the bladder, a posterior surface that is related to the ampulla of the rectum, and inferolateral related to levator ani.
What are the bulbourethral glands shaped like?
Two pea-size glands
Where are the bulbourethral glands embedded?
Embedded within the external urethral
sphincter
Where are the bulbourethral glands open?
Open in the proximal part of spongy urethra
What do the bulbourethral glands have?
Mucus-like secretions
Benign hypertrophy of the prostate is common after?
Middle age
Hypertrophy of the prostate englargement projects into?
The urinary bladder
What are some issues associated with an enlarged prostate?
Weak or slow urinary stream
Feeling of incomplete bladder emptying
Difficulty starting urination
Urgency to urinate
Increased frequency at night
How is hypertrophy of the prostate diagnosed?
Digital rectal examination
How can you fix hypertrophy of the prostate?
TURP, transurethral resection of prostate
What are the female pelvic viscera?
Ovaries, uterine tubes, uterus (round ligament of uterus), vagina (fornices)
What is the size and shape of the ovaries?
About the size and shape of an almond.
What do the ovaries contain?
Site of oocyte development
What are the ovaries suspended by?
Mesovarium
What do neurovascular structures pass to and from the ovary via?
The suspensory ligament of the ovary
What tethers the ovary to the uterus?
The ligament of the ovary
Where do the uterine tubes lie?
In the mesosalpinx
Where do the uterine tubes extend posterolaterally to and arch anterosuperiorly to?
extend posterolaterally to the lateral pelvic walls and arch anterosuperior to the ovaries
What are the 4 divisible parts of the uterine tubes?
Infundibulum, ampulla, isthmus, uterine part (intramural)
What is the pathway of an ovulated oocyte?
Expelled from the ovary
Free floats in the peritoneal cavity
Captured by fimbriae of uterine tube
Cilia propel oocyte to infundibulum, then ampulla of uterine tube
If sperm are present, where does fertilization typically occur?
In the ampulla
What is the uterus like? Walls, shape, density
Thick-walled, pear-shaped, hollow muscular organ
What does the uterus do during childbirth?
Provides power for expulsion
What are the two divisible main parts of the uterus?
Body of the uterus, cervix
What does the body of the uterus encompass, what separates from cervix?
forms the superior 2/3 and includes the fundus.
Isthmus of the uterus separates the body from the cervix
What is the cervix shaped like and what does it encompass?
cylindrical, narrow inferior 1/3 of the uterus
What is the normal position of the uterus?
Anteverted and antiflexed
What does the anteverted position of the uterus mean?
Tipped anterosuperiorly relative to vaginal axis
What does the antiflexed position of the uterus mean?
Flexed anteriorly relative to cervix
What is used to determine size and disposition of the uterus?
Bimanual palpation
What is the vagina and what does it encompass?
Distensible musculomembranous tube
Extends from the vaginal part of cervix to vaginal orifice
What are the functions of the vagina?
Canal for menstrual fluid
Inferior part of birth canal
Receives the penis and ejaculate during sexual intercourse
What is the broad ligament of the uterus and where is it?
Double layer of peritoneum that extends from the sides of the uterus to the lateral walls of the pelvis
What are the parts of the broad ligament of the uterus?
Mesovarium, mesosalpinx, mesometrium
What are the ligaments of the female pelvic viscera?
Broad ligament, ligament of the ovary, round ligament of the uterus, suspensory ligament of the ovary, cardinal ligament, uterosacral ligaments
What does the ligament of the ovary attach?
Attaches ovary to the uterus
What does the round ligament of the uterus attach?
Attaches antero-inferiorly to uterotubal junction
What does the suspensory ligament of the ovary carry?
neurovascular structures
What does the cardinal ligament attach?
From lateral parts of fornix to lateral walls of pelvis
Uterine artery travels in this
What does the uterosacral ligaments attach?
From side of cervix to sacrum
What does the ovarian artery originate from?
The aorta
What do the uterine and vaginal arteries arise from?
Internal iliac artery
How do the arteries to the female viscera travel?
Run between layers of the broad ligament
What is the etiology of cystocele, urethrocele, and urinary incontinence?
Damage to the pelvic floor during childbirth
Laceration of perineal muscles
Lesions of nerves supplying them
Rupture of fascial support of the vagina
What happens to the bladder during cystocele, urethrocele, and urinary incontinence?
Bladder collapses onto the anterior vaginal wall
What is cystocele?
Herniation of urinary bladder
What is urethrocele?
Alterations in the placement, direction, or angle of the urethra
