4.4 Flashcards
Label
Kidneys: lateral to T12-L3
Suprarenal (adrenal) glands: sit atop kidneys
- part of endocrine system, not urinary
Ureters: descend from renal pelvis to pelvic cavity
Bladder: hollow, muscular sac in pelvis
Kidneys
Retroperitoneal
Inferior to diaphragm
Against quadratus lumborum
Surrounded by fat
Renal architecture
- renal capsule surrounds and protects kidneys
- renal artery and vein
- renal pelvis: urin leaves kidney
Function: filter blood from urine
Suprarenal glands
Within the fat surrounding the kidney
Hormone secreting gland
Ureters
Retroperitoneal
Muscular tubes
Enter posteromedial aspect of bladder by tunneling through bladder wall
Obstructions are common
- stones tend to lodge
Bladder
Infraperitoneal
Located in pelvis when empty and can reach umbilicus when full
Reservoir for urine
Structure
- hollow
- detrusor muscle: muscle of bladder wall
- ureteric orifice: where ureters empty into
- internal urethral sphincter
Pelvic cavity
Greater pelvis = false pelvis
- plane of pelvic inlet
* pubic crest, sacral promontory, iliopectineal line, and hip bones
Lesser pelvis = true pelvis
- pelvic diaphragm
Boundaries of pelvic cavity
Pelvic cavity is continuous with abdominal cavity
- angled posteroinferiorly
* superior: pelvic inlet
* inferior: pelvic outlet (pubic symphysis, inferior pubic ramus, ischial tuberosity)
* anterior: symphyseal surface - symphysis of pubic bones
* posterior: sacrum
Perineum is inferior to pelvic cavity
Contents of pelvic cavty
False pelvis:
- loops of intestines
True pelvis:
- terminal ureters
- urinary bladder
- rectum
- reproductive organs
Pelvic cavity gender differences
Peritoneum
Parietal peritoneum reflects over superior surface of pelvic viscera.
Intraperitoneal organs:
- ovaries
- uterine tubes
Infraperitoneal organs:
- bladder
- inferior rectum
- uterus
- vagina
Relationship between peritoneum and pain perception
The peritoneum that contacts organs sends pain afferent nerves to upper lumbar/lower thoracic spinal cord
- GI tract to sigmoid colon
- Ovaries and oviducts
- Uterine fundus
- Ureters
- Upper bladder
- Testes
Infraperitoneal organs with NO CONTACT with peritoneum send pain afferents to pelvic nerves at S2-S4
- Cervix
- Vagina
- Lower bladder
- Male reproductive organs (except testes)
Exceptions: in contact with peritoneum but below pain line
- lower sigmoid
- rectum
Where does the anterior abdominal wall end?
inguinal ligament
Inguinal ligament
Inferior, rolled-under border of external oblique aponeurosis
Extends from ASIS to pubic tubercle
Retinaculum for hip muscles
Inguinal canal
Oblique passageway through anterior abdominal wall
Male: transmits spermatic cord
Female: transmits round ligament (of uterus)
All: transmits ilioinguinal nerve, blood, and lymph vessels
Inguinal region
Beginning: deep inguinal ring»_space; opening in transversalis fascia
- located lateral to inferior epigastric vessels
Ending: superficial inguinal ring»_space; opening in external oblique aponeurosis
- superomedial leg of the split is in medial crus and inferolateral leg is the lateral crus
* they are connected by intercrural fibers which prevent the splitting of the superficial ring
Support for inguinal canal
3 musculoaponeurotic arches
- contraction of abdominal muscles = contraction of arcade
- contraction narrows inguinal canal
- some protection from herniation
Subinguinal space
Below inguinal canal
Contains femoral artery, vein, and nerve; lymphatics; and hip flexor muscles
Femoral hernias are more common in women
Inguinal hernias
Protrusion of parietal peritoneum and viscera through a normal or abnormal opening of abdominal cavity
2 types
- indirect (congenital) inguinal hernia: failure to close deep inguinal ring following testicular descent
* lateral to inferior epigastric vessels
* protrusion through deep inguinal ring
- direct (acquired) inguinal hernia: occurs in weak point of abdominal wall
- medial to inferior epigastric vessels
- protrusion through superficial inguinal ring
Sports hernia - athletic pubalgia
Not a hernia
Symptoms:
- lower abdominal or anterior pelvic (groin) pain
Mechanism:
- acute muscle strain or chronic microtrauma from overuse
- involves muscles attaching to anterior pelvis near inguinal canal and superficial ring
Muscles involved:
- rectus abdominis
- obliques
Parietal pelvic muscles
Act on lower extremity
- piriformis
- obturator internus
Both abduct and externally rotate
Pelvic diaphragm
The pelvic diaphragm forms the pelvic floor.
- coccygeus
- levator ani
* has 3 parts that are named for their attachments
> iliococcygeus
> pubococcygeus
> puborectalis
Apertures
- anterior hiatus: urethra, vagina
- posterior hiatus: rectum
What forms the rectal sling?
Pubococcygeus and puborectalis
Clinical significance of rectum/anus
When the rectum has to be removed (cancer), the retrovesical septum allows its removal without damaging prostate and urethra.
If rectal cancer involves posterior rectal wall, sacral plexus will be involved.
Pathological thickening of ureters can be palpated through rectal wall.
Enlargement of seminal vesicles (due to pus accumulation) can be palpated.
Enlarged prostate gland (due to BPH or CA) can be palpated through rectal wall
Pectinate (dentate) line
Irregular line marking transition from visceral to parietal epithelium
- true GI mucosa above line, skin below
- autonomic innervation above line, somatic below
