4.4

Question 1

Label

Answer 1

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

Question 2

Kidneys

Answer 2

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

Question 3

Suprarenal glands

Answer 3

Within the fat surrounding the kidney
Hormone secreting gland

Question 4

Ureters

Answer 4

Retroperitoneal
Muscular tubes
Enter posteromedial aspect of bladder by tunneling through bladder wall
Obstructions are common
- stones tend to lodge

Question 5

Bladder

Answer 5

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

Question 6

Pelvic cavity

Answer 6

Greater pelvis = false pelvis
- plane of pelvic inlet
* pubic crest, sacral promontory, iliopectineal line, and hip bones
Lesser pelvis = true pelvis
- pelvic diaphragm

Question 7

Boundaries of pelvic cavity

Answer 7

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

Question 8

Contents of pelvic cavty

Answer 8

False pelvis:
- loops of intestines

True pelvis:
- terminal ureters
- urinary bladder
- rectum
- reproductive organs

Question 9

Pelvic cavity gender differences

Answer 9

Question 10

Peritoneum

Answer 10

Parietal peritoneum reflects over superior surface of pelvic viscera.
Intraperitoneal organs:
- ovaries
- uterine tubes
Infraperitoneal organs:
- bladder
- inferior rectum
- uterus
- vagina

Question 11

Relationship between peritoneum and pain perception

Answer 11

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

Question 12

Where does the anterior abdominal wall end?

Answer 12

inguinal ligament

Question 13

Inguinal ligament

Answer 13

Inferior, rolled-under border of external oblique aponeurosis
Extends from ASIS to pubic tubercle
Retinaculum for hip muscles

Question 14

Inguinal canal

Answer 14

Oblique passageway through anterior abdominal wall
Male: transmits spermatic cord
Female: transmits round ligament (of uterus)
All: transmits ilioinguinal nerve, blood, and lymph vessels

Question 15

Inguinal region

Answer 15

Beginning: deep inguinal ring&raquo_space; opening in transversalis fascia
- located lateral to inferior epigastric vessels
Ending: superficial inguinal ring&raquo_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

Question 16

Support for inguinal canal

Answer 16

3 musculoaponeurotic arches
- contraction of abdominal muscles = contraction of arcade
- contraction narrows inguinal canal
- some protection from herniation

Question 17

Subinguinal space

Answer 17

Below inguinal canal
Contains femoral artery, vein, and nerve; lymphatics; and hip flexor muscles

Femoral hernias are more common in women

Question 18

Inguinal hernias

Answer 18

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

Question 19

Sports hernia - athletic pubalgia

Answer 19

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

Question 20

Parietal pelvic muscles

Answer 20

Act on lower extremity
- piriformis
- obturator internus

Both abduct and externally rotate

Question 21

Pelvic diaphragm

Answer 21

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

Question 22

What forms the rectal sling?

Answer 22

Pubococcygeus and puborectalis

Question 23

Clinical significance of rectum/anus

Answer 23

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

Question 24

Pectinate (dentate) line

Answer 24

Irregular line marking transition from visceral to parietal epithelium
- true GI mucosa above line, skin below
- autonomic innervation above line, somatic below

Question 25

Sphincters of rectum/anus

Answer 25

1. Internal: thickening of circular layer of smooth muscle of GI tract; involuntary
2. External: blends with levator ani; voluntary

Hemorrhoidal plexus: normal collection of vessels in anal canal

Question 26

Arteries of rectum/anus

Answer 26

Branches of internal mammary artery and superior rectal artery
Upper rectum supplied by internal mammary artery and superior rectal artery
Lower rectum and anal canal supplied by middle and inferior branches of internal iliac artery
- inferior rectal branches from internal pudendal artery

Question 27

Veins of rectum/anus

Answer 27

Rectal venous plexus
Superior –> portal vein
Middle and inferior –> systemic vein

Question 28

Hemorrhoids

Answer 28

Swollen, enlarged veins of anal canal