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Anatomy Exam 3 (April 29th) (Semester 2) > Anat- GUT Urinary Tract and Pelvis > Flashcards

Anat- GUT Urinary Tract and Pelvis Flashcards

1
Q

Renal arteries at what level?

A

L1-L2

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2
Q

Aortic aneurysms can involve the ______ arteries

A

renal

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3
Q

Note “________” in the ureters, stones tend to hangup at these levels and cause ______

A
  • “constrictions”

- hematuria

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4
Q

Visceral afferents= _____ fibers, return to ___ to ____ spinal cord levels

A

pain fibers, T12-L2

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5
Q

Pain is referred to cutaneous areas supplied by ____ to ____— posterior and lateral
abdominal wall below ribs and above
iliac crest into scrotum and labia majora
and proximal anterior thigh

A

T12-L2

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6
Q

First constriction =

A

ureteropelvic junction (right where ureters exit kidney)

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7
Q

second constriction=

A

pelvic inlet** (right where common iliac arteries branch into external and internal iliac arteries)

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8
Q

third constriction=

A

entrance to bladder

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9
Q

Psoas Major m – innervated by _______

-Joins _____ muscle at _____

A

L1-L3

-joins iliacus at L2-L4, femoral nerve, to become iliopsoas muscle

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10
Q

Quadratus lumborum innervated by _____

A

T12-L4

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11
Q

Psoas abscess can occur with what Sx?

A

pain and psoas spasm

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12
Q

Kidneys are retroperitoneal and surrounded by ______

A

renal fascia

Note:
Renal Fascia

Perinephric (Perirenal) Fat

Psoas M

IVC and Aorta

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13
Q

Kidneys= swimming pool shaped organ in the retroperitoneum, supine, approx. _____ to ___ vertebrae, Ribs ____ to ___, Right kidney is LOWER than left

A

**approximately T12 to L3 vertebrae, Ribs 11-12 to L3-4

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14
Q

On Right, kidney is close to:

A

descending duodenum,
posterior liver, hepatic flexure
of colon

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15
Q

On left, kidney is close to :

A

the Stomach, Spleen, Pancreas, and Splenic Flexure

Medially are Psoas MM
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16
Q

The Bony Pelvis:

Superior view: Pelvic inlet: note True (lesser) pelvis and False (____) pelvis are separated by the _______

A

False (greater)

-separated by pelvic inlet

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17
Q

Normally the pelvic inlet is tilted ____ degrees forward and the Ischiopubic arch is horizontal

A

50-60

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18
Q

Pelvic outlet: Borders?

A
  • ischiopubic ramus
  • Sacrotuberous ligament**
  • coccyx
  • ischial tuberosity
  • pubic symphysis
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19
Q

Dermatomes: sacral segments=

A

S3 to S5

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20
Q

Skeletal mm in Perineum and Pelvic Floor including urethral and anal sphincters= S__ to S___

A

S2-S4

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21
Q

Much of the somatic motor and sensory innervation is via the ______ Nerve (S__ to S__) – the major nerve of the Perineum

A

**pudendal nerve - S2-S4

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22
Q

Where is a pudendal nerve block given?

A

pudendal nerve block–> aims to block the nerve as it enters the **lesser sciatic foramen, 1 cm inferior and medial relative to the attachment of the sacrospinous ligament to the ischial spine (S2-S4)

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23
Q

Inferior Hypogastric (Pelvic) Plexus= PSNS, SNS, and ______ Afferents

A

visceral

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24
Q

arterial supply to the pelvis?

A

basically from internal iliac artery,** anterior and posterior branches (iliolumbar a, lateral sacral arteries, superior gluteal a)

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25
DEEP pelvic structures drain into the:
internal and external iliac chains
26
DEEP perineal structures drain into the _____
internal iliac chain
27
Some Superficial Perineal structures (Penis and Scrotum, Clitoris and Labia majora) drain into the:
Superficial Inguinal nodes
28
Other Superficial Perineal structures (Glans penis and Glans clitoris, Labia minora, and inferior end of Vagina) drain into the:
Deep Inguinal nodes and the External Iliac Chain
29
The Ovaries and related Uterine structures and the Testes (the lymphatics accompany the gonadal arteries) drain into the:
Lateral and Pre-Aortic nodes
30
Gluteal nodes drain into the:
Internal Iliac chain
31
Drainage from the lower extremities is into the:
Superficial and Deep Inguinal Nodes
32
Lower abdominal wall, gluteal, and superficial areas of the lower limb drain into the:
Superficial Inguinal Nodes
33
Deep Inguinal Nodes receive drainage from the Femoral lymphatics and ______areas
perineal
34
Lymphatic Drainage: KEY PARTS - deep parts of the Perineum are drained by the: - The superficial Perineum and external genitalia are drained by the:
**Internal Pudendal Chain > Internal Iliac nodes > Aortic nodes **Superficial Inguinal Nodes, the Deep inguinal nodes, into the External Iliac nodes KNOW
35
Extending across the Ischiopubic arch is a thick triangular fascial structure that has transverse muscles within =
Urogenital Diaphragm/Perineal Membrane and Deep Perineal Pouch -Note Location and “perforations”
36
Perineum includes:
-urogenital triangle** (anterior) and anal triangle (posterior) KNOW
37
Perineum: | Note its diamond shape – Innervation is the _____ n and artery is the_____ ______ artery
Pudendal - Internal Pudendal KNOW
38
The perineal membrane is a thick fibrous sheet with a ___ _______ border. The Deep Perineal pouch contains muscles and ______ _______ structures
free posterior -neuro- vascular structures.
39
Pelvic Diaphragm: is composed of_____
Levator Ani - Iliococcygeus muscle - Pubococcygeus muscle - Puborectalis muscle --& Coccygeus muscle
40
The Levator Ani (Levator Sling) arises from the walls of the true pelvis, from the: (list borders)
the posterior pubic bone, from a ligament on the Obturator internus muscle, from the Ischial tuberosity.
41
The Coccygeus arises from the:
Ischial spine and Sacrospinous ligament and inserts on the sacrum and coccyx
42
Levator ani openings (list 2**)
- Urogenital Hiatus | - Anal Aperture
43
Levator Ani is comprised of:
Pubococcygeus muscle Puborectalis muscle – pulls anorectal junction forward to help keep the GI system closed at rectal area (called perineal flexure), helping the anal sphincter muscles. Iliococcygeus muscle-which arises from the ilium and the tendonous arch on the obturator internus muscle
44
The Ischiorectal (ischioanal) fossa is also called the _____
**Deep perineal space-- abscesses can FORM HERE
45
The Levator Ani and Perineal Membranecome together at the ______
**Perineal body Note: perineal body and it's relation to episiotomy
46
Internal Anal Sphincter: - what kind of muscle? - controlled by?
smooth muscle – Autonomic [SNS(contracts) and PSNS (relaxes)] NS
47
External Anal Sphincter: - what kind of muscle? - controlled by?
**skeletal muscle - has three components – innervated by the Inferior rectal branches of the Pudendal nerve – a somatic nerve
48
Note: transition zone between rectal mucosa and nonkeratinized squamous epithelium (=Anal _____), then the _______ Line (=true skin)
Pecten | -Anocutaneous
49
rectal aka ________ veins
hemorrhoidal veins
50
Peritoneal folds associated with the Uterus=
Broad Ligament, Mesovarium, Mesosalpinx, Round Ligament
51
Pouch of Douglas= - aka ? - A DEEP POUCH located ______
Rectouterine or Rectovaginal Pouch or Space -**This is a deep pouch posterior to the uterus and anterior to the rectum
52
Supporting Structures of the Ovary: 3 things
**Mesovarium – a fold of peritoneum off of the Broad Ligament **Suspensory Ligament of Ovary – a fold of peritoneum from superiolateral pelvic wall and contains arteries, veins, lymphatics **Ligament of Ovary – continuous with Round Ligament of Uterus. Attached to lower pole of ovary to Uterus
53
Urethral Catheterization: - will be ____ specific** - ____ urethra that is surrounded by erectile tissue of the penis just below the Deep perineal pouch is thin** and angled** and vulnerable to injury**
- gender | - **spongy part of the urethra
54
Prostatic Urethra curves _____
**slightly anterior
55
membranous part of the urethra (in males) is located just after ______
the deep perineal pouch and right before the 2nd bend (when penis is flaccid)
56
Voiding cystourethrogram (VCUG)=
an exam that takes images of the urinary system. The patient's bladder is filled with a liquid called contrast material. Then, images of the bladder and kidneys are taken as the bladder fills and also while the patient urinates (pees). -ie used to dx VUR, determine if there are abnormalities or blockages
57
Prostate: | -majority, about 70% of prostate cancers are in the _______
**peripheral zone
58
What is the 2nd MC zone for prostate CA's to arise (aka 20-30% of prostate cancers arise here)?
**Transitional zone
59
A small % of prostate CA's arise in the _____
central zone
60
The anterior Fibromuscular Stroma (AFS) of the prostate: | -contains glands or aglandular?
**aglandular (NO glands)
61
______ zone of the prostate directly surrounds the urethra
- periurethral zone - then the Transitional zone and central zone, then peripheral zone -AFS outide of Transitional zone
62
Spermatic Cord contents | and Relationships**
-**Ductus (Vas) deferens -**Pampiniform Plexus = heat exchanger - Course of the Inguinal Canal - Inguinal Rings -Genitofemoral N – to cremaster muscle (Cremasteric reflex) -Sympathetic and visceral afferent nn Note abdominal wall
63
inner capsule that surrounds testis=
Tunica albuginea**
64
Outer layer that surrounds entire testis (scrotum)=
Tunica vaginalis= Parietal layer, cavity and visceral layer**
65
Penis: | -Arterial supply via:
**Internal Pudendal AA giving branches to the Dorsal A of the Penis, to the Perineal AA giving branches to the Deep A of the Penis and to penile erectile tissues.** Erectile Dysfunction.
66
Penis: | -Veins=
**Dorsal V of Penis to **Prostatic Plexus to **Vesicle Plexus to Internal Pudendal veins to Internal Iliac veins
67
Testicular AA arise from______
**Abdominal Aorta to scrotum via inguinal canal
68
Testicle: | -cremasteric arteries arise from _____
External Iliac AA to the Inferior Epigastric AA
69
Testicle: | -Testicular veins to ____
Inferior Vena Cava on Right and Left Renal Vein on Left
70
Scrotum: | -arterial supply via ______
Perineal arteries
71
Scrotum: | -veins drain via _____
-testicular veins, , Internal Iliac veins, and Internal Saphenous veins
72
Scrotal venous anatomy: | -note drainage via multiple ____
*systems= think plexuses
73
Cave/Space of Retzius=
Retropubic space***
74
Why is the retropubic space (aka Space of Retzius) so important?
- an extraperitoneal space located posterior to the pubic symphysis and anterior to the urinary bladder. - Clinical significance Examples of surgeries involving the retropubic space include: The Sling procedure. Slings are or considered the first line surgical treatment for women with stress incontinence. Artificial Urinary Sphincters are considered first line surgical treatment for certain types of incontinence in men.
75
Parasympathetic fibers from ___ to ___ via Pelvic Splanchnic nerves to the _____ ______ Plexus and Deep Perineal pouch and Perineal Membrane: -stimulates ?
S2 to S4 -inferior hypogastric plexus - **Stimulates erection – vasodilation of branches of the Internal Pudendal arteries to corpora cavernosa and spongiosa - Prostatectomy can destroy these nerves and cause impotence - **Stimulate bladder contraction
76
Sympathetic fibers carried by Sacral Splanchnic nerves and the ____ ______ plexus, to the Hypogastric nerve, to the _____ ______ Plexus: -cause contraction of ?
* *Superior Hypogastric - Inferior Hypogastric - **Contraction of Internal Urethral Sphincter in men - Smooth muscle contractions of reproductive tracts moving fluids from Epididymis and seminal vesicles into the urethra
77
Somatic Afferents (sensation) from the Penis is via the Pudendal and Perineal nerves – _____
**S2-S4
78
Colle’s Fascia=
=The superficial fascia of the Urogenital triangle is continuous with the membranous layer of superficial fascia up the anterior abdominal wall. - This fascia does not extend into the Anal Triangle. - Therefore, infection, blood or fluid (urine-ie urethral rupture) tracks anteriorly to the anterior abdominal wall and NOT posteriorly into the Anal Triangle space - It does not go inferior as the fascia stops at the Inguinal Ligament

Anatomy Exam 3 (April 29th) (Semester 2) (6 decks)

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