Anatomy Bladder, ureter, urethra, anus and perineum Flashcards
Name the two peritoneal pouches either side of the uterus.
Vesicouterine pouch (superior surface of bladder to to uterus) Rectouterine pouch ( from posterior fornix of vagina to middle part of rectum)
What is the pubvesicle ligament? What is the name of the equivalent in males?
What is the function of these ligaments?
The pubovesical ligament is a ligament that extends from the neck of the bladder to the inferior aspect of the pubis bones. In the female it is divided into two branches, the lateral pubovesical ligament and the medial pubovesical ligament.
In males it is called puboprostatic ligament.
To give support to the neck of the bladder and in urinary continence.
What is the apex of the bladder attached to? What was its use in embryological development?
The apex of bladder is conntinous with the urachus (fibrous cord) forming the median umbilical ligament.
Closed upper end of the vesicourthral canal present in embryonic development.
What type of muscle is detrusor muscle? How many layers? Describe their layout?
How does this change at the internal urethral orifice?
Smooth muscle.
3 Layers. Outer longitudinal layer, middle thin circular layer, inner longitudinal layer.
At the internal urethral orifice the middle circular layer become thick forming the sphincter vesicae.
What is the trigone? How does the mucus membrane differ here form the rest of the bladder?
The trigone a smooth triangular region on the posterior internal wall of the bladder where the two ureteric orifices and the internal urethral orifice.
Elsewhere in the bladder the mucus membrane is attached loosely to the smooth muscle wall, forming fold allowing the bladder to stretch when distended. At the trigone the mucus membrane is firmly attached to the underlying muscle.
Describe the innervation of the bladder.
Autonmic from pelvic plexus. Efferent Parasymathetic from the pelvic splanchnic nerves - motor fibres to detrusor muscle and inhibit sphincter vesicae. Urethral sphincter (urogenital diaphragm) is supplied by pudendal nerve.
Where is the urethra located in relation to the vagina.
Firmly attached to anterior wall of the vagina.
What is the paraurethral duct, where does it open?
The paraurethral ducts (or Skene ducts) drain the paraurethral glands (collection of mucous secreting glands) of the female urethra. There is one duct, draining each gland, on each side, just proximal to the external urethral meatus.
How does the smooth muscle layout differ from the bladder? Describe the 2 sphincters.
Urethra has internal longitudinal and external circular fibres. Circular fibres at proximal end form sphincter vesicae or the internal sphincter. The distal end is sphincter urethrae or external sphincter orifice.
What type of epitheliums are found within the urethra
Continous with bladder, proximal transitional epithelium.
Distally non-keratinised stratified squamous nature.
What is the blood supply of the urethra?
Where does it autonomic innervation come from?
Branches of internal pudendal artery
Pelvic plexus
If rupture of the urethra occurs, what route does the urine take?
Urine escapes below the urogential diagphragm but deep to the superficial fascia. The only route it can take is via the areolar tissue of the mons pubis and anterior abdominal wall.
How long are the ureters? What is there relation to the peritoneum.
Roughly 25cm. Retroperitoneal.
From ureter to bladder: Describe the relation of the ureter to the following structures:
1) Psoas major
2) Genitofemoral nerve
3) Ovarian artery & vein
4) Bifurcation of the common iliac artery
5) The uterine artery + vessels (what route is the ureter taking at this level)
6) Ovary (level of internal iliac)
7) Lateral fornix of vagina
The ureter..
1) Descends anteriorly over psoas major
2) Passes anterior to gentiofemoral nerve
3) is posterior to the ovarian artery and vessels as the descend into the pelvis.
4) Passes anterior - common iliac
5) The ureter is posterior to the uterine vessels as it turns medially from the lateral wall of pelvis in the fascia of the pelvic floor (at levels of ischial spine) to reach the lateral aspect of the bladder.
6) At level of internal iliac artery, the utter is immediately posterior to the ovary.
7) Ureters 2cm lateral to supravaginal region of the cervix, as ureters pass forwards to reach bladder.
What are the 3 histological layers of the ureter
- Outer fibrous layer
- Smooth muscle (upper 2 thirds, inner longitudinal and outer circular layer. Inner 1/3, additional outer longitudinal layer)
- Transitional epithelium
Ares of luminal narrowing of the ureter
Pelviureteric junction
Crossing pelvic brim (level of crossing bifurcation)
Vesicoureteric junction
The ureters recieved blood from an anastomosis of several arteries. Name as many as you can.
Renal artery Uterine/vaginal arteries Gonadal artery Middle rectal Superior vesical (and inferior vesical in men) arteries
