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Life Cycles Part I > Anatomy: Pelvis II > Flashcards

Anatomy: Pelvis II Flashcards

1
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Pelvic Viscera

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A. the urinary tract

B. the genital tract

C. the intestinal tract

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2
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The pelvic portion of the urinary tract:

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  1. Ureters
  2. Urinary Bladder
  3. Urethra
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3
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The pelvic portion of the urinary tract: Ureters

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The ureter connects the kidney with the urinary bladder.

a. the ureters cross the pelvic brim in front of the bifurcation of the common iliac artery.
b. the ureter joins the urinary bladder at one corner of the vesical trigone.

In the female, the ureter passes very close to the cervix of the uterus. The uterine artery crosses the ureter superiorly as the ureter passes the cervix.

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4
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The pelvic portion of the urinary tract: Urinary Bladder

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a. the apex- where the median umbilical ligament is attached.
b. base, or fundus.

In the female, the base of the urinary bladder is in contact with the vagina such that the vesicouterine pouch of the peritoneum is between the bladder and the uterus.

In the male, the base of the urinary bladder is in contact with the seminal vesicles and the final parts of the ductus deferens. The rectovesical pouch is between male bladder and the rectum.

On the internal surface of the base, there is a smooth triangular area which is called the trigone, or vesical trigone.

The corners, or angles, of the trigone are marked by the two ureteric orifices and the internal urethral orifice.

c. neck, the most inferior part of the urinary bladder

In the female, it rests upon the pelvic diaphragm In the male, the neck rests upon the prostate gland.

In males, the bladder neck contains the internal urethral sphincter, which contracts with sympathetic stimulation and relaxes with parasympathetic stimulation.

The walls of the bladder are composed of the detrusor muscle, which contracts in response to parasympathetic stimulation.

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5
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The pelvic portion of the urinary tract: Urethra

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In the female, the urethra passes from the neck of the urinary bladder through the urogenital hiatus of the pelvic diaphragm. Almost the entire length of the female urethra is thus below the pelvic diaphragm, in the perineum.

In the male, the urethra has a pelvic portion, which runs through the prostate gland, the prostatic portion. The two ejaculatory ducts and the ducts of the prostate gland open into the prostatic portion of the urethra. Below the prostate gland, the urethra passes through the urogenital hiatus of the pelvic diaphragm into the perineum.

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10
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Female Genital Viscera:

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  1. Ovaries
  2. Uterine (Fallopian Tubes)
  3. Uterus
  4. Ligaments of the Uterus
  5. Vagina
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11
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Female Genital Viscera: Ovaries

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The ovaries have two major attachments

a. The suspensory ligament of the ovary (infundibulopelvic ligament) - attaches the ovary to the pelvic wall at the pelvic brim. The suspensory ligament of the ovary conducts the ovarian artery/vein from the pelvic wall to the ovary.
b. The ovarian ligament attaches the uterine pole of the ovary to the uterus. It raises a sharp fold in the posterior layer of the broad ligament. c. The mesovarium (part of the broad ligament)

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12
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Female Genital Viscera: Uterine (Fallopian) Tubes

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The uterine tubes are enfolded in the mesosalpinx, part of the broad ligament.

a. The one third of its length nearest the uterus is called the isthmus.
b. The middle portion of the tube is the ampulla. Fertilization occurs most commonly in the ampulla
c. The funnel shaped end is the infundibulum. The opening of the infundibulum into the peritoneal sac is surrounded by fimbriae.

The fact that the uterine tubes are open to the peritoneum means that women are more susceptible to pelvic inflammatory disease.

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13
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Female Genital Viscera: Uterus

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The entire organ is normally tilted forward (anteverted) to a 90-degree angle between the cervix and the vagina, and also its long axis is curved forward (anteflexed) when the urinary bladder is not distended.

a. body – bulk of the uterus. Most common site of embryo implantation.
b. fundus - the rounded most superior portion of the body above the attachment of the uterine tubes
c. cervix - projects into the vagina through the anterior vaginal wall.

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19
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Female Genital Viscera: Ligaments of the Uterus

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The uterus together with the broad ligaments separate the pelvic portion of the female peritoneal sac into the vesicouterine pouch and the rectouterine pouch.

a. The broad ligament encloses the uterus and uterine tubes (mesosalpinx) There are two fibrous cords between the layers of the broad ligament.
1. The ovarian ligament attaches the ovary to the uterus. This ligament forms a ridge in the posterior layer of the broad ligament.
2. The round ligament of the uterus passes from the uterus to the deep inguinal ring and then down the inguinal canal. This ligament raises a ridge in the anterior layer of the broad ligament.

Fascial condensations attach to the cervix of the uterus below the peritoneal floor of the pelvic cavity and above the pelvic diaphragm. These fascial condensations provide major support for the uterus. The most significant elements of these supports are the transverse cervical ligaments (cardinal ligaments) and the uterosacral ligaments.

The transverse cervical ligaments are the main lateral supports of the uterus and conduct the uterine artery to the uterus.

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24
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Female Genital Viscera: Vagina

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The vagina passes through the urogenital hiatus of the pelvic diaphragm and is thus partly in the pelvic cavity and partly in the perineum.

Pelvic portion of the vagina The circular groove around the projection of the uterine cervix into the vagina is called fornix of the vagina. The wall of the posterior fornix of the vagina is all that separates the vagina from the rectouterine pouch of the peritoneal sac (the pouch of Douglas, or Douglas’ cul-de-sac).

25
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Male Genital Viscera:

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  1. Prostate Gland
  2. Seminal Vesicles
  3. Ductus Deferens
  4. Ejaculatory Ducts
26
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Male Genital Viscera: Prostate Gland

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a. The prostate gland rests upon the pelvic diaphragm over the urogenital hiatus.
b. The first part of the urethra and the entire lengths of the two ejaculatory ducts are within the prostate gland.
c. The ducts of the prostate gland open into the prostatic portion of the urethra through the posterior wall of the urethra. There are about twenty of these ducts.

Erectile dysfunction after prostate surgery (found in approximately 30-70% of patients) is the result of damage to the autonomic nerves that supply the erectile tissues of the penis. This damage most commonly involves parasympathetic fibers from S2-S4 (erection) and sympathetic fibers from T11-L2 (ejaculation).

27
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Male Genital Viscera: Seminal Vesicles

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a. The seminal vesicles are in contact with the posterior surface of the urinary bladder just lateral to the converging ductus deferentes.
b. The duct of each seminal vesicle joins the ductus deferens to form an ejaculatory duct.

28
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Male Genital Viscera: Ductus Deferens

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a. ascends in the spermatic cord to the superficial inguinal ring then up the inguinal canal to the deep inguinal ring and then into the abdominal cavity. From the deep inguinal ring, the ductus deferens descends about an inch to the pelvic brim.
b. at the superior edge of the prostate gland, it ends by combining with the duct of the seminal vesicle to form the ejaculatory duct

29
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Male Genital Viscera: Ejaculatory Ducts

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a. begin at the superior edge of the prostate gland by merger of the ductus deferens with the duct of the seminal vesicle.
b. they pass forward within the prostate gland to junction with the urethra. This junction is the merger of the genital tract with the urinary tract.

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34
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Intestinal Viscera:

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  1. Sigmoid Colon
  2. Rectum
35
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Intestinal Viscera: Sigmoid Colon

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Nothing in the notes. I guess it’s just there.

36
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Intestinal Viscera: Rectum

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a. The rectum lies in front of the sacrum and coccyx.
b. The posterior flexure at the end of the rectum is the anorectal flexure, which marks the end of the rectum and the beginning of the anal canal. The anorectal flexure is at the passage of the intestinal tract through the pelvic diaphragm.

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39
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Arteries of the Pelvis

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  1. Internal Iliac Branches
    - posterior
    - anterior
  2. Gonadal (from abdominal aorta)
  3. Superior Rectal (from inferior mesenteric)
  4. Median Sacral (from the back of the aortic bifurcation)
40
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Arteries of the Pelvis: Internal Iliac Posterior Division

A

a. The iliolumbar artery.

The iliac branch supplies the iliacus muscle.

The lumbar branch supplies the lumbar vertebrae. These arteries are sometimes direct branches of the internal iliac artery, in which case there is no iliolumbar artery.

b. The lateral sacral arteries.
c. The superior gluteal artery

41
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Arteries of the Pelvis: Internal Iliac Anterior Division

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d. The umbilical artery is mostly obliterated after birth. The proximal portion remains patent and the remainder becomes the medial umbilical ligament. It supplies blood to the superior portion of the urinary bladder.
e. The obturator artery passes through the obturator canal into the medial musculature of the thigh.
f. The inferior vesical artery is closely associated with the ureter as it approaches the urinary bladder. It also serves the prostate gland and a seminal vesicle and often the ductus deferens (males). In the female, the uterine and vaginal arteries may be the main blood supply of the inferior part of the urinary bladder, and there may not be a separate inferior vesical artery branching from the internal iliac artery.
g. The middle rectal artery serves the prostate gland or vagina in addition to the rectum. It may be combined with, or replaced by, the vaginal artery in the female.
h. The uterine artery approaches the cervix of the uterus in the base of the transverse cervical (cardinal) ligament, contributes a branch to the side of the vagina and then ascends along the side of the uterus within the broad ligament. It also sends branches to the uterine tube and the ovary as well as the base of the urinary bladder.
i. The vaginal artery divides into numerous branches which ramify on both the anterior and posterior surfaces of the vagina. It also sends branches to the base of the urinary bladder and to the rectum.
j. The internal pudendal artery leaves the pelvis through the greater sciatic foramen. It then passes through the lesser sciatic foramen into the perineum, for which it is the chief blood supply.
k. The inferior gluteal artery leaves the pelvis through the greater sciatic foramen along with the internal pudendal artery.

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45
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Veins of the Pelvis

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The viscera of the pelvis have well developed venous return, and these pelvic venous plexuses (prostatic, vesicle, uterine) drain predominantly into the internal iliac vein.

The gonadal and ovarian arteries drain into the IVC (right side) and the renal vein (left side).

The superior rectal and sigmoid veins are tributaries of the inferior mesenteric vein. These are the most inferior veins of the portal system. Thus, this is an important site of Portal-Systemic Anastomosis.

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50
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Nerves of the Pelvis: Sympathetic

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Fibers to the pelvic viscera come from the abdominal sympathetic trunk via the lumbar splanchnic nerves to the superior hypogastric plexus and thence via the hypogastric nerve to the inferior hypogastric (pelvic) plexus.

51
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Nerves of the Pelvis: Parasympathetic

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The entire parasympathetic input into the pelvic visceral plexus is conducted in the pelvic splanchnic nerves from the ventral primary rami of spinal nerves S2, S3 and S4.

52
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Actions controlled by autonomic innervation of the pelvis:

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  1. Defecation (rectum) and urination (detrusor muscle of the bladder) result from contraction of smooth muscle during parasympathetic stimulation. However, relaxation of the internal anal sphincter of the anal canal is also the result of parasympathetic stimulation.
  2. In males, the smooth musculature at the neck of the urinary bladder and the beginning of the prostatic urethra (internal urethral sphincter) contracts in response to sympathetic stimulation to prevent the flow of urine out of the urinary bladder and during ejaculation to prevent flow of semen into the bladder.
  3. Emission (movement of sperm and glandular secretion into the prostatic urethra) is a sympathetic response and results from the following contractions of smooth muscle:
    a. the walls of each ductus deferens
    b. the walls of each seminal vesicle contracts to force fluid from the seminal vesicle into the ejaculatory duct.
    c. the smooth muscle of the prostate gland. This forces fluid from the prostate gland into the prostatic portion of the urethra.

The autonomic fibers distributed from the pelvic visceral plexus are accompanied by visceral afferent fibers.

In the thorax and abdomen, the visceral afferent fibers that transmit pain accompany the sympathetic fibers, and the visceral afferent fibers that transmit other sensations (e.g., stretch) accompany the parasympathetic fibers. However, this generalization is not true of the pelvic viscera. Pelvic viscera may have pain fibers in both sympathetic and parasympathetic innervation.

53
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Sacral Plexus

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a. the ventral primary rami of the first four sacral spinal nerves
b. the lumbosacral trunk- ventral primary rami of L4 and L5

The sacral plexus lies against the posterolateral part of the pelvic wall on the piriformis muscle. With the exception of small branches to the piriformis and levator ani muscles and the pudendal nerve, the entire sacral plexus exits the pelvic cavity through the greater sciatic foramen. The pudendal nerve is the main nerve to the striated muscles and skin of the perineum.

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Life Cycles Part I (24 decks)

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