Case 8 Anatomy Flashcards
where is the empty bladder located in the adult? what happens as it fills? what about in children?
- In the adult the empty bladder is located entirely within the pelvis
- As the bladder fills it ascends into the greater pelvis where it lies within the extraperitoneal fascia of the abdominal wall
- It should be noted that in the infant and young child the bladder projects into the abdomen even when empty
when a patient has urinary retention, how can the access to the bladder be achieved?
through the hypogastric region of the abdominal wall
what is the bladder surrounded by?
endopelvic fascia
what does the endopelvic fascia consist of?
loose, areolar, fatty connective tissue that is packed between adjacent structures
what are the different parts of the bladder?
apex, base (fundus) (inferoposterior), body, superior surface, neck, and two inferolateral surfaces
where does the apex of the bladder lie?
anteriorly, behind the upper margin of the symphasis pubis
what is the apex attached to the umbilicus by?
the median umbilical ligament
where does the base/fundus of bladder face? what shape?
- faces posteriorly
- triangular in shape
- slightly convex
where is the body of the bladder located?
between the apex and the base
what is the superior surface covered in? where is it?
- covered with peritoneum
- bulges into the abdominal cavity when distended
what is the neck of the bladder held in position by?
- by the puboprostatic ligament (in males)
- by the pubovesical ligament (in females)
what does the inferolateral surface of the bladder lie adjacent to?
to the pubic bone and the retropubic fat pad
which relations in the bladder are the same in both males and females?
anterior and lateral relations
what are the anterior relations of the bladder?
- Symphasis pubis
- Anterior abdominal wall
- Retropubic fat pad
what are the lateral relations of the bladder?
- Obturator internus muscle
* Levator ani muscle
what are the superior relations of the bladder in female and male?
female:
• Body of the uterus
• Uterovesical pouch (directly above the bladder)
male:
• Coils of ileum
• Sigmoid colon
• Peritoneal cavity
what are the inferior relations of the bladder in the female and male?
female:
• Urogenital diaphragm
male:
• Prostate gland
what are the posterior relations of the bladder in the female and male?
female:
• Vagina
male: • Vas deferens • Rectum • Rectovesical pouch • Seminal vesicles
what are the layers of the bladder wall?
same four layers as that of the ureter:
- epithelium
- lamina propria
- muscularis
- adventia
(epithelium, lamina propria and muscularis mucosae = mucosa)
describe the internal surface of the bladder
- The epithelium and underlying lamina propria are loosely connected to the muscular layer of the bladder
- This allows the mucosa to be thrown into folds when the bladder is empty and to flatten out as the bladder fills
- However, one area on the base of the bladder always appears smooth because the mucosa is firmly attached to the underlying muscle
- Smooth region = trigone
describe the trigone
- Each of the three angles of the triangle presents a small ostium: two superiorly and the one inferiorly
- The ureters open into the bladder at the superior openings of the trigone
- The urethra opens into the bladder at the inferior opening of the trigone
what does the muscular coat of the bladder consist of?
three interlacing layers of smooth muscle
what is the muscle of the bladder?
detrusor
what are the muscle fibres of the neck continuous with in males and females?
- In females the muscle fibres of the neck are continuous with the muscle fibres of the urethra
- However, in males the muscles fibres are continuous with the fibromuscular tissue of the prostate
what prevents reflux back into ureter?
- In order to prevent reflux of urine from the bladder to the ureter, the ureters pass obliquely through the detrusor muscle on their way to the ureteric orifices of the trigone
- In addition, fibres of the detrusor muscle encircle the ureteric orifices and these tighten when the bladder contracts
what is the blood supply of the bladder?
bladder receives arterial blood from the superior vesical arteries and the inferior vesical (males) or vaginal arteries (females)
where do the superior vesical, inferior vesical and vaginal arteries arise from?
the internal iliac artery
what is the venous drainage of the bladder?
vesical venous plexus