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Anatomy II Test II - Jourdan > Common Pelvic Viscera, Innervation and Vasculature > Flashcards

Common Pelvic Viscera, Innervation and Vasculature Flashcards

1
Q

What region is the pelvic cavity?

A

Region encased within the pelvic girdle, or bony pelvis Basin-shaped ring of bones consisting of R & L “hip bones” (ilium, ischium, pubis) & the sacrum

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2
Q

What is the pelvic cavity continuous with?

A

With the abdominal cavity superiorly, and occupies the space superior to the pelvic diaphragm (above the perineum)

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3
Q

What does the pelvic cavity contain?

A

Terminal parts of ureters,urinary bladder, rectum, pelvic genital organs, and part of sigmoid colon and ileum

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4
Q

What is the pelvis divided into?

A

Greater (false) pelvis and lesser (true) pelvis

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5
Q

The divisions of the pelvis is separated by what?

A

Oblique plane of pelvic inlet

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6
Q

The bony edge outlining the inlet is formed by what?

A

Sacral promontory and ala, and the linea terminalis of each hip bone

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7
Q

What does the linea terminalis consists of?

A

The arcuate line on inner surface of ilium, pectineal line, and the pubic crest of superior border of superior ramus and body of the pubis

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8
Q

What does the greater pelvis contain?

A

Abdominal contents (ileum and sigmoid colon)

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9
Q

What is the lesser pelvis between?

A

Pelvic inlet and outlet

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10
Q

What does the lesser pelvis contain?

A

Pelvic viscera

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11
Q

What is the pelvic outlet bounded by?

A

Pubic arch anteriorly, ischial tuberosities laterally Sacrotuberous ligament posterolaterally, and tip of coccyx posteriorly

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12
Q

True or False: Peritoneum lies over pelvic structures so they are covered on all sides?

A

False: Peritoneum lies over pelvic structures so they are NOT covered on all sides

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13
Q

What does the peritoneum serve as?

A

A conduit for arteries, veins, lymphatic vessels, nerves

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14
Q

What does the peritoneum form?

A

Folds, fossae (pouches) and ligaments over some structures

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15
Q

How does the peritoneum from the anterior abdominal wall reflect over the bladder? What does this allow?

A

Loosely over the bladder Allows the bladder to expand when full

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16
Q

Name 2, 3, 5, 6, and 7

A
  1. Supravesical fossa
  2. paravesical fossa(e)
  3. Ureteric fold
  4. rectovesical pouch (fossa)
  5. pararectal fossa(e)
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17
Q

Name 2, 3, 4, 6, and 7

A

2, supravesical fossa

  1. paravesical fossa(e)
  2. vesicouterine pouch (fossa)
  3. rectouterine pouch (fossa)
  4. pararectal fossa(e)
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18
Q

What pouch is the pouch of Douglas?

A

The rectouterine pouch

Collects fluid and is the common site of metastasis of endometriosis

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19
Q

The membranous pelvic fasica is situated between what?

A

Peritoneum and muscular pelvic walls and floor

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20
Q

Describe the parietal pelvic fascia?

A

Continuouation of transversalis fascia

Lines muscles of pelvic walls and floor

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21
Q

Describe the visceral pelvic fascia?

A

Loose connective tissue, compressible

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22
Q

The endopelvic pelvic fascia is situated between what?

A

Mebranous fascial layers

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23
Q

Describe loose pelvic fasica

A

Consists of areolar “packing material” that forms a supportive connective tissue matrix for pelvic viscera

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24
Q

Describe condensed pelvic fascia?

A

Ligamentous

Has a much more fibrous consistency with collagen, eleastic, and smooth muscle fibers

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25
Q

What are the potential spaces?

A

Prevesical space and retrorectal space

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26
Q

Describe the prevesical space

A

Retropubic

Potential space between pubic symphysis and bladder

Filled with loose endopelvic fat and connective tissue to allow for bladder expansion

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27
Q

Describe the retrorectal space

A

Potential space between sacrum and rectum

Filled with loose endopelvic fascia that allows rectal ampulla to fill

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28
Q

What forms ligaments of hypogastric sheath? What are the ligaments?

A

Condensed endopelvic fasica

Transverse cervical ligament

Sacrouterine ligament

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29
Q

Parietal membranous pelvic fascia condenses to form what?

A

Pubovesical ligaments in female

Or

Puboprostatic ligaments in male

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30
Q

What separates the rectum from the prostate and the seminal vesicles?

A

Rectovesical septum (urorectal) which is a condensed endopelvic fascia

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31
Q

What are muscular tubes comprised of smooth muscle and transitional epithelium

Also retroperitoneal?

A

Ureters

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32
Q

How is urine pushed towards the bladder?

A

Peristalsis

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33
Q

What are ureters supplied by?

A

Richly supplied by several sets of blood vessels and nerves

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34
Q

What are the 3 places where urinary calculi catch?

A

Ureteric junction of renal pelvis

Crossing the external iliac artery and pelvic brin

Vesicoureteric junction

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35
Q

How do the ureters enter the bladder wall?

A

Obliquely

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36
Q

In females, describe the relationship of the ureter to the uterine artery

A

The ureter runs medially to the uterine artery and then is crossed by it

Water under the bridge

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37
Q

In males, desribe the relationship of the ureter to the ductus deferens

A

Crosses posterolaterally to the ductus deferens on its way to the bladder

Water under the bridge

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38
Q

Where is the urinary bladder located?

A

“in” the retropubic space, inferior to the peritoneum and posterior to the pubic symphysis

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39
Q

What are the parts of the bladder?

A

Apex

Base (fundus)

Body

Neck

40
Q

What is the neck of the bladder anchored by?

A

By lateral ligaments of bladder

Puboprostatic/vesical ligaments(females)

41
Q

The walls of the bladder are primarily ______ muscle

A

detrusor

42
Q

The inside of the bladder is lined by what?

A

Transitional epithelium that form rugae when empty

43
Q

Describe trigone

A

Internal smooth thickened area defined by 2 ureteric orifices and the urethra

44
Q

Openings of ureters are encircled in ______ muscle that tightens with contraction of the bladder to prevent ____ of urine.

A

Detrusor

Reflux

45
Q

What is the blood supply to the superior bladder?

A

Superior vesical aa from the internal iliac

46
Q

What is the blood supply to the inferior/posterior bladder?

A

Inferior vesical aa (male)

vaginal or inferior rectal aa (female)

47
Q
A
  1. intramural part
  2. prostatic urethra
  3. membranous urethra
  4. spongy urethra
48
Q

What part of the urethra is voluntary?

A

Sphincter urethrae

49
Q

Where does the urethra begin in females?

A

At internal urethral orifice of the bladder, there is no internal urethral sphincter

50
Q

Describe the urethra pathway in females?

A

Passes through pelvic diaphragm, external urethral sphincter and perineal membrane

51
Q

What is the urethral sphincter (females) innervated by?

A

Deep perineal nerve from pudendal nerve

52
Q

The urethra is shorter in males or females?

A

Females (4cm)

Short length allows for bacteria from the external environment to be introduced into the bladder, which can lead to UTI

53
Q

Where does the rectum run from and to?

A

From rectosigmoid junction to anorectal junction

54
Q

The rectum is S-shaped from lateral view due to what?

A

Sacral flexure and anorectal flexures

55
Q

What are the three transverse rectal folds (lateral flexures)?

A

Superior

Intermediate

Inferior

56
Q

Describe the rectal ampulla?

A

Dialated terminal part of rectum

Superior to anorectal line: line joins the tops of the anal columns

57
Q

What is the rectum innervated by?

A

Lumbar splanchnic nerves (sympathetic)

Hypogastric plexuses

Pelvic splanchnic nerves (parasympathetic)

58
Q

What is the anorectal flexure?

A

Sharp posteroinferior angle at tip of coccyx bone where gut perforates pelvic diaphragm (leavtor ani muscles)

59
Q

What is the anorectal flexure created by?

A

Puborectalis muscle as it forms a “sling” at the anorectal junction

60
Q

What is the significance of the anorectal flexure?

A

Important mechanism for fecal continence due to tonus of puborectalis muscle during resting state, or its active contraction during peristaltic conctraction if defecations is not to occur

80 degree angle

61
Q

What does the pectinate line divide?

A

Upper 2/3 (endoderm) from lower 1/3 (ectoderm) of anal canal

62
Q

Describe the neurovascular supply to the superior 2/3 of anal canal (endoderm)

A

Superior rectal artery (br of inferior mesenteric a)

Internal venous plexus drains superiorly

Lymph drains to internal iliac nodes

Visceral nn.; pain fibers travel with parasympathetics to S2, S3, S4

63
Q

Describe the neurovascular supply to the 1/3 (ectoderm)

A

Inferior rectal artery (br of internal pudendal a)

Internal venous plexus drains into inferior rectal veins

Lymph drains to superficial inguinal lymph nodes

Somatic nn. - canal is sensitive to pain, touch and temperature

64
Q

What are the divisions of the internal iliac artery?

A

Posterior and anterior

65
Q

The posterior division of the internal iliac artery gives off what arteries?

A

Superior gluteal artery

Illiolumbar artery

Lateral sacral artery

66
Q

Where does the superior gluteal artery usually exits the pelvis?

A

Between the lumbosacral trunck (L4/L5) and S1

67
Q

Where does the illiolumbar artery run?

A

Superolaterally towards iliac fossa

68
Q

Where does the lateral sacral artery supply?

A

Pass medially and anterior to supply rami of sacral plexus

69
Q

What are the parts of the external anal sphincter?

A

Deep, superficial and subcutaneous part.

70
Q

How much of the population have an “abnormal” or accessory obturator artery?

A

20%

71
Q

What artery is a branch of the inferior epigastric, crosses over the pelvic brin along the pubic ramus, and is endangered during hernia surgeries?

A

Obturator artery

72
Q

What artery in the pelvic cavity is obliterated?

A

umbilical artery

73
Q

What are the branches of the anterior divison of the internal illiac artery?

A

Obturator artery

Ubilical artery

Internal pudendal artery

Superior vesical arteries

Uterine artery

Vaginal artery

Middle rectal artery

Inferior gluteal artery

74
Q

What arteries are from patent part of umbilical a. and supplies the superior bladder?

A

Superior vesical arteries

75
Q

What artery usually leaves the pelvis between S2 and S3 of the sacral plexus? But is extremely variable?

A

Inferior gluteal artery

76
Q

What artery almost always exits the pelvis near the ischial spine?

A

Internal pudendal artery

77
Q

What is the attachment point of coccygeus muscle?

A

Ischial spine

78
Q

The vaginal artery takes the place of what artery that is found in males?

A

Inferior vesical a.

79
Q

Males do not have a uterine artery, what may replace this artery in males?

A

Ductus deferand a.

80
Q

What is the blood supply for the superior bladder?

A

Superior vesical aa from the internal iliac artery

81
Q

What is the blood supply to the inferior/posterior bladder?

A

Inferior vesical aa (male)

Vaginal or inferior rectal aa (female)

82
Q

What arteries arise from the aorta

cross anterior to the ureter, over bifurcation of common iliac arteries and

run in the suspensory ligament (infundibulopelvic) created by peritoneum?

A

Ovarian arteries

83
Q

What artery arises from posterior aorta at bifurcation into common iliac aa.?

A

Median sacral a.

84
Q

What aa. anastomose with the deep circumflex iliac aa. off of external iliac aa.?

A

Iliolumbar aa

85
Q

The superior rectal artery arises from what?

A

inferior mesenteric

86
Q

The pelvic plexus of veins is made up of what?

A

Rectal plexus (internal and external)

Vesical plexus

Prostatic plexus (m)

Uterine plexus (f)

Vaginal plexus (f)

87
Q

What do the veins of the pelvis drain into?

A

internal iliac veins

88
Q

What do the superior rectal vv empty into?

A

The inferior mesenteric vein, which in turn empties into the portal vein

89
Q

What do the middle rectal vv empty into?

A

Internal iliac vv which empties into the inferior vena cava

90
Q

What do the inferior rectal vv drain into?

A

The internal pudendal veins which eventually drains to the internal iliac

91
Q

Hemorrhoids may or may not be related to _____ or high blood pressure, but the anatomical ____ contributes to them

A

cirrhosis

overlap

92
Q

What hemorrhoid is a prolapsed rectal mucosa containing veins of the internal rectal plexus?

A

Internal: internal rectal veins that prolapse into the anal canal and often strangulate -> painless (visceral nerves)

93
Q

What hemorrhoid is clots in veins of the external rectal venous plexus (fed by branches of the inferior rectal vein)?

A

External:

Clotted blood in the external rectal veins. usually caused by increased abdominal pressure or straining -> painful (somatic nerves)

94
Q

What are the pudendal nerve branches (M)?

A

Inferior rectal nerve

Perineal nerve: superficial (posterior scrotal n.) and deep

Dorsal nerve of penis

95
Q
A

Anatomy II Test II - Jourdan (9 decks)

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