Common Pelvic Viscera, Innervation and Vasculature Flashcards
The pelvic cavity is a region encased within the __ __, or bony pelvis
pelvic girdle
What bones make up the pelvic girdle?
ilium, ischium, pubis, and sacrum
What does the pelvic cavity contain?
terminal parts of ureters, urinary bladder, rectum, pelvic genital organs, and part of sigmoid colon and ileum
The greater (true) and lesser (false) pelvis are separated by the __ __
pelvic inlet
The pelvic inlet is formed by what?
the sacral promontory & ala, and the line terminals of each hip bone
What do the greater and lesser pelvis contain?
greater (true) : abdominal contents
lesser (false) : pelvic viscera
This lies over pelvic structures so they are not covered on all sides; serves as a conduit for arteries, veins, lymphatic vessels, nerves; forms folds, fuss & ligaments over some structures
peritoneum
This type of pelvic fascia is situated between peritoneum and muscular pelvic walls & floor
membranous
This type of pelvic fascia is situated between membranous fascial layers
endopelvic
This potential space in the pelvic cavity is between the pubic symphysis and bladder
prevesical space
This potential space in the pelvic cavity is between the sacrum and rectum
retrorectal space
Condensed endopelvic fascia forms what?
ligaments of hypogastric sheath
Parietal membranous fascia condenses to form what?
pubovesical ligaments (female) or puboprostatic ligaments (male)
The rectovesical septum separates what?
the rectum from the prostate and seminal vesicles
Name the following structure:
retroperitoneal; muscular tubes comprised of smooth muscle and transitional epithelium; peristalsis pushes urine toward the bladder; richly supplied by several sets of blood vessels and nerves; enter the bladder wall obliquely
ureters
In regards to ureters, what are the 3 places where urinary calculi catch
steric junction of renal pelvis, crossing of the external iliac artery and pelvic brim, vesicoureteric junction
The ureter in the female runs medially to the __ artery and is then crossed by it. Relationship is described as “water under the bridge”
uterine
The ureter in the male crosses posterolaterally to the ___ ____ on its way to the bladder
ductus deferns
The urinary bladder is located in the ____ space, inferior to the peritoneum and posterior to the pubic symphysis
retropubic
The walls of the bladder are primarily made up of which muscle?
detrusor muscle
The inside of the bladder is lined by transitional epithelium that form ___ when empty
rugae
The ___ is an internal smooth thickened area defined by 2 urethra orifices and the urethra
trigone
What sympathetics stimulate internal urethral sphincter to contract?
T11- L2
Parasympathetics are motor to the ___ muscle and also inhibit internal urethral sphincter in males
detrusor
The arteries that supply the superior bladder are called the ___ ___ aa and come from where?
superior vesical; internal iliac
The arteries that supply the inferior/posterior bladder are called what?
male: inferior vesical aa
female: vaginal or inferior rectal aa
The urethra in the female begins where?
internal urethral orifice
note: no internal urethral sphincter in females
The female urethra passes through which 3 things?
pelvic diaphragm, external urethral sphincter, and perineal membrane
True or false?
The urethra is much longer in females
False; shorter
note: short length allows for bacteria form the external environment to be introduced into the bladder - reason why UTI’s are more common in females
The rectum is found between what two junctions?
the rectosigmoid and anorectal junctions
The lumbar splanchnic nerves, hypogastric plexuses, and pelvic splanchnic nerves all innervate what?
rectum
The sharp posteroinferior angle at the tip of the coccyx bone where gut perforates pelvic diaphragm is called what?
anorectal flexure
The angle in the anorectal flexure is created by this muscle as it forms a “sling” at the anorectal junction
puborectalis muscle
The anorectal flexure serves as an important mechanism for ___ ___ due to tons of puborectalis muscle during rectal state, or its active contraction during peristaltic contractions if defecation is not to occur
fecal continence
In regards to the anal canal, the pectinate line divers what?
upper 2/3 from lower 1/3 anal canal
In terms of development, the superior 2/3 of the anal canal comes from endoderm, mesoderm, or ectoderm?
endoderm
In terms of development, the lower 1/3 of the anal canal comes from endoderm, mesoderm, or ectoderm?
ectoderm
What are the arteries of pelvis?
common iliac a, external iliac a, internal iliac a
Name the three posterior branches off of the internal iliac a
superior gluteal a, iliolumbar a, lateral sacral a
Name the anterior branches off of the internal iliac a
obturator a, umbilical a, internal pudendal a, supeior vescial aa, uterine a, vaginal a, middle rectal a, inferior gluteal a
The inferior gluteal a usually leaves the pelvis between __ and __ of the sacral plexus
S2; S3
This artery (anterior branch of internal iliac a) almost always exists the pelvis near the ischial spine
internal pudendal a
What are the differences in the internal iliac a between males and females?
males have an inferior vesicle a, females have vaginal aa; males do not have a uterine a
The following is another type of pelvic artery found found in females:
arise from aorta
cross anterior to the ureter, over bifurcation of common iliac aa
run in the suspensory ligament
ovarian aa
Name the following pelvic artery:
arises form posterior aorta at bifurcation into common iliac aa
median sacral a
Name the following pelvic artery:
anatomies with the deep circumflex iliac aa off of external iliac aa
iliolumbar aa
Veins of the pelvic drain into what?
internal iliac veins
The superior rectal vv empty into what?
the inferior mesenteric vein, which in turn empties into the portal vein
The middle rectal vv empty into what?
the inferior vena cava
The inferior rectal vv empty into what?
the internal pudendal veins which eventually drain to the internal iliac
The condition involving prolapsed rectal mucosa containing veins of the internal rectal plexus is called what?
internal hemorrhoids
note: associated with visceral nerves
The condition involving clots in veins of the external rectal venous plexus is called what?
external hemorrhoids
note: associated with somatic nerves
True or False
External hemorrhoids are painless, while internal hemorrhoids are excruciating
false; internal hemorrhoids are painless, external hemorrhoids are very painful
What are the branches of the pudendal nerve in males?
inferior rectal n, perineal n, and dorsal n of penis
What is formed by the bowl-shaped pelvic diaphragm, which includes the coccygeus & levator ani muscle group? (LAM)
pelvic floor
The diaphragm attaches to a thickening in the obturator fascia, known as the ___ ___ of levator Dani, which covers the obturator interns muscle overlying the lateral pelvic wall
tendinous arch
The anterior gap in the medial borders of the LAM that allow for passage of the urethra, and vagina in females is called what?
urogenital hiatus
The pelvic floor is mostly tonically contracted which resists what?
increases in intra-abdominal pressure, supports abdominopelvic viscera, assists in maintaining urinary and fecal continence
What is the pelvic floor innervated by?
levator ani n, inferior rectal n, and coccygeal plexus
The leavtor ani n arises from which sacral rami?
S4 mostly and S3
True or false?
The levator ani n can sometimes be injured during vaginal birth
true
Disruption of the levator ani n can lead to what type of dysfunction in the pelvic floor?
urinary incontinence and prolapse of pelvic viscera
What is the inferior part of vagina innervated by?
somatic branches from the internal pudendal n
What are the middle and superior parts of the vagina and uterus innervated by?
visceral nn. from uterovaginal plexus, by sympathetics from lumbar splanchnic, and by parasympathetics from S2-4
The pelvic pain line follows the peritoneum. Pain from viscera above the line follows ___. Pain from viscera below the line follows ___.
sympathetics; parasympathetics
