Common Pelvic Viscera, Innervation, And Vasculature Flashcards
What are the peritoneal spaces/fossa of the female?
- supravesical fossa
- paravesical fossa
- vesicouterine pouch
- rectouterine pouch
- pararectal fossa
What allows the bladder to expand in the abdominal wall?
-peritoneum from the anterior abdominal wall reflecting loosely over the bladder
What are the peritoneal spaces/fossa in the male?
- supravesical fossa
- paravesical fossa
- ureteric fold
- rectovesical pouch
- pararectal fossa
What are the two layers of the pelvic fascia?
- parietal: transversalis fascia, membranous
- visceral: loose CT, compressible
What is the prevesical space/retropubic?
- between pubic symphysis and bladder
- potential space
- filled with endo pelvic fat and CT
What is the retrorectal/presacral space?
- between sacrum and rectum
- potential space
What is the endopelvic fascia do?
-condenses to form ligaments
What ligaments are found in the body cavity?
- pubovesical ligaments
- transverse cervical ligaments
- sacrouterine ligaments
- pubovesical ligaments (female) or puboprostatic ligaments (male) -> condensations of visceral endopelvic fascia
What is the rectovesical septum?
- separates the rectum from the prostate and the seminal vesicles
- condensed endopelvic fascia
What ischioanal abcesses?
-infections from within the anal canal, pelvic infections, etc can spread into the ischioanal fossa. Infection can spread through the superficial and deep postanal spaces to the other side
Describe the ureters.
- retroperitoneal
- muscular tubes
- peristalsis pushes urine toward the bladder
- several sets of blood vessels and nerves
- 3 places where urinary calcului catch
- cross the pelvic brim where the common iliacs bifurcate
- enter the bladder wall obliquely
What is the relationship between the ureter and the uterine artery?
-ureter runs medially to the uterine artery and then is crossed by it
Relationship between the ureter and ductus deferens in the male.
-ductus deferens crosses anterior to the ureter, ureter goes inferior to the ductus to enter the bladder
Where is the urinary bladder?
-located in the retropubic space inferior to the peritoneum and posterior to the pubic symphysis
What the structures of the bladder?
- apex
- base
- body
- neck
Describe the bladder.
- walls of the bladder are primarily detrusor muscles
- inside of the bladder is lined with transitional epithelium that form rugae when empty
- the trig one is an internal smooth thickened area defined by the openings of the 2 ureters and the urethra
What vessels supply the superior bladder?
-superior vesical a from the internal iliac
What vessels supply the inferior/posterior bladder?
- inferior vesical a (male)
- vaginal or inferior rectal a (female)
What is the innervation of the bladder and inferior ureters???
- T11-L2
- superior. Hypogastric plexus
- inferior hypogastric plexus
- vesical n plexus
- parasympathetics are motor to the detrusor m
What are the four parts of the male urethra?
- Intramural part
- Prostatic urethra
- Membranous urethra
- Spongy urethra
Name the 4 male features of the urethra.
- urethral crest
- urethral sinus
- seminal colliculus
- prostatic utricle
Describe the female urethra.
- begins at the internal urethral orifice of the bladder
- no internal urethral sphincter
- passes through the pelvic diaphragm, external urethral sphincter and perineal membrane
Where is the rectum?
-between sigmoid colon and anal canal
How many rectal folds are there?
3 (superior, intermediate, inferior)
What is the rectal ampulla?
- dilated terminal part of rectum
- superior to ano-rectal junction
- a line joining the tops of the anal columns
What does the puborectalis part of the levator ani form?
-a sling at the anorectal junction and forms the anorectal angle
What is the anorectal line?
-a line joining the tops of the rectal columns
What is the pectinate line?
-a line joining the inferior ends of the anal valves
What is superior to the pectinate line?
- superior rectal artery
- internal venous plexus drains superiorly
- lymphatics drain to internal iliac nodes
- nerves are visceral
- pain fibers travel with parasympathetics to S2-3
What is inferior to the pectinate line?
- inferior rectal artery
- internal venous plexus drains into inferior rectal veins
- lymphatics drain to superficial inguinal lymph nodes
- nerves are somatic so canal is sensitive to pain, touch, and temperature
Pelvic arteries
-ovarian a
+from aorta, cross anterior to ureter, over the bifurcation of the common iliac arteries, run in the suspensory ligament
-median sacral a
+from aorta, at bifurcation
-iliolumbar a -> anastomoses with the deep circumflex iliac arteries
-superior rectal a
+from inferior mesenteric
What are the veins of the pelvis?
- rectal plexus (internal and external)
- vesical plexus
- prostatic plexus (male)
- uterine plexus (female)
- vaginal plexus (female)
ALL DRAIN INTO INTERNAL ILIAC VEINS
Superior rectal veins empty into what?
Inferior mesenteric vein -> portal vein
Middle rectal vein empties into what?
Internal iliac veins -> IVC
Inferior rectal veins drain into what?
Internal pudental veins -> internal iliac
What may causes hemorrhoids?
- may be related to cirrhosis or high bp
- internal hemorrhoids are prolapsed rectal mucosa containing veins of the internal rectal plexus -> prolapse into anal canal and strangulate
- external hemorrhoids are clots in veins of the external rectal venous plexus (fed by branches of the inferior rectal veins) -> usually caused by increased abdominal pressure if straining
Where do the prostate and uterus drain into? What does the bladder drain into? What do perineal structures drain into? LYMPHATICS
- Prostate and uterus: internal iliac nodes
- bladder: external iliac nodes
- perineal: superficial inguinal nodes
What are the branches of the pudental nerve in the male?
- perineal nerve
- posterior scrotal nerves
- dorsal nerve of penis
Branches of pudental nerve in female.
- dorsal nerve of clitoris
- deep perineal nerve
- superficial perineal nerve
- dorsal nerve of clitoris
- perineal nerve
What are the sympathetics of the pelvis?
- sacral plexus
- on the pelvic surface of the piriformis muscle
- lumbosacral trunk (L4-S5)
- sacral splanchnics -> sympathetics
- coccygeal plexus
Autonomic so and afferents of the pelvis.
- superior hypogastric plexus
- hypogastric nerves
-inferior hypogastric plexus
+made up of pelvic plexuses (rectal, prostatic, vesical, uterovaginal)
-pelvic splanchnics
+parasympathetics, S2-4
What is the inferior part if the vagina innervated by?
-somatic branches from internal pudental n
What is the middle and superior part so fat evaginations innervate by?
-visceral n
+uterovaginal plexus
+sympathetics from lumbar splanchnics
+parasympathetics from S2-4
What does the pelvic pain line follow?
- follows the peritoneum
- pain from viscera above the line follows sympathetics
- pain from viscera below the line follows parasympathetics
How does the peritoneum lie?
- peritoneum lies over pelvic structures so they are not covered on all sides
- peritoneum forms folds over some structures
- peritoneum forms fossa or pouches
