Common Pelvic Viscera, Innervation and Vasculature

Question 1

Answer 1

• 2.) Supravesical fossa
• 3.) Paravesical fossa(e)
• 4.) vesicouterine pouch (fossa)
• 6.) rectouterine pouch (fossa)
• 7.) pararectal fossa(e)

Question 2

Peritoneum from the anterior abdominal wall reflects loosely over the bladder. This allows the bladder to

Answer 2

expand when full

Question 3

Answer 3

• 2.) Supravesical fossa
• 3.) paravesical fossa(e)
• 5.) ureteric fold
• 6.) rectovesical pouch (fossa)
• 7.) pararectal fossa(e)

Question 4

What is the prevesical space (retropubic)

Answer 4

• Between pubic symphysis and bladder
• potential space
• filled with endopelvic fat and connective tissue

Question 5

Answer 5

Retrorectal (presacral) space

Question 6

Answer 6

Question 7

Answer 7

Question 9

Answer 9

• Pubovesical ligaments (female)/ puboprostatic ligaments (male)
• (note that these are condensations of visceral endopelvic fascia)

Question 10

Answer 10

• (Top) rectovesical septum (urorectal)
  
  • separates the rectum from the prostate and the seminal vesicles (bottom arrow)
  • this is formed by condensed endopelvic fascia

Question 11

Ischioanal abcesses

Answer 11

• infections from within the anal canal (sinuses), pelvic infections, etc can spread into the ischianal fossae. These infections can spread through the superficial and deep postanal spaces to the other side

Question 12

ureters have ___ places where urinary calculi catch

Answer 12

3

Question 13

Where do the ureters cross the pelvic brim

Answer 13

Where the common iliacs bifurcate

Question 14

Ureters enter the bladder wall ____

Answer 14

obliquely

Question 15

are the ureters retroperitoneal

Answer 15

yes

Question 16

The ureter runs ___ to the uterine artery and then is

Answer 16

• The ureter runs medially to the uterine artery and then is crossed by it
• (water under the bridge)

Question 17

The ductus deferens crosses _____ to the ureter to

Answer 17

• anterior
  
  • (this is the same as the uterine artery (water under the bridge))

Question 19

The urinary bladder is located

Answer 19

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

Question 20

Question 21

The walls of the bladder are primarily

Answer 21

detrusor muscle

Question 22

The inside of the bladder is lined by

Answer 22

transitional epithelium that form rugae when empty

Question 23

The ____ is an interal smooth thickened area of the bladder defined by the opening of the 2 ureters and the urethra

Answer 23

Trigone

Question 24

Arteries and veins of the bladder

Answer 24

• Superior bladder
  
  • superior vesical artery form the interal iliac
• Inferior/posterior bladder
  
  • inferior vesical artery (male)
  • vaginal or inferior rectal artery (female)

Question 25

Innervation of the bladder and inferior ureters

Question 26

Answer 26

1. intramural part
2. prostatic urethra
3. membranous urethra
4. spongy urethra

Question 27

Female urethra

Answer 27

• begins at the interal urethral orifice of the bladder
• no internal sphincter
• passes through the pelvic diaphragm, external urethral sphincter and perineal membrane

Question 28

The rectum is between

Answer 28

the sigmoid colon and the anal canal

Question 29

What is the rectal ampulla

Answer 29

• dilated terminal part of rectum
• superior to ano-rectal junction (line)
  
  • Ano-rectal junciton (line) is a line joining tops of the anal columns

Question 30

line joining the tops of the anal columns

Answer 30

Ano-recal juntion (line)

Question 31

Answer 31

Question 32

The puborectalis part of the ______ muscle forms a “sling” at the anorectal junction and forms the anorectal angle (flexure)

Answer 32

• Levator ani muscle
  
  • (note the anorectal angle (flexure) is at 80 degrees)

Question 33

A line joining the inferior ends of the anal valves

Answer 33

• Pectinate line

Question 34

Iliolumbar arteries anastomose

Answer 34

with the deep circumflex iliac arteries

Question 35

Superior to the pecinate line

Answer 35

• Superior rectal artery
• interal venous plexus drains superiorly
• lymphatics drain to internal iliac nodes
• nerves are visceral
• pain fibers travel with parasympathetics to S2, S3, S4

Question 36

Inferior to the pectinate line

Answer 36

• 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

Question 37

Ovarian artery(ies) characteristics

Answer 37

• From the aorta
• cross anterior to the ureter
• over the bifurcation of the common iliac arteries
• run in the suspensory ligament (infundibulopelvic)

Question 38

The superior rectal artery arises from

Answer 38

the inferior mesenteric artery

Question 39

Veins of the pelvis

Answer 39

• Pelvic plexus of veins
  
  • made up of
    
    • rectal plexus
      
      • internal
      • external
    • vesical plexus
    • prostatic plexus (m)
    • uterine plexus (f)
    • vaginal plexus
• All of these drain into the internal iliac veins

Question 40

Answer 40

• (Top ) vesical plexus
• ​(bottome) prostatic plexus (m)

Question 41

superior rectal veins empty into

Answer 41

inferior mesenteric which in turn empties into the portal vein

Question 42

Middle rectal veins empty into the

Answer 42

internal iliac veins which in turn empty into the inferior vena cava

Question 43

Inferior rectal veins drain into the

Answer 43

internal pudendal veins which eventually drain to the internal iliac

Question 44

Answer 44

• (top) superior rectal veins
• (mid) middle rectal veins
• (bottom) inferior rectal veins

Question 45

Internal hemorrhoids are prolapsed rectal mucosa containing veins of the

Answer 45

internal rectal plexus

Question 46

External hemorrhoids are clots in veins of the ______

Answer 46

external rectal venous plexus (fed by branches of the inferior rectal veins)

Question 47

Internal hemorrhoids are internal rectal veins that prolapse into the anal canal and often ______

Answer 47

strangulate

Question 48

External hemorrhoids are clotted blood in the external rectal veins. Usually caused by

Answer 48

increased abdominal pressure or straining

Question 49

Lymphatics of the prostate and uterus drain primarily to

Answer 49

internal iliac nodes

Question 50

Lymphatics of the bladder primarily drain to

Answer 50

external iliac nodes

Question 51

Lymphatics of the perineal structures drain primarily to

Answer 51

superficial inguinal nodes

Question 52

The Sacral plexus is on the pelvic surface of the

Answer 52

piriformis muscle

Question 53

The inferior part of the vagina is innervated by

Answer 53

somatic branches from the internal pudendal nerve

Question 54

The middle and superior parts of the vagina and uterus are innervated by

Answer 54

• visceral nerves
  
  • Uterovaginal plexus (part of the pelvic plexus)
  • Sympathetics from lumbar splanchnics
  • Parasympathetics from S2, S3, S4 (motor to the uterus and vagina)

Question 55

The pelvic pain line follows the

Answer 55

• Peritoneum
  
  • pain from viscera above the line follows sympathetics
  • pain from viscera below the line follows parasympathetics

Question 56

Question 57

Question 58

Question 59