Exam IV - General Information Flashcards
/What are the functions of the kidney?
- Remove water, salts, and products of protein metabolism from the blood
What injury may be mistaken for kidney pain?
- Strained psoas major
What is the name of the vertical fissure on the medial surface of the kidney?
- Hiilum of the kidney
What structures are located within the hilum of the kidney?
- Renal Vein
- Renal Arter
- Ureter
- Autonomic and Sensory Nerves
The structures that enter the hilum of the kidney are collectively known as what?
- Renal Pedicle
How many renal pyramids are included in the renal medulla?
- 8-12
How many renal papillae fit into the minor calices?
- 8-12
What is the blood supply of the kidney?
- Renal Artery
What is drained by the left renal vein?
- Left kidney
- Suprarenal Gland
- Gonad
- Diaphragm
- Body Wall
The renal plexus is formed by what?
- Celiac Plexus
- Aortic Plexus
- Thoracic and Lumbar splanchnic Nerves (mainly least splanchnic)
What is the function of the fat around the kidney?
- Protection
- Insulation
- Support
T/F The Ureter is interperitoneal.
- False; it is retroperitoneal
What are the three constrictions where kidney stones may become lodged?
- Ureteropelvic junction
- Pelvic Brim
- Where it enters the wall of the bladder
What is the blood supply of the ureter?
- Renal A.
- Gonadal A.
- Aorta
- Common iliac A.
- Superior Vesical A.
What is the innervation of the ureter?
- Renal Plexus
- Hypogastric Plexus
What part of the suprarenal glands secrete catecholamines?
- Medulla
What part of the suprarenal gland secretes corticosteroids?
- Cortex
What is the medulla of suprarenal gland derived from?
- Neural crest cells (modified sympathetic ganglion)
Which suprarenal gland is pyramidal and which one is semilunar?
- Right - Pyramidal
- Left - Semilunar
What is the blood supply for the suprarenal glands?
- Superior Suprarenal A. (Inferior Phrenic)
- Middle Suprarenal A. (Aorta)
- Inferior Suprarenal A. (Renal A.)
Where does each suprarenal gland drain?
- Right - directly into inferior vena cava
- Left - left renal vein
What is the innervation of the suprarenal glands?
- Celiac Plexus
- Thoracic Splanchnic N.
(Primarily Sympathetic)
What gland, relative to its size, has the largest autonomic nerve supply of any organ?
- Suprarenal Glands
The right crus of the diaphragm originates from where?
- Upper three lumbar vertebrae
splits to surround the esophagus
The left crus of the diaphragm originates from where?
- Upper two lumbar vertebrae
What connects the the right and left diaphragmatic crux?
- Median Arcuate Ligament (also forms the border of the aortic hiatus)
What connects the body of the 1st lumbar vertebra to the TVP of the 1st lumbar?
- Medial Arcuate Ligament (passes over the psoas major muscle and sympathetic trunk)
What connects the TVP of L1 to rib 12?
- Lateral Arcuate Ligament (passes over puadratus lumborum)
The lumbar plexus is made up of what nerves?
- Anterior primary rami L1-L3 and part of L4
Iliohypogastric Nerve (L1)
- Sensory to the skin covering the pubis and gluteal region
Ilioinguinal Nerve (L1)
- Sensory innervation to the skin of scrotum/labia majora and the thigh
Genitofemoral Nerve (L1,L2)
- Genital Branch: Supplies the cremaster muscle
- Femoral Branch: Supplies the skin over the femoral triangle
- Pierces psoas major
Lateral Cutaneous Nerve of Thigh (L2,L3)
- Supplies skin of Ant. and Lat. aspects of thigh
- Travels across iliacus
Femoral Nerve (L2-L4)
- Supplies the muscles and skin of thigh
Obturator Nerve (L2-L4)
- Supplies muscles and skin of medial surface of thigh
Where does the aorta bifurcate?
- Anterior to L4
What are the 4 functions of the pelvis?
- Locomotion
- Partruition
- Support of Abdominal Viscera
- Protection of Pelvic Viscera
Which way does the pelvic cavity project?
- Posteriorly from abdmonal cavity
What are the boundaries of the pelvic inlet?
- Sacral Promontory
- Sacral Alae
- Arcuate Line
- Pectin Pubis
- Pubic Crest
T/F The opening itself is the pelvic brim, the border is the pelvic inlet.
- False; the opening is the pelvic inlet, the border is the pelvic brim
What divides the greater and lesser pelvis?
- Pelvic brim
What are the functions of the greater pelvis?
- Support abdominal viscera
- Attachment site for muscles of locomotion
What is contained within the lesser pelvis?
- Lower part of G.I. tract
- Urinary Bladder
- Lower part of ureter
- Internal reproductive organs
What are the boundaries of the pelvic outlet?
- Pubic Symphysis
- Isciopubic Rami
- Ischial Tuberosities
- Sacrotuberous Ligament
- Tip of the Coccyx
What structures make up the pubic arch?
- Pubic Symphysis
- Ischiopubic Rami
- Ischial Tuberosities
Which pelvis type has a long A-P diameter and short transverse diameter?
- Anthropoid Pelvis (some males; 20% females)
What pelvis type has a short A-P diameter and wide transverse?
- Platypelloid Pelvis (rarest; most associated with birthing difficulties)
Which pelvis type has a hear-shaped inlet?
- Android Pelvis (most males; 30% females)
Which pelvis type has an ovoid/round inlet?
- Gynecoid Pelvis (50% females; ideal for childbirth)
Know differences between male/female pelvis.
- Page 155
What are the joints associated with the pelvis?
- Lumbosacral Joint (contains IVD)
- Sacroiliac Joint (Synovial Joint; Least mobile)
- Pubic Symphysis (fibrocartilaginous; contains interpubic disc)
- Sacrococcygeal Joint (contains IVD; often fused)
Sacralization of L5 is a variation of which pelvic joint?
- Lumbosacral Joint
What effect does the hormone relaxin have on pelvic joints?
- The joints become more loose
What is transmitted within the Greater Sciatic Foramen?
- Piriformis
- Sup. and Inf. Gluteal Vessels and Nerves
- Internal Pudendal Vessels
- Pudendal Nerve
- Sciatic Nerve
- Post. Cutaneous N. of Thigh
- N to Obturator Internus
- N. to Quadratus Femoris
What are the boundaries of the greater sciatic foramen?
- Greater Sciatic Notch
- Sacrotuberous Lig.
- Sacrospinous Lig.
What are the boundaries of the lesser sciatic foramen?
- Lesser Sciatic Notch
- Sacrotuberous Lig.
- Sacrospinous Lig.
What is transmitted in the lesser sciatic foramen?
- Tendon of the Obturator Internus
- N. to Obturator Internus
- Internal Pudendal Vessels
- Pudendal N.
What is the only structure that passes through the lesser sciatic foramen that doesn’t also pass through the greater sciatic foramen?
- Tendon of the Obturator Internus Muscle
What is the bony framework of the lateral pelvic wall?
- Hip bone that lies below the pelvic brim
What is the lateral pelvic wall primarily covered by?
- Obturator Internus Muscle
- Obturator Fascia
What is the bony framework of the posterior pelvic wall?
- Sacrum and Coccyx
What is the posterior pelvic wall primarily covered by?
- Piriformis Muscle
- Coccygeus Muscle
What structures make up the pelvic floor?
- Peritoneum
- Pelvic Diaphragm
Where does ascites and blood accumulate in the male pelvis?
- Rectovesical Pouch
Where does ascites and blood accumulate in the female pelvis?
- Rectouterine pouch
Where do ectopic pregnancies usually occur?
- Rectouterine Pouch
What muscles make up the pelvic diaphragm?
- Coccygeus
- Levator Ani
What are the two openings in the pelvic diaphragm?
- Urogenital Hiatus (transmits urethra and vagina)
- Anal Aperture
What is the most posterior part of levator ani?
- Iliococcygeus
What is the main part of levator ani?
- Pubococcygeus
What forms a sling around the urethra beneath the prostate?
- Puboprostaticus
What forms a sling arouund the urethra and vagina?
- Pubovaginalis
Which portions of levator ani function in micturition?
- Puboprostaticus and Pubovaginalis
What may be affected with sacral misalignment?
- Fecal Continence
- Partruition
- Urinary Continence
- Integrity of Pelvic Floor
What are the branches of the external iliac A.?
- Deep Circumflex Iliac A.
- Inferior Epigastric A.
The internal iliac A. continues as what below the inguinal lig.?
- Femoral Artery
What is the major source of blood to structures within the pelvis?
- Internal Iliac A.
What branch of the iliolumbar A. supplies iliacus and ilium?
- Iliac Branch
What branch of the iliolumbar A. supplies psoas major and quadratus lumborum?
- Lumbar Branch
What artery anastomoses with median sacral artery?
- Lateral Sacral Artery
What artery supplies Glute Max?
- Inferior Gluteal A.
What artery supplies the muscles of the thigh?
- Obturator A.
What artery supplies the inferior part of the bladder, prostate gland, and seminal vesicles?
- Inferior Vesical A.
What artery supplies the middle portion of the rectum, prostate, and vagina?
- Middle Rectal A.
What other arteries supply structures within the pelvis?
- Gonadal A. (aorta)
- Superior Rectal A. (inf. mesenteric)
- Median Sacral A. ( aortic bifurcation)
Most pelvic structures drain into the caval system. Which do not?
- Rectum and Anal Canal
What structures form the sacral plexus?
- Lumbosacral Trunk (L4,L5)
- Anterior Primary Rami of S1-S4
What nerve supplies glute med., glute min., and tensor fasciae latae?
- Superior Gluteal Nerve (L4-S1)
Weakness in muscles supplied by superior gluteal nerve results in what?
- Trendelenburg Gait
glute med., glute min., tensor fascia lata
What is the largest nerve in the body?
- Sciatic Nerve (L4-S3)
What nerve supplies obturator internus and superior gemellus?
- Nerve to Obturator Internus (L5-S2)
What nerve supplies hte quadratus femoris and inferior gemellus?
- Nerve to Quadratus Femoris (L5-S1)
What nerve is sensory to part of the gluteal region and perineum?
- Post. Cutaneous Nerve of Thigh (S1-S3)
Which branches of the sacral plexus supply the pelvis?
- N. to Piriformis (S1,S2) (Piriformis Syndrome)
- N. to Levator Ani and Coccygeus (S3,S4) ( urinary/fecal incontinence, problems w/ partruition, integrity of pelvic floor)
- N. to External Anal Sphincter (S4)
- Pudendal Nerve (S2-S4) (sexual dysfunction)
What structures make up the coccygeal plexus?
- Ventral primary rami of S4, S5
- Coccygeal Nerve
What is supplied by the coccygeal plexus?
- sacrococcygeal joint
- coccyx
- overlying skin
How do sympathetic fibers reach the pelvis?
- Downward continuation of sympathetic trunk
- Downward continuation of aortic plexus
What is formed by the formation of left and right sympathetic trunks?
- Ganglion Impar
What is the continuation of the aortic plexus?
- Superior Hypogastric Plexus
- Sympathetic fibers from lumbar splanchnic N.
- Visceral Afferent Fibers
What connects the superior hypgastric plexus to the inferior hypogastric plexus?
- Left and Right Hypogastric Nerves
What is formed by the union of the hypogastric, pelvic splanchnic, and sacral splanchnic nerves?
- Left and Right Inferior Hypogastric Plexuses
What is contained within the pelvic plexuses?
- Sympathetic Fibers
- Parasympathetic Fibers
- Visceral Afferent fibers
The inferior hypogastric plexuses give rise to what?
- Subsidiary plexuses (supply pelvic viscera)
What preganglionic sympathetic nerves arise from the sympathetic trunk and synapse in the inferior hypogastric plexus?
- Sacral Splanchnic Nerves
What parasympathetic nerves arise from S2-S4?
- Pelvic Splanchnic Nerves
What is the upper limit of the rectum?
- Rectosigmoid Junction
What is the lower limit of the rectum?
- Anorectal Junction
T/F The rectum has no mesentery, omental appendices, or haustra.
True
What is the peritoneal covering of the rectum?
- Upper third: covers front and sides
- Middle third: covers front
- Lower third: no covering
Where does one get anal hemorroids?
- Anal Columns (5-10 longitudinal folds)
What connect the lower ends of the anal columns?
- Anal Valves
What are the recesses between the anal valves and wall of the anal canal?
- Anal Sinuses (assist with lubrication)
What marks the lower limit of the anal valves around the circumference of the anal canal?
- Pectinate Line
What is the continuation of smooth muscle layer below the pelvic diaphragm under involuntary control?
- Internal Anal Sphincter
What is the blood supply of the rectum and anal canal?
- Superior Rectal A.
- Middle Rectal A.
- Inferior Rectal A.
- Median Sacral A.
Know the differences between tissue above and below pectinate line.
Page 167
Know the mechanism of defecation.
Page 167
T/F When the bladder is full, it lies entirely within the pelvis.
False; it does when it’s empty; may rise to the umbilicus when full
What forms the apex of the bladder?
- Superior and inferolateral surfaces
What forms the neck of the bladder?
- inferolateral surfaces and fundus
Where is the retropubic fat pad located?
- Retropubic Space
What attaches the prostate gland to the pubis?
- Puboprostatic Lig.
What attaches the base of the bladder to the rectovesical/rectouterine fold?
- Lateral Lig. of the Bladder
What is located on the posterior and inferior wall of the bladder?
- Trigone
What marks the openings of the trigone?
- Internal Urethral Orifice
- Two Ureteric Orifices
What is formed when the ureter travels obliquely through the bladder wall?
- Flap Valve
What is the median ridge which extends above and behind the internal urethral orifice?
- Uvula of Bladder
What is the smooth muscle that lies within the wall of the bladder?
- Detrusor Muscle
What is the blood supply of the bladder?
- Superior Vesical A.
- Inferior Vesical A.
- Vaginal A.
What blood vessels drain the bladder?
- Prostatic/Vesical plexus
What is the innervation of the bladder?
- Sympathetic: lower 3 T and upper 2 L
- Parasympathetic: Pelvic Splanchnic N. (S2-S4)
Know the Mechanism of Micturition.
Page 170
What is the innervation of the ductus deferens?
- Sup. and Inf. Hypogastric Plexus
What glandular structures lie lateral to the ampullae of the ductus deferens?
- Seminal Vesicles
The seminal vesicles join the ductus deferense to form what?
- Ejaculatory Ducts
What is produced within the seminal vesicles?
- Alkaline component of semen
T/F The Seminal Vesicles store sperm.
False
What is the innervation of the seminal vesicles?
- Inferior Hypogastric Plexus
What makes up the ejaculatory duct?
- Ductus Deferens
- Duct of Seminal Vesicle
What is the blood suppy to the ductus deferens, seminal vesicle, and ejaculatory duct?
- A. to the ductus deferens
- Inferior Vesical A. (most important)
- Middle Rectal A.
Where do the ejaculatory ducts and prostatic utricle open?
- Seminal Colliculus
What receives the ducts of the prostate gland?
- Prostatic Sinus
What is the blood supply to the prostate gland?
- Inferior Vesical A.
- Middle Rectal A.
- Internal Pudendal A.
What is the innervation of the prostate gland?
- Prostatic Plexus (Inferior Hypogastric Plexus)
