Final Exam Flashcards
What is the anal canal?
The portion between the pelvic diaphragm and anus
What is the anocutaneous line?
Distal termination of the anal canal (where it meets the skin)
Which sphincter of the anal canal is a continuation of smooth muscle and is under involuntary control?
Internal sphincter
Which sphincter of the anal canal surrounds the anal canal and consists of 3 parts?
External sphincter
What are the 3 muscle layers of the external anal sphincter?
Subcutaneous (most superficial)
Superficial
Deep
What arteries supply the anal canal?
Superior rectal artery
Middle rectal artery
Inferior rectal artery
Median sacral artery
What artery supplying the anal canal is a branch of the internal iliac artery?
Middle rectal artery
What artery does the median sacral artery branch off of?
Abdominal aorta
What artery supplying blood to the anal canal is a branch off of the inferior mesenteric?
Superior rectal artery
What artery supplying the anal canal is branch off of the internal pudendal artery?
Inferior rectal artery
What are varicosities of the superior rectal vein?
Internal hemorrhoids
What hemorrhoids occur above the pectinate line?
Internal hemorrhoids
Which hemorrhoids are generally painless?
Internal hemorrhoids
Which hemorrhoids could cause severe bleeding?
Internal hemorrhoids
External hemorrhoids are varicosities of what vein?
Inferior rectal vein
T or F: external hemorrhoids occur below the pectinate line?
True
Can external hemorrhoids be very painful?
Yes
What are some causes of hemorrhoids?
Pregnancy
Heavy lifting
Sitting
Straining
Portal hypertension
Who is at a high risk for developing hemorrhoids?
Long distance truck drivers
What marks the lower limits of the anal valves?
Pectinate line
What is the importance of the pectinate line?
It divides the anal canal into an upper 2/3 and a lower 1/3
Where is the urinary bladder generally located?
Below the peritoneum
Size, shape, and position of the bladder varies depending on what?
Age
Amount of urine within
As the bladder fills, it can reach the level of what?
Umbilicus
What travels subperitoneally along the lateral wall of the placid and enter the bladder at its fundus?
Ureters
When the bladder of a female is empty, where does the body of the uterus sit?
It overlies the bladder
What is the retropubic space?
U-shaped space between pubis and bladder that contains retropubic fat.
What are 2 important ligaments of the urinary bladder?
Puboprostatic/pubovesical ligament
Lateral ligament of the bladder
What does the puboprostatic ligament attach in males?
The prostate gland to the pubis
What does the puboprostatic ligament attach in females?
Neck of the bladder to the pubis
What does the lateral ligament of the bladder attach in males?
Base of the bladder to the rectovesical fold
What does the lateral ligament of the bladder attach in females?
Base of the bladder to retrouterine fold
What is the trigone of the urinary bladder?
Smooth triangular structure on the posterior and inferior wall of the bladder
What are the openings to the trigone?
Internal urethral orifice
2 ureteric orifices
What is the smooth muscle within the wall of the bladder?
Detrusor muscle
What carries sperm from the epididymis to the ejaculatory duct?
Ductus deferens
What happens to the ductus deferens after entering the abdomen?
It crosses over the ureters and descends posterior to the bladder
What structure joins the duct of the seminal vesicle to make the ejaculatory duct?
Ductus deferens
Do seminal vesicles store sperm?
No
What are the seminal vesicles?
Lobulated glandular structures that lie lateral to the ampullae of the ductus deferens against the fundus of the bladder
What does the seminal vesicles produce?
The alkaline component of sperm
Where does the ejaculatory duct open into?
The seminal colliculus within prostatic urethra
What tissues make up the prostate gland?
Smooth muscle
Glandular tissue
Fibrous tissue
What structure makes the non-alkaline portion of semen?
Prostate gland
In a male. What structure surrounds the urethra?
Prostate gland
The prostate gland is immediately anterior to what structure?
Rectal ampulla
What part of the prostate gland lies anterior to the urethra?
Isthmus of prostate
What do we call the portion of the urethra that is surrounded by the prostate?
Prostatic urethra
After age ____ the prostate tends to enlarge.
40
What leads to difficulty in micturition through compression of the urethra in men?
Benign prostatic hypertrophy
What is the main difference in prostate cancer in older men vs younger men?
In older men it is slow growing
In younger men it is very aggressive
How does prostate cancer metastasize?
Through blood and lymph tissue
T or F: Bone involvement is common in prostate cancer
True
Chronic inflammation of the prostate or prostatic cancer may cause referred pain where?
To the sacrum
What subluxations may be related to prostate or bladder problems?
Sacral misalignments or L1/L2 subluxations
What do ovaries produce?
Oocytes
When do ovaries start to produce oocytes?
After puberty
Ovaries secrete what hormones?
Estrogen, progesterone, relaxin
T or F: ovaries are covered by a peritoneum?
False
Where are ovaries located?
The posterior aspect of the broad ligament on the lateral wall of the true pelvis
What transports oocytes from the ovary to the uterus?
Uterine tubes
Uterine tubes transport sperm in the same or opposite direction of ovary transportation?
Opposite
What are the 4 parts of the uterine tubes?
Infundibulum
Ampulla
Isthmus
Uterine part
What is the opening of the uterine tube near the ovary?
Abdominal ostium
What are fibriae?
Finger link projections that catch the oocyte being released
What are ovarian fimbria?
The longest fibria. They are fused to the ovary.
What is the function of the ovarian fimbria?
To keep the infundibulum close to the ovary
What is an ectopic pregnancy?
The development of a fetus at some other site than the uterine cavity
What is the most common type of ectopic pregnancy?
Tubal ectopic pregnancy
- account of 90-95% of ectopic pregnancies
What is a tubal ectopic pregnancy?
Development of the fetus in the uterine tube
Why are tubal ectopic pregnancies dangerous?
They usually result in rupture of the uterine tube with severe hemorrhage
What are the big 3 risk factors for having an ectopic pregnancy?
STD
Reversal of tubal ligation
- meaning a woman got her tubes tied and then had it reversed
Endometriosis
Implantation in the rectourerine pouch causes what type of ectopic pregnancy?
Abdominal ectopic pregnancy
What forms the birth canal?
Cavities of the uterus and vagina
A uterus is variable in size, shape, location, and structure depending on what?
of pregnancies
Age
What is a nulliparous woman?
One with no children
What is the position of the uterus?
Anteverted and anteflexed
What would we expect the structure of the uterus to be in a nulliparous woman?
Thick and muscular uterine walls and shaped like an inverted pair
What part of the uterus lies within the body of the uterus?
Uterine cavity
The cervical canal extends from ______ to the ______.
Internal os
External os
Where is the vesicouterine pouch?
Between the uterus and bladder
Where is the rectouterine pouch?
Between the uterus and rectum
What extends from the uterus to the lateral wall of the pelvis and has 3 parts?
Broad ligament
What attaches the uterus below and anterior to the uterine tubes?
Round ligament
Which passes through the inguinal canal?
Broad ligament
Round ligament
Round
What is the transverse cervical ligament?
Thickening of pelvic fascia passing laterally to the cervix and merging with the upper fascia of pelvic diaphragm
What ligament runs within the rectouterine fold from the cervix to the sacrum?
Uterosacral ligament
What ligament runs from the cervix lateral to the urethra to the pelvis?
Pubocervical ligament
What are the 3 functions of the vagina?
- Female organ of copulation
- Lower portion of birth canal
- Excretory duct for products of menstruation
What lies anterior to the vagina?
Bladder and urethra
What lies posterior to the vagina?
Rectum
What is a recess between the cervix and the walls of the vagina?
Fornix
What is the blood supply to the upper part of the vagina?
Uterine artery
What is the blood supply to the lower part of the vagina?
Vaginal artery
T or F: there is little sensation in the vagina
True. Except for the lower most part of it
What is bulging of the rectum into the posterior wall of the vagina?
Rectocele
What is rectocele due to?
Damage to the posterior part of the Levator ani and posterior wall of vagina
T or F: Rectocele may cause difficulty in defacation
True
What is a cystocele?
Bulging of the bladder into the anterior wall of the vagina
What is cystocele due to?
Damage of more anterior parts of Levator ani and anterior wall of vagina
T or F: Cystocele may cause difficulty in defecation
False
Cause difficulty in micturation
________ is when the uterus slips down into vagina and descends to an abnormally low position in the pelvis
Uterine prolapse
What causes uterine prolapse?
Problems with pelvic floor integrity
Risk factors: multiple births and retroverted uterus
What is diamond shaped and has the same boundaries as the pelvic outlet?
Perineum
What 2 triangles make up the perineum?
Urogenital
Anal
What are the layers of the perineum from superficial to deep?
Skin
Superficial perineal pouch
Perineal membrane
Feel perineal pouch
Inferior fascia of the pelvic diaphragm
What is continuous with dartos layer of scrotum and scarpa’s fascia?
Colles Fascia
What is fused anteriorly with the suspensory ligament of the penis/clitoris?
Deep perineal pouch
What is the perineal body?
Fibromuscular mass located at the center of perineum between anal canal and bulb of penis/vagina
What is the significance of the perineal body?
It is an important point of attachment for muscles.
What muscles attach to the perineal body?
Superficial transverse perineal
Deep transverse perineal
Bulbospongiosus
Levator ani
Sphincter ani externus
T or F: Ischiocavernosus attaches to the perineal body
False
What are the 2 glands which lie posterolateral to the intermediate part of the urethra in males?
Bulbourethral glands
What is the pathway of the Bulbourethral duct?
It passes downward through the perineal membrane into the bulb of the penis to empty into the spongy urethra
What is the function of the Bulbourethral gland?
Secrete mucus-like substance
Bulbourethral gland is to male as _________ is to female.
Greater vestibular gland
What is the space called that lies ok either side of the anal canal?
Ischioanal fossa
What are the contents of the ischioanal fossa?
-Fat
-Pudendal canal
-Inferior rectal nerve and vessels
-Perineal branch of the posterior cutaneous nerve of the thigh
What part of the ischioanal fossa extends anteriorly into the urogenital triangle?
Anterior recesses
What part of the ischioanal fossa connects the external anal sphincter to the coccyx?
Anococcygeal ligament
What are the contents of the female external genitalia?
Mons pubis, labia majora, labia minora, vestibule, clitoris, bulb of the vestibule
What is the name of the external female genitalia?
Vulva
Labia majora is to female as __________ is to male
Scrotum
What is the hymen?
A membranous crescentric fold which partially closes opening of vagina into vestibule
Penis is to male as __________is to female
Clitoris
What tissue primarily makes up the clitoris?
Erectile tissue
T or F: the clitoris has a corpus spongiosum
False
The crura of the clitoris are covered by what muscle?
Ischiocavernosus
What is the function of the kidneys?
- Remove water and salts
- Produce protein metabolism for blood
T or F: kidneys are retroperironeal
True
What vertebral levels do kidneys lie?
T12-L3
The right kidney is slightly ________ than the left due to the ________.
Lower
Liver
Kidneys lie anterior to what muscle?
Papas major
What is the superior end of the ureter within the hilum?
Renal pelvis
What is the recess located within the hilum filled with fat?
Renal sinus
All the structures that enter the hilum of the kidney are collectively called what?
The renal pedicle
What structures enter the hilum of the kidney?
Renal vein
Renal artery
Ureter
Autonomic and sensory nerves
What part of the kidney contains the filtration system?
Renal cortex (The outside part)
What are projections of the renal cortex into the medulla between renal pyramids?
Renal columns
How many pyramids are there in each kidney?
*renal pyramids are in the medulla of kidney
8-12
Where do renal pyramids terminate?
Renal papilla
What are minor calices of the kidney?
Cup shaped structures into which renal papillae fit
What are major calices?
2 to 3 major channels into which the minor calices empty
What do the major calices empty into?
Renal pelvis
What is the anatomical nutcracker?
Left renal vein and third part of duodenum May be compressed between aorta (behind) and superior mesenteric artery (front)
What causes anatomical nutcracker?
Compressive abdominal trauma
Application of body cast
Aortic aneurysm (Most common)
What are the layers covering the kidney from superficial to deep?
ParAnephric fat
Renal fascia
PerInephric fat
Renal capsule
What is a membranous layer of extraperitoneal tissues which split to enclose the kidney?
Renal fascia
What is the legit term for kidney stones?
Renal calculi
What are kidney stones made of?
Calcium oxalate, calcium phosphate, uric acid
What are the big risk factors of renal calculi?
Male
Dehydration
Living in southeastern USA
What is it called when a kidney becomes hyper mobile and moves down into pelvis? Aka a floating kidney
Nephroptosis
What group of people are at risk for nephroptosis?
Very thin people
What is the danger in nephroptosis?
The kidney can turn upside down, twisting blood vessels and ureters
What is a muscular tube which connects kidney to urinary bladder?
Ureter
What muscle does the ureter descend down?
Psoas major
T or F: the ureter is retroperironeal?
True
What crosses the ureter?
Gonadal vessels
What does the ureter cross?
Common iliac artery at it bifurcation
What are the 3 constriction areas of the ureter?
Ureteropelvic junction
Pelvic brim
Where it enters the wall of the bladder
What are the 2 parts of the suprarenal gland and what do they secrete?
Medulla: secretes epinephrine + norepinephrine
Cortex: secretes corticosteroids
What body system is the suprarenal glands apart of?
Endocrine
What are the shapes of the suprarenal glands?
Right= pyramid
Left=senilunar
T or F: kidney infections are more common in males
False. More common in females due to short urethra
Kidney or suprarenal gland pain is often referred where?
Paralumbar region/flank
An infection is probably present if kidney pain presents with a ________.
Fever
