Final Exam Flashcards
What are the 3 functions of the kidney?
Remove water, salts and products of protein metabolism from the blood
Which kidney lies slightly lower than the other and why?
the right is slightly lower
because right lobe of liver pushes it down
What 4 structures are transmitted through the hilum of the kidney
Renal Vein
Renal Artery
Ureter
Autonomic and Sensory nerves
What is the name for the expanded superior end of the ureter within hilum of kidney
Renal pelvis
What is the renal sinus filled with?
fat
The structures which enter the hilum of the kidney are collectively known as what/
renal pedicle
What is the blood supply of the kidney?
renal artery (from abdominal aorta)
what are extrahilar arteries?
accessory arteries which may originate from the abdominal aorta (above or below renal artery)
What drains the kidneys
Renal vein
True or false, the right renal vein drains an extensive region including suprarenal gland, gonad, diaphragm and body wall
False, the Left renal vein does all of that
What is the “anatomical nutcracker”
left renal vein and 3 part of duodenum may be compressed between aorta behind and superior mesenteric artery in front
what is the innervation of the kidneys? What makes up the plexus?
renal plexus
branches of: celiac plexus, aortic plexus, and direct branches from thoracic and lumbar splanchnics
What are the 4 layers covering the kidney
renal capsule (innermost)
perinephric fat
renal fascia
paranephric fat (outermost)
What are the 3 things that compose kidney stones
calcium oxalate
calcium phosphate
uric acid
What are the symptoms of kidney stones? What are some complications that can occur?
Dull ache in kidney while in the organ, then extremely painful once entering ureter
May become lodged while being passed
What are 3 risk factors for kidney stones
Being male
low fluid intake/dehydration
“stone belt” southeastern USA
Extracorcoreal shock-wave elithdripsy (ESWL) is a possible treatment for what?
Kidney stones
What is nephroptosis? Who is it more common in?
“floating kidney”
Kidney becomes hyper mobile and moves down within renal fascia
More common in very skinny people
What is the muscular tube connecting the kidney to the urinary bladder?
Ureter
The ureter has three constrictions where kidney stones can become lodged, what are they?
ureteropelvic junction
pelvic brim
where it enters the bladder
What are the 5 branches that supply blood to the ureter
renal a. gonadal a. aorta common iliac a. superior vesical a.
What 2 structures innervate the ureter
renal plexus
hypogastric plexus
What structure that lies on the superior aspect of the kidney is part of the endocrine system?
suprarenal gland
What are the 2 parts of the suprarenal gland
medulla
cortex
What are the 3 arteries supplying the suprarenal gland
superior, middle, and inferior suprarenal a.
What drains the suprarenal gland?
suprarenal vein
What two structures innervate the suprarenal gland
Celiac plexus
thoracic splanchnic nerves (sympathetics)
Where is kidney and suprarenal gland pain often referred to, why?
pain referred to paralumbar region
because receive innervation from T11-L2
What is the “psoas sign” what can a positive right psoas sign indicate?
Pain produced when thigh extended against resistance
positive right psoas sign suggests appendicitis
What percentage of people have a psoas minor?
60%
What ventral primary rami make up the lumbar plexus
L1, L2, L3, L4
What are the two branches of the lumbar plexus consisting of L1 primary rami?
Iliohyogastric and ilioinguinal Nerve
What does the ilioinguinal never accompany through inguinal canal? And what does it supply?
Accompanies the spermatic cord (round ligament of uterus in females)
Supplies skin of scrotum or labia majora
What branch of the lumbar plexus made up of ventral primary rami L1 and L2
What is the nerves 2 branches
Genitofemoral nerve Genital branch (supplies cremaster muscle) femoral branch (skin femoral triangle)
What branch of the lumbar plexus is made up of ventral primary rami L2 and L3
What does it supply
Lateral cutaneous nerve of thigh
skin of anterior and lateral aspect of thigh
What 2 branches of lumbar plexus is made up of ventral primary rami L2, L3, L4
Femoral nerve
Obturator nerve
What ventral primary rami make up sacral plexus?
L4-S4
How many branches are there in the abdominal aorta
9
What do each of the common iliac artery bifurcate into?
internal and external iliac artery
What are the 4 functions of the pelvis?
locomotion
parturition
support of abdominal viscera
protection of pelvic viscera
True or false the ASIS and upper margin of the pubic symphysis do not lie in the same vertical plane?
false, they do lie in the same plane
The tip of the coccyx and upper margin of pubic symphysis lie in which plane together?
horizontal
What are the 5 boundaries of the pelvic inlet?
sacral promontory sacral alae arcuate line pecten pubis pubic crest
The pelvis is divided into what?
False and True pelvis
What are the 4 things in the True pelvis?
Lower part of the G.I. tract
urinary bladder
lower part of ureter
internal reproductive organs
What are the 5 boundaries of the pelvic outlet
pubic symphysis ischiopubic rami ischial tuberosities sacrotuberous ligament tip of coccyx
What is a anthropoid pelvis? Who is it present in?
Long A-P diameter and short transverse diameter
In some males, in 20% of females
What is a platypelloid pelvis? Who is it present in?
short A-P diameter and wide transverse
Rare in males, 2% of females
What is a Android pelvis? Who is it present in?
heart shaped inlet
Most males, 30% of females
What is a gynecoid pelvis? Who is it present in?
Ovoid or round inlet
50% of females (no males)
Ideal for childbirth
What are general shapes of male and female pelvic inlets
Male - heart
Female - oval
The pelvic cavity and pelvic outlet is larger in what sex?
Female
Subpubic angle is larger in which sex?
female
The greater sciatic notch is more broad and shallow in which sex?
Female
Male- narrow and deep
True or false female sacrums is shorter and wider than males
true
True or false the pubic symphysis contains a cartilage disc?
True interpubic disc
True or false the sacrococcygeal joint contains intervertebral disc and is often fused
True
During pregnancy what causes the ligaments of the pelvis to loosen?
the hormone relaxin
What are the 3 things that bind the greater sciatic foramen
Greater sciatic notch
sacrotuberous
sacrospinous
What are the 3 things that bind the lesser sciatic foramen
Lesser sciatic notch
sacrotuberous
sacrospinous
Which sciatic foramen lies above pelvic floor
greater sciatic foramen
Which sciatic foramen lies below pelvic floor
lesser sciatic foramen
Name the 3 structures that pass through both the greater and lesser sciatic foramen
pudendal nerve
internal pudendal vessels
nerve to obturator internus
What structure that passes through the greater sciatic foramen is particularly vulnerable in sacrum misalignments
sciatic nerve
What are 3 intrapelvic causes of sciatica
piriformis syndrome
compression by fetal head during pregnancy
pelvic tumors
What 2 structures cover the lateral wall of pelvis
obturator internus muscle
obturator fascia
What is the important structure of the pelvic floor that supports the abdominal and pelvic viscera
pelvic diaphragm
What is a possible complication of nephroptosis
The kidney being hyper mobile can turn upside and twist, constricting the ureter and blood vessels
Name the 9 branches of the abdominal aorta
Cassandra, She Is Impossibly Magnificent, (&) Really Good Lover Man
Celiac Trunk A. Superior Mesenteric A. Inferior Mesenteric A. Inferior Phrenic A. Middle Suprarenal A. Renal A. Gonadal A. Lumbar A. Median Sacral A.
What are the two openings of the pelvic diaphragm?
Urogenital Hiatus (transmits urethra in males, urethra and vagina in females) Anal aperture
Damage to which nerve causes the pelvis to slump to the unsupported side during gait (Trendelenburg’s Sign)
Superior Gluteal N.
The levator ani has 3 major parts, what are they?
iliococcygeus
pubococcygeus
Puborectalis
What are the 3 subdivisions of the pubococcygeus part of the levator ani
Puboprostaticus
Pubovaginalis
Puboanalis
Both the puboprostaticus and pubovaginalis subdivisions of the pubococcygeus part of the levator ani, function in what?
micturition (peeing)
The lateral femoral cutaneous nerve originates from which spinal segments?
L2 and L3
The abdominal aorta bifurcates into the left and right common iliac arteries at what level. What does the common iliac branch into?
L4
the external and internal iliac a.
what are the 2 branches of the external iliac a.
deep circumflex iliac a.
inferior epigastric a.
What artery continues as the femoral a. below the inguinal ligament?
the external iliac a.
What layer of the perineum is the deepest? (most internal?
deep perineal space
True or false, the male pelvis has a broad, shallow greater sciatic notch
false, female pelvis’ do
What are the 3 branches of the posterior trunk of the internal iliac a.
iliolumbar a.
lateral sacral a.
superior gluteal a.
What are the two branches of the iliolumbar a.
iliac branch
lumbar branch
What happens to the distal portion of the umbilical artery after birth?
It is obliterated and continues as the medial umbilical ligament
The inferior vesicle a. in males is important in what?
Reproduction
Is the internal iliac a. the only supplier or blood to the pelvis?
No, it is a major supplier but there are 3 other vessels
Gonadal a.
Superior rectal a.
Median sacral a.
Name the 8 branches of the anterior trunk of the internal iliac a.
If I Utilize Olives In My Utrilce Varies
Inferior Gluteal a. Internal pudendal a. umbilical a. obturator a. inferior vesical a. middle rectal a. uterine a. vaginal a.
What do most pelvic structures drain into?
caval system
What are the only structures of your pelvis that drain into your portal system
Rectum and anal canal
The internal and external iliac veins unite to form the common iliac veins. What do the common iliac veins unite to form into?
inferior vena cava
What two structures make up the sacral plexus
Lumbosacral trunk L4 and L5
anterior primary rami S1-4
True or false the sacral plexus lies mainly on surface of piriformis
true
What is another name for the sacral plexus?
Somatic plexus
What are the 6 branches of the sacral plexus
Superior Gluteal (L4-S1)
Inferior Gluteal (L5-S2)
Sciatic (L4-S3)
Nerve to obturator internus muscle (L5-S2)
Nerve to Quadratus Femoris Muscle (L5-S1)
Posterior cutaneous nerve of thigh (S1-S3)
Sympathetic fibers reach the pelvis via what 2 pathways
Sympathetic trunk
aortic plexus
The superior vesicle a. is a direct branch of what?
umbilical a.
What lobe of the prostate gland contains no glandular tissue?
anterior lobe
True or false, lymphatic drainage of the lower 1/4 of the vagina is to the superficial inguinal nodes
true
True or false, the hypogastric nerves connect the superior hypogastric plexus to the inferior hypogastric plexus
true
True or false, external hemorrhoids are due to varicosities of the superior rectal vein
False
true or false, the superior surface of the bladder is also called the fundus
false
True or false, the pecten of the anal canal lies between the pectinate line and anal verge
true
True or false, the lateral arcuate ligament passes over the quadrates lumborum muscle?
True
How many transverse rectal folds are there?
3
Does the rectum contain mesentery, omental appendices, or haustra
No
True or false, the anal columns each contain a small branch of the superior rectal artery and small tributary of the superficial rectal vein
true
What does the pectinate line mark the end of?
end of hind gut
True or false, the anal sinuses do not contain mucus glands
false, they do
What is the bluish white zone inferior to the pectinate line of the anal canal
anal pecten
Is the internal anal sphincter muscle under voluntary or involuntary control
involuntary
What are the 3 parts of the external anal sphincter muscle? Is it under voluntary or involuntary control?
subcutaneous
superficial
deep
voluntary control
What 4 blood vessels supply the rectum and anal canal
superior rectal artery
middle rectal artery
inferior rectal artery
median sacral artery
What are internal hemorrhoids caused by? Do they occur above or below pectinate line? What are the symptoms? Painful?
Varicosities of superior rectal vein
above pectinate line
blood in stool
Not painful
What are external hemorrhoids cause by? Do they occur above or below pectinate line? What are the symptoms? Painful?
Varicosities of the inferior rectal vein
below pectinate line
Bulging out
yes very painful
What are 5 causes of hemorrhoids
pregnancy heavy lifting sitting a lot straining constipation portal hypertension
What does the pectinate line mark?
Important division in anal canal. Separates upper 2/3 visceral from lower 1/3 somatic
What is the innervation and lymph drainage above the pectinate line
autonomic fibers
internal iliac
What is the innervation and lymph drainage below the pectinate line
pudendal nerve
superficial inguinal
What muscle has to relax in order for stool to reach internal anal sphincter
puborectalis
Is urinary bladder located above or below peritoneum? Does it’s location differ between sexes?
Below, and lower in females
True or false when you’re born, your bladder lies mostly in your abdomen and is spindled shaped?
True
An empty bladder has 4 identifiable parts, what are they?
superior
left inferolateral
right inferolateral
fundus (base)
Where does the ureter attach to the bladder?
at its fundus
What are the 2 ligaments of the bladder
puboprostatic
Lateral ligament of bladder
What is the detrusor muscle?
bundles of smooth muscle which lie in wall of bladder
What does the internal urethral sphincter do in males during reproduction
prevents reflux of semen into bladder during ejaculation
What are the 3 arteries of the bladder
superior vesical
inferior vesical
vaginal
What drains the bladder
prostatic venous plexus or vesical venous plexus in females
What innervates the bladder
prostatic plexus or vesical plexus in females
Bladder fullness triggers the micturition reflex, which sends information where? What muscle is subsequently triggered, and what relaxes
parasympathetic fibers pelvic splanchnics S2, S3, S4
detrusor muscle
internal urethral sphincter in males relaxes
(External urethral sphincter is voluntary control)
What is a vasectomy (deferentecomy)
transection and ligation of the ductus deferens
The ductus deferens joins what duct at its end
duct of the seminal vesicle forming the ejaculatory duct
What is the dilated terminal portion of the ductus deferens called?
ampulla of the ductus deferens
What is the innervation of ductus deferens
superior and inferior hypogastric plexus
What function do the seminal vesicles have?
produce a alkaline solution for semen
Important because vagina is very acidic and would kill semen otherwise
Do the seminal vesicles store sperm
no
What is the seminal vesicle innervation
inferior hypogastric plexus
What forms the ejaculatory duct
union of ductus defers and duct seminal vesicle
What do the 2 ejaculatory ducts open into
the seminal colliculus (within the prostatic urethra)
What is the blood supply of ductus deferens, seminal vesicle, and ejaculatory duct
a. of ductus deferens
inferior vesical a.
middle rectal a.
What is the most important artery for the internal genitalia of men
inferior vesical a.
What is the function of the prostate gland
produce semen
What aspect of the prostate gland is prone to tumors
posterior aspect (why prostate exams through anal canal)
Does the isthmus of the prostate contain any glandular tissue?
no
What is the prostatic utricle homologous to?
the uterus
What is the blood supply of the prostate
inferior vesical a. (again most important a. in internal male genitalia)
middle rectal a.
internal pudenal a.
What is benign prostatic hypertrophy? Who is prone to this? What does it cause? Holistic treatment?
Prostate enlarges due to influence of hormones
men over 40
causes difficulty in micturition
Saw Palmetto supplementation shown to help
What is most common cancer in men? Where does it metastasize? Why is it so deadly
Prostate Cancer
Metastasizes through blood and lymph
Prostate’s connections with sacral venous plexus allows metastasis to vertebral column
Common involvement in bone
What is PSA? (prostate specific antigen)
Early detection test for prostate cancer
Where might chronic prostate pain due to inflammation or prostate cancer be referred to? Subluxations in this region may be related to what problems?
Pain referred to sacrum
Prostate or bladder problems
What 4 structures are included in the female reproductive system
ovary
uterus
vagina
uterine tube
Ovaries have two functions, what are they
Produce oocytes after puberty Exocrine function (releases relaxin, estrogen, and progesterone)
True or false, the ovary is located on the lateral wall of the true pelvis
true
True or false the ovary is covered by peritoneum
false it is not (how ectopic pregnancies are possible)
What 2 vessels supply the ovary
ovarian artery
ovarian branch of uterine artery
What innervates the ovary
ovarian plexus
How does the uterine tubes transport oocytes? How long does it take
through ciliary action and muscle contraction
3 to 4 days
The same ciliary action and muscle contraction aids in what?
transport of sperm
What are the 4 parts of the uterine tube
Uterine part
isthmus
ampulla
infundibulum
What is the abdominal ostium
opening near uterine tube above ovary
What are fimbriae? what is their function? are they all alike?
fingerlike projections at the end of the infundibulum
to catch the oocyte from the ovary
usually one extra long frimbriae called, ovarian fimbriae
Where does fertilization take place? What is the most common site? Second most common?
in the uterine tube
Ampulla
infundibulum
What is the blood supply of the uterine tube
tubal branches of the uterine a. and ovarian a.
What is the innervation of the uterine tube
ovarian plexus and inferior hypogastric plexus
What is abdominal ectopic pregnancy?
implantation of fertilized oocyte in rectouterine pouch
What is ectopic pregnancy? Where is it most common? What does it result in? What is a common cause of it
Development of fetus at a site other than uterine cavity
most common: tubal ectopic
Results in rupture of uterine tube, severe hemorrhage
Common cause: inflammation due to
History or STDs
Endometriosis
Reversed tubal ligation
the cavities of the uterus and vagina together form what?
birth canal
True or false, the shape, size and location of the uterus is variable due to age, or number or pregnancies
true
What happens in the uterus after menopause
increase in fibrous tissue and cyst development
In nulliparous woman (one with no children) what does their uterus look like?
muscular, thick and inverted pear shaped
What is retroversion of the uterus? What is it associated with?
uterus is bent backwards (opposite of anterversion) associated with
severe menstral cramps
severe pain in maturition (birth)
increased risk in uterine prolaps
What is anteversion of uterus?
lower end of the uterus forms a right angle with vagina
What are the 5 parts of the uterus
Body, isthmus (internal os), cervix, external os, fundus
What is the blood supply of the uterus
Uterine and ovarian a.
What are the lymphatics of the uterus
lumbar nodes
external and internal iliac nodes
Produces the alkaline component of semen
seminal vesicle
transports sperm and the alkaline component of semen
ejaculatory duct
transports sperm, alkaline, and non-alkaline components of semen
prostatic urethra
transports sperm only
ductus deferens
produces a non-alkaline component of semen
prostate gland
True or false, the round ligament of the uterus gives support to the uterus
false, it does not
Part of the broad ligament of the uterus which covers uterine tube and lies between the uterine tube and ovary
mesosalpinx
bulging of the rectum into the posterior wall of the vagina due to muscle damage caused by childbirth is called what
rectocele
The layer of smooth muscle in the wall of the bladder is called what
detrusor
The folds of mucosa which join the anal columns together inferiorly are called
anal valves
The 2 sacculated pouches which produce components of semen and which are attached to the posterior surface of the prostate are called
seminal vesicles
What is the innervation of the uterus
uterovaginal plexus
What are the vaginas 3 functions
female organ of copulation
lower part of birth canal
excretory duct of menstration
What is the fornix
recess between cervix and walls of vagina
What are the subdivisions of the fornix
anterior posterior and two lateral fornices
What 4 structures support the vagina
levator ani
perineal body
perineal membrane
pubocervical, transverse cervical, and uterosacral ligaments
What is the blood supply of the vagina
uterine and vaginal a.
What is the lymphatic drainage of vagina
internal iliac nodes (upper 3/4)
superficial inguinal nodes (lower 1/4)
What is the innervation of the vagina
pudendal nerve
uterovaginal plexus
What is cystocele? what can it cause
Bulging of the bladder into anterior wall of vagina
difficulty in micturition
What is uterine prolapse? What is a possible sign? What are some risk factors
The uterus slips down into the vagina
Cervix may protrude externally through vaginal orifice
Multiple births, retroverted uterus
What are the 2 triangles of the perineum?
urogenital (anterior)
anal (posterior)
Colles fascia (membranous layer of the perineum) is continuous with what in males?
dartos layer of scrotum and scarpas fascia
The superficial perineal pouch contains everything from the vagina model in lab, plus what 2 structures?
branches of the internal pudendal a.
branches of the pudendal n.
What is a episiotomy? When/why is it used
Incision during parturition (birth) from posterior vaginal wall to perineal body
Used to prevent uncontrolled tearing of the perineum during parturition
What two muscles contract to maintain an erection? What is the innervation?
Bulbospongiosus and Ischiocavernosus muscles
Parasympathetic activation S2, S3, S4
S2,3,4 keeps your penis off the floor!
What two structures are in both the superficial and deep perineal pouches
branches of the internal pudendal a.
pudendal n.
The perineal body is an important attachment site for 5 muscles, what are they
superficial transverse perineal deep transverse perineal bulbospongiosus levator ani sphincter ani externus
Other than the branches of the internal pudendal a. and pudendal n. what is located in the deep perineal pouch
deep transverse perineal muscle external urethral sphincter intermediate part of urethra bulbourethral gland (males)
What is a possible complication of the external urethral sphincter muscle for females?
May be damaged during parturition (results in urinary incontinence)
In what sex can you find the bulbourethral gland? What is it homologous to? What does it do?
Male
greater vestibular gland of females
secretes a mucus like substance in spongy urethra
What are the 3 things in the anal triangle?
anal canal, external anal sphincter and ischioanal fossa
Where is the ischioanal fossa? What 4 things are in it?
on either side of anal canal, extends between skin and anal region
Fat
Pudendal canal
inferior rectal nerve and vessels
perineal branch of posterior cutaneous nerve of thigh
True or false the pudendal canal lies on the lateral wall of the ischioanal fossa and is formed by the obturator fascia
true
What is the main blood supply of the perineum?
the internal pudendal a. and it’s branches
The internal pudendal a. is a branch of the internal iliac a. and travels where?
through greater sciatic foramen, between piriformis and coccyges and enters perineum through lesser sciatic foramen
What are the 7 branches of the internal pudendal a.
inferior rectal a. perineal a. posterior scrotal a. artery of bulb urethral a. deep a. of penis or clitoris dorsal a. of penis or clitoris
What innervates the perineum?
pudendal nerve (S2,3,4)
What are the 3 branches of the pudendal n.
inferior rectal n.
perineal n. (deep and superficial branch)
dorsal n. of penis or clitoris
