GA-Pelvic Viscera I and II Flashcards
what are the boundaries of the male peritoneum? what does it cover?
pelvic peritoneum ends at superior bladder and has several deeper puches
covers bladder, ureters, ductus deferesne, and superior end of seminal gland, up the rectum and sigmoid colon
what is the most inferior point in male anatomy? what does it separate?
the rectovesicular pouch
rectum and bladder
what is the endopelvic fascia? what is it made up of?
a lining beneath the peritoneum that covers the pelvic organs, pelvic wall, and pelvic floor
continuations of transversalis fascia and ligaments/other thickened fascia?
what are ligaments that make up the endopelvic fascia?
tendinous arch of levator ani puboprostatic ligament (male) pubovesicular ligament (female) lateral ligament of bladder cardinal ligament (females) paracolpium
what is the paracolpium?
thickened fascia from the vagina to the tendinous arch
helps support
what are the potential spaces/pouches in the male pelvic region?
retrovesicular space (lowest)
paravesicular fossa
retrorectal space
retropubic space (puboprostatic ligament)
which space contains the puboprostatic/pubovesicular ligaments?
retropubic space
what are the relationships of the vas deferens?
enters the abdominal cavity via deep inguinal ring –> passes superior to literally every structure (emphasis on ureter) –> expands into an ampulla at the posterior bladder –> thins out and goes under bladder medial to seminal vesicle
where are the seminal vesicles located?
posterior bladder lateral to where the vas deferens enters
what two structures join together to form the ejaculatory duct?
vas deferens . and seminal vesicles
where is the prostate located?
inferior to bladder, surrounds prostatic urethra, superior to bulbourethral gland
what nerves innervate the male pelvic organs? testes?
sympathetic T10-L2
parasympathetic S2-S4 pelvic splanchnic
visceral afferent with parasympahtetic
testes with sympathetic (T10)
what male organs drain into the internal iliac nodes? 4
vas deferens
seminal vesicle
prostate
fundus and neck of bladder
what male organs drain into the external iliac nodes? 2
scrotal vas deferens
superior/lateral bladder
what is the path of the ureter?
retroperitoneal
exit kidney –> over pelvic brim –> obliquely enter posterior bladder wall
what structures in the male and female are located superior to the ureters?
male: vas deferens
female: uterine artery/vein
what supplies blood to the ureter?
renal a, gonadal a, aorta, internal iliac branches
what innervates the ureter?
preaortic plexus, hypogastric plexus, pelvic splanchnics
what are the parts of the bladder? their relationships?
apex-points towards pubis
fundus-opposite apex
body- in between
neck-where urethra starts
what ligaments support the bladder in males? females? which are part of the endopelvic fascia?
median umbilical ligament (urachus remnant)
part of endopelvic fascia
lateral ligaments
puboprostatic ligament
pubovesical ligamnet
what supplies blood to the bladder?
superior and inferior vesicular arteries
vaginal artery contributes in females
what innervates the bladder? (p and s)
sympathetic-superior hypogastric plexus
parasympathetic-pelvic splanchnic/inferior hypogastric plexus
what muscle lines the bladder wall and what innervates it and whats its function
detrusor
parasympathetic fibers
contract to expel urine
what is the trigone? what is important about it?
a triangle formed by two ureters and beginning of urethra
its very sensitive to stretch, relays lots of sensory info
what is the difference between male and female urethras?
males have spongy, prostatic, and membranous
females only have membranous
what is the seminal colliculus?
an enlarged area of the prostatic urethra that accommodates incoming fluid from ejaculatory duct and prostate
where are the prostatic sinuses located? what does it secrete?
in the prostatic urethra lateral to the ridges, alkaline fluid from prostate
what innervates the internal urinary sphincter?
inferior hypogastric plexus (parasympathetic relaxes)
what innervates the external urinary sphincter?
deep perineal branch of pudendal nerve (voluntary)
what problems can arise from an enlarged prostate, why does this happen?
benign growth due to age
can cause urethral obstruction, urinary issues, bladder infections, kidney damage
what are the attachments of the ovary and to where do they attach? 3
anterior attachment to fallopian tube via mesovarium
medial pole attachment to lateral uterus is ovarian ligament
lateral attachment to lateral pelvic wall is suspensory ligament of ovary
starting at the ovary what is the path in the fallopian tube? where does fertilization occur?
infindibulum –> ampulla –> isthmius –> intrauterine
ampulla
what is the location and parts of the uterus?
posterior/superior to bladder
fundus, body, cervix
from superficial to deep what are the layers of the uterus?
perimetrium, myometrium, endometrium
what are the normal positioning angles of the uterus
anterverted-angle of vagina and cervix
anteflex-angle of cervix to uters
what issues can arise from uterine positioning? sx?
can be excessively retroverted or excessively flexed
no impact on fertility, causes back pain/dysuria
what is formed when the cervix pushes into the vagina?
fornices
where does the lymph from the round ligament and fundus drain ?
superficial inguinal lns
where does the lymph from the ovary/fallopian tubes/fundus drain?
lumbar lns
where does everything else in the female drain?
internal iliac nodes
what innervates the female pelvic viscera?
inferior hypogastric plexus
what is different about the ovarian plexus innervation?
innervated by vagus and sympathetic T10/T11
Where is the pelvic pain line? what innervates above/below?
level of sacral base, inferior limit of peritoneum
above-sympathetic (T12-L2)
below-parasympathetic (pelvic splanchnic)
what are the peritoneal folds of the female? what structures are a part of this?
two folded layers of peritoneum
rectouterine fold
suspensory ligament of ovary
broad ligament
what is the most inferior part of the female peritoneum?
rectouterine pouch
what 3 ligaments are part of the female endopelvic fascia?
cardinal ligament
pubocervical ligament
uterosacral ligament
what is contained in the cardinal ligament? function?
uterine a/v
main support of uterus
what is contained in the pubocervical ligament?
superior vesicular a
what is contained in the uterosacral ligament? where is it located?
middle rectal a/v
found in the rectouterine fold
what is contained in the broad ligament?
round ligament fallopian tube ovary uterus proper ovarian ligament uterina a/v ureter
what are the three parts of the broad ligament, what do they connecT?
mesovarium-ovary to fallopian but closer to ovary
mesosapinx-ovary to fallopian but closer to fallopian
mesometrium-idk
what causes uterine prolapse?
weakened cardinal ligament or pelvic diaphragm due to pregnancy (mostly), aging, or menopause
what does a spinal block anesthesia take sensation away from? what level do you do this?
L3-L4 subarachnoid space
everything waist down-
intraperitoneal structures
subperitoneal structures
somatic structures
what does a caudal epidural block take sensation away from?
epidural space at S5/co
cant feel anything below pelvic pain line
no subperitoneal or somatic sensation
what does a pudendal nerve block denervate?
somatic sensation
mother can still feel uterine contractions cause cervix and superior vagina still feel pain
