GU 4 - Pelvic Organs and Female External Genitalia Flashcards
List male organs involved in reproduction
Testes
Epididymides
Vas deferens
Seminal vesicles
Ejaculatory ducts
Bulbo-urethral glands
Prostate gland
penis
Where is the prostate gland located
lies against the neck of the bladder and is pierced by the urethra and ejaculatory ducts
List the parts of the vagina
labia major
labia minora
Vestibule
Vestibular glands
Vaginal opening
Clitoris
Urinary meatus
Mons pubis
Hymen
Is urinary bladder superficial or deep to the peritoneum
Deep
What artery supplies the urinary bladder and what is it a branch of
Vesicle
Internal iliac artery
which veins drain blood from the urinary bladder and what are they a branch of
vesicle
internal iliac vein
How much mL of liquid apron can an adult bladder hold
400-600 mL
what id the function of rugae in the urinary bladder
Stretch
The internal urethral sphincter is located at the base of the bladder where it opens into the urethra. It is composed of _______ muscle and is under __________ control. The external urethral sphincter is located just after the ______ in males, and in the _____ ______ _____ in females. The external sphincter is composed of _____ muscle and is under ______ control.
smooth
involuntary
prostate
deep perineal pouch
skeletal
voluntary
Describe somatic innervation of the bladder
branches of the pudendal nerve (S2-S4) allowing voluntary control of the external urethral sphincter.
Describe sympathetic innervation of the bladder
branches of hypogastric nerve (sympathetic chain, T12-L2)
* Causes relaxation of the detrusor and contraction of the internal urethral sphincter, allowing storage of urine.
Describe parasympathetic innervation of the bladder
Via the pelvic splanchnic nerves (S2-S4)
* Causes contraction of the detrusor and relaxation of the internal urethral sphincter, allowing initiation of micturition.
. If a patient suffers an injury to their spinal cord above the sacral level, which pathways are inhibited
1)ascending pathways conveying the sensation of bladder filling to the brain (so the patient is no longer aware of bladder filling)
- descending pathways that exert voluntary, inhibitory control over the external urethral sphincter (so the external sphincter is permanently relaxed).
what happens if a patient suffers an injury to the spinal cord or cauda equina at or below the level of the sacral micturition centre
-the reflex arc itself is disrupted and the bladder filles with urine without emptying
-The internal urethral sphincter is permanently contracted
-As the bladder continues to fill, the pressure in the bladder eventually exceeds the strength of the internal urethral sphincter and urination will occur
- This type of incontinence is ‘overflow incontinence’. If the pressure inside the bladder does not overcome the sphincter the patient develops urinary retention. Eventually urine may back up to the ureters and kidneys if a urinary catheter is not placed.
The rectum is the terminal part of the ___ intestine
large
This is misleading as the rectum has two notable curves (flexures), sacral which is ______ and anorectal which is
anterior
posterior
what is primary function of rectum and how long in cm is it
12 cm
storage of faeces
what is The most distal part of the gastrointestinal tract
anal canall
The internal anal sphincter is composed of ____ muscle and is _______ controlled, whilst the external anal sphincter is composed of ______ muscle and is voluntarily controlled.
smooth
involuntarily
skeletal
voluntarily
The superior part of the anal canal, above the pectinate line, is derived from ______, whereas the inferior part of the anal canal, below the pectinate line, is derived from ______
endoderm
ectoderm
The superior part of the anal canal is part of the hindgut and is supplied by which arteries and drained bay which veins
nferior mesenteric artery
portal venous system
Below the pectinate line, the inferior part of the anal canal is supplied by which arteries and veins
middle and inferior rectal arteries
systemic venous system
would it be a haemorrhoid above or bellow the pectinate line where pain would felt
below
Why may inflammation of the ovary may cause pain along the medial aspect of the thigh?
The ovary sits alongside the lateral pelvic wall very close to the obturator nerve.
* The obturator nerve innervates the skin of the medial thigh.
* Irritation of the obturator nerve by ovarian pathology leads to referred pain felt
in the medial thigh.
What is a retroverted uterus?
The uterus normally lies tilted forwards over the bladder (anteverted).
* Retroversion is when it is tilted backwards and may lie against the anterior wall
of the rectum or sacrum.
which lymph nodes would cervical cancer spread?
lymph nodes bear internal iliac arteries
What structures may be palpable during examination through the vagina?
Anteriorly: base of bladder, urethra
Laterally: ureter, levator ani muscle, ovary by bimanual palpation
*Posteriorly: rectum, rectouterine pouch, perineal body.
Why is the ureter in danger of being damaged during a hysterectomy
The ureter runs immediately under the uterine artery which is ligated during hysterectomy
A 25 year old woman involved in a car crash suffered complete transection of her spinal cord at the level of T6. Do you think she is able to tell when her bladder is full? Does her bladder empty via muscle contraction or does it simply “overflow”
- No sensation is possible as the spinal cord has been disconnected from the higher centres.
- Her bladder will empty by muscle contraction via the spinal micturition reflex
-As the bladder fills it is detected by the sensory nerves entering the cord at S2-4. Once the bladder is sufficiently full, these sensory nerves will stimulate the motor nerves to contract the detrusor muscle and relax the sphincters, thereby causing micturition. This is an automatic reflex of the bladder and is the same as found in children before they are ‘potty-trained’.
- In this patient, the inhibitory impulses from the brain cannot reach the bladder anymore because they’ve been cut off due to the spinal cord injury, so once micturition is initiated it cannot be suppressed.
