GU 4 - Pelvic Organs and Female External Genitalia

Question 1

List male organs involved in reproduction

Answer 1

Testes
Epididymides
Vas deferens
Seminal vesicles
Ejaculatory ducts
Bulbo-urethral glands
Prostate gland
penis

Question 2

Where is the prostate gland located

Answer 2

lies against the neck of the bladder and is pierced by the urethra and ejaculatory ducts

Question 3

List the parts of the vagina

Answer 3

labia major
labia minora
Vestibule
Vestibular glands
Vaginal opening
Clitoris
Urinary meatus
Mons pubis
Hymen

Question 4

Is urinary bladder superficial or deep to the peritoneum

Answer 4

Deep

Question 5

What artery supplies the urinary bladder and what is it a branch of

Answer 5

Vesicle
Internal iliac artery

Question 6

which veins drain blood from the urinary bladder and what are they a branch of

Answer 6

vesicle
internal iliac vein

Question 7

How much mL of liquid apron can an adult bladder hold

Answer 7

400-600 mL

Question 8

what id the function of rugae in the urinary bladder

Answer 8

Stretch

Question 9

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.

Answer 9

smooth
involuntary
prostate
deep perineal pouch
skeletal
voluntary

Question 10

Describe somatic innervation of the bladder

Answer 10

branches of the pudendal nerve (S2-S4) allowing voluntary control of the external urethral sphincter.

Question 11

Describe sympathetic innervation of the bladder

Answer 11

branches of hypogastric nerve (sympathetic chain, T12-L2)
* Causes relaxation of the detrusor and contraction of the internal urethral sphincter, allowing storage of urine.

Question 12

Describe parasympathetic innervation of the bladder

Answer 12

Via the pelvic splanchnic nerves (S2-S4)
* Causes contraction of the detrusor and relaxation of the internal urethral sphincter, allowing initiation of micturition.

Question 13

. If a patient suffers an injury to their spinal cord above the sacral level, which pathways are inhibited

Answer 13

1)ascending pathways conveying the sensation of bladder filling to the brain (so the patient is no longer aware of bladder filling)

2. descending pathways that exert voluntary, inhibitory control over the external urethral sphincter (so the external sphincter is permanently relaxed).

Question 14

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

Answer 14

-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.

Question 15

The rectum is the terminal part of the ___ intestine

Answer 15

large

Question 16

This is misleading as the rectum has two notable curves (flexures), sacral which is ______ and anorectal which is

Answer 16

anterior
posterior

Question 17

what is primary function of rectum and how long in cm is it

Answer 17

12 cm
storage of faeces

Question 18

what is The most distal part of the gastrointestinal tract

Answer 18

anal canall

Question 19

The internal anal sphincter is composed of ____ muscle and is _______ controlled, whilst the external anal sphincter is composed of ______ muscle and is voluntarily controlled.

Answer 19

smooth
involuntarily
skeletal
voluntarily

Question 20

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 ______

Answer 20

endoderm
ectoderm

Question 21

The superior part of the anal canal is part of the hindgut and is supplied by which arteries and drained bay which veins

Answer 21

nferior mesenteric artery
portal venous system

Question 22

Below the pectinate line, the inferior part of the anal canal is supplied by which arteries and veins

Answer 22

middle and inferior rectal arteries
systemic venous system

Question 23

would it be a haemorrhoid above or bellow the pectinate line where pain would felt

Answer 23

below

Question 24

Why may inflammation of the ovary may cause pain along the medial aspect of the thigh?

Answer 24

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.

Question 25

What is a retroverted uterus?

Answer 25

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.

Question 26

which lymph nodes would cervical cancer spread?

Answer 26

lymph nodes bear internal iliac arteries

Question 27

What structures may be palpable during examination through the vagina?

Answer 27

Anteriorly: base of bladder, urethra

Laterally: ureter, levator ani muscle, ovary by bimanual palpation

*Posteriorly: rectum, rectouterine pouch, perineal body.

Question 28

Why is the ureter in danger of being damaged during a hysterectomy

Answer 28

The ureter runs immediately under the uterine artery which is ligated during hysterectomy

Question 29

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”

Answer 29

• 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.