GUT Flashcards
1
Q
level of the renal arteries
A
L1-2
2
Q
the renal arteries arise from the __ aspect of the abdominal aorta
just below the __
A
lateral
superior mesenteric a
3
Q
the __ renal artery is slightly superior
to the __ renal artery
A
left is superior to the right
4
Q
retroperitoneal structures
A
SADPUCKER
suprarenal (adrenal gland)
aorta/IVC
duodenum (2nd and 3rd parts)
pancreas (minus tail)
ureters
colon (ascending/descending)
kidneys
esophagus
rectum
5
Q
the renal arteries course laterally towards the hilum of the kidney __ to the renal veins, nerves, and pancreas
A
posterior
6
Q
aortic aneurysms can involve the
A
renal arteries
7
Q
the renal arteries divide into __
and __ branches in the hilum of the kidney
A
anterior
posterior
8
Q
layer of fat that surrounds the kidney
A
perinephric fact
9
Q
is the perinephric fat deep or superficial to the fascia
A
deep
10
Q
fascial layers of the kidney
A
transversalis fascia
renal fascia
11
Q
what muscles surround the kidneys
A
posas major
quadratus lumborum
anterolateral abdominal wall muscles
12
Q
what muscles surround the kidneys
A
posas major
quadratus lumborum
anterolateral abdominal wall muscles
13
Q
internal structures of the kidneys
A
medulla and cortex
renal pyramids
papilla
calyces
pelvis
14
Q
visceral afferent pain fibers innervating the kidney return to __ spinal cord levels
A
T12-L2
15
Q
renal pain is referred to cutaneous areas supplied by __,
which supply the __ (3)
A
T12 - L2
posterior/lateral abd wall below the ribs/above iliac crest
scrotum and labia majora
proximal anterior thigh
16
Q
the testicular/gonadal arteries branch off of the
A
abdominal aorta
17
Q
the psoas major m is innervated by __
and functions to __ (2)
A
L1-L3
flex/laterally rotate thigh at the hip
flexes trunk
stabilizes vertebral column
18
Q
quadratus lumborum m is innervated by
A
T12-L4
19
Q
supine, the kidneys are located at __ vertebrae
and __ ribs
A
T12 - L3 vertebrae - L3-L4 vertebrae
ribs 11-12
20
Q
what structures are related to the right kidney
A
descending duodenum
posterior liver
hepatic flexure of colon
21
Q
what structures are associated w. the left kidney (4)
A
stomach
spleen
pancreas
splenic flexure
22
Q
structure associated w. medial kidneys
A
psoas m
23
Q
origin of the ureters
A
utereopelvic junction (UPJ) of kidney
24
Q
3 constrictions of the ureters/mc place for stones
A
UPJ - uteropelvic junction (same same PUJ - pelvicureteric junction)
common iliac artery bifurcation
vesicoureteric junction (VUJ)
25
mc place for renal stones
vesicoureteric junction (VUJ/UVJ)
26
the ureters are __ to the renal vein and artery in the hilum
posterior
27
the ureters enter the pelvis at the __ at the bifurcation of the
\_\_
sacroiliac joint
common iliac
28
when erect, the kidneys are slightly \_\_
and the __ kidney is lower than the left
lower
right
29
causes of hydronephrosis in utero/childhood
uterovesical reflux
males: congenital posterior urethral valve
congenital stenosis
neurogenic bladder
30
congenital cause of hydronephrosis that only affects males
congenital posterior urethral valve
31
causes of hydronephrosis in adults
ureteral calculi
pregnancy
neurogenic bladder
32
causes of hydronephrosis in older adults
BPH
prostatic ca
cervical ca
fecal impaction
neurogenic bladder
33
lymphatics accompany the \_\_
gonadal arteries (same-same testicular a/ovarian a)
34
the gonadal arteries arise from the __ at
\_\_ level
abdominal aorta
L2
35
the testicular artery supplies (3)
head, body, tail of epididymis
ureters
parenchyma of testes
36
the gonadal veins (testicular/ovarian) join the __ anterior
to the \_\_
IVC
renal a
37
which renal vein is longer
left renal vein is 3x longer than the right
38
clinical significance of a short urethra
predisposition to cystitis
39
orientation of urethra for catheterization
40
the male urethra curves \_\_
at a __ angle
at the \_\_
upward
30
prostate
41
how is the female urethra different from the male urethra
shorter
no curve
42
the pelvic inlet separates the \_\_
and __ pelvis
true (lesser)
and
false (greater)
43
the pelvic inlet is tilted \_\_
and the ischiopubic arch is \_\_
anteriorly
horizontal
44
area between anus and genitals; extends from vaginal opening to the anus or the scrotum to the anus
perineal region
45
thick triangular fascial structure that extends across the ischiopubic arch and has transverse muscles within
urogenital diaphragm/perineal membrane and deep perineal pouch
46
what passes through the gap between the pubic symphysis and the perineal membrane
dorsal vein of penis and clitoris
47
orifices in the floor of the perineum (3)
urethra
vagina
anus
48
the perineum includes (2)
urogenital triangle (anterior)
anal triangle (posterior)
49
anterior border of the perineum
pubic symphysis
50
lateral border of the perineum
ischipubic rami
sacrotuberous ligament
51
inferior border of the perineum
tip of coccyx
52
ligaments associated w. the perineum (2)
sacrotuberous ligament
sacrospinous ligament
53
the sacrospinous ligament and the ilium form the \_\_
which contains the __ (3)
lesser sciatic foramen
obturator interns m.
pudendal n
internal prudential vein and artery
54
the perineal membrane has a free __ border
and the deep perineal pouch contains __ (2)
posterior
muscles and neuromuscular structures
55
what 2 “openings” are in the perineal membrane
vagina
urethra (external urethral sphincter)
56
the pelvic diaphragm is composed of (2)
levator ani m
coccygeus m
57
origins of the levator ani (pelvic sling)
true pelvis →
posterior pubic bone
ligament on obturator internus m
ischial tuberosity
58
origins and insertion of the coccygeus m
origin: ischial spine and sacrospinous ligament
insertion: sacrum and coccyx
59
2 openings of levator ani
urogenital hiatus
anal aperture
60
what passes thru the urogenital hiatus (2)
urethra
vagina
61
what is the anal aperture
opening of the anus
62
what 3 muscles form the levator ani
pubococcygeus m
puborectalis m
illiococcygeus m
63
fxn of puborectalis m
perineal flexure →
pulls anorectal junction forward → keeps GI system closed at rectal area
*aids anal sphincter m*
64
origin of iliococcygeus m
ilium
obturator internus
65
what does the levator ani hold up (4)
bladder
distal end of ureters
rectum
reproductive organs
66
kegel exercises strengthen the
levator ani
67
ischiorectal fossa is same same \_\_
and is within the \_\_
deep perineal space
anal triangle
68
borders of ischioanal fossa
roof: levator ani
floor: perineal fascia
medial: external anal sphincters/anal canal
69
clinical significance of ischioanal fossa
abscesses form here dt decreased blood supply
difficult to treat
70
what is found in the lower lateral sheath of the ischiorectal fossa
pudendal canal (same-same Alcock's canal)
71
what passes thru the pudendal canal
pudendal v
pudendal a
pudendal n
72
the pudendal n arises from the border of the __ ligament
and __ muscle,
courses inferiorly, and leaves the pelvis thru the \_\_
sacrotuberous
ischiococcygeus m
greater sciatic foramen
73
the levator ani and perineal membrane come together at the
perineal body
74
fxn of perineal body
separates and reinforces integrity of adjacent vagina and anus
75
clinical significance of perineal body
can rupture during vaginal delivery → leads to widening of gap btw free borders of levator ani on both sides
can cause incontinence
76
what procedure is performed to prevent damage to the perineal body during vaginal delivery
episiotomy → helps avoid 3rd/4th degree tears
77
internal anal sphincter is composed of __ m
smooth
78
external anal sphincter is composed of __ m
skeletal
79
transition zone btw rectal mucosa and nonkeratinized squamous epithelium
anal pecten
80
the analcutaneous line indicates
true skin
81
the anal pecten is composed of \_\_
the anal aperture is composed of \_\_
nonkeratinized squamous epithelium
keratinized squamous epithelium
82
SNS innervation causes __ of the internal anal sphincter
contraction
83
PSNS innervation causes __ of the internal anal sphincter
relaxation
84
external anal sphincter control has 3 components and is innervated by \_\_,
which is a __ nerve
inferior rectal branches of pudendal n
somatic
85
3 components of external anal sphincter innervation
deep
superficial
subcutaneous
86
hemorrhoids occur in the
rectal veins
87
2 venous systems of rectal veins
portal
caval
88
superior rectal veins enter the
portal system
89
middle and inferior rectal veins enter the
caval system
90
where do you administer a nerve block to numb the entire perineum
adjacent to the ischial tuberosity on the inside
91
what happens if you administer a more proximal block adjacent to the ischial spine
you will involve the inferior anal n and the perineal nerves
92
a more distal block at the level of the ischial tuberosity will involve the
perineal nerves
93
dermatome innervation of the perineum
S3-S5
94
innervation of the skeletal m in perineum and pelvic floor - including urethral and anal sphincters
S2-S4
95
much of the somatic motor and sensory innervation of the perineum is via the
pudendal n
***the major n of the perineum***
96
roots of the pudendal n
S2-S4
97
the iliohypogastric n provides \_\_
and __ innervation to the hypogastric regions
motor
sensory
98
ilioinguinal n provides sensory innervation to (4)
root of penis
scrotum
mons pubis
labia majora
99
genitofemoral n provides sensory innervation to
scrotal skin
round ligament
mons pubis
labia major
100
the genitofemoral nerve is mostly sensory
but what is its motor innervation
cremaster m → elevation of testes
101
the lateral cutaneous n of the thigh has __ innervation only
motor
102
femoral n innervates the
anterior thigh
103
obturator n innervates the
medial thigh
104
\_\_ connects the lumbar and sacral plexuses
L4/L5
105
the pudendal n is included in the __ plexus
sacral → S2-S4
106
the inferior hypogastric plexus is same-same
pelvic plexus
107
the inferior hypogastric plexus supplies __ of the pelvic cavity,
and has __ innervation (3)
viscera
PSNS
SNS
visceral afferents
108
arterial supply of the pelvis
anterior and posterior branches of the **internal** iliac artery and veins
*ex. pudendal artery*
109
what structures follow this lymph drainage pathway:
superficial perineum → superficial inguinal nodes → external iliac nodes
penis
scrotum
clitoris
labia majora
lower extremities
abdominal wall
110
what structures follow this lymph drainage pathway:
superficial perineum → deep inguinal nodes → external iliac nodes
glans penis
glans clitoris
labia minora
inferior vagina
lower extremities
femoral lymphatics
111
what structures follow this lymph drainage pathway:
deep perineum → deep pudendal nodes → internal iliac nodes → lateral/pre aortic nodes
ovaries
uterus (and related structures)
testes
112
deep pelvic structures drain directly into the __ nodes
internal/external iliac
113
gluteal nodes drain into the
internal iliac chain
114
mc mode of spread for ovarian ca
transcoelomic (thru the peritineum)
*2nd mc: lymphatic spread*
115
lymphatic spread of ovarian ca:
80% \_\_
78% \_\_
50% \_\_
**80%: pelvic nodes**
**78%: para-aortic nodes**
40-50% mediastinal nodes, supraclavicular nodes, inguinal nodes
116
what is sister mary joseph sign
malignant metastatic umbilical nodule → indicates advanced intra-abdominal malignancy
117
sympathetic innervation of the bladder
L1-L3
118
parasympathetic innervation of the bladder
S2-S4
119
during filling of the bladder,
\_\_ innervation controls
\_\_ of the detrusor m
and __ of the internal sphincter
sympathetic
relaxation of detrusor
contraction of internal sphincter
120
during emptying of the bladder, ___ innervation controls
\_\_ of the detrusor m
and __ of the internal sphincter
parasympathetic
contraction
relaxation
121
contraction of the external bladder sphincter is under __ control
voluntary
122
what forms the trigone of the bladder
internal urethra
ureters
123
course of the round ligament
thru inguinal canal (deep ring -\> superficial ring) → labia majora
124
when the round ligament stretches during pregnancy, pain can be felt __ (2)
groin
labia majora
125
ligamentous structures that have a substantial role in supporting/stabilizing the uterus → **true support structures**
cardinal (same-same transverse cervical)
uterosacral ligaments
anterior pubocervical ligament
126
damage to the true uterine support structures during childbirth can lead to
prolapse of bladder and/or uterus
127
ligaments of the ovary that are NOT true support structures
broad ligament
round ligament
suspensory ligament
peritoneal folds
128
fibromuscular fascia from either side of the cervix to the pelvic walls
cardinal ligament (transverse cervical)
129
ligament from posterior cervix to the sacrum; comprised of recto-uterine folds and fibrous tissue/muscle fibers attached to the front of the sacrum
uterosacral ligament
130
ligament from the uterus to the pubic symphysis
anterior pubocervical ligament
131
peritoneal folds of the broad ligament
mesovarium
mesosalpinx
***not supportive***
132
why do we care that the ureters are very close to the cervix
cervical carcinoma
*this was on his commentary?*
133
what ligament connects the front of the uterus to the groin
round ligament
134
ligament that holds the uterus in position and maintains its relationship w. the fallopian tubes and ovaries
broad ligament
135
peritoneal folds in the pelvis form what 2 pouches
vesicouterine pouch
rectouterine pouch (pouch of douglas)
136
location of rectouterine pouch (pouch of douglas)
deep pouch posterior to uterus and anterior to rectum
137
clinical significance of rectouterine pouch (douglas)
deep pouch → blood, fluid, tumor, pus can accumulate here
138
peritoneal folds associated w. the bladder
urachus
umbilical folds
139
ligament on superiolateral pelvic wall that contains arteries, veins, lymphatics
suspensory ligament of ovary
140
ligament that is continuous with the round ligament of uterus and attaches lower pole of the ovary to the uterus
ligament of ovary
141
a total hysterectomy is removal of the (4)
uterus
body
fundus
cervix
142
a total hysterectomy with bilateral oophrectomy includes removal of the
ovaries
143
when a woman has a total hysterectomy but the ovaries are spared, it is important to retain the \_\_
bc it contains \_\_
suspensory ligament of the ovary
blood supply and lymphatics
144
blood supply to the uterus is via
ovarian artery
uterine artery
vaginal artery
145
the uterine and vaginal arteries are branches of the
internal iliac artery
146
the ovarian artery branches off of the
aorta
147
why are ectopic pregnancies so dangerous
90% occur in fallopian tube → can involve ovarian a → high pressure and branch of aorta → risk for hemorrhage
148
venous supply of the uterus
myometrial veins → uterine or ovarian vein in broad ligament
149
the ovarian a runs through the __ ligament
suspensory
150
the uterine and vaginal arteries run through the __ ligament
broad
151
perineal membrane support structures for erectile tissue (in males obv) (2)
corpora cavernosum
corpus spongiosum
*attached to perineal membrane*
152
3 muscles that comprise the superficial layer of the male peritoneum
ischiocavernous m
bulbospongiosus m
superficial transvers perineal m
153
where does intraperitoneal blood collect in males
rectovesicular pouch
154
4 parts of the urethra
preprostatic
prostatic
membranous
spongy
155
which part of the urethra is surrounded by erectile tissue
spongy
156
which part of the urethra is just below the deep perineal pouch, and is thin, angled and vulnerable to injury
spongy
157
new zone classification for prostate
peripheral zone
transitional zone
central zone
anterior fibromuscular stroma
158
peripheral zone of the prostate surrounds the
distal urethra
159
the transition zone of the prostate surrounds the
proximal urethra
160
the central zone of the prostate surrounds the
ejaculatory duct
161
mc location for prostate ca
peripheral zone → 70%
***70% of prostate ca should be palpable on DRE***
162
2nd mc location for prostate ca
transitional zone
163
it is rare for cancers to prostate ca to occur in the
central zone
164
what portion of the prostate is aglandular
anterior fibromuscular stroma
165
prostate ca mc spreads to
bones
166
what structures are associated w. the male urethra (4)
internal urethral sphincter
external urethral sphincter
prostate gland
deep perineal pouch and membrane
167
what structure surrounds the male urethra
prostate gland
168
components of the spermatic cord (4)
ductus deferens
pampiniform plexus
genitofemoral n → cremasteric m
sympathetic/visceral afferents
testicular artery
169
fxn of spermatic cord
suspends testis and epididymis
170
the spermatic cord originates from the \_\_
and passes through the \_\_
deep inguinal ring
superficial inguinal ring
*runs along the inguinal canal*
171
nerve pathway of cremasteric reflex
stroke inner thigh → L1 → sensory afferents →
spinal cord → genitofemoral n (L1,L2) → cremasteric m
elevates testes
172
sensory component of cremasteric reflex
ilioinguinal n (L1)
173
motor component of cremasteric reflex
genitofemoral n (L1, L2)
174
male equivalent of ovarian artery
testicular artery → supplies testes (duh)
175
testicular artery branches off of the
aorta
176
what transports sperm from the urethra in preparation for ejaculation
vas deferens
177
arterial supply to the penis
internal pudendal a → dorsal a → perineal a → deep a → penile erectile tissue
178
veinous supply of penis
dorsal v of penis → prostatic plexus → vesicle plexus → internal pudendal v → internal iliac v
179
blood supply of the testes
testicular a
cremasteric a
testicular v
180
the testicular a arises from the \_\_
and travels to the \_\_
via the \_\_
aorta
scrotum
inguinal canal
181
the cremasteric a arises from the \_\_
to the \_\_
external ililac a
epigastric a
182
the testicular v joins with the __ on the right
and the __ on the left
right: IVC
left: renal v
183
arterial supply of the scrotum
perineal a
184
veinous supply of the scrotum
testicular v → internal iliac v → internal saphenous v
185
PSNS pathway of erection stimulation
S2-S4 → pelvic splanchnic n → inferior hypogastric plexus, deep perineal pouch, and perineal membrane
186
PSNS innervation causes __ of branches of the
\_\_ arteries,
to the __ (2)
vasodilation
pudendal a
corpora cavernosa and spongiosa
187
how can a prostatectomy cause ED
it can destroy PSNS nerves
*this can also cause stimulation of bladder contraction*
188
sympathetic nerve pathway of ejaculation
sacral splanchnic nerves and superior hypogastric plexus → hypogastric n → inferior hypogastric plexus
189
sympathetic stimulation causes __ of the
\_\_ and
\_\_
constriction
internal urethral sphincter
smooth muscle of reproductive tract
190
sympathetic stimulation causes fluids to move from the \_\_
to the __ (2)
epididymis
seminal vesicles and urethra
191
somatic afferent sensation from the penis and perineum is via the (2)
**S2-S4 →**
pudendal n
perineal n
192
cutaneous innervation of the pelvic floor
L1 - S5
| (minus L4)
193
clinical significance of retropubic space (space of retzius)
way to get into bladder w.o going thru perineum (less risk of infxn)
194
location of retropubic space/space of retzius
deep to camper's fascia and rectus sheath
195
hollow canal connecting the fetal urinary bladder to the umbilical cord
urachus
196
during development, the urachus becomes the
median umbilical ligament/fold
197
is the media**n** umbilical fold same-same media**l** umbilical ligament
no!
198
the medial umbilical ligament is a remnant of the \_\_,
which is connected to the \_\_
during fetal development
obliterated umbilical artery
internal iliac a
199
during development:
the urachus becomes the \_\_
and the umbilical artery becomes the \_\_
median umbilical fold
medial ligament
200
what happens when the urachus remains open after fetal development
space btw bladder and umbilicus → urachal cyst
*urine from belly button*
201
superficial fascia of male urogenital triangle
colle's fascia
scarpa's fascia
202
colle's fascia of the __ is continuous w. \_\_
up the anterior abdominal wall
urogenital triangle
scarpa's fascia
203
scarpa's fascia is same-same
membranous fascia
204
does colle's fascia extend posteriorly into the anal triangle
no!
it only travels up anterior abdominal wall and stops at the inguinal ligament
205
clinical significance of colle's fascia
nectrotizing fascitis and other testicular/skin infxns can travel all the way up the abd wall
*but will not go inferiorly*
206
what fascia is deep to scarpa's fascia
camper's fascia
207
fascia iliaca nerve blocks (FINB) are done to
provide pain relief for hip fx
208
what 2 nerves do FINB target
lateral cutaneous n of thigh
femoral n
209
what structures do FINB target
anterior structures of the lumbar plexus
210
fascia of the upper thigh
fascia lata
211
2 approaches to the FINB
**lateral:** fascia iliaca compartment
**medial:** femoral nerve stimulator
212
FINB is done at the __ muscle
iliopsoas
213
benefit of FINB
good pain relief w.o narcotics
214
bell clapper deformity makes you think of
testicular torsion
