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A&P II - Exam 3 > GUT > Flashcards

GUT Flashcards

1
Q

level of the renal arteries

A

L1-2

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2
Q

the renal arteries arise from the __ aspect of the abdominal aorta

just below the __

A

lateral

superior mesenteric a

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3
Q

the __ renal artery is slightly superior

to the __ renal artery

A

left is superior to the right

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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

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5
Q

the renal arteries course laterally towards the hilum of the kidney __ to the renal veins, nerves, and pancreas

A

posterior

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6
Q

aortic aneurysms can involve the

A

renal arteries

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7
Q

the renal arteries divide into __

and __ branches in the hilum of the kidney

A

anterior

posterior

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8
Q

layer of fat that surrounds the kidney

A

perinephric fact

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9
Q

is the perinephric fat deep or superficial to the fascia

A

deep

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10
Q

fascial layers of the kidney

A

transversalis fascia

renal fascia

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11
Q

what muscles surround the kidneys

A

posas major

quadratus lumborum

anterolateral abdominal wall muscles

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12
Q

what muscles surround the kidneys

A

posas major

quadratus lumborum

anterolateral abdominal wall muscles

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13
Q

internal structures of the kidneys

A

medulla and cortex

renal pyramids

papilla

calyces

pelvis

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14
Q

visceral afferent pain fibers innervating the kidney return to __ spinal cord levels

A

T12-L2

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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

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16
Q

the testicular/gonadal arteries branch off of the

A

abdominal aorta

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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

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18
Q

quadratus lumborum m is innervated by

A

T12-L4

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19
Q

supine, the kidneys are located at __ vertebrae

and __ ribs

A

T12 - L3 vertebrae - L3-L4 vertebrae

ribs 11-12

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20
Q

what structures are related to the right kidney

A

descending duodenum

posterior liver

hepatic flexure of colon

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21
Q

what structures are associated w. the left kidney (4)

A

stomach

spleen

pancreas

splenic flexure

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22
Q

structure associated w. medial kidneys

A

psoas m

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23
Q

origin of the ureters

A

utereopelvic junction (UPJ) of kidney

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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)

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25
Q

mc place for renal stones

A

vesicoureteric junction (VUJ/UVJ)

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26
Q

the ureters are __ to the renal vein and artery in the hilum

A

posterior

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27
Q

the ureters enter the pelvis at the __ at the bifurcation of the

__

A

sacroiliac joint

common iliac

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28
Q

when erect, the kidneys are slightly __

and the __ kidney is lower than the left

A

lower

right

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29
Q

causes of hydronephrosis in utero/childhood

A

uterovesical reflux

males: congenital posterior urethral valve

congenital stenosis

neurogenic bladder

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30
Q

congenital cause of hydronephrosis that only affects males

A

congenital posterior urethral valve

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31
Q

causes of hydronephrosis in adults

A

ureteral calculi

pregnancy

neurogenic bladder

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32
Q

causes of hydronephrosis in older adults

A

BPH

prostatic ca

cervical ca

fecal impaction

neurogenic bladder

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33
Q

lymphatics accompany the __

A

gonadal arteries (same-same testicular a/ovarian a)

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34
Q

the gonadal arteries arise from the __ at

__ level

A

abdominal aorta

L2

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35
Q

the testicular artery supplies (3)

A

head, body, tail of epididymis

ureters

parenchyma of testes

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36
Q

the gonadal veins (testicular/ovarian) join the __ anterior

to the __

A

IVC

renal a

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37
Q

which renal vein is longer

A

left renal vein is 3x longer than the right

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38
Q

clinical significance of a short urethra

A

predisposition to cystitis

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39
Q

orientation of urethra for catheterization

A
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40
Q

the male urethra curves __

at a __ angle

at the __

A

upward

30

prostate

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41
Q

how is the female urethra different from the male urethra

A

shorter

no curve

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42
Q

the pelvic inlet separates the __

and __ pelvis

A

true (lesser)

and

false (greater)

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43
Q

the pelvic inlet is tilted __

and the ischiopubic arch is __

A

anteriorly

horizontal

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44
Q

area between anus and genitals; extends from vaginal opening to the anus or the scrotum to the anus

A

perineal region

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45
Q

thick triangular fascial structure that extends across the ischiopubic arch and has transverse muscles within

A

urogenital diaphragm/perineal membrane and deep perineal pouch

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46
Q

what passes through the gap between the pubic symphysis and the perineal membrane

A

dorsal vein of penis and clitoris

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47
Q

orifices in the floor of the perineum (3)

A

urethra

vagina

anus

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48
Q

the perineum includes (2)

A

urogenital triangle (anterior)

anal triangle (posterior)

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49
Q

anterior border of the perineum

A

pubic symphysis

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50
Q

lateral border of the perineum

A

ischipubic rami

sacrotuberous ligament

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51
Q

inferior border of the perineum

A

tip of coccyx

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52
Q

ligaments associated w. the perineum (2)

A

sacrotuberous ligament

sacrospinous ligament

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53
Q

the sacrospinous ligament and the ilium form the __

which contains the __ (3)

A

lesser sciatic foramen

obturator interns m.

pudendal n

internal prudential vein and artery

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54
Q

the perineal membrane has a free __ border

and the deep perineal pouch contains __ (2)

A

posterior

muscles and neuromuscular structures

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55
Q

what 2 “openings” are in the perineal membrane

A

vagina

urethra (external urethral sphincter)

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56
Q

the pelvic diaphragm is composed of (2)

A

levator ani m

coccygeus m

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57
Q

origins of the levator ani (pelvic sling)

A

true pelvis →

posterior pubic bone

ligament on obturator internus m

ischial tuberosity

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58
Q

origins and insertion of the coccygeus m

A

origin: ischial spine and sacrospinous ligament
insertion: sacrum and coccyx

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59
Q

2 openings of levator ani

A

urogenital hiatus

anal aperture

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60
Q

what passes thru the urogenital hiatus (2)

A

urethra

vagina

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61
Q

what is the anal aperture

A

opening of the anus

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62
Q

what 3 muscles form the levator ani

A

pubococcygeus m

puborectalis m

illiococcygeus m

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63
Q

fxn of puborectalis m

A

perineal flexure →

pulls anorectal junction forward → keeps GI system closed at rectal area

aids anal sphincter m

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64
Q

origin of iliococcygeus m

A

ilium

obturator internus

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65
Q

what does the levator ani hold up (4)

A

bladder

distal end of ureters

rectum

reproductive organs

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66
Q

kegel exercises strengthen the

A

levator ani

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67
Q

ischiorectal fossa is same same __

and is within the __

A

deep perineal space

anal triangle

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68
Q

borders of ischioanal fossa

A

roof: levator ani
floor: perineal fascia
medial: external anal sphincters/anal canal

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69
Q

clinical significance of ischioanal fossa

A

abscesses form here dt decreased blood supply

difficult to treat

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70
Q

what is found in the lower lateral sheath of the ischiorectal fossa

A

pudendal canal (same-same Alcock’s canal)

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71
Q

what passes thru the pudendal canal

A

pudendal v

pudendal a

pudendal n

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72
Q

the pudendal n arises from the border of the __ ligament

and __ muscle,

courses inferiorly, and leaves the pelvis thru the __

A

sacrotuberous

ischiococcygeus m

greater sciatic foramen

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73
Q

the levator ani and perineal membrane come together at the

A

perineal body

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74
Q

fxn of perineal body

A

separates and reinforces integrity of adjacent vagina and anus

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75
Q

clinical significance of perineal body

A

can rupture during vaginal delivery → leads to widening of gap btw free borders of levator ani on both sides

can cause incontinence

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76
Q

what procedure is performed to prevent damage to the perineal body during vaginal delivery

A

episiotomy → helps avoid 3rd/4th degree tears

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77
Q

internal anal sphincter is composed of __ m

A

smooth

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78
Q

external anal sphincter is composed of __ m

A

skeletal

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79
Q

transition zone btw rectal mucosa and nonkeratinized squamous epithelium

A

anal pecten

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80
Q

the analcutaneous line indicates

A

true skin

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81
Q

the anal pecten is composed of __

the anal aperture is composed of __

A

nonkeratinized squamous epithelium

keratinized squamous epithelium

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82
Q

SNS innervation causes __ of the internal anal sphincter

A

contraction

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83
Q

PSNS innervation causes __ of the internal anal sphincter

A

relaxation

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84
Q

external anal sphincter control has 3 components and is innervated by __,

which is a __ nerve

A

inferior rectal branches of pudendal n

somatic

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85
Q

3 components of external anal sphincter innervation

A

deep

superficial

subcutaneous

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86
Q

hemorrhoids occur in the

A

rectal veins

87
Q

2 venous systems of rectal veins

A

portal

caval

88
Q

superior rectal veins enter the

A

portal system

89
Q

middle and inferior rectal veins enter the

A

caval system

90
Q

where do you administer a nerve block to numb the entire perineum

A

adjacent to the ischial tuberosity on the inside

91
Q

what happens if you administer a more proximal block adjacent to the ischial spine

A

you will involve the inferior anal n and the perineal nerves

92
Q

a more distal block at the level of the ischial tuberosity will involve the

A

perineal nerves

93
Q

dermatome innervation of the perineum

A

S3-S5

94
Q

innervation of the skeletal m in perineum and pelvic floor - including urethral and anal sphincters

A

S2-S4

95
Q

much of the somatic motor and sensory innervation of the perineum is via the

A

pudendal n

the major n of the perineum

96
Q

roots of the pudendal n

A

S2-S4

97
Q

the iliohypogastric n provides __

and __ innervation to the hypogastric regions

A

motor

sensory

98
Q

ilioinguinal n provides sensory innervation to (4)

A

root of penis

scrotum

mons pubis

labia majora

99
Q

genitofemoral n provides sensory innervation to

A

scrotal skin

round ligament

mons pubis

labia major

100
Q

the genitofemoral nerve is mostly sensory

but what is its motor innervation

A

cremaster m → elevation of testes

101
Q

the lateral cutaneous n of the thigh has __ innervation only

A

motor

102
Q

femoral n innervates the

A

anterior thigh

103
Q

obturator n innervates the

A

medial thigh

104
Q

__ connects the lumbar and sacral plexuses

A

L4/L5

105
Q

the pudendal n is included in the __ plexus

A

sacral → S2-S4

106
Q

the inferior hypogastric plexus is same-same

A

pelvic plexus

107
Q

the inferior hypogastric plexus supplies __ of the pelvic cavity,

and has __ innervation (3)

A

viscera

PSNS

SNS

visceral afferents

108
Q

arterial supply of the pelvis

A

anterior and posterior branches of the internal iliac artery and veins

ex. pudendal artery

109
Q

what structures follow this lymph drainage pathway:

superficial perineum → superficial inguinal nodes → external iliac nodes

A

penis

scrotum

clitoris

labia majora

lower extremities

abdominal wall

110
Q

what structures follow this lymph drainage pathway:

superficial perineum → deep inguinal nodes → external iliac nodes

A

glans penis

glans clitoris

labia minora

inferior vagina

lower extremities

femoral lymphatics

111
Q

what structures follow this lymph drainage pathway:

deep perineum → deep pudendal nodes → internal iliac nodes → lateral/pre aortic nodes

A

ovaries

uterus (and related structures)

testes

112
Q

deep pelvic structures drain directly into the __ nodes

A

internal/external iliac

113
Q

gluteal nodes drain into the

A

internal iliac chain

114
Q

mc mode of spread for ovarian ca

A

transcoelomic (thru the peritineum)

2nd mc: lymphatic spread

115
Q

lymphatic spread of ovarian ca:

80% __

78% __

50% __

A

80%: pelvic nodes

78%: para-aortic nodes

40-50% mediastinal nodes, supraclavicular nodes, inguinal nodes

116
Q

what is sister mary joseph sign

A

malignant metastatic umbilical nodule → indicates advanced intra-abdominal malignancy

117
Q

sympathetic innervation of the bladder

A

L1-L3

118
Q

parasympathetic innervation of the bladder

A

S2-S4

119
Q

during filling of the bladder,

__ innervation controls

__ of the detrusor m

and __ of the internal sphincter

A

sympathetic

relaxation of detrusor

contraction of internal sphincter

120
Q

during emptying of the bladder, ___ innervation controls

__ of the detrusor m

and __ of the internal sphincter

A

parasympathetic

contraction

relaxation

121
Q

contraction of the external bladder sphincter is under __ control

A

voluntary

122
Q

what forms the trigone of the bladder

A

internal urethra

ureters

123
Q

course of the round ligament

A

thru inguinal canal (deep ring -> superficial ring) → labia majora

124
Q

when the round ligament stretches during pregnancy, pain can be felt __ (2)

A

groin

labia majora

125
Q

ligamentous structures that have a substantial role in supporting/stabilizing the uterus → true support structures

A

cardinal (same-same transverse cervical)

uterosacral ligaments

anterior pubocervical ligament

126
Q

damage to the true uterine support structures during childbirth can lead to

A

prolapse of bladder and/or uterus

127
Q

ligaments of the ovary that are NOT true support structures

A

broad ligament

round ligament

suspensory ligament

peritoneal folds

128
Q

fibromuscular fascia from either side of the cervix to the pelvic walls

A

cardinal ligament (transverse cervical)

129
Q

ligament from posterior cervix to the sacrum; comprised of recto-uterine folds and fibrous tissue/muscle fibers attached to the front of the sacrum

A

uterosacral ligament

130
Q

ligament from the uterus to the pubic symphysis

A

anterior pubocervical ligament

131
Q

peritoneal folds of the broad ligament

A

mesovarium

mesosalpinx

not supportive

132
Q

why do we care that the ureters are very close to the cervix

A

cervical carcinoma

this was on his commentary?

133
Q

what ligament connects the front of the uterus to the groin

A

round ligament

134
Q

ligament that holds the uterus in position and maintains its relationship w. the fallopian tubes and ovaries

A

broad ligament

135
Q

peritoneal folds in the pelvis form what 2 pouches

A

vesicouterine pouch

rectouterine pouch (pouch of douglas)

136
Q

location of rectouterine pouch (pouch of douglas)

A

deep pouch posterior to uterus and anterior to rectum

137
Q

clinical significance of rectouterine pouch (douglas)

A

deep pouch → blood, fluid, tumor, pus can accumulate here

138
Q

peritoneal folds associated w. the bladder

A

urachus

umbilical folds

139
Q

ligament on superiolateral pelvic wall that contains arteries, veins, lymphatics

A

suspensory ligament of ovary

140
Q

ligament that is continuous with the round ligament of uterus and attaches lower pole of the ovary to the uterus

A

ligament of ovary

141
Q

a total hysterectomy is removal of the (4)

A

uterus

body

fundus

cervix

142
Q

a total hysterectomy with bilateral oophrectomy includes removal of the

A

ovaries

143
Q

when a woman has a total hysterectomy but the ovaries are spared, it is important to retain the __

bc it contains __

A

suspensory ligament of the ovary

blood supply and lymphatics

144
Q

blood supply to the uterus is via

A

ovarian artery

uterine artery

vaginal artery

145
Q

the uterine and vaginal arteries are branches of the

A

internal iliac artery

146
Q

the ovarian artery branches off of the

A

aorta

147
Q

why are ectopic pregnancies so dangerous

A

90% occur in fallopian tube → can involve ovarian a → high pressure and branch of aorta → risk for hemorrhage

148
Q

venous supply of the uterus

A

myometrial veins → uterine or ovarian vein in broad ligament

149
Q

the ovarian a runs through the __ ligament

A

suspensory

150
Q

the uterine and vaginal arteries run through the __ ligament

A

broad

151
Q

perineal membrane support structures for erectile tissue (in males obv) (2)

A

corpora cavernosum

corpus spongiosum

attached to perineal membrane

152
Q

3 muscles that comprise the superficial layer of the male peritoneum

A

ischiocavernous m

bulbospongiosus m

superficial transvers perineal m

153
Q

where does intraperitoneal blood collect in males

A

rectovesicular pouch

154
Q

4 parts of the urethra

A

preprostatic

prostatic

membranous

spongy

155
Q

which part of the urethra is surrounded by erectile tissue

A

spongy

156
Q

which part of the urethra is just below the deep perineal pouch, and is thin, angled and vulnerable to injury

A

spongy

157
Q

new zone classification for prostate

A

peripheral zone

transitional zone

central zone

anterior fibromuscular stroma

158
Q

peripheral zone of the prostate surrounds the

A

distal urethra

159
Q

the transition zone of the prostate surrounds the

A

proximal urethra

160
Q

the central zone of the prostate surrounds the

A

ejaculatory duct

161
Q

mc location for prostate ca

A

peripheral zone → 70%

70% of prostate ca should be palpable on DRE

162
Q

2nd mc location for prostate ca

A

transitional zone

163
Q

it is rare for cancers to prostate ca to occur in the

A

central zone

164
Q

what portion of the prostate is aglandular

A

anterior fibromuscular stroma

165
Q

prostate ca mc spreads to

A

bones

166
Q

what structures are associated w. the male urethra (4)

A

internal urethral sphincter

external urethral sphincter

prostate gland

deep perineal pouch and membrane

167
Q

what structure surrounds the male urethra

A

prostate gland

168
Q

components of the spermatic cord (4)

A

ductus deferens

pampiniform plexus

genitofemoral n → cremasteric m

sympathetic/visceral afferents

testicular artery

169
Q

fxn of spermatic cord

A

suspends testis and epididymis

170
Q

the spermatic cord originates from the __

and passes through the __

A

deep inguinal ring

superficial inguinal ring

runs along the inguinal canal

171
Q

nerve pathway of cremasteric reflex

A

stroke inner thigh → L1 → sensory afferents →

spinal cord → genitofemoral n (L1,L2) → cremasteric m

elevates testes

172
Q

sensory component of cremasteric reflex

A

ilioinguinal n (L1)

173
Q

motor component of cremasteric reflex

A

genitofemoral n (L1, L2)

174
Q

male equivalent of ovarian artery

A

testicular artery → supplies testes (duh)

175
Q

testicular artery branches off of the

A

aorta

176
Q

what transports sperm from the urethra in preparation for ejaculation

A

vas deferens

177
Q

arterial supply to the penis

A

internal pudendal a → dorsal a → perineal a → deep a → penile erectile tissue

178
Q

veinous supply of penis

A

dorsal v of penis → prostatic plexus → vesicle plexus → internal pudendal v → internal iliac v

179
Q

blood supply of the testes

A

testicular a

cremasteric a

testicular v

180
Q

the testicular a arises from the __

and travels to the __

via the __

A

aorta

scrotum

inguinal canal

181
Q

the cremasteric a arises from the __

to the __

A

external ililac a

epigastric a

182
Q

the testicular v joins with the __ on the right

and the __ on the left

A

right: IVC
left: renal v

183
Q

arterial supply of the scrotum

A

perineal a

184
Q

veinous supply of the scrotum

A

testicular v → internal iliac v → internal saphenous v

185
Q

PSNS pathway of erection stimulation

A

S2-S4 → pelvic splanchnic n → inferior hypogastric plexus, deep perineal pouch, and perineal membrane

186
Q

PSNS innervation causes __ of branches of the

__ arteries,

to the __ (2)

A

vasodilation

pudendal a

corpora cavernosa and spongiosa

187
Q

how can a prostatectomy cause ED

A

it can destroy PSNS nerves

this can also cause stimulation of bladder contraction

188
Q

sympathetic nerve pathway of ejaculation

A

sacral splanchnic nerves and superior hypogastric plexus → hypogastric n → inferior hypogastric plexus

189
Q

sympathetic stimulation causes __ of the

__ and

__

A

constriction

internal urethral sphincter

smooth muscle of reproductive tract

190
Q

sympathetic stimulation causes fluids to move from the __

to the __ (2)

A

epididymis

seminal vesicles and urethra

191
Q

somatic afferent sensation from the penis and perineum is via the (2)

A

S2-S4 →

pudendal n

perineal n

192
Q

cutaneous innervation of the pelvic floor

A

L1 - S5

(minus L4)

193
Q

clinical significance of retropubic space (space of retzius)

A

way to get into bladder w.o going thru perineum (less risk of infxn)

194
Q

location of retropubic space/space of retzius

A

deep to camper’s fascia and rectus sheath

195
Q

hollow canal connecting the fetal urinary bladder to the umbilical cord

A

urachus

196
Q

during development, the urachus becomes the

A

median umbilical ligament/fold

197
Q

is the median umbilical fold same-same medial umbilical ligament

A

no!

198
Q

the medial umbilical ligament is a remnant of the __,

which is connected to the __

during fetal development

A

obliterated umbilical artery

internal iliac a

199
Q

during development:

the urachus becomes the __

and the umbilical artery becomes the __

A

median umbilical fold

medial ligament

200
Q

what happens when the urachus remains open after fetal development

A

space btw bladder and umbilicus → urachal cyst

urine from belly button

201
Q

superficial fascia of male urogenital triangle

A

colle’s fascia

scarpa’s fascia

202
Q

colle’s fascia of the __ is continuous w. __

up the anterior abdominal wall

A

urogenital triangle

scarpa’s fascia

203
Q

scarpa’s fascia is same-same

A

membranous fascia

204
Q

does colle’s fascia extend posteriorly into the anal triangle

A

no!

it only travels up anterior abdominal wall and stops at the inguinal ligament

205
Q

clinical significance of colle’s fascia

A

nectrotizing fascitis and other testicular/skin infxns can travel all the way up the abd wall

but will not go inferiorly

206
Q

what fascia is deep to scarpa’s fascia

A

camper’s fascia

207
Q

fascia iliaca nerve blocks (FINB) are done to

A

provide pain relief for hip fx

208
Q

what 2 nerves do FINB target

A

lateral cutaneous n of thigh

femoral n

209
Q

what structures do FINB target

A

anterior structures of the lumbar plexus

210
Q

fascia of the upper thigh

A

fascia lata

211
Q

2 approaches to the FINB

A

lateral: fascia iliaca compartment

medial: femoral nerve stimulator

212
Q

FINB is done at the __ muscle

A

iliopsoas

213
Q

benefit of FINB

A

good pain relief w.o narcotics

214
Q

bell clapper deformity makes you think of

A

testicular torsion

A&P II - Exam 3 (2 decks)

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