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Anatomy > Interval 5 > Flashcards

Interval 5 Flashcards

1
Q

Location of pelvic viscera:

A

lesser pelvis

-pelvic diaphragm: major muscle is levator ani

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2
Q

Perineum:

A
  • space that contains any structure below the pelvic diaphragm
  • where the roots of the male/female external genitalia is found
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3
Q

Components of pelvic bone:

A
  • ilium
  • between the ilium and ischium on the lateral (back) side is the tuberosity
  • ischium (posterior)
  • pubis (anterior)
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4
Q

Fusion of the innominate bones:

A
  • articulate anteriorly at the pubic symphysis *ischium dont touch
  • articulate posteriorly with the sacrum at sacroiliac joints *the ilium dont touch
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5
Q

Pelvic brim:

A

series of bony parts that separate greater and lesser pelvis

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6
Q

Greater pelvis:

A

part of the abdominal wall

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7
Q

Male versus female pelvis:

A

FEMALE:

  • shallower pelvis
  • opening is wider
  • oval pelvic inlet
  • ischiopubic rami is wider angle (thumb and index)

MALE:

  • pelvic inlet is heart shaped
  • ischiopubic rami is index and middle finger
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8
Q

Female pubic bone:

A
  • true obstetric conjugate: anterior - posterior line typically slightly greater than 10 cm
  • interspinous distance (ischial spine to the other): transverse plane - smallest diameter
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9
Q

Pelvic diaphrams:

A
  • two skeletal muscle diaphragms (like the abdominal skeletal muscle diaphragm)
  • pelvic: funnel shaped, external anal sphincter
  • urogenital diaphragm: stretched across the width of the perineum, skeletal muscle, shorter, sphincter urethrae
  • tonic contraction of these keeps bowl movement in
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10
Q

Pelvic diaphragm:

A

-3 parts, named after the bone that makes them up

1) Levator ani:
- Pubococcygeus(vagina/prostate and anorectal) and puborectalis (form sling for anterior part of anal canal): pubic bone

  • Illiococcygeus
    2) ischio coccygeus
  • funnel SHAPE and attach to ligament by the coccyx
  • supports the bladder and the prostate gland
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11
Q

What transverses the pelvic diaphragm?

A
  • female: urethra, vagina, anal canal

- male: urethra, anal canal

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12
Q

Obturator internus:

A

-blocks ischio coccygeus from having bony attachment so attaches to the tendinous arch of obturator fascia

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13
Q

Pudental neurovascular bundle:

A
  • ventral rami that innervate the skeletal muscle of the two diaphragms and providing voluntary control of the sphincter
  • S2, 3, 4
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14
Q

Ischioanal fossa

A

-tissue and fat that can be distended when fecal components stretch the anal canal

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15
Q

Internal sphincter muscle and innervation:

A

-smooth muscle, sympathetic innervation

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16
Q

Extrernal sphincter muscle:

A
  • skeletal
  • maintains urinary contents
  • both sexes
  • urogenital diaphragm location
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17
Q

Bladder:

A
  • wall muscle is detrusor smooth muscle, contraction empties urine
  • urethra in males transverse the length of the prostate, female it is shorter
  • transitional epithelium
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18
Q

Prostate:

A

-release seminal fluid into the urethra via ejaculatory ducts

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19
Q

Internal urethral sphincter

A
  • prevents reflux of sperm and seminal fluid into the bladder
  • males (small in females)
  • above the prostate, before the bladder
  • smooth muscle, sympathetic control
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20
Q

transparent peritoneum

A

-covers the pelvic viscera

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21
Q

Rectovesical pouch

A
  • reflection between the posterior bladder and anterior rectum
  • most inferior extent of the male peritoneal cavity
  • potential space normally filled up by gut structures or the rectum pushing up against the bladder
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22
Q

Seminal vesicle:

A

-second gland that like the prostate produces seminal fluid

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23
Q

Male continuous duct system:

A
  • epididymous -> ductus deferens -> ejaculatory duct (where the seminal vesicle and ductus merge above the prostate)
    ductus: courses in close proximity to the seminal vesicle
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24
Q

ductus deferens:

A
  • water under the bridge (ductus goes obliquely to urether

- runs medial to the seminal vesicle

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25
Q

Prostate cancer:

A
  • peripheral zone: site of adenocarcinoma, contains true prostatic glands POSTERIOR thats why the finger can push against the anterior wall of the rectum which is against the posterior wall of the prostate and can feel whether there is a metastatic condition there
  • periurethral zone: sites of BPH (benign prostatic hyperplasia) ANTERIOR
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26
Q

Female peritoneal reflection points:

A
  • two due to the presence of the uterus
  • vesicouterine and rectouterine pouch of Douglas more significant and deeper (most inferior portion of the female peritoneal cavity)
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27
Q

Vestibule

A

-common chamber into which the short urethra terminates and inferior opening of the vagina

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28
Q

Posterior fornix:

A

-arch shaped space where the rectouterine pouch extends between the uterus and rectum

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29
Q

Angles of flexion from the uterus folding over the bladder:

A

-uterus is anteverted and antiflexed

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30
Q

Broad ligament:

A

peritoneal covering of the uterus, uterine tubes, ovaries (it is a mesentery with a front and back)

  • mesentery: double layer of peritoneum
  • the clear covering that dr. white covered himself (the uterus) with
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31
Q

Secondarily peritoneal:

A
  • uterus, uterine tubes, ovaries

- didnt start out with a peritoneum during development but then developed one later

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32
Q

Parts of the broad ligament:

A
  • mesosalpinx
  • mesovarium
  • mesometrium
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33
Q

Cardinal ligament:

A
  • each of the ureters passes through the base of the broad ligament
  • this is the fascia that supports the uterus
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34
Q

Immediately after ovulation where is the ovum?

A
  • inside the peritoneal cavity after passing through the peritoneum covering the ovary
  • each uterine tube punches a hole in the peritoneal wall to allow this to go out
  • females more likely to get peritonitus because of these two tiny holes in the peritoneum
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35
Q

Ampulla of the uterine tube:

A
  • inside the peritoneal cavity

- site of fertilization and ectopic implantation

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36
Q

Ovary and peritoneal cavity

A

-ovary is not in the cavity but extrudes the secondary oocyte into the peritoneal cavity

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37
Q

subpubic symphysis:

A

where the ischiopubic rami unite

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38
Q

divisions of the pelvic outlet:

A
  • urogenital triangle: directly behind the pubic symphysis
  • anal triangle: posterior to the urogenital
  • lateral border of both at the ischial tuberosities
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39
Q

perineal body:

A

central tendon of the perineum

-midline between the ischial tuberosities

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40
Q

Pelvis divisions:

A

greater (false) - contains iliacus muscle, shallower in females

lesser (true) - formed by the hipbones

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41
Q

pelvic diaphragm innervation:

A

skeletal muscle innervated directly by ventral rami S2 and S3 spinal nerves and of the pudendal nerve

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42
Q

Ischioanal fossa:

A

encloses the pelvic diaphragm

fat and CT

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43
Q

Where does the pelvic diaphram insert?

A

coccyx

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44
Q

Bladder:

A
  • retroperitoneal
  • superior aspect covered by peritoneum which reflects on anterior aspect of uterus (vesicouterine pouch) or rectum (rectovesical pouch)
  • located below/posterior to the pubic bone
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45
Q

Components of the bladder:

A
  • trigone: inner posterior wall, where ureters open into the bladder - urethra opens at the apex
  • detrusor muscle: smooth muscle that contracts to allow passage of urine
  • sphincter vesica (internal urethral sphincter): smooth muscle that encircles the urethra at the junction of the bladder
  • sphincter urethrae (external): smooth muscle that encircles the urethra at the urogenital diaphragm
46
Q

Male urethra parts:

A
  • prostatic: bladder-prostate - urogenital hiatus of the pelvic diaphragm (internal sphincter)
  • membranous: external sphincter in the urogenital diapgram
  • penile: transverses the bulb and corpus spongiosum
  • 12 cm
47
Q

Female urethra:

A

*5 cm

opens into the vestibule just anterior to the opening of the vagina

*more elastic, easier to put in a catheter

48
Q

anococcygeal ligament:

A

joins the anal canal to the coccyx

49
Q

Parts of the anal canal:

A
  • contains anal columns which contain the superior rectal artery and veins
  • divided into parts by the pectinate line
    1) Above: lined by muscosa, superior rectal artery and internal rectal venous plexus (drains to superior rectal vein), lymph to the internal iliac nodes, innervated by the ANS (not sensitive to pain)
  • visceral
    2) below: lined by skin, inferior rectal artery and external rectal venous plexus (drains to the internal iliac vein), lymph to the superficial inguinal nodes, sensory innervation by the pudendal nerve
50
Q

anal canal sphincters:

A
  • internal: smooth muscle innervated by sympathetic (contraction) and parasympathetic (relax)
  • external: skeletal muscle from the puborectalis muscle, voluntary control via inferior rectal branches of the pudendal nerve
51
Q

ductus deferens:

A
  • arises from the epididymis transverse the inguinal canal, goes into the pelvis and reaches the posterior aspect of the bladder
  • transports sperm from the speminiferous tubules
52
Q

seminal vesicles

A
  • on the bladder, just lateral to the ductus deferens
  • secrete fructose rich seminal fluid
  • sperm metabolism, major component of semen
53
Q

ejaculatory duct:

A
  • ductus deferns joining with the seminal vesicle (just above the prostate)
  • transports sperm and seminal fluid through the prostate
54
Q

prostate:

A
  • consists of glandular tissue and smooth muscle
  • periurethral zone: surrounds the urethra and contains gland (site of BPH)
  • peripheral zone: contains the main prostatic glands which secrete prostatic acid phosphatase and prostate specific antigen which contribute to sperm motility and activation (cancer site)
55
Q

What passes through the funnel of the pelvic diaphragm in males?

A
  • anteriorly: urethra

- posteriorly: anal canal

56
Q

Uterus:

A
  • between the bladder and the rectum
  • smooth muscle
  • fundus, body, an isthmus, and cervix
  • anteverted in 50% of females (folded anteriorly at the junction of the cervix) could be retroverted (folded posteriorly or in midline position
57
Q

Uterus facilitates:

A
  • movement of sperm from cervix
  • protective environment for embryo
  • contracts to push out fetus
58
Q

uterine tubes:

A
  • intramural part, isthmus, ampulla, and infundibulum (contains the ostium which opens into the peritoneal cavity)
  • facilitates the transport of sperm from the uterus and ovum to the uterus
59
Q

Vagina:

A
  • connects the uterus to the vestibule
  • encircles cervix at the fornix
  • passes through the urogenital hiatus of the pelvic diaphragm and urogenital diaphragm
60
Q

Cervix:

A
  • external opening: at the endocervical canal

- internal opening

61
Q

What is covered by peritoneum in the female?

A

-upper portions of the bladder, anterior/posterior uterus (uterine tube and ovaries), upper/anterior rectum

62
Q

urogenital diaphragm:

A
  • skeletal muscle
  • contains deep transversus perineus muscle and sphincter urethrae (external)
  • perineal membrane covers the inferior surface
  • site of attachment of the erectile bodies/skeletal muscle roots of the penis and the clitoris
63
Q

deep perineal pouch:

A
  • contains deep transversus perineus muscle and sphincter urethrae (external)
  • between superior/inferior fascia layers of the UG diaphragm
  • males: membranous urethra and bulbourethral (Cowpers) glands
  • female: urethra and vagina
64
Q

superficial perineal pouch:

A
  • crura and bulbs of the penis/clitoris
  • attached to the ichiopubic rami and perineal membrane
  • continue as corpora cavernose into penis/clitoris
65
Q

Bulbs:

A

males: bulb of penis lies in the midline, contains penile urethra
females: bulb of the vestibule in the wall of the vestibule with the greater vestibular (Bartholins) glands

66
Q

Muscle of the crura and bulbs:

A
  • skeletal
    crura: ischiocavernous muscle (attach to bulb or penis or vestibule)
    bulb: bulbospongiosus (contract in males during ejaculation/micturition)
  • both contract during sex to limit venous drainage
67
Q

Colle’s fascia:

A
  • forms the superficial fascial boundary of superficial perineal space
  • continuous with the fascia of the scrotum, penis/clitoris, and Scarpa’s
68
Q

Muscles IN the penis:

A
  • 2 corpora cavernose

- corpus spongiosum

69
Q

Paraurethral glands of Littre:

A

adjacent to the penile urethra

-lubricate the penile urethra

70
Q

Buck’s fasica (deep penile)

A

-encloses the 3 erectile bodies, deep dorsal vein, dorsal nerves, and arteries

71
Q

Labia majora:

A
  • CT and fat
  • homologous to the scrotum
  • round ligaments of the uterus end here
72
Q

labia minora:

A

-in the lateral walls of the vestibule

73
Q

vestibule:

A

-chamber into which the urethra and vagina open after passing through the UG diaphragm

74
Q

paraurethral (Skene’s) glands:

A
  • homologous to the prostate

- lubricate the urethra and the vestibule

75
Q

Clitoris:

A

-2 corpa cavernose

76
Q

Blood supply to the pelvic viscera:

A

internal iliac artery

77
Q

Bladder blood supply:

A

-superior vesical arteries that come from the umbilical artery

78
Q

Uterus blood supply:

A

-uterine artery, branch of the umbilical artery courses through the round ligament

79
Q

ductus deferens and testis blood supply:

A
  • inferior vesical artery

* also supplies the bladder and prostate

80
Q

bladder and vagina blood supply:

A

-vaginal artery, branch of uterine

81
Q

Rectum and anal canal blood supply:

A
  • middle rectal artery

- branch of the internal pudendal artery

82
Q

Internal pudendal artery:

A
  • supplies structures in perineum

- exits pelvis via greater sciatic foramen and passes through lesser

83
Q

Inferior rectal artery:

A

-supplies anal canal below pelvic diaphragm

84
Q

perineal branchs of internal pudendal:

A

-muscles in the superficial and deep perineal pouches, skin of labia, vestibule, and scrotum

85
Q

Deep artery/artery to the bulb

A

-supply penis/clitoris, erectile tissue, bulbourethral gland, greater vestibular gland

86
Q

dorsal artery:

A

-skin of penis/clitoris, erectile tissue

87
Q

iliolumbar artery:

A

-supplies iliacus, psoas major/minor, quadratus lumborum

88
Q

lateral sacral artery:

A

-structures in the walls of the lesser pelvis

89
Q

Pudendal nerve:

A
  • innervates skeletal muscle of the pelvic diaphrahm, perineal pouches, and skin that overlies the perineum
  • formed by ventral rami of S2, 3, 4
  • passes through the greater sciatic foramen crosses ischial spine and enters the pudendal canal through the lesser sciatic foramen
90
Q

3 branches of the pudendal nerve:

A
  • inferior rectal nerve: innervates the external sphincter, skin of the anal triangle, and skin of the anal canal
  • perineal nerve: skin of posterior scrotum and labia majora/vestibule. Deep branch innervates superficial/deep perineal pouch muscles (transverse perineus, sphincter urethrae, bulbospongiosus, ischiocavernosus)
  • dorsal nerve of the penis/clitoris: skin
91
Q

Pudendal sensory nerve:

A

-general sensory fibers that convey pain from the structures in the perineum

92
Q

Motor functions of the pudendal nerve:

A
  • contraction of sphincter urethrae (voluntarily prevent urination)
  • contaction of external anal sphincter (voluntarily keep feces in)
  • supports pelvic viscera/prevents prollapse by contracting skeletal muscles in pelvic/UG diaphragms
  • maintains erection
  • contract bulbospongiosus for ejaculation and micturition
93
Q

Sympathetic innervation of the pelvis/perineum:

A
  • lower thoracic and lumbar splanchnics
  • preganglionic sympathetic axons from T11-L2 spinal cord
  • synapse at inferior mesenteric ganglion or prevertebral ganglia in the inferior hypogastic plexus
94
Q

Superior hypogastric plexus contains:

A
  • visceral pain fibers ad sympathetic axons

- visceral pain fibers course back to the spinal cord with the thoracic and lumber splanchnics

95
Q

lower thoracic and lumbar splanchnic functions:

A
  • contraction of sphincter vesicae (bladder filling, prevents retrograde ejaculation)
  • contraction of smooth muscle in ductus deferens, prostate, and seminal vesicles pushes sperm to the prosthetic urethra
  • emptying of the secretory products of the bulbourethral and greater vestibular glands
  • contraction of the internal anal sphincter (maintains feces)
  • carry visceral pain sensations from the GI structures in the hindgut and from pelvic viscera
  • carry pain from fundus, body, and cervix of the uterus
  • pain can be referred to the T11-L1 dermatomes
96
Q

Parasympathetic innervation of the pelvis and perineum:

A
  • pelvic splanchnic nerves
  • contain preganglionic parasympathetic axons that arise from neurons in the S2, 3, 4 spinal cord segments
  • they branch from the ventral rami of S2, 3, 4 spinal nerves as they emerge from the ventral sacral foramina
  • synapse in terminal ganglia situated in the wall of the bladder and in the hind gut and inferior hypogastric plexus
  • contain sensory fibers that respond to bladder distention, rectal distention, and distension of the uterus
97
Q

Inferior hypogastric plexus

A

-parasympathetic pelvic splanchnic join with the sympathetic splanchnic nerves in the superior hypogastric plexus to form the inferior hypogastric plexus

98
Q

Motor functions of the pelvic splanchnic nerves:

A
  • contraction of the detrusor muscle in the bladder wall = micturition
  • relax the internal anal sphincter and contraction of smooth muscle in the ampulla of rectum = defecation
  • dilation of the helicine arteries = erection
  • stimulate the secretory activity of the prostate, seminal vesicles, bulbourethral and greater vestibular glands
99
Q

Micturition:

A
  • urine flows from the bladder to the urethra
  • mediated by vesical relax which has two stages: filling and emptying and is facilitated by parasympathetic, sympathetic, and pudendal nerves
100
Q

Filling stage:

A
  • pelvic sphlanchnic nerves contain sensory fibers which sense urine
  • CNS bladder storage system is activated, sympathetic nerves inhibit the detrusor allowing bladder walls to stretch
  • bladder walls obstruct the entry point of the ureters to prevent reflux
  • at micturition threshold, conscious appreciation of bladder fullness
  • pain fibers course with the thoracic and lumbar splanchnic nerves and refer pain to T11 - L1 dermatomes (lower abdominal wall)
101
Q

Emptying stage:

A
  • CNS micturition center activated
  • sphincter urethrae and sphincter vesicae relax
  • pelvic sphlanchnic nerves contract detrusor and urine passes
  • bulbospongiosus muscle in males contracts to expel urine from the penile urethra
  • thoracoabdominal diaphragm and abdominal muscles contract to increase intrapelvic pressue and speed up flow
102
Q

Micturition disorders:

A
  • CNS control center lesions: cause supraspinal bladder disorders where bladder fills and empties suddenly
  • lesions above the sacral level of spinal cord: spinal, autonomic, spastic bladder where parasympathetic neurons are not inhibited when bladder is stretched so detrusor contracts after minimum stretch and there is frequent urination (small bladder, some urine can stay, risk of infection)
  • lesions to the sacral spinal cord or roots of sacral spinal nerves: atonic bladder due to disruption of the vesical reflex, bladder fills but urine dribblers because detrusor fails to contact and urethral sphincter may be weaker (high infection risk)
103
Q

Defecation:

A
  • visceral sensory fibers course into the sacral spinal cord in pelvic splanchnic nerves
  • pelvic splanchnic nerves facilitate peristalsis via stimulation of smooth muscle in the rectum
  • internal/external sphincter are inhibited allowing emptying
104
Q

Sexual reflexes:

A
  • erection -> secretion -> emission -> ejaculation

- erection: pelvic splanchnic and postganglionic cavernous

105
Q

erection

A
  • pelvic splanchnic and postganglionic cavernous
  • relation of smooth muscle
  • dilation of arteries in the erectile tissue of the crura and corpora cavernosa, bulb, and corpus spongiosum
  • ischiocavernous and bulbospongiosus muscle contractions help maintain erection
  • parasympathetic

Point and shoot (erection and emission parasympathetic and sympathetic)

106
Q

Sectretion:

A
  • also pelvic splanchnic nerves
    males: stimulate secretory activity of the prostate and seminal vesicles
    female: stimulate secretory activity of the vaginal glands and greater vestibular glands (vagina moves to midposition in pelvis)
107
Q

Emission:

A
  • facilitated by lower thoracic and lumber splanchnics (sympathetic)
  • contraction of smooth muscle in ductus deferens and prostate/seminal vesicles promotes movement of sperm
  • contraction of sphincter vesicae prevents retrograde ejaculation
  • ejaculation closely follows emission
108
Q

Ejaculation:

A
  • facilitated by the prudendal nerve
  • sphincter urethrae relaxes
  • rhythmic contractions of the bulbospongiosus propels sperm
109
Q

Sacrospinous ligament

A

converts the greater sciatic notch to the greater sciatic foramen

110
Q

Ureter courses:

A

-inferior to the uterine artery

111
Q

Location of the UG diaphragm:

A
  • runs horizontal
  • below the ischiocavernosus muscle
  • between the prostate and the bulb of the penis
112
Q

Location of the pelvic diaphragm:

A

-runs vertical

Anatomy (9 decks)

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