L7.1 Pelvic viscera Flashcards
1
Q
Unpaired viscera
A
- develop in midline (Some may migrate to non-midline)
- Receive NS from both sides of spinal cord → Refer pain back to midline
2
Q
Paired viscera
A
- Develop bilaterally
- NS & BS form each side
- Refer pain to same side
3
Q
2 types of sphincters
A
- Tubular viscera has sphincter guarding entrance & exit
- Anatomical
- Smooth circular muscles - within body cavity
- Skeletal muscles - Near exit of body
- Functional
- Wall of tube acts as sphincter (e.g. bladder & ureter)
4
Q
Ureter
A
- 25cm (pelvic part 12.5cm)
- Serosa → Muscularis (has circular & longitudinal S.M) → Mucosa
- Passes urine down via peristalsis
- Pierce bladder POS-LATerally via urethral orifice
- Intramural part = part passing through the wall
- Increase pressure in bladder as it fills → closes ureter at the intramural part (FUNCTIONAL sphincter)
- Prevents reflux of urine back to ureter/kidney (may occur when there is damage)
5
Q
BS to the ureter
A
- Extensive along the length
- Coming from medial (in abdominal part)
- Coming from lateral (in pelvic part)
6
Q
Things crossing the ureter
A
- Males: Crossed only by vas deferens
- Females: Uterine A
7
Q
Uteric calculi
A
- Stones → may lodge at sites of narrowing → spasm → passes N impulses
- Referred pain: T11-L1 (follow sym) dermatomes
8
Q
Renal and uteric anomalies
A
- Semi/Bifid ureters (1%)
- Increase association with urinary tract infections (Much narrower)
- Pelvic (horseshoe) kidney (0.2%)
- Normally: Starts off in midline → post development → Changes with body elongation
- May be obstructed by big vessels (i.e IMA)
- In pelvic kidney: Kidney left within pelvic cavity & not in ab cavity
- Normally: Starts off in midline → post development → Changes with body elongation
9
Q
Bladder
A
- Rests on vagina (if vag prolapse → decrease support)
- Increasing bladder volume → pushes peritoneal coat up (which coats rectum, vagina & bladder)
- Neck is continous with urethra (needs support of vag & L.Ani)
- Lack of support leads to incontinence
- Median umbilical ligament (remnant of aracheus) - ascends from apex
- Open in fetus → urine from bladder to umbilicus
- If it remains open in adults → urine may leak from belly button
- In children <6yo, position is in the abdomen
10
Q
Median umbilical ligament
A
- Median umbilical ligament (remnant of aracheus) - ascends from apex
- Open in fetus → urine from bladder to umbilicus
- If it remains open in adults → urine may leak from belly button
11
Q
Internal urethral sphincter
A
- Internal urethral sphincter ONLY in males
- Primarily to prevent backflow of semen from prostatic urethra
- TURP process (removal of prostate) → may damage sphincter → seminal regurgitation in bladder
12
Q
Walls of the bladder
A
- Mucosa (detrusor)
- Large SA → allows expansion to accommodate increase in urine
- Trigone (where ureters come in)
- Interuteric bar lies in b/w the 2 orifice
- Is a layer of SM which is different from detrusor (cannot be stretched)
- Walls allow motility/expansion of bladder
13
Q
What occurs when critical point of storage is reached?
A
- Critical point of storage → reflexes triggered → micturition
14
Q
Micturition reflex
A
- Receptor = bladder → full → afferent → CNS (Pudendal N = S2-4) → efferent → effector = bladder → contraction of detrusor muscles
- Relaxation of external urethral sphincter (Males and females)
- Voluntary
- Relaxation of internal urethral sphincter (Males)
- Involuntary - by SNS T12-L1
- Increase abdominal pressure
- Pudendal N & L.Ani required for micturition
15
Q
What is the suprapubic puncture
A
- Used when urine remains in bladder → may become infected
- But puncture causes danger in penetrating other structures
16
Q
Urethra
A
- Females: Short, opens ANT to vag (below clitoris)
- Males:
- Pre-prostatic (intramural part)
- Prostatic (through prostate)
- Membranous (Through ex urethral sphincter, in deep perineal pouch)
- Spongy (on corpus spongiosum)
- Navicular fossa = dilated opening at the glans
17
Q
Urethral caterterisation
A
- Simple for females short
- Longer for males and has to be navigated
18
Q
Urinary incontinence
A
- Incontinence results from N damage or less of mechanical support
- Artificial urinary sphincter: Could use device to regulate time for urinary expulsion
19
Q
Sigmoid colon
A
- Etends from D.colon to rectum at S3
- Sigmoid mesocolon → allows mobility
- Muscle layers externally for peristalsis
20
Q
Rectum
A
- 3rd part of sacrum to tip of coccyx
- Transverse rectal folds → storage of feces in rectum
- Allows air passing through without expelling contents
- Surrounded by rectal fascia
- Ampulla = dilated 3rd distal part
21
Q
Pelvic peritoneum
A
- Peritoneum on SUP A-L upper 2/3 of rectum
- Uterus
- Urinary bladder (SUP)
- → goes to ANT ab wall
