LEC 2 Flashcards
there are three constrictions along the course of the ureter, where stones may be arrested, namely
a. At pelviureteral junction
b. Where it crosses pelvic brim
c. Where it passes through muscular wall of bladder
Anterior Relations of Right Ureter
- 2nd part and beginning of 3rd part of duodenum
- Near superior aperture of lesser pelvis, it is related to lower part of root of mesentery of small intestine and terminal part of ileum
- crossed by right colic, ileocolic, and right gonadal vessels
Anterior Relations of Left Ureter
- It is crossed by left colic and gonadal vessels
2. Near the SUPERIOR aperture of lesser pelvis, it is related to sigmoid colon and mesocolon
Posterior Relations of ureters
- Psoas major muscle separates the ureter from the transverse processes of LUMBAR vertebrae
- common iliac artery
Arterial Supply of ureters
- Upper part Renal artery.
- Middle part Gonadal artery.
- Lower part Superior vesical artery.
Lymph Drainage or ureters
To lateral aortic and iliac lymph nodes
Nerve Supply of the ureter
Abdominal part: Renal & gonadal plexuses
Pelvic part: Sup. & inf. Hypogastric plexuses.
Visceral afferent fibers: Enter the spinal cord
at segment T 11 & 12 and L 1 & 2
When a stone enters lower part of ureter colicky pain is felt at ————- and is referred to ———
lower level and is often referred to testis and/or tip of penis or labium majus in female
Renal colic due to stone in renal pelvis or upper part of ureter Colicky pain referred to
skin areas that are supplied by these segments of spinal cord ( loin, groin, flank)
Sometime pain caused by stones is referred along———— nerve, which will be felt in the ————-
femoral branch of genitofemoral (L 1 and 2)
upper part of the front of the thigh
The pain is often sever that afferent pain impulse spread within CNS, giving rise to ———-
nausea
Colicky pain is due to
spasm of smooth muscle
The wall of the ureter consists of three
coats
- Outer fibrous coat Is continuous with the fibrous capsule of the kidney in the renal sinus.
- Middle muscular coat
- Inner mucous coat Continuous with the mucous membrane of bladder
Middle muscular coat :
In the upper two thirds of ureter this coat is made
up of ———-
In the lower third ————-
- outer circularly smooth muscle + inner longitudinal
- the ureter acquires an additional outer longitudinal layer of smooth muscle
Inner mucous coat of ureter Present———————folds
5-6 longitudinal
Inner mucous coat of ureter Consists of ———–lined by———
lamina propria–> has many elastic fibers
transitional epithelium–>4-5 cells thick
apex is connected to umbilicus by ————Which is the fibrous remains of the ———–
median umbilical ligament
embryonic urachus
Empty bladder is located within ————-
pelvic cavity, immediately behind pubic bones
The superior wall of a distended bladder may rises up into
hypogastric region
Maximum capacity of the bladder is about
500 ml
the neck lies behind
lower part of symphysis pubis.
the neck rest on
male ——
female ——
male–> rests on superior surface of prostate
female –> rests on pelvic fascia
does the peritoneum cover the bladder
only the superior surface
the relation btw ureter and peritoneum
retroperitoneal
the bladder is related superiorly to
male ———–
female ———-
male-> to terminal coils of ileum and to sigmoid colon
female –> The posterior part of superior surface is related to uterus
The space between the superior surface of bladder and uterus is known as the ———
uterovesical pouch
Posterior surface of bladder Is related in male to—– but separated from it
- above–>
- below –>
- rectum
- rectovesical pouch of peritoneum
- two vas deferens, two seminal vesicles, and rectovesical fascia
posterior surface of bladder In female, is separated from rectum by
vagina
inferolateral surface Anterior part is separated from pubic bones by
retropubic pad of fat
inferolateral surface of bladder posterior part lies in contact above with——- and bellow with ——-
obturator internus muscle and below with levator ani muscle with their covering fascia
Lateral and medial puboprostatic ligaments (male)
or pubovesical ligaments (female) Connect bladder to
pubic bone
Vesical Ligaments
1- Lateral and medial puboprostatic ligaments or pubovesical ligaments 2- Median umblical ligament 3- Lateral true ligaments 4- Posterior ligaments
Median umblical ligament
Connects bladder to
umbilicus
Lateral true ligaments Connects side of bladder to the
tindinous arch of the pelvic fascia
Posterior ligaments Envelops on each side ———— that extends to ————–
vesical venous plexus and extends from posterior wall of bladder to internal iliac vein
Intraperitoneal rupture of bladder Usually involves
superior surface when the bladder is extended and full
Intraperitoneal rupture results in
urine escapes freely into peritoneal cavity
Extraperitoneal rupture Involves
anterior wall
Extraperitoneal rupture could be a result of
fractures of pelvis
In extraperitoneal rupture there is in most patients a
lower abdominal pain and hematuria
The area of mucous membrane covering internal surface of posterior wall of bladder is known as
trigone of bladder
does the trigon has rugae ?
mucous membrane is always smooth
even when bladder is empty
The two posterolateral angle of the trigon contain the
two ureteral opening
the anteromedial angle of the trigon contains
the opening of the urethra (internal urethral
opening),
Blood Supply of Urinary Bladder
- Superior and inferior vesical arteries
- Veins form a complicated venous plexus on
the inferolateral surface called vesical
venous plexus, which drains on each side
into internal iliac vein
nerve supply of bladder
From inferior hypogastric plexus :
1- sympathetic -> Preganglionic fibers from L 1 and 2
–> enter 1 st and 2 nd lumbar sympathetic ganglia –> postganglionic descend through the hypogastric nerve plexus to reach bladder
2- Parasympathetic nerve fibers Preganglionic fibers (pelvic splanchnic nerves), which arise from the S 2+3 +4–>descend through inferior hypogastric plexus –>
Postganglionic fibers supplied bladder
3- Visceral afferent fibers enter S 2+3+4 segments of
spinal cord via the pelvic splanchnic nerves
However some of afferent fibers pass
through hypogastric plexus to enter L 1 and 2
segments of spinal cord
what is the sympathetic and parasympathetic action on the bladder
Sympathetic nerves
Inhibit contraction of detrusor muscle of
bladder wall and stimulate closure of
sphincter vesicae
Parasympathetic
nerves Stimulate contraction of detrusor muscle and inhibit action of the sphincter vesicae
Lymph Drainage of Urinary Bladder
Drains into the internal and external iliac lymph nodes
The wall of bladder is composed of three coats and their components
(1 )Outer serous or peritoneal coat Covers only superior surface of bladder
(2) Middle muscular coat (detrusor muscle ) -> outer and inner longitudinal , middle circular
(3)Inner mucous coat –>The mucosa consists of transitional epithelium and a lamina propria of loose to
dense connective tissue
which muscle forms the internal urethral sphincter
At neck of bladder, circular layer forms internal urethral sphincter, which surrounds internal urethral orifice
how much is the thickness of the distended bladder and the empty
The transitional epithelium of in the un
distended state is 5 6 cells in thickness
When bladder is full of urine, the epithelium
is only 3 4 cells in thickness
how does the shape of cells change from distended to empty bladder
empty :
The cells of basal layer are cuboidal in
form, while those of intermediate layers are more columnar.
the surface layer made of dome shaped (umbrella) cells
distended :
the superficial cells become squamous
female urethra at Its lower end pierces
perineal membrane
the external urethral sphincter is located
above the perineal membrane encircled by striated muscles
the widest part of the male urethra is
prostatic urethra
On each side of the urethral crest, there is a shallow depression
the urethral or prostatic sinus
the urethral or prostatic sinus floor is perforated by
orifices of prostatic ducts
about middle of urethral crest we have ——– on which slit like orifice of ———— is situated
the seminal colliculus
prostatic utricle
On each side of the orifice of the prostatic
utricle, there is opening of the
ejaculatory ducts
where does the bulbourethral glands lie
above perineal membrane, one on each side posterolateral to the membranous urethra
where does the bulbourethral duct lie
The duct of each gland pierces perineal membrane to open into proximal part of penile urethra, about 2.5 cm below perineal membrane.
The part of the urethra that lies within glans penis is dilated to form
the Navicular fossa or fossa terminalis
Penile (Spongy) Urethra traversed bulb of
penis——— and opens on
summit of ——— as —————
corpus spongiosum
glans penis
external urethral meatus
what is the narrowest part of urethra
The external urethral orifice or meatus
Sphincter Urethrae Muscle (External Urethral Sphincter) Composed of ————— surrounds ————
circular striated muscle fibers that surrounds the membranous part of the urethra
Sphincter Urethrae Muscle (External Urethral Sphincter) is supplied by
pudendal nerve
Sphincter Vesicae Muscle (internal Urethral Sphincter) Composed of
non striated circulatory muscles surrounds the internal urethral orifice at neck region of bladder
Sphincter Vesicae Muscle (internal
Urethral Sphincter) is innervated by
sympathetic nervous
system
The wall of female urethra consists of
mucosa, which Is folded,
surrounded by a muscular coat
the mucosa of female urethra is lined by
Near neck of bladder the urethra is lined by transitional epithelium
The remaining part of the urethra is lined by non keratinizing stratified squamous epithelium
The two paraurethral glands in females correspond to———– in males
prostatic gland
The mucous membrane of urethra in females is much folded and contains a number of mucous glands called
skene’s glands
paraurethral glands open by way of long
ducts on
either side of external urethral orifice
the muscular coat of the female urethra consists of
internal longitudinal and external circular fibers
The wall of the male urethra consists of which type of cells
The prostatic urethra is lined by transitional epithelium
The remaining part of male urethra is lined by stratified or pseudostratified columnar epithelium, but there may be many patches of stratified squamous epithelium
The fossa terminalis is completely lined by stratified squamous epithelium
