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(PA school) Gross Anatomy > Lecture 11 pt 2 > Flashcards

Lecture 11 pt 2 Flashcards

1
Q

What structures pass through the pelvic diaphragm to reach the perineal compartment? (3)

A

Rectum
Vagina
Urethra

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2
Q

1) Where is the rectum found?
2) Where are the vagina and urethra found?

A

1) Posterior triangle
2) Anterior urogenital triangle

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3
Q

What are the 3 urinary organs?

A

Ureters
Urinary bladder
Urethra

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4
Q

1) Are ureters retroperitoneal or intraperitoneal?
2) Where are they found?
3) What do they follow? To where?

A

1) Retroperitoneal
2) Pelvic region at bifurcation of iliac a.
3) Follow internal iliac a. to the posterior bladder

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5
Q

1) _______________________ thru bladder wall acts as sphincter to prevent retrograde urine flow from ureters during voiding along with ___________________ at ureteral orifice at trigone
2) In males the ___________________ is related to the ureters

A

1) Oblique passage; circular m.
2) ductus deferens

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6
Q

Where is the urinary bladder? What does this depend on?

A

Lesser pelvis - empty bladder
Greater pelvis (+) with full bladder

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7
Q

1) What is the urinary bladder inferior to?
2) Where does it rest?
3) Where is the apex of the urinary bladder?

A

1) Peritoneum (subperitoneal)
2) Rests on pelvic floor
3) Anterior toward pubis

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8
Q

1) Where is the fundus/ base of the urinary bladder in males and females?
2) Where is the body of the urinary bladder?
3) Where the fundus and inferolateral walls of the bladder converge inferiorly is called what?

A

1) In female adjacent to anterior wall of vagina; males adjacent to rectum
2) Body between apex and fundus
3) Neck

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9
Q

1) What is the trigone of the bladder?
2) What is the uvula of the bladder?

A

1) Triangle region with ureters and urethra orifice
2) Slight elevation of the trigone in the internal urethral orifice

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10
Q

True or false: the urinary bladder is attached anteriorly to the pubis

A

False

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11
Q

1) What do the detrusor muscle fibers do near the neck of the male bladder? What does this do?
2) What do some of these detrusor muscle fibers do?

A

1) Form the involuntary internal urethral sphincter which contracts during ejaculation (sympathetic stimulation)
2) Run radially & assist in opening the internal urethral sphincter.

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12
Q

1) What are detrusor muscle fibers in the neck of the bladder continuous with in males?
2) What about in females?

A

1) Fibromuscular tissue of prostate
2) Muscle fibers of urethra

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13
Q

What are at the angles of the trigone of the bladder?

A

Ureteric orifices and internal urethral orifice

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14
Q

1) Ureteric orifice is circled by what? What does this muscle do and why?
2) What is the inferior portion of the bladder called?

A

1) Detrusor m. that tighten during voiding to prevent reflux urine into ureter
2) Uvula of bladder

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15
Q

1) What supplies the bladder with blood?
2) Describe venous drainage of the bladder and include where they drain

A

1) Branches of the internal iliac aa.
2) Veins draining bladder correspond to arteries and drain into the internal iliac veins (Caval system)

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16
Q

Lymphatics from superior surface of bladder drain into _______________________, while those from the fundus drain into ________________________.

A

external iliac nodes; internal iliac nodes

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17
Q

1) What innervates the bladder sympathetically?
2) Sympathetic innervation that stimulates ejaculation simultaneously causes what? Why?

A

1) Sympathetic fibers from T11-L2 to pelvic plexus
2) Contraction of the internal urethral sphincter to prevent reflux of semen into the bladder

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18
Q

1) What innervates the bladder parasympathetically? (what fibers and plexus?)
2) What do they provide motor innervation to? What do they do in males?
3) When visceral afferent fibers stimulated by stretching, what happens in males? What suppresses this reflex?

A

1) Parasympathetic fibers from S2-3-4 via pelvic splanchnic n. to inferior hypogastric plexus
2) Motor to detrusor muscle & inhibitor to internal urethral sphincter in males
3) Detrusor m. contracts & the internal urethral sphincter relaxes and urine flows into the urethra; toilet training suppresses this reflex (along with external urethral sphincter)

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19
Q

Why is the female urethra more prone to UTI?

A

Short length, sexual “trauma”

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20
Q

1) Where does the female urethra run to and from?
2) Where does it lie in relation to the vagina? How does it leave through the pelvic floor?

A

1) Internal urethral orifice in bladder to external urethral orifice in vestibule of vagina
2) Anterior and parallel to vagina and passes along with the vagina thru the pelvic floor, external urethral sphincter and perineal membrane

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21
Q

Urethral glands homolog to ______________, common paraurethral duct bilaterally near external urethral orifice.

A

prostate

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22
Q

1) What somatically innervate the female urethra? (plexus and nerve)
2) What nerve viscerally innervates the female urethra? Where?

A

1) Vesicle nerve plexus and pudendal nerve (somatic)
2) Pelvic splanchnic n; most below pelvic pain line

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23
Q

What are the 4 parts of the male urethra?

A

1) Intramural
2) Prostatic urethra
3) Intermediate (membranous)
4) Spongy urethra

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24
Q

1) The intramural part of the male urethra is surrounded by what?
2) What is this area’s innervation?
3) What does this area prevent?
4) ____________________ fibers are inhibitory to internal urethral sphincter resulting in relaxing of sphincter during voiding

A

1) Internal urethral sphincter
2) Sympathetic innervated smooth muscle
3) Retrograde ejaculation
4) Parasympathetic fibers

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25
Q

1) What traverses through the prostate?
2) What surrounds the intermediate (membranous) part of the male urethra? What is this?

A

1) Prostatic urethra
2) Surrounded by external urethral sphincter; somatically innervated voluntary muscle

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26
Q

1) What part of the male urethra is surrounded by external urethral sphincter?
2) What primarily controls continence?

A

1) Intermediate (membranous)
2) Tonic and phasic contraction of external urethra sphincter

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27
Q

1) What sphincters must be inhibited to void?
2) What is the spongy urethra also called?

A

1) Both internal and external urethral sphincters must be inhibited to void
2) Corpus spongiosum

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28
Q

1) What does parasympathetic stimulation do during micturition?
2) The _______________________ is under somatic control and is inhibited during micturition

A

1) Causes the detrusor muscle to contract & inhibits the internal urethral sphincter.
2) external urethral sphincter

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29
Q

True or false: In infants, voiding occurs involuntarily (as a reflex)

A

True

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30
Q

To gain voluntary control over micturition, infants must learn to suppress and stimulate what?

A

1) Suppress: the visceral afferent urge to void
2) Stimulate: the somatic motor of external urethral sphincter

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31
Q

1) What muscle is in the wall of the bladder and is involved in micturition?
2) What form the “involuntary” internal urethral sphincter?
3) What is the “voluntary” (Somatic) sphincter and where is it?

A

1) Detrusor muscle in wall of bladder
2) Neck of bladder muscles
3) External urethral sphincter; above perineal membrane

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32
Q

1) What is stress incontinence?
2) What causes it?
3) Who is it more common in?
4) How is it treated?

A

1) Leakage when cough, sneeze, run, jump
2) Weak external sphincter/pelvic floor
3) Older parous women - post vaginal deliveries
4) Manage with PT

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33
Q

1) What is urge incontinence?
2) What causes it?
3) How it it managed?

A

1) “GOTA GO NOW!!!!”
2) Detrusor instability
3) With Rx

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34
Q

List the male genital organs

A

Testis, epididymis, ductus deferens, seminal glands, ejaculatory ducts, prostate, and bulbourethral glands

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35
Q

1) What is the ductus deferens?
2) Where does it ascend? Where does it pass through?
3) Where does it cross over to enter the pelvis? What does it pass retroperitoneally?
4) Where does it end?

A

1) Continuation of the duct of epididymis from inferior pole of testis
2) In the spermatic cord; passes through the inguinal canal
3) External iliac vessels; passes along the lateral pelvic wall
4) By joining the duct of the seminal gland to form the ejaculatory duct

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36
Q

1) Where are the seminal glands (vesicles)?
2) What fluid do they secrete? What does it do?
3) What part of the seminal glands is covered in peritoneum?

A

1) Lie obliquely between the fundus of bladder and rectum
2) Alkaline fluid, mixes with sperm, major contributor to volume of semen ~ 75%
3) Superior aspect

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37
Q

1) What are ejaculatory ducts?
2) Where do they pass through?
3) Where do they open and how?

A

1) Tube arising from union of vas deferens and seminal gland duct
2) Posterior prostate
3) By slit like apertures on or within the prostatic utricle

38
Q

1) What is the prostate?
2) What does it surround?
3) Hormonally induced hypertrophy of the uvula extends where?

A

1) Walnut sized gland
2) Surrounds urethra (prostatic urethra)
3) Into internal urethral orifice

39
Q

What are the two divisions of the prostate? Define each.

Which one incorporates the prostatic plexus?

A

1) Glandular part 2/3
2) Fibromuscular 1/3: dense fibromuscular capsule
-Incorporates the prostatic plexus of nerves and veins

40
Q

1) Define base of prostate
2) Define apex of prostate

A

1) Base: superior aspect related to neck of bladder
2) Apex: inferior related to external urethral sphincter

41
Q

1) What part of the prostate contributes to the external urethral sphincter?
2) What part of the prostate is palpable via DRE?

A

1) Muscular anterior surface (AMZ)
2) Posterior surface related to the ampulla of the rectum

42
Q

1) How many prostatic ducts open into prostatic sinuses?
2) Where are the prostatic sinuses?

A

1) 20+
2) On either side of seminal colliculus on posterior wall of the prostatic urethra

43
Q

1) Prostatic fluid accounts for ~____% of volume of semen
2) Where are the Bulbourethral glands (Cowper’s glands)?
3) Where do the Bulbourethral glands open to?

A

1) ~25%
2) Lie posterolateral to the intermediate part of the urethra embedded in external urethral sphincter
3) Proximal spongy urethra

44
Q

What are the 2 categories of LUTS (lower urinary tract symptoms)? List what’s in each

A

1) Irritative symptoms
-Frequency
2) Obstructive symptoms
-Dribbling
-Push harder
-Nocturia
-Repeat voiding

45
Q

What is BPH?

A

Middle lobe (CZ) hormonally induced enlarged prostate & uvula projects into bladder which impedes urination by distorting the prostatic urethra

46
Q

What medications BPH be treated with?

A

-Rx alpha blockers; Tamsulosin (Flomax)
-5 alpha-reductase inhibitor – antiandrogen - Finasteride (Proscar, Propecia)

47
Q

What is TURP?

A

A surgical procedure that removes tissue from the prostate to treat benign prostatic hyperplasia (BPH) or other conditions

48
Q

1) Where are most adenocarcinoma of the prostate cases?
2) Are they palpable via DRE?
3) Where does metastatic disease go?

A

1) Posterior PZ
2) Yes
3) To iliac and sacral nodes

49
Q

Adenocarcinoma of the prostate:
1) Prostatectomy results in injury to nerve plexus can cause what?
2) Prostatic plexus is closely associated with what?
3) What does the prostatic plexus give rise to?

A

1) ED
2) Prostatic sheath
3) Parasympathetic fibers that give rise to cavernous nerves that convey fibers for erection.

50
Q

What are the 4 female internal genital organs?

A

1) Uterus
2) Uterine tubes
3) Ovary
4) Vagina

51
Q

1) Where does the uterus lie when nongravid?
2) Where is it typically relative to the vagina and cervix?

A

1) In lesser pelvis with its body lying on the bladder and cervix between the bladder and rectum
2) Anteverted (relative to vagina) and body anteflexed (relative to cervix)

52
Q

What organ’s position is variable associated with fullness of bladder and rectum?

A

Uterus

53
Q

What are the 2 main parts of the uterus? Define each

A

1) Body: superior 2/3, lies between the layers of the broad ligaments and is freely movable
2) Cervix: narrow inferior part of uterus, fibrous, most mobile part of the uterus

54
Q

List and define the 3 parts of the body of the uterus

A

1) Fundus: rounded part superior to orifices of uterine tubes
2) Isthmus: just superior to the cervix
3) Uterine horns: where uterine tubes enter

55
Q

List the 3 parts of the cervix of the uterus

A

1) Supravaginal part
2) Vaginal part: projects into vagina and has the external os of the uterus
3) Cervical canal and external os

56
Q

1) The rounded part of the uterus superior to orifices of uterine tubes is called what?
2) What part of the uterus is just superior to the cervix?

A

1) Fundus
2) Isthmus

57
Q

1) A gravid uterus puts pressure on what 2 things?
2) The majority of vessels and nerves course within what coat of the uterus?

A

1) Bladder and rectum
2) Myometrium

58
Q

List and define the 3 layers of the wall of the uterus

A

1) Perimetrium: outer serous coat, peritoneum + connective tissue
2) Myometrium: middle muscular coat of smooth muscle – majority of vessels and nerves course within this coat
3) Endometrium: inner mucous coat, firms adheres to myometrium

59
Q

1) What part of the wall of the uterus is actively involved in the menstrual cycle? What does it do?
2) Where does implantation occur with conception?

A

1) Endometrium differs in structure with each stage of cycle, inner surface is shed during menstruation
2) Endometrium (within fundus of uterus)

60
Q

1) What does the ligament of the ovary do? Where?
2) What does the the round ligament of the uterus attach?
3) What does the round ligament enter and where does it end?

A

1) Connects the ovary to the uterus; near the uterotubal jct.
2) Attaches close to above, vestiges of the ovarian gubernaculum related to decent of ovary from the posterior abdominal wall
3) The internal/deep inguinal ring and ends within the inguinal canal

61
Q

1) What is the broad ligament of the uterus
2) What does it do?
3) What does it mostly contain?

A

1) Double layer of peritoneum (mesentery) that extends from the sides of the uterus to the lateral walls and floor of the pelvis
2) Keeps uterus relatively centered in the pelvis
3) Ovaries, uterine tubes/related structures + vessels that serve them

62
Q

1) What is prolonged laterally over ovary vessels as the suspensory ligament of the ovary?
2) What keeps uterus relatively centered in the pelvis?

A

1) Broad ligament of the uterus
2) Broad ligament of the uterus

63
Q

What 3 things make up the broad ligament?

A

1) Mesovarium
2) Mesosalpinx
3) Mesometrium

64
Q

What 4 things are found between layers of the broad ligament bilaterally?

A

1) Uterine tubes
2) Ligament of the ovary
3) Round ligament of the uterus
4) Suspensory ligament of the ovary

65
Q

1) What extend laterally and open into the peritoneal cavity near the ovaries?
2) What part of this is intramural?

A

1) Oviducts or fallopian tubes
2) Uterine part

66
Q

1) Where are the oviducts or fallopian tubes?
2) Define and describe the infundibulum
3) List the last 3 parts of the fallopian tubes

A

1) Lie in mesosalpinx of the free edge of the broad ligament
2) Funnel shaped distal end of fallopian tube, fimbriae spread over the surface of the ovary, one large ovarian fimbria is attached to the ovary
3) Ampulla, isthmus, and uterine part (intramural, uterine ostium)

67
Q

1) What are the ovaries near?
2) What are they suspended by?

A

1) The attachment of the broad ligament to the lateral pelvic walls
2) Mesovarium (both peritoneal folds) and the suspensory ligament of the ovary

68
Q

1) Suspensory ligament conveys what?
2) Where does the round ligament attach?
3) Vestiges of the ovarian gubernaculum related to what? What do they enter and where do they end?

A

1) Vessels, lymphatics, and nerves to and from the ovary
2) Close to above structures
3) Descent of ovary from the posterior abdominal wall … enter the internal/deep inguinal ring and ends within the inguinal canal

69
Q

1) Is the ovary intraperitoneal, retroperitoneal, or something else? Is it suspended or fixed?
2) Where does the oocyte expelled during ovulation go?

A

1) Not covered by peritoneum and suspended within the peritoneal cavity
2) Passes into and through the peritoneal cavity, but is usually captured by the fimbriae and passed to the ampulla of the tubes

70
Q

What is the significance of “fill and spill”?

A

How to tell if the fimbriae open into the peritoneal cavity

71
Q

1) Is the vagina retroperitoneal, intraperitoneal, or something else?
2) Where does it extend from and to?

A

1) Mostly subperitoneal
2) From posterior fornix to the vestibule of the vagina

72
Q

1) What is the vestibule of the vagina?
2) What does it contain?

A

1) Cleft between the labia minora into which the vagina and urethra open
2) Vaginal and urethral orifices, openings of the 2 greater vestibular glands

73
Q

1) Superior end of vagina surrounds what?
2) The recess around the protruding cervix is called what?
3) What are the 3 recesses called?
4) Which recess is deepest? What is it related to?

A

1) Cervix
2) Vaginal fornix (3)
3) Anterior, postural, and lateral recesses
4) Posterior fornix is deepest, related to rectum

74
Q

The vagina is typically collapsed; what 4 muscles compress vagina?

A

1) Pubovanginalis m.
2) External urethral sphincter m
3) Urethrovaginal sphincter m
4) Bulbospongiosus m.

75
Q

What is the clinical significance of the location of the ureter in relation to the uterine arteries?

A

Can accidently be cut during a hysterectomy instead of a uterine artery

76
Q

Which is deeper, the ureter or the uterine artery?

A

Ureter

77
Q

What other vessel is near the ureter and uterine artery?

A

Internal iliac

78
Q

What 6 structures can be palpated vaginally?

A

1) Uterus: Size and position, composition (fibroids), gravid, cervix & CMT
2) Bilateral “adnexa”: Ovaries, uterine tubes
3) Bladder
4) Anterior rectum
5) Sacral promontory (pelvic inlet)
6) Ischial spine (for pudendal nerve block)

79
Q

What 4 things can you note about the uterus from vaginal palpation?

A

1) Size and position
2) Composition (fibroids)
3) Gravid
4) Cervix & CMT

80
Q

1) Where is lymph drained from female pelvic viscera to?
2) Where is it drained from the female perineum to?

A

1) Internal, external, common iliac nodes & sacral node
2) Perineum to superficial inguinal nodes

81
Q

Lymphatic drainage of male pelvis and perineum is the same as female except what?

A

Testicular lymphatics run up near the celiac/renal nodes

82
Q

1) Where is the rectum?
2) What shape is it in lateral views?
3) What can be seen in A-P view?

A

1) Sigmoid colon to anal canal
2) S-shaped
3) 3 lateral flexures

83
Q

1) At the Rectosigmoid jct. ~ S3, what does the rectum do?
2) What is the ampulla and what does it do?

A

1) Follows curve of sacrum and coccyx forming sacral flexure of rectum
2) Ampulla is the dilated terminal part of rectum, retains fecal mass prior to defecation

84
Q

1) What perforates the pelvic floor/diaphragm to become anal canal? Where?
2) What forms the “puborectal sling”?

A

1) Rectum at anorectal flexure
2) Puborectalis m.

85
Q

1) 3 _________________ of rectum are formed in relation to 3 Transverse rectal folds.
2) Puborectalis m. helps create what? At what angle? What does it perforate?
3) Resting state is by what?

A

1) lateral flexures
2) Anorectal flexure; ~ 80-degree, perforates the pelvic diaphragm as the anal canal
3) Tonus of the puborectalis m

86
Q

1) What prevents defecation during peristaltic contractions? Is this voluntary or involuntary?
2) Relaxation during defecation results in what?

A

1) Active contraction; voluntary (learned via “potty training” in toddlers)
2) Straightening of the anorectal angle

87
Q

How is fecal continence maintained? What structures are involved?

A

1) 3 lateral flexures of rectum
2) Puborectalis m. helps create the anorectal flexure

88
Q

What are the two main arterial supplies of the rectum and anus?

A

1) IMA’s superior rectal artery
2) Branches of internal iliac

89
Q

What does the superior rectal artery from the IMA do?

A

Supplies proximal rectum

90
Q

1) What do the middle rectal arteries drain?
2) What branch off the internal pudendal arteries? What do they supply?

A

1) Middle and inferior rectum
2) Inferior rectal arteries; anorectal jct. and anal canal

91
Q

What are the 4 main venous supplies of the rectum and anus? List what each drains to

A

1) Rectal venous plexuses:
-Internal (just deep to epithelium)
-External (to muscular wall of rectum)
2) Superior rectal veins
-Drains into portal veins
3) Middle rectal v.
-Drain into systemic veins
4) Inferior rectal v.
-Drains into systemic veins

92
Q

What two things are involved in Portocaval Anastomosis ?

A

Internal (just deep to epithelium) and external (to muscular wall of rectum) rectal venous plexuses

(PA school) Gross Anatomy (52 decks)

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