Lecture 19 RH

Question 1

What are the principles underlying referred pain of abdominal viscera?

Answer 1

Pain from paired viscera is often referred to a side of the body.
Pain from unpaired viscera is referred to the midline.

Question 2

What are the principles underlying tubular viscera?

Answer 2

tubular viscera typically consist of a sphincter at both ends and could contain a physiological sphincter within them.

Question 3

WHat muscles do ureters contain in their walls?

Answer 3

longitudinal and circular.

Question 4

How does urine pass through the ureters?

Answer 4

via peristalsis.

Question 5

How long are ureters?

Answer 5

typically 25cm with half its length in the pelvis.

Question 6

How does the ureter regulate what enters the bladder?

Answer 6

The ureter pierces the bladder posterolaterally and closes when the pressure inside the bladder increases in response to being filled up with urine. This is carried out via a functional sphincter.

Question 7

What layers do the ureters consist of?

Answer 7

Serosa coat

muscle coat consisting of both circular and longitudinal muscle

mucosa layer inside

Question 8

What are the blood vessels that supply the ureters?

Answer 8

The ureters receive a segmental arterial supply, which varies along its course.

The upper part of the ureter closest to the kidney is supplied by the renal arteries.

The middle part of the ureter is supplied by the common iliac arteries, direct branches from the abdominal aorta, and gonadal arteries (the testicular artery in men or ovarian artery in women).

The lower part of the ureter closest to the bladder is supplied by branches from the internal iliac arteries,as well as:
Superior vesical artery
Uterine artery (in women only)
Middle rectal artery
Vaginal arteries (in women only)
Inferior vesical artery (in men only)

Question 9

What are ureteric calculi and how do they develop?

Answer 9

Ureteric calculi are kidney stones and they develop as a result of a high calcium diet.

Question 10

Where is the most common site of ureteric calculi accumulation?

Answer 10

at the narrowings for the kidney (including the one at the pelvic brim).

Question 11

What causes pain to be felt when experiencing ureteric calculi? Where is the pain felt?

Answer 11

distension of the ureters causes muscle spasms and this causes sensory neurons to fire signals to the brain causing referred pain to side, back and lower abdomen. In some cases it can be referred to the scrotum (in males) or the vulva (in females)

Question 12

Which sympathetics do visceral afferents of ureters follow?

Answer 12

T11 - L1

Question 13

How are ureteric calculi treated?

Answer 13

they are left alone to pass through urine. Patients are often given painkillers for the pain, however, opioids cause spasms so they aren’t prescribed.

Question 14

What are some variations that can be seen in kidneys?

Answer 14

Some people have double ureters that either fuse before reaching the bladder or fuse with the bladder. (1% of population)

Some people have pelvic horseshoe kidneys that are fused in the pelvis (0.2% of the population)

Question 15

Where is the bladder located relative to the rectum and the vagina?

Answer 15

anterior to the rectum and posterior to the vagina

Question 16

How is the bladder held in place?

Answer 16

Bladders neck is continuous with the urethra and is held in place at the levator ani by the neck.

Question 17

What happens to the contents of the bladder if levator ani was stretched?

Answer 17

Urinary incontinence.

Question 18

What is the median umbilical ligament? What is the clinical significance of this ligament?

Answer 18

A midline fold that is remnant of the urachus that connects the bladder’s apex to the umbilicus. It could cause urine to leak from the belly button.

Question 19

Where is the bladder located in children? Why?

Answer 19

In the abdomen because children’s pelvises are too small to hold the bladder

Question 20

What are the contents of the bladder wall?

Answer 20

a layer of muscle known as detruser muscle.

A triangular trigone made up of the ureteral and urethral orifices.

Question 21

What is the function of the detruser muscle?

Answer 21

The detruser muscle can stretch to accommodate lots of urine without contracting until the fluid reaches a critical point.

Question 22

Where does the female bladder lie?

Answer 22

Female bladder lies above levator ani.

Question 23

Where is the internal urethral sphincter located?

Answer 23

Within the prostate of men (not found in women)

Question 24

What is the function of the internal urethral sphincter?

Answer 24

it prevents backflow of semen into the bladder.

Question 25

What does hypertrophy of the bladder cause?

Answer 25

hypertrophy of the bladder creates a tight bladder which makes urination difficult.

Question 26

What causes the bladder to contract during micturition reflex?

Answer 26

parasympathetic fibers act on detruser muscle to contract after bladder cells stretch.

Question 27

What spinal segments are involved in the micturition reflex?

Answer 27

S2 - 4

Question 28

How does voluntary urination take place?

Answer 28

Pudendal nerve innervates the levator ani and the external urethral sphincter to contract and allow urine to be expelled.

Question 29

What is the treatment to people who can’t expel their urine?

Answer 29

supra pubic puncture can be made

Question 30

What structures are endangered by a suprapubic puncture?

Answer 30

Peritoneal cavity

Intestines

uterus

Retropubic space

blood vessels of bladder mucosa

Inferior epigastric vessels

Question 31

What can be done to someone who has lost their nerve innervation of urination?

Answer 31

Installation of an artificial sphincter. (contains button in scrotum)

Question 32

Where does the GI tract terminate within the pelvis?

Answer 32

at the rectum which extends from S3 to the tip of the coccyx

Question 33

What covers the rectum?

Answer 33

Rectum contains 3 transverse folds and tough fascia