Lecture 27: Pelvic Viscera

Question 1

What is the course of the ureter?

Answer 1

From kidney behind the parietal peritoneum (retroperitoneal) > crosses over the iliac arteries > pelvic brim into pelvis minor > enters bladder at postero-superior angle

Question 2

How does the ureter move urine into the bladder?

What prevents backflow of urine in the bladder?

Answer 2

• peristalsis

- one way flap valve in bladder wall

Question 3

What is the anatomical location of the urinary bladder in males?

Answer 3

• located in the anterior-inferior pelvis minor below the peritoneum. apex is forward while neck is backward. neck joins urethra and rests on prostate gland.
• separated from rectum by the peritoneal recess

Question 4

What are the parts of the urinary bladder (same in males and females)?

Be able to label on blocked image

Answer 4

Ureter
Detrusor m.
Ureteral openings 
Trigone
Neck

Question 5

What is the trigone?

Answer 5

• posterior bladder where the ureter enters and the urethra exits
• consists of 1 internal urethral orifice and 2 ureteric orifices

Question 6

What consists the lateral surfaces of the bladder?

Answer 6

veiscal fascia with venous plexus

Question 7

What is the anatomical location of the urinary bladder in females?

Answer 7

• located anterior to cervix and vagina, inferior to body and fundus of uterus
• separated from the uterus b the vesicouterine pouch

Question 8

What are the 4 parts of the male urethra

Answer 8

1. Intramural region (with internal urethral sphincter)
2. Prostatic urethra (through the prostate gland)
3. Membranous urethral (through the urogenital diaphragm)
4. Spongy/penile urethra (bulb, body and penis glans)

Terminates at the external urethral orifice

Question 9

What are are the features of the prostatic urethra?

Be able to label on the blocked image

Answer 9

Urethral crest
Prostatic sinus
Prostatic utricle
Ejaculatory ducts

Question 10

What are the characteristics of the female urethra?

Answer 10

short
external orifice terminates at the vaginal vestibule
paraurethral glands on either side (homologous to prostate glands)

Question 11

What is the anatomical course of the vas/ductus deferens?

Answer 11

continuous with the epididymis and travels inside the spermatic cord > inguinal canal > crosses ueter > joins seminal vesicle duct > ejaculatory duct

-peristalsis to move sperm

Question 12

What is the anatomical course of the seminal vesicles?

Answer 12

• coiled tubes posterior to bladder and between the vas deferens and prostate
• produce semen

Question 13

What is the anatomical course of the ejaculatory duct?

Answer 13

-comes from duct of seminal vesicle and vas deferens merging > leads to urethra (prostatic part at seminal colliculus

Question 14

What is the anatomical boundaries of the prostate gland?

What does it produce?

Answer 14

• Base adjacent to bladder and apex is adjacent to urogenital diaphragm
• anterior is retropubic space
• Posterior: ampulla of rectum
• Lateral: prostatic venous plexus

Alkaline secretions that is part of the semen

Question 15

Benign Prostatic Hyperplasia (BPH)
Cause
Clinical

Answer 15

Large prostate glands that constrict the urethra

-difficulty urinating, weak urine stream, nocturia

Question 16

What are the 4 major areas of prostate cancer metastases?

Answer 16

lung, liver, bone, lymph nodes

cells travel through lymph or blood

Question 17

What are bulbourethral glands?

Answer 17

• glands in the male urogenital diaphragm that produce mucous that lubricates urethra before ejaculation
• ducts to perineal membrane to enter bulb of penis

Question 18

What are the anatomical features of the rectum?

Answer 18

S3 level, anterior to sacrum and coccyx with 3 flexures/folds (superior, intermediate and inferior)
-has bilateral pararectal fossae that helps rectum expand as it fills with feces without compressing structures

Question 19

Peritoneal coverings of the rectum

Answer 19

Upper 1/3 - covered anteriorly and laterally
Middle 1/3 - covered anteriorly
Lower 1/3 - not covered

Question 20

What are the anatomical features of the vagina?

Answer 20

-muscular tube with 4 fornices (spaces) that form a circle around the cervix
posterior to bladder and urethra and anterior to rectum and anal canal
-Orifice between labia minor behind the urethra

Question 21

What are the 4 vagina fornices?

Answer 21

anterior, 2 lateral, 1 posterior (continuous with the rectouterine pouch)

Question 22

What are the borders of the uterus?

Answer 22

Anterior-inferior: bladder

Posterior-superior: intestines

Question 23

What are the parts and layers of the uterus?

Answer 23

• Fundus (most superior portion), body, cervix (opens into the internal os and external os
• layers of the uterus: endometrium (epithelium), myometrium (smooth muscle), perimetrium (peritoneum)

Question 24

What are the uterine ligaments?

Be able to label where they are on the blocked images

Answer 24

Attaches the uterus and ovaries to the pelvic walls

Round ligament 
Uterosacral ligament
Broad ligament
Suspensory ligament 
transverse cervical ligament 
Ovarian ligament

Question 25

What are the parts of the broad ligament?

Answer 25

Broad ligament is membrane looking
Mesometrium - attached to uterus
Mesovarium - attached to ovary
Mesosalpinx - attached to uterine tube

Question 26

What are uterine tubes/oviducts?

Answer 26

-Tubes from the uterus in the mesosalpinx of the broad ligament that open into the peritoneal cavity

Question 27

What are the 4 parts of the uterine tubes?

Be able to label on the blocked image

Answer 27

Infundibulum - opens into peritoneal cavity with fimbriae projections
Ampulla - wides and longest part
Isthmus - short
Uterine - opens at uterine ostium

Question 28

When epidurals are given during childbirth what nerve is targeted, where do you inject, and what structures are anesthetized?

Answer 28

• Pudendal N. (S2-S4), epidural space between L3 and L4

- Structures below the pelvic pain line: distal rectum, anal canal, uteirne cervix, vagina, bladder

Question 29

Anatomical characteristics of ovaries

Answer 29

• located in the ovarian fossa, posterior to the broad ligament
• medially attached to ligament of the ovary and laterally attached to the suspensory ligament (which contains the ovarian vessels, nerves and lymphatics)