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COM: Endocrine - Final COPY > Lecture 3: Pelvic Viscera I & II > Flashcards

Lecture 3: Pelvic Viscera I & II Flashcards

1
Q

Where does abdominal fluid collect in men and is where abscesses are likely to form?

A

The lowes point of parietal peritoneum which is ~2cm above the seminal vesicles

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2
Q

What is the retropubic space?

A

Space between the pubis and bladder

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3
Q

What is the retrorectal (presacral) space?

A

Space between rectum and sacrum

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4
Q

What is the rectovesical pouch/fossa?

A

Space between bladder and rectum

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5
Q

Where is endopelvic fascia found?

A

Beneath perineum and covering viscera, pelvic wall and floor; continuous with endoabdominal fascia

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6
Q

What is the paracolpium?

A

Thickened fascia from lateral vagina to tendinous arch

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7
Q

The ureter travels under the ____________ (male anatomy). The bladder is __________ (superior/inferior) to the prostate. Seminal vesicles lie on the ____________ (anterior/posterior) surface of the bladder. The ____________ gland is located within the UG membrane.

A

Vas Deferens; superior; posterior; bulbourethral

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8
Q

The prostate is positioned immedately _________ (above/below) bladder but _________ (superior/inferior) to UG membrane

A

Below; superior

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9
Q

Are ureters intra- or retro-peritoneal?

A

Retroperitoneal

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10
Q

In males, the ureter runs inferior to ___________ and in females runs inferior to ____________

A

Vas deferens; uterine artery

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11
Q

The ureters receive multiple artery supply. What 4 arteries supply blood to them?

A

Renal
Gonadal
Aortic
Internal iliac branches

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12
Q

What nerves innervate the ureters?

A

Preaortic plexus
Hypogastric plexus
Pelvic splanchnic nerves

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13
Q

The apex of the bladder points towards the _____________, the fundus points ___________, the body lies ______ and the neck lies __________

A

Pubic symphysis; just opposite; between; at the bottom

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14
Q

The bladder is supported by what ligament?

A

Lateral ligament (endopelvic fascia)

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15
Q

The median umbilical ligament (urachus) continues to the __________

A

Umbilicus

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16
Q

Normally the bladder does not rise above the ___________ when empty but does so when full

A

Pelvic brim

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17
Q

__________ muscle (visceral smooth muscle) lines the bladder walls and is continuous with the internal urethral sphincter as well as the ureteric sphincters

A

Detrusor

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18
Q

Where iis the male external urethral sphincter located?

A

Located primarily at the level of the memrbanous urethra, but extends superiorly around the prostatic urethra

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19
Q

The internal urethral sphincter is made of smooth muscle and is involuntary. What nerves innervate this?

A

Inferior hypogastric plexus

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20
Q

The external urethral sphincter is made of skeletal muscle and is under voluntary control. What nerves innervate this?

A

Deep perineal branch of the pudendal nerve

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21
Q

What is the male urethral crest?

A

A posterior ridge on the urethra as it passes through the prostate

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22
Q

What is the male seminal colliculus?

A

An enlarged area on the crest onto which open the 2 ejaculatory ducts (bringing sperm from the vas deferens and fluid from the seminal vesicle)

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23
Q

What is the male prostatic utricle?

A

Remnant of paramesonephric system

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24
Q

What are the male prostatic sinuses?

A

Depressions on either side of the ridge into which prostatic glands open and secrete an alkaline prostatic fluid

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25
Q

The prostate gland is a walnut-sized gland that surrounds the _______________. Its 2/3 _______ and 1/3 _______.

A

Prostatic urethra; 2/3 gland; 1/3 fibromuscular tissue

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26
Q

What is the largest male reproductive accessory organ?

A

Prostate

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27
Q

Prostatic ducts open chiefly into the _________________

A

Prostatic sinuses

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28
Q

When does hypertrophy of the prostate typically occur?

A

Its common after middle age, affecting virtually every male that lives long enough

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29
Q

Hypertrophy of the prostate is a common cause of ________________, leading to what symptoms?

A

Common cause of urethral obstruction leading to nocturia, dysuria and urgency to urinate

30
Q

What does hypertrophy of the prostate increase the risk of?

A

Bladder infections (cystitis) as well as kidney damage

31
Q

Hypertrophy of the prostate projects into the _________________, impedes ruination by distorting the ____________________

A

Urinary bladder; prostatic urethra

32
Q

The vas deferens enter the abdomen via _____________. they pass __________ (inferior/superior) to all structures including the ureters and iliac vessels. Once passing the ureter they expand into an ___________ before narrowing again and joining the duct of the ________________

A

Deep inguinal ring; superior; ampulla; seminal vesicle

33
Q

What male structures are bilateral, lobulated sacs lying lateral to the ampulla of the vas deferens?

A

Seminal vesicles

34
Q

Duct of the seminal vesicle and the vas deferens join on each side to form what structure?

A

An ejaculatory duct

35
Q

What is the vascular supply for the seminal vesicles?

A

Umbilical and inferior vesicular arteries

36
Q

What is the sympathetic supply to the male reproductive organs?

A

From T10-L2 via similar route as bladder

37
Q

What is the parasympathetic supply to male reproductive organs?

A

From pelvic splanchnic nerves

38
Q

What is the visceral afferent supply to male reproductive organs?

A

Most travel with parasympathetic fibers to S2-S4

exceptiions include testis (sympathetic to T10

39
Q

Most lymphatic drainage from the vas deferens and inferior portion of seminal vesicles is to the ________________ nodes; with scrotal portion of vas deferens draining into ______________ nodes

A

Internal iliac nodes; external iliac nodes

40
Q

The male prostate glands terminate chiefly in the _____________ LNs with some to the _________ nodes

A

Internal iliac nodes; sacral nodes

41
Q

The bladder drains both into the __________ LNs and ___________ LNs

A

External iliac nodes (superiolateral portion)

Internal iliac nodes (fundus and neck)

42
Q

What are the rectouterine and vesicouterine pouches separated by?

A

The broad ligament of the uterus and uterus

43
Q

The rectouterine pouch can be surgically approached through what structure?

A

Fornix of the vagina

44
Q

What ligament iis found within the rectouterine fold?

A

Uterosacral ligament

45
Q

The uterus is commonly divided into 3 parts, what are they?

A

Fundus
Body
Cervix -> protrudes into vagina forming vaginal fornices: internal os and external os

46
Q

Major changes during the menstrual cycle are primarily in what layer of the uterus?

A

Endometrium

47
Q

What are the 3 layers of the uterus?

A

Perimetrium
Myometrium
Endometrium

48
Q

A vertex uterine positon is the angle between what 2 structures?

A

Vagina and cervix -> normally anteverted

49
Q

A flexed uterine posiition is the angle between what 2 structures?

A

Uterine body and cervix -> normally anteflexed

50
Q

A retroverted uterus is usually genetic but may be caused by what 4 things?

A

Fibroids
Endometriosis
PID
Labor

51
Q

What are the symptoms of a retroverted uterus? Is fertility affected?

A

No effect on fertility, but can be associated with lower back pain, dysuria, and dyspareunia

52
Q

Though uncommon, pregnant retroflexed uterus can become trapped by what?

A

The curve of the sacrum

53
Q

When does uterine prolapse occur?

A

Can occur when pelvic ligaments (especially the cardinal ligament) OR pelvic diagram weakens/tears

54
Q

What is the main cause of uterin prolapse? What else can contribute?

A

Main cause = pregnancy, but aging, menopause, and obesity can contribute

55
Q

The uterine/Fallopian tubes are commonly divided into 4 parts, what are they?

A

Intrauterine
Isthmus
Ampulla
Infundibulum

56
Q

What are the 3 layers of the uterine/Fallopian tubes?

A

Mucosa
Muscularis
Serosa

57
Q

Ovaries lie on the _______ wall of the pelvis and are covered laterally by _______ of the uterine tube

A

Lateral; fimbrae

58
Q

The ovaries are attached anteriorly to the ___________ ligament via __________, laterally to the ___________ ligament and medially to the ___________ ligament

A

Broad ligament via mesovarium; suspensory ligament; (proper) ovarian ligament

59
Q

The fornix of the vagina is the recess between what 2 structures?

A

Cervix and the vaginal wall

60
Q

The opening to the vestibule can be partially closed by what structure?

A

Membranous hymen

61
Q

What part of the external urethral sphincter changes with age?

A

Proximal EUS is where striated muscle length and thickness are lost with age

**Pelvic floor exercises can increase EUS size

62
Q

What urethral sphincter aids in reflex closure of the urethra during acute instances of increased intra-abdominal pressure such as coughing, sneezing and laughing?

A

External urethral sphincter

63
Q

Most lymph from the female perineal area drains to the iliac nodes except for what 5 exceptions?

A

Round ligament and fundus (+ external genitalia) -> superficial inguinal LNs

Ovary, uterine tube, fundus -> lumbar nodes

64
Q

What nerve plexus is the primary efferent innervation to female internal viscera?

A

Inferior hypogastric plexus

65
Q

What nerve plexus is associated with the ovarian artery and composed of parasympathetic from vagus nerve and sympathetics from T10/11?

A

Ovarian plexus

66
Q

What is the inferior limit of the peritoneum?

A

Pelvic pain line

67
Q

What is responsible for the innervation superior to the pelvic pain line?

A

Sympathetics to T12-L2

**Includes structures within broad ligament (body and fundus of uterus!)

68
Q

What is responsible for the innervation inferior to the pelvic pain line?

A

Parasympathetic to Pelvis (S2-S4)

69
Q

Anesthesia delivery to the pelvis specifically targets the pelvic pain line differences. What structures does a spinal block or lumbar puncture target?

A

Blocks from the waste down (intra- and sub-peritoneal plus some somatic areas)

70
Q

Anesthesia delivery specifically targets pelvic pain line differences. What areas does a caudal block (epidural) target?

A

Blocks sub-peritoneal and somatic areas innervated by the pudendal nerve

71
Q

Anesthesia delivery specifically targets pelvic pain line differences. What areas does a pudendal nerve block target?

A

Blocks areas innnervated by the pudendal nerve

72
Q

Which of the ligaments of the spine is the lumbosacral ligament most like?

A

Anterior transverse ligament -> bc it goes from transverse process of L5 and is going to the sacral ala which would’ve been the transverse process of S1 if it wasnt fused vertebra

COM: Endocrine - Final COPY (15 decks)

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