midline structures of the pelvis

Question 1

why does pus tend to accumulate in rectovesical or rectouterine pouches

Answer 1

when upright these pouches are the lowest part of the peritoneal cavity so fluid collects here

Question 2

what happens when a badder gets full

Answer 2

it buldges upwards, above the pelvic brim

Question 3

what is suprapubic catheterisation

Answer 3

catheter inserted via small hole a few inches below belly button

Question 4

what are teh advantages of a suprapubic catheter

Answer 4

no damage to urethra
less likely to be displaced
less likely to be infected
short healing time after removal

Question 5

what is the posterior relation to the base of the bladder in males/females

Answer 5

rectum/vagina and cervix

Question 6

what is the trigone bounded by

Answer 6

two ureteric openings superolaterally

urethral opening inferiorly

Question 7

how is the trigone unlike the rest of the bladder

Answer 7

always smooth with no folds (rugae)

Question 8

in males, which structure separates the bladder neck from pelvic floor

Answer 8

prostate

Question 9

what is the normal capacity for the bladder

Answer 9

approximately 500ml

Question 10

what is the blood supply to the bladder

Answer 10

superior vesical arteries
males-inferior vesicle arteries
females-vaginal arteries

Question 11

what is the nerve supply to the bladder

Answer 11

sympathetics via hypogastric plexuses

parasympathetic via pelvic splanchnic nerves

Question 12

what effect does the parasympathic stimulation have on the muscle of the bladder

Answer 12

Constriction of upper detrusor muscle. Relaxation of lower trigone region, and internal urethral sphincter

Question 13

how do the secretions from the prostate reach the urethra

Answer 13

via the prostate ducts, open into the prostatic sinuses either side of the seminal colliculus

Question 14

How might the prostate be approached surgically without opening the peritoneal cavity

Answer 14

TURP

done with resectoscope which passes up urethra

Question 15

What is the route of the vas deferens

Answer 15

epididymus of testes–> spermadic cord–> over pelvic brim–> unites with seminal vesicle–>ejaculatory duct

Question 16

what is a vasectomy

Answer 16

vas deferens looped then cut and tied within the scrotum

Question 17

What structures provide mechanical support for the uterus within the pelvis

Answer 17

round, ovarian, broad and suspensory ligaments

Question 18

what are fibroids

Answer 18

benign tumour of fibrous/muscular wall of uterus

Question 19

‘water flows under the bridge’ is a useful way to remember what relationship

Answer 19

ureter goes under the uterine artery

Question 20

the round ligament is the remenent of what embryological structure

Answer 20

gubernaculum

Question 21

Where do the ovarian arteries originate

Answer 21

aorta at L2

Question 22

which nerve lies adjacent to the ovary on the lateral wall of the pelvis

Answer 22

obturator

Question 23

What structures can be palpated anterior to the vagina

Answer 23

bladder, fundus and urethra

Question 24

What structures can be palpated posterior to the vagina

Answer 24

rectum

Question 25

What structures can be palpated lateral to the vagina

Answer 25

ischial spines

Question 26

posterior fornix is closely related to which part of the peritoneal cavity

Answer 26

rectouterine pouch

Question 27

What is the lymphatic drainage of the uterus and vagina

Answer 27

superficial inguinal lymph nodes