Notecards from Ross SG Flashcards
The renal arteries are located where in the body?
L1 transpyloric line
What surrounds the kidneys and why is it important?
Gerota’s fascia surrounds the kidneys and it is important because it doesn’t degrade. When we have a situation like pancreatits, the infection could spread to the kidneys and degrade them. Gerota’s fascia separates perinephric fat from paranephric fat—the fat in the front and back of the kidney.
Renal innervation is related to visceral afferents (conscious and unconscious sensations) to what dermatomes? What are the significant correlations in the body?
-Renal Colic PAIN (T12 to L2) can be felt under the ribs, above iliac crest, labia majora, scrotum and proximal anterior thigh
What are three common sites for constrictions and or kidney stones?
- Uteropelvic junction (UPJ) - near kidneys
- Pelvic inlet at the common iliac arteries
- Uterovesicular junction (UVJ) -at entrance to the bladder
What are adjacent retroperitoneal structures to the kidneys? (first start with recalling SADPUCKER= retroperitoneal)
sprarenal glands, aorta/ivc, duodenum (2nd and 3rd parts), pancreas (except tail), ureters, colon (ascending, descending), kidneys, esophagus, rectum
So adjacent = aorta/ivc, oancreas, duodenum, colon, esophagus
What is the difference between a male and female prostate?
Male = curve at prostate Female = no curve and shorter
The internal sphincter is innervated by what nerve? What type of muscle is it? And is it voluntary or involuntary control?
Smooth muscle under involuntary control
SNS contracts, PSNS relaxes (pudendal n.) OR inferior hypogastric plexus
What nerves are involved in the anal wink? What nerve is it?
S2-4, pudendal n.
Most of the roots = S4
Where do you do a pudendal nerve block?
medial to ischial tuberosity
What kind of muscle is the external sphincter made of and it is innervated by what nerve? Does it have voluntary or involuntary control?
Skeletal muscle and innervates by branches of the pudendal nerve.
How does an erection happen?
Under PSNS control- vasodilation of branches of internal pudendal arteries to corpus cavernosa and spongiosa
*Also pelvic splanchnic to inferior hypogastric PPI (POINT)
What happens if the internal pudendal arteries are damaged during a prostatectomy?
Male cannot get an erection
Sensation of the penis is via what nerves?
Via pudendal and perineal nerves (S2-S4)
The deep parts of the perineum are drained how?
Internal pudendal -> internal iliac -> aortic
DIIA
The superficial perineum and external genitalia are drained how?
superficial inguinal nodes -> deep inguinal nodes -> external iliac nodes
What two structures drain right to the periaortic lymph nodes?
Ovaries and testes
What two important areas does the perineum hold up?
Urogenital triangle and the anal triangle
Nerve innervation of the urogenital diaphragm?
pudendal nerve
Artery innervation of the urogenital diaphragm?
internal pudendal artery
The pelvic diaphragm is composed of the ________ and ________
levator ani and coccygeus
What three muscles are a part of the levator ani?
I Plan Poorly
Iliococcygeus m
Pubococcygeus m
Puborectalis m
This is a part of the levator ani and pulls the anorectal junction forward to keep the GI system closed at the rectal area, helping the anal sphincter muscles relax
Puborectalis m
This is a part of the levator ani and it arises from the ilium and the tendonous arch on the obturator internus muscle
ilicoccygeus m
What does the levator ani hold up?
Levator ani AKA pelvic floor supports the rectum, bladder, and uterus.
Bypasses the vaginal canal and urethra
Where is the ischorectal fossa and why is it important?
The ischiorectal fossa is a triangular area in between the pelvic diaphragm and the urogenital diaphragm. AKA Deep perineal space. Important because abscessed will form here due to decreased blood supply from anal area or genital area.
What is significance of Perineal body?
The levator ani and perineal membrane come together to form the perineal body. This is the space between the vagina and the rectum. You don’t want to cut here when doing an epysiotomy
What system do the external hemorrhoids come from?
Systemic venous system
What system do internal hemorrhoids come from?
come from the portal veins
Where is the pudendal nerve located?
Medial to the ischial tuberosity
What dermatomes are responsible for skeletal mm in the perineum and pelvic floor including urethral and anal sphincters?
S2-S4
Much of the somatic motor and sensory innervation is via the ____________
Pudendal nerve (S2 to S4)
What are the true support structures of the uterus?
CUA
Cardinal, uterosacral and anterior pubocervical ligaments
What happens when there is damage to the true support structures of the uterus?
typically childbirth can lead to prolapse of bladder and or uterus
Where does intraperitoneal fluid/blood collect?
Rectouterine pouch or pouch of douglas
Does the vesicovaginal space collect intraperitoneal fluid?
No its in between the vagina and the bladder
The ovarian arteries come off of the _____
aorta
The uterine and vaginal arteries come off of what arteries?
Internal iliac arteries
The uterine and vaginal arteries are found within the?
broad ligament
The fallopian tube is very vascular and supplied by what artery?
The ovarian artery
What is the significance of the ectopic pregnancy?
The Fallopian tube is very vascular and is supplied by Ovarian art, This is why Ectopic pregnancy rupture carries high mortality because you are bleeding off of the aorta.
What are the erectile tissues?
Corpus cavernosum, corpus spongiosum
What is the support structure for the erectile tissues?
perineal membrane
What three layers comprise the superficial perineal membrane in the male?
Ischiocavernosus m, bulbospongiosus m, superficial transverse perineal muscle
In males, the ___________ pouch is where intraperitoneal blood will collect.
Rectovesicular
What are the four parts of the male urethra?
- Preprostatic
- Prostatic
- Membranous
- Spongy
A majority of prostate cancers are in the ________ zone whereas BPH occurs in the ________ zone
peripheral, transitional (periurethral)
What are the spermatic cord contents?
Ductus deferens, panpiniform plexus, genitofemoral n
Genitofemoral nerve is responsible for what?
Cremasteric reflex
The sympathetic and visceral afferent of the spermatic cord goes through the…
Superficial and deep inguinal rings
What is the heat exchanger of the spermatic cord?
Pampiniform plexus
What are the sensory and motor components of the cremasteric reflex?
Cremasteric reflex involves stroking on the inner thigh Ilioinguinal n. L1 (sensory afferents) to Spinal Cord to Genitofemoral n. L1-L2 (motor) which causes the Cremasteric m to elevate Testes.
The testicles are supplies by the _________ artery which comes off the what?
testicular artery and abdominal aorta- similar to the ovaries
How is an erection stimulated?
PSNS from pelvic splanchnic n to inferior hypogastric plexus: stimulated erection
How is ejaculation stimulated?
SNS form sacral splanchnic n to superior hypogastric plexus stimulates smooth muscle contractions, ejaculation
What level of the vertebrae do the testes start at and how long does it take for them to descend?
Start at T10-12 and takes about 9 months
*go through the deep inguinal ring and then the superficial inguinal ring
What is the retropubic space (space of rezius)?
Retropubic space is a potential avascular space located between the pubic symphysis and the urinary bladder. The retropubic space is a preperitoneal space, located behind the transversalis fascia and in front of peritoneum .[1]
This fascia is a continuation of scarpa’s fascia and is superficial to the urogenital triangle that is continuous with anterior abdominal wall?
Colle’s Fascia
