pelvic cavity Flashcards
pelvic cavity
- area between pelvic inlet and outlet
- cavity of the true pelvis
pelvic diaphragm
divides pelvic cavity into main pelvic cavity and perineum
(3) contents of pelvic cavity
1) lower ends of GI tract
2) distal part of urinary tract
3) internal organs of rep sys. (for reproduction)
- blood supply
- lymphatics
- nerve supply
sigmoid colon length & shape
- 10 to 15 inches long
- s-shaped
(2) sigmoid colon surface anatomy (continuation/level)
1) continuation of descending colon / level of pelvic brim
2) continues with rectum / in front of S3
True/False:
Sigmoid colon have mesenteries called the “sigmoid mesocolon” that attaches it to the posterior wall.
true
blood/venous/nerve supply + branches
blood: inferior mesenteric art. (sigmoid branch)
vein: inferior mesenteric v. (joins portal vein)
nerve: inferior hypogastric plexus (symp/parasymp)
boundaries of sigmoid colon (AP: male & female)
clue/mnemonic: PREC/SAC/IL
Anterior
M: urinary bladder
F: uterus (posterior), vagina (upper part)
Posterior
M: rectum
F: sacrum
MF: ileum (terminal part, lower coils)
(3) clinical condis of sigmoid colon
1) volvulus
2) cancer (colon)
3) diverticula
another name for volvulus
mesentery twist
volvulus
- extreme mobility > rotates sigmoid colon counterclockwise (around its mesentery)
- affects blood supply (decreases)
- cause ischemia (to tissues of intestine) > abdominal pain
- enlargement of abdomen > fluid/waste products not allowed to pass
(2) treatment of volvulus
1) derotate (through surgery)
2) resection (of infected and non-functioning areas/if ischemic)
common site of cancer of large bowel (colon cancer)
sigmoid colon
symptom of colon cancer
bloody stool
diverticula
- out-pouchings of the wall/mucous membrane of colon
- complication: diverticulosis/diverticulitis (irritation of portion where feces enter/ > enlarges feces > severe pain/inflammation)
most common cause of left lower quadrant pain
diverticula
most common cause of right lower quadrant pain
appendicitis
(1) treatment of diverticula
1) purely ANTIBIOTICS
(3) sigmoid colon procedures
1) sigmoidoscopy (rectum > sigmoid)
2) colonoscopy (e.g. pt comes w/ rectal bleeding/severe abd. pain suspecting there’s a mass)
3) colostomy (feces leaving through STOMA)
sigmoidoscopy
- sigmoid examination under DIRECT vision (for pathologic lesions) through flexible tube
colonoscopy
- DIRECT inspection of ENTIRE colon (including cecum)
colostomy
- surgical procedure (exposed colon/opening of abdomen: STOMA)
- connects part of colon to anterior abdominal wall
- colostomy > feces leave pt’s body (through STOMA)
- maybe permanent or temporary (depending on reasons for use)
length of rectum
5 inches
(5) rectum surface anatomy (continuation/level)
1) continues with sigmoid (level of S3)
2) continues to tip of coccyx
3) continues with anal canal (penetrates pelvic floor > perineum > end of anus)
rectal ampulla
dilated/lower part of rectum
puborectalis muscle
forms a SLING at the junction of RECTUM and ANAL CANAL (anorectal angle)
rectum function
- produces anorectal angle
(4) anorectal triangle function
1) waste products/water > passes large intestine > become feces
2) goes to sigmoid > rectum (stays here)
3) water is reabsorbed back (where feces form) > hardens
4) puborectalis muscle relaxes > angle becomes straight > feces get out
constipation
- happens when defecation does not take place for days
- water keeps reabsorbing/feces harden too much
peritoneum
- covers first third (upper 2/3) of rectum ANTERIORLY AND LATERALLY
- covers middle third of rectum only ANTERIORLY
houston valves/transverse folds
SEMICIRCULAR permanent folds of rectum formed by its MUCOUS membrane and CIRCULAR muscle layers
True/False:
Muscular coat of rectum is arranged with inner longitudinal and inner circular layers of smooth muscles.
false
t/n: OUTER longitudinal and INNER circular layers of smooth muscles
rectum boundaries (anteriorly/male & female)
M upper 2/3:
- sigmoid colon
- coils of ileum (at rectovesical pouch)
M lower 1/3:
- posterior surface of bladder
- vans deference/seminal vesicles (on each side)
- prostate
F upper 2/3:
- sigmoid colon
- coils of ileum
F lower 1/3:
- posterior surface of vagina
rectum boundaries (posteriorly)
- sacrum & coccyx
- piriformis, coccygeous, & levator ani
- sacral plexus & sympathetic trunks
blood supply of rectum
superior/middle/inferior rectal art.
nerve supply of rectum
inferior hypogastric plexuses
True/False:
Inferior hypogastric plexuses is sensitive only to stretch.
true
t/n: only stretch, not pain
other name for hirschsprung’s disease
primary megacolon
hirschsprung’s disease symptoms
- ENLARGMENT of lumen > inability to pass out meconium
- UNDERDEVELOPED nervous system (parasympathetic ganglion cells) in the wall of large intestine before birth
megacolon
- enlargement of colon
- caused by constriction > dilation > trapped stool
(1) treatment of hirschsprung
(1) surgical removal of diseased/non-functioning segment of bowel
(2) stages of surgery for hirschsprung
1) first stage - colostomy
2) second stage - pull-through procedure (closes stoma)
pull-through procedure
repairs colon by CONNECTING functional bowel to anus
kidney color and shape
reddish brown, bean-shaped
True/False:
Kidney is an excretory organ.
true
True/False:
Left kidney is lower.
false
t/n: right kidney is lower, liver on the right side pushes it lower. when diaphragm contracts, it can move the kidneys up and down by about an inch
(3) kidney functions
1) excretion of waste products of metabolism
2) controls water and electrolyte balance within the body
3) maintains acid-base (normal ph) of blood
hilum
VERTICAL SLIT in medial concave borders of the kidney
structures that enter and exit hilum (most anterior to most posterior)
clue/mnemonic: RV, 2B, U, 3B, LV / SYMPFB
(RV to good 2B trUe, went to 3rd branch of Louis Vuitton / Symp ang Females n Boys)
most anterior: renal vein
2nd branch of RA
ureter
3rd branch of RA
lymph vessels
most posterior: sympathetic fibers
renal sinus
- extension of hilum, a large cavity
- SPACE in the hilum containing renal pelvis
(2) spaces of renal sinus
1) minor calyces
2) major calyces
minor calyces location
end of each papilla
calyces formation
minor > major > renal pelvis
renal pelvis
EXPANDED part of ureter
cortex (color, inner/outer)
part of kidney that is a dark brown outer layer
medulla (color, inner/outer)
lighter inner layer
(4) medulla contents (renals)
1) renal pyramids
2) renal papilla (apex/ends of pyramids)
3) renal columns (between adjacent pyramids)
4) medulla rays
(5) right & left kidney AP relationships: anterior
- suprarenal gland
- liver / spleen
- 2nd part of duodenum / stomach
- (R) colic flexure / (L) colic flexure
+ coils of jejunum
right & left kidney AP relationships: posterior
- diaphragm
- costodiaphg. process (of pleura)
- 12th rib / 11th-12th rib
- psoas/quad lumb./transv. abd.
- subcostal/iliohypog/ilioing. nerves
(6) kidney blood supply w/ landmarks
clue/mnemonic: RSLIAN / Rehab Sci Let’s Inspire and Aspire Internationally!
- renal artery (direct branch from AORTA / level of L2)
- segmental artery (entering HIL)
- lobar artery (supplies each renal PYRAMID)
- interlobar artery (supplies CORTEX)
- arcuate artery (found at BASES of PYRAMIDS)
- interlobular arteries (ascends in CORTEX)
each kidney has (4)
1) fibrous capsule (SURROUNDS kindey outside)
2) perirenal fat (COVERS fib capsule)
3) renal fascia (ENCLOSES kidney & sup glands, continuous w/ fascia transv.)
4) pararenal fat (EXTERNAL to renal fascia, forms retroperiton. fat)
suprarenal / adrenal glands
yellow retroperitoneal organs on upper pole of kidneys
surrounds suprarenal glands
renal fascia
separates suprarenal gland from kidney
perirenal fat
(2) parts of suprarenal glands
1) cortex
2) medulla
suprarenal glands relationship (R)
- pyramid shapes
- has caps on upper pole
- lies behind (R) lobe of liver / extends medially behind IVC
suprarenal glands relationship (L)
- crescentic shape
- extends along medial border of (L) kidney / upper pole to hilum
- lies behind pancreas, lesser sac, stomach
suprarenal glands relationship (RL)
rests posteriorly on diaphragm
cortex functions
- secretes mineral corticoids > control electrolyte balance
- secrete glucocorticoids > control carbs, fats & protein metabolism
- secrete sex hormones > testes, estrogen
medulla function
(produces?) epinephrine and nonepinephrine
ureters type of structure
abdominal and pelvic structure
ureters
- muscular tube that extends from kidney to posterior surface of bladder
- urine > kidney > renal pelvis > ureter
- bifurcation at SI joint
- anterior of IIC artery / level of ischial spine
(3) constrictions of ureters
1) renal pelvis > ureter
2) pelvic brim
3) > bladder
kidney stones
- stones formed in the kidney d/t uric acid crystals or calcium
- formed stones > w/urine > get stuck > urine doesn’t flow > kidney enlarge
ureters arteries (upper/middle/lower end)
upper end: renal artery
middle end: testicular artery
lower end: superior vesical artery
other name for kidney stones
hydronephrosis
urinary bladder
receptable/storage of urine
t/n: kidney produces, bladder stores
urinary bladder shape
pyramidal
normal capacity of urinary bladder
500cc/mL
apex of bladder
> umbilicus (by median umbilical ligament)
base/post surface of bladder
- triangular
- SL angle
- joined by ureter and inferior part of urethra
- ureters pierce > bring urine inside bladder
neck of bladder
- male: rests on upper surface of prostate / held in position to the pubic bone by pbp ligaments
- female: held in position to the pubic bone by pbv ligament
trigone
- triangular shape where mucous membrane covers internal surface of BASE of bladder
- serves as NATURAL SPHINCTER of urine
- valve-like action / preventing reverse flow of urine toward kidney as it fills
- where urethra exits (end of trigone)
detrusor muscle
- smooth muscle that forms wall of the bladder
t/n: wall is not smooth
detrusor muscle functions
SNS: fill bladder > relaxed bladder > internal sphincter closed (to fill w/ urine)
PNS: contract detrusor)
external sphincter
- smooth muscle controlled by both SNS and PNS
- controllable
- striated muscle (why we can hold in our urine)
True/False:
Urine can hold twice the normal capacity of 500mL without rupturing.
true
t/n: the outflow is obstructed
True/False:
The desire to urinate usually starts when bladder reaches around 50% of its working volume.
false
t/n: 75%
micturition reflex
- initiated when volume of urine bladder reaches 300mL
- stretch receptors > cns > micturate
- assisted by raise in intraabd. pressure to expel urine
bulbocavernosus reflex
- check if bladder is spastic/flaccid by using anal sphincter (using fingers)
(3) common neurologic bladder in SCI patients
1) atonic bladder
2) automatic reflex bladder
3) autonomous bladder
atonic bladder
- occurs during 1st phase of spinal shock
- first 47 hrs
- bladder muscle = relaxed / sphincter = contracted
- pt not aware bladder is full
- bladder distended > overflows
automatic reflex bladder
- occurs after pt has recovered from spinal shock (lesion above s2-s4)
- bladder fills and empties reflexly
- simple reflex occurs every 1-4 hrs
- common in infants, alzheimer’s, dementia, comatose pts
autonomous bladder
- occurs in sacral segment
- bladder without external reflex control
- bladder wall = flaccid / bladder capacity = increases
- causes infection and back pressure effect in ureters and kidneys
urethra begins and ends
begins: base of bladder / ends: external opening of perineum
urethra in women
- short, 4cm long
- slightly curved
- opening anterior to skene’s glands
- UTI is more common
urethra in men
- long, 20cm long
- bends twice > base of bladder > inferior to prostate
- divided into (4) parts
urethra in men (4) parts
1) preprostatic (intramural part, 1-1.5cm long)
2) prostatic (widest/most dilatable, 4cm long)
3) membranous (shortest/narrowest, 1-2cm long)
4) spongy urethra (longest/15-16cm/5mm in diameter)
vas deferens
- THICK wall tube
- 18 inches in length
- ampulla = dilated terminal part
- > duct of seminal vesicle > form ejaculatory duct
deminal vesicle
- 2 lobulated organ about 2 inches long / posterior surface of bladder
- produce secretion added to seminal fluid
ejaculatory ducts
- less than 1 inch in length
- union of vas deferens and duct of seminal vesicle
- drain seminal fluid to prostatic urethra
prostrate
- unpaired/single fibromuscular glandular organ
- made of 30-40 numerous gland
- paraurethral in female
- produces thin milky fluid added to seminal fluid (at time of ejaculation)
(4) lobes of prostate
1) anterior (in front of urethra/devoided of glandular tissue)
2) median/middle (between urethra and ejac ducts/upper surface related to trigon)
3) posterior (behind urethra and below ejac ducts)
4) left and right lateral lobes (seprated by vertical groove)
median/middle: rich in glands
posterior: with gland tissue
lateral lobes: has many glands
prostatic cancer
- benign enlargement of prostate
- common in men > 50 yrs
- imbalance of hormonal control of gland
- mostly affects posterior lobe (PROS/POST)
prostatic cancer signs and complications
signs/symptoms:
- intense feeling to micturate
- difficulty in passing urine
treatmnet: removal of part in prostate affected
prostatic cancer prevention
rectal exam (early detection)
bulbourethral glands
- one on each side
- small, pea-shaped mucous glands
- > deep perineal pouch (lateral to membranous part of urethra) > bulb of spongy urethra (root of penis)
ovary
- oval shaped, 1.5 x 1.75 inches
- found on lateral wall of pelvis (ovarian fossa)
suspensory ligament of ovary
- keeps ovary in place
- part between mesovarium and lateral wall of pelvis
tunical albuginea
thin fibrous capsule around ovary
ovary function
- produces female sex hormones (estrogen and progesterone)
- site of egg production (oogenesis)
ovary blood supply
ovarian artery (from abdominal aorta)
True/False:
(R) and (L) ovary has only certain no. of egg cells.
true
t/n: ovary released = start of mens / no eg produced = menopause
uterine tube
- 4 inches
- has (4) parts
(4) parts of uterine tube/fallopian tube
1) infundibulum
- funnel shape lateral projections
- ends w/ fingerlike free edge (fimbriae)
2) ampulla
- widest part of tube where sperm meets egg
(fertilization of ova and sperm)
3) isthmus
- narrowest part (lateral to uterus)
4) intramural part (pierces uterine wall)
uterine tube blood supply
uterine artery
pelvic inflammatory disease
- severe pain in pelvic area
- pathogen enters body through sexual contact, ascends through uterus > enters uterine tube
salpingitis
leak of pus (to peritoneal cavity) > pelvic peritonitis
pelvic inflamm. disease treatment
antibiotics
ectopic pregnancy
implantation/growth of fertilized ovum OUTSIDE uterine caviry
tubal ligation
ligation/division of uterine tube as PERMANENT BIRTH CONTROL
uterus
- hollow, pear shape organ
- with THICK muscular coat
- has (4) parts
(4) parts of uterus
1) fundus (above entrance of fallop. tube)
2) body (below entrance of uterine tube)
3) cervix (divided to supravaginal/vaginal parts)
4) cavity (triangular/)
uterus function
site for reception/retention/nutrition of fertilized ovum
pelvic female viscera positions
anterversion
- long axis (vagina) bent forward > long axis (vagina)
anteflexion
- long axis bent forward > internal os
retroverted
- fundus/body of uterus bent backward > vagina
retroflexed
- body of uterus bent back > cervix
body of uterus lies in what plane
almost horizontal plane
(3) structures of uterus
1) muscle wall/myometrium
- THICK smooth muscle
2) endometrium
- MUCOUS MEMBRANE lining body of uterus
3) parametrium
- where uterine CROSSES ureter on each side
