Pelvic Contents Flashcards
Describe the relationship of the peritoneum and rectum?
Upper 1/3 - covered by visceral peritoneum
Middle 1/3 - peritoneum on anterior surface
Lower 1/3 - infraperitoneal
What is the structure indicated by the red line?
Lateral fornix - spaces found either side of the cervix
What is the lymphatic drainage of the uterus?
- Fundus - aortic nodes at L2 at ovarian artery
- Body - External iliac nodes via the broad ligament
- Top of internal os - internal iliac and sacral
What structure is highlighted?
Transverse folds of the rectum
Which part of the uterine tube is fertilisation most likely to occur in?
The ampulla
What is the nerve supply to the ovaries?
Aortic plexus
Describe the innervation of the sphincters of the bladder?
Sphincter vesicae is formed of smooth muscle and is under control by the ANS (involuntary)
External sphincter of micturition is under voluntary control
What is the venous drainage of the bladder?
First to the vesical plexus and then to the internal iliac veins
What is seen on the internal surface of the bladder?
Rugae
What do the fimbrae do?
Gather the ovum released by the ovary into the uterine tube
What is the arterial supply to the ovaries?
The ovarian (gonadal) artery - a direct branch of the abdominal aorta at L2
What do the transverse folds and rectal ampulla facilitate?
The storage of faeces before it is excreted to the anal canal
What ligament is formed by the peritoneum as it passes over the uterus?
The broad ligament
What is the lymphatic drainage of the anal canal?
Anal canal superior to the pectinate line drains to internal iliac nodes
Anal canal inferior to the pectinate line drains to superficial inguinal nodes
What structures does the ovarian artery supply?
The ovaries, uterine tubes and the fundus
What is highlighted?
The rectum
What is the lymphatic drainage of the uterine tubes?
- Aortic nodes at the root of ovarian artery - L2
- Superficial inguinal nodes via the round ligament
What does anteverted mean?
That the long axis of the uterus bends forward on the long axis of the vagina
What muscle forms the muscular wall of the bladder?
Detrusor muscle
What is the standard position that the uterus lies in?
Anteverted and anteflexed
What artery does the uterine artery anastomose with?
Ovarian artery
Describe the venous drainage of the rectum
Site of portal anastamosis
Blood from superior aspect of rectum drains into the portal system via the inferior mesenteric vein
Inferior parts of the rectum drain into local veins to the internal iliac vein into the systemic venous system
What is the name of the enlarged area between the 3 transverse folds of the rectum?
Rectal ampulla
What ligaments support the neck of the bladder?
Male - puboprastatic ligament
Female - pubovesical ligament
What pelvic floor muscles help prevent uterine prolapse through the pelvic floor?
The pubococcygeus - forms a sling around the vagina called the pubovaginalis
What are the roles of the 3 parts of the broad ligament?
Mesovarium - holds the ovaries to the posterior surface of the broad ligament
Mesosalpinx - supports the uterine tubes
Mesometrium - main part of the broad ligament associated with the body of the uterus
What enter and exit the bladder at the trigone?
The urethra exits and the ureters enter
Describe the lymphatic drainage of the rectum
Superior aspect of the rectum drains to the inferior mesenteric nodes found at the preaortic level L3
Inferior rectum drains to para-rectal nodes then to the internal iliac nodes
What is the relationship between the ureter and uterine artery?
Ureter passes under the uterine artery - bridge over water
What is the nerve supply to the bladder?
ANS via the inferior hypogastric plexus
What maintains the relation of the apex of the bladder to the pubic bone?
The urachus
What is the urachus an embryological remenant of?
A structure that drained the foetal bladder and joined to the umbilical cord
What structure is highlighted?
The rectal ampulla
Describe the venous drainage of the ovaries?
Right ovarian vein drains into IVC
Left ovarian vein drains into left renal vein
What ligament is highlighted?
The round ligament
What sphincter does the detrusor muscle contribute to?
Sphincter vesicae
What is the nerve supply to the rectum?
The inferior hypogastric plexus
What is the vaginal artery a branch of?
Can be a branch of the uterine artery or a direct branch of the anterior division of the internal iliac artery
What is the lymphatic drainage of the vagina?
Internal iliac nodes and then to the superficial inguinal nodes
What is the lymphatic drainage of the ovaries?
Aortic nodes at the root of the ovarian artery L2
What are the ligaments that support the cervix?
- Uterosacral (sacrocervical)
- Pubocervical (pubovesical)
- Transverse cervical (cardinal ligament)
What structure is highlighted?
The broad ligament
What attaches the ovaries to the broad ligament?
The mesovarian
What is the most superior part of the uterus?
The fundus
What muscle is highlighted?
The puborectalis - passes round the rectum and contracts to bend the wall of the rectum
Describe the location of the rectum
An extension of the sigmoid colon which becomes the rectum at S3
From the sacrum it passes to the tip of the coccyx and pierces the pelvic floor to become the anal canal
(3rd sacral vertebrae to tip of coccyx)
What is the name of the condition in which a fertilised ovum implants into the uterine tube?
Ectopic pregnancy
What are the 3 named arteries that supply blood to the rectum and what is their origin?
Superior rectal artery (from inferior mesenteric)
Middle rectal artery (from internal iliac)
Inferior rectal artery (from internal pudendal)
What arteries supply the bladder?
2 superior vesical arteries
1 inferior vesical artery (vaginal artery in females)
What are the parts of the uterine tube?
Blue - Fimbrae
Red - Infundibulum
Green - Ampulla
Yellow - Isthimus
What does the vaginal artery supply?
Distal uterus and vagina
What is highlighted in green in the image?
Urachus/ Median umbilical ligament
What is the main lymphatic drainage of the bladder and urethra?
The internal iliac nodes
What is held within the suspensory ovarian ligament?
Ovarian artery and vein
True or False?
The 3 named arteries that supply blood to the rectum are all bilateral
False!
There is only one superior rectal artery
The middle and inferior are seen bilaterally as they are branches of the internal iliac arteries
What does the internal pudendal artery supply?
The distal vagina and perineum
What is the male equivalent of the pubovaginalis?
Puboprostaticus which supports the prostate gland
What lines the muscular walls of the uterus and is shed each menstrual cycle?
Endometrium
What are the 2 pouches formed by the parietal peritoneum in females?
- Vesicouterine pouch between the uterus and bladder
- Pouch of Douglas/rectouterine pouch between the uterus and rectum
What pouch is formed by the peritoneum in males?
The vesicorectal pouch between the bladder and rectum
Describe the origin of the vesicular arteries that supply the bladder?
Superior vesical arteries arise from the umbilical branch of the anterior division of internal iliac artery.
Inferior vesical artery is a branch of the anterior division of the internal iliac artery
What covers the uterus?
The broad ligament
What is highlighted?
The vagina
What is the blood supply to the uterus?
Uterine arteries which branch off the anterior division of the internal iliac artery
What are the three parts of the broad ligament?
Mesosalpinx
Mesovarium
Mesometrium
What does anteflexed mean?
The long axis of the uterus is bend forward at the internal os with the long axis of the vagina
