Pelvic contents Flashcards
what are the 2 peritoneal pouches in the female
rectouterine - Pouch of Douglas
vesicouterine
what is the name of the peritoneum overlying the uterus
broad ligament
what is the name of the peritoneal pouch in males
vesicorectal pouch
describe the internal surface of the bladder
folded into rugae
transitional epithelium
describe the peritoneum of the bladder
peritoneum covers the superior surface of the bladder and holds it against the pubic bones
what happens when the bladder fills
rugae disappear
rises above the pubic bones into suprapubic region
why might the bladder be seen above the pubic bones and quite large
if there was a problem releasing urine during life
how is the relation of the apex of the bladder to the pubic bones maintained
small piece of connective tissue called the urachus
what is the urachus
embryological remnant of a structure that drained the foetal bladder and joined the umbilical cord
at the base of the bladder there is a small smooth triangular area of smooth mucous membrane called the
trigone
what enters/exits at the trigone
the 2 ureters enter the bladder and the urethra exits
the muscular wall of the bladder is called
detrusor muscle - smooth muscle
the detrusor muscle forms what at the neck of the bladder
an incomplete sphincter - sphincter vesicae
describe the sphincter vesicae
composed of smooth muscle under ANS not voluntary control
describe the other sphincter in the urinary tract
external voluntary sphincter of micturation (urination) in the urogenital diaphragm
the base of the bladder is supported by what
ligaments that pass from the pubic bones
- males: puboprostatic
- females: pubovesical
describe the blood supply of the bladder
bladder supplied from above by superior vesical arteries (2)
and deeper within the pelvic by inferior vesical artery (1)
where do the superior vescial arteries come from
from umbilical branch of anterior division of the internal iliac artery
where does the inferior vesical artery come from
branch of the anterior division of the internal iliac artery
what is the inferior vesical artery in females
vaginal artery
venous drainage of the bladder is to the
vesical plexus and then into the internal iliac veins
what is the nerve supply of the bladder
supplied by ANS via the inferior hypogastric plexus
where does the ureter drain lymph
lumbar, common iliac, external iliac, internal iliac
(as they descend towards the bladder)
what is the main lymph drainage of the urethra
main drainage to the internal iliac
the spongy urethra in males drains where
deep inguinal nodes
some of the lymph from female urethra can drain where
sacral nodes
what is the main lymph drainage of the bladder
main drainage to the internal iliac nodes
lymph from the bladder drains mainly to the internal iliac nodes, but some may go where
some superior to external iliac and some lymph from neck of bladder to sacral nodes
how do urinary stones form
if there is an issue releasing urine from the bladder the urine may sit in the bladder and the salts present in the urine can accrete to form urinary stones
how are urinary stones seen
CT - classic jackstone appearance
where does the sigmoid colon become the rectum
as it crosses the 3rd (Fused) sacral vertebrae
when does the rectum become the anal canal
tip of the coccyx where it pierces the pelvic floor
the upper 1/3 of the rectum is covered by
visceral peritoneum
the middle 1/3 of the rectum is covered by
peritoneum on anterior surface
the lower 1/3 of the rectum is
infraperitoneal
where does the rectum go between
3rd sacral vertebrae to tip of coccyx
the anterior wall of the rectum in males is closely associated with what
prostate gland
describe the internal surface of the rectum
3 transverse folds with an enlarged area called the rectal ampulla between them
the internal shape of the rectum helps in what
storage of faeces before it is excreted via the anal canal
the rectum is supported by what
levator ani muscles - specifically puborectalis
describe puborectalis and its function
sling of muscle that passes around the rectum and when it contracts it bends the wall of the rectum making it more difficult to pass faeces from rectum to anal canal and therefore maintaining continence
describe the blood supply of the rectum
3 arteries:
- superior middle and inferior rectal arteries
where does the superior rectal artery come from
inferior mesenteric
where does the middle rectal artery come from
internal iliac
where does the inferior rectal artery come from
internal pudendal
specifically describe the blood supply of the rectum
- superior rectal artery is a single branch from inferior mesenteric
- middle rectal and internal pudendal (giving inferior) are bilateral structures as they are branches from internal iliac arteries
the middle rectal arteries and internal pudendal arteries are branches from what
internal iliac arteries
what does it mean that the rectum is a site of portal systemic anastomosis
blood from the superior part of the rectum passes into the portal system via the inferior mesenteric vein but inferior parts of the rectum drain to local veins that drain into the internal iliac veins that are part of systemic system
blood from superior parts of rectum drain where
passes into portal system via inferior mesenteric vein
blood from inferior rectum drains where
local veins that drain into the internal iliac veins that are part of the systemic system
the superior rectal vein drains where
portal system via inferior mesenteric
the middle rectal vein drains where
internal iliac
the inferior rectal vein drains where
internal pudendal
lymph from the rectum drains where
superior parts: pre-aortic nodes at L3 clustered around IMA
lower parts: local pararectal nodes to nodes around internal iliac arteries
nerve supply of rectum
inferior hypogastric plexus
lymph from superior rectum drains where
aortic nodes at L3
lymph from inferior rectum drains where
internal iliac nodes
lymph from anal canal superior to pectinate line drains where
internal iliac nodes
lymph from anal canal inferior to pectinate line drains where
superficial inguinal nodes
what is the broad ligament
fold of peritoneum that overlies the uterus and uterine tubes
what does the broad ligament do
provides a small degree of support and carries the neurovascular structures of the uterus
the main support of the uterus is from where
ligaments at the cervix
the broad ligament is divided into what 3 areas
mesosalpinx
mesovarium
mesometrium
what is the function of the mesovarium
holds the ovaries to the posterior surface of the broad ligament
what is the function of the mesosalpinx
supports the uterine tubes
what is the function of the mesometrium
main part of the broad ligament associated with the body of the uterus
the most superior part of the uterus which rises above the entrance of the uterine tubes is called the
fundus
the walls of the uterus are
muscular (myometrium)
the myometrium is lined by
endometrium
describe the endometrium
increases and then is shed during each menstrual cycle
describe the main part of the uterus
body which narrows to form the cervix inferiorly
the cervix opens where
muscular tube called the vagina
what is the area of the uterine tube adjacent to the ovaries
fimbrae
what is the small narrowed area superior to the cervix
internal os
what is the small narrowed area inferior to the cervix
external os
what are the fornices
as the cervix bulges into the vagina there are small spaces each side of the cervix called the lateral fornices
what is the blood supply of the uterus
uterine arteries from anterior division of internal iliac artery
the uterine artery anastomoses with what superiorly
ovarian artery which supplies the ovaries, fundus of uterus and uterine tubes
the uterine artery is where in relation to the ureter
superior (bridge over water)
what is the name of the narrowing as the uterine tubes enter the uterus
isthmus
name the parts of the uterine tube from the uterus
narrow isthmus to expanded area called ampulla which ends at a wide infundibulum
describe the distal part of the uterine tube
divided into finger-like fimbrae which help gather the ovum released by the ovary and direct it to the uterine tube
how is the ovum briefly suspended in the peritoneal cavity
no direct contact between fimbrae and ovary
where is the ovum usually fertilised
along the uterine tube (ampulla)
what is an ectopic pregnancy
when a fertilised ovum implants somewhere other than endometrium e.g. uterine tube - can lead to rupture
why is the main support for the uterus at the cervix
allows uterus to expand and rise into the abdomen during pregnancy but still maintain relationship with the vagina and pelvic floor
what are the 3 main ligaments at the cervix
transverse cervical (Cardinal)
pubocervical (pubovesical)
uterosacral (sacrocervical)
what is the significance of the round ligament of the uterus
potential lymph pathway
what is the most common uterine position
anteverted anteflexed
what is anteversion
long axis of uterus bent forward on the long axis of vagina
what is anteflexion
long axis of uterus bent forward at the internal os with the long axis of vagina
in anteverted anteflexed the uterus lies over what
bladder
what supports the uterus to prevent prolapse
pelvic floor muscles
what part of the pelvic floor gives the main support to the uterus
pubococcygeus forms a sling around the vagina (pubovaginalis)
what is the equivalent to pubovaginalis in males
puboprostaticus
support for the uterus comes from where
ligaments at cervix
bladder
pelvic floor
what is the function of the ovaries
ova and hormone production
how are the ovaries held in place
attached to back of broad ligament by mesovarium
what is the arterial supply of the ovaries
direct branches of abdominal aorta at L2
what is the venous drainage of the ovaries
right: veins drain directly into IVC
left: veins drain into left renal vein
nerve supply of ovaries
aortic plexus
what is the ligament of the ovary
passes between the uterus and the ovary
what is the suspensory ligament of the ovary
carries ovarian artery and vein
the ovarian and uterine arteries supply
the ovaries, uterine tubes and uterus
the vaginal artery supplies
distal uterus and vagina
the vaginal artery is a branch from where
either the uterine artery or a direct branch of anterior division of the internal iliac artery
the vaginal artery is the equivalent to what in males
inferior vesical artery
what artery supplies the distal vagina and perineum
internal pudendal
lymph from where drains to aortic nodes at root of ovarian artery (L2)
ovaries
uterine tube
fundus
lymph from where drains to the superficial inguinal nodes via the round ligament
where uterine tube meets uterus/isthmus
lymph from where drains to external iliac nodes via the broad ligament
body of uterus
lymph from where drains to internal iliac nodes (some to sacral)
cervix
lymph from where drains to internal iliac then superficial inguinal nodes
vagina
lymph from body of uterus drains where
external iliac nodes via the broad ligament
lymph from cervix drains where
internal iliac nodes (some to sacral)
lymph from vagina drains where
internal iliac then superficial inguinal nodes
