Pelvic contents

Question 1

what are the 2 peritoneal pouches in the female

Answer 1

rectouterine - Pouch of Douglas

vesicouterine

Question 2

what is the name of the peritoneum overlying the uterus

Answer 2

broad ligament

Question 3

what is the name of the peritoneal pouch in males

Answer 3

vesicorectal pouch

Question 4

describe the internal surface of the bladder

Answer 4

folded into rugae

transitional epithelium

Question 5

describe the peritoneum of the bladder

Answer 5

peritoneum covers the superior surface of the bladder and holds it against the pubic bones

Question 6

what happens when the bladder fills

Answer 6

rugae disappear

rises above the pubic bones into suprapubic region

Question 7

why might the bladder be seen above the pubic bones and quite large

Answer 7

if there was a problem releasing urine during life

Question 8

how is the relation of the apex of the bladder to the pubic bones maintained

Answer 8

small piece of connective tissue called the urachus

Question 9

what is the urachus

Answer 9

embryological remnant of a structure that drained the foetal bladder and joined the umbilical cord

Question 10

at the base of the bladder there is a small smooth triangular area of smooth mucous membrane called the

Answer 10

trigone

Question 11

what enters/exits at the trigone

Answer 11

the 2 ureters enter the bladder and the urethra exits

Question 12

the muscular wall of the bladder is called

Answer 12

detrusor muscle - smooth muscle

Question 13

the detrusor muscle forms what at the neck of the bladder

Answer 13

an incomplete sphincter - sphincter vesicae

Question 14

describe the sphincter vesicae

Answer 14

composed of smooth muscle under ANS not voluntary control

Question 15

describe the other sphincter in the urinary tract

Answer 15

external voluntary sphincter of micturation (urination) in the urogenital diaphragm

Question 16

the base of the bladder is supported by what

Answer 16

ligaments that pass from the pubic bones

• males: puboprostatic
• females: pubovesical

Question 17

describe the blood supply of the bladder

Answer 17

bladder supplied from above by superior vesical arteries (2)

and deeper within the pelvic by inferior vesical artery (1)

Question 18

where do the superior vescial arteries come from

Answer 18

from umbilical branch of anterior division of the internal iliac artery

Question 19

where does the inferior vesical artery come from

Answer 19

branch of the anterior division of the internal iliac artery

Question 20

what is the inferior vesical artery in females

Answer 20

vaginal artery

Question 21

venous drainage of the bladder is to the

Answer 21

vesical plexus and then into the internal iliac veins

Question 22

what is the nerve supply of the bladder

Answer 22

supplied by ANS via the inferior hypogastric plexus

Question 23

where does the ureter drain lymph

Answer 23

lumbar, common iliac, external iliac, internal iliac

as they descend towards the bladder

Question 24

what is the main lymph drainage of the urethra

Answer 24

main drainage to the internal iliac

Question 25

the spongy urethra in males drains where

Answer 25

deep inguinal nodes

Question 26

some of the lymph from female urethra can drain where

Answer 26

sacral nodes

Question 27

what is the main lymph drainage of the bladder

Answer 27

main drainage to the internal iliac nodes

Question 28

lymph from the bladder drains mainly to the internal iliac nodes, but some may go where

Answer 28

some superior to external iliac and some lymph from neck of bladder to sacral nodes

Question 29

how do urinary stones form

Answer 29

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

Question 30

how are urinary stones seen

Answer 30

CT - classic jackstone appearance

Question 31

where does the sigmoid colon become the rectum

Answer 31

as it crosses the 3rd (Fused) sacral vertebrae

Question 32

when does the rectum become the anal canal

Answer 32

tip of the coccyx where it pierces the pelvic floor

Question 33

the upper 1/3 of the rectum is covered by

Answer 33

visceral peritoneum

Question 34

the middle 1/3 of the rectum is covered by

Answer 34

peritoneum on anterior surface

Question 35

the lower 1/3 of the rectum is

Answer 35

infraperitoneal

Question 36

where does the rectum go between

Answer 36

3rd sacral vertebrae to tip of coccyx

Question 37

the anterior wall of the rectum in males is closely associated with what

Answer 37

prostate gland

Question 38

describe the internal surface of the rectum

Answer 38

3 transverse folds with an enlarged area called the rectal ampulla between them

Question 39

the internal shape of the rectum helps in what

Answer 39

storage of faeces before it is excreted via the anal canal

Question 40

the rectum is supported by what

Answer 40

levator ani muscles - specifically puborectalis

Question 41

describe puborectalis and its function

Answer 41

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

Question 42

describe the blood supply of the rectum

Answer 42

3 arteries: | - superior middle and inferior rectal arteries

Question 43

where does the superior rectal artery come from

Answer 43

inferior mesenteric

Question 44

where does the middle rectal artery come from

Answer 44

internal iliac

Question 45

where does the inferior rectal artery come from

Answer 45

internal pudendal

Question 46

specifically describe the blood supply of the rectum

Answer 46

- 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

Question 47

the middle rectal arteries and internal pudendal arteries are branches from what

Answer 47

internal iliac arteries

Question 48

what does it mean that the rectum is a site of portal systemic anastomosis

Answer 48

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

Question 49

blood from superior parts of rectum drain where

Answer 49

passes into portal system via inferior mesenteric vein

Question 50

blood from inferior rectum drains where

Answer 50

local veins that drain into the internal iliac veins that are part of the systemic system

Question 51

the superior rectal vein drains where

Answer 51

portal system via inferior mesenteric

Question 52

the middle rectal vein drains where

Answer 52

internal iliac

Question 53

the inferior rectal vein drains where

Answer 53

internal pudendal

Question 54

lymph from the rectum drains where

Answer 54

superior parts: pre-aortic nodes at L3 clustered around IMA lower parts: local pararectal nodes to nodes around internal iliac arteries

Question 55

nerve supply of rectum

Answer 55

inferior hypogastric plexus

Question 56

lymph from superior rectum drains where

Answer 56

aortic nodes at L3

Question 57

lymph from inferior rectum drains where

Answer 57

internal iliac nodes

Question 58

lymph from anal canal superior to pectinate line drains where

Answer 58

internal iliac nodes

Question 59

lymph from anal canal inferior to pectinate line drains where

Answer 59

superficial inguinal nodes

Question 60

what is the broad ligament

Answer 60

fold of peritoneum that overlies the uterus and uterine tubes

Question 61

what does the broad ligament do

Answer 61

provides a small degree of support and carries the neurovascular structures of the uterus

Question 62

the main support of the uterus is from where

Answer 62

ligaments at the cervix

Question 63

the broad ligament is divided into what 3 areas

Answer 63

mesosalpinx mesovarium mesometrium

Question 64

what is the function of the mesovarium

Answer 64

holds the ovaries to the posterior surface of the broad ligament

Question 65

what is the function of the mesosalpinx

Answer 65

supports the uterine tubes

Question 66

what is the function of the mesometrium

Answer 66

main part of the broad ligament associated with the body of the uterus

Question 67

the most superior part of the uterus which rises above the entrance of the uterine tubes is called the

Answer 67

fundus

Question 68

the walls of the uterus are

Answer 68

muscular (myometrium)

Question 69

the myometrium is lined by

Answer 69

endometrium

Question 70

describe the endometrium

Answer 70

increases and then is shed during each menstrual cycle

Question 71

describe the main part of the uterus

Answer 71

body which narrows to form the cervix inferiorly

Question 72

the cervix opens where

Answer 72

muscular tube called the vagina

Question 73

what is the area of the uterine tube adjacent to the ovaries

Answer 73

fimbrae

Question 74

what is the small narrowed area superior to the cervix

Answer 74

internal os

Question 75

what is the small narrowed area inferior to the cervix

Answer 75

external os

Question 76

what are the fornices

Answer 76

as the cervix bulges into the vagina there are small spaces each side of the cervix called the lateral fornices

Question 77

what is the blood supply of the uterus

Answer 77

uterine arteries from anterior division of internal iliac artery

Question 78

the uterine artery anastomoses with what superiorly

Answer 78

ovarian artery which supplies the ovaries, fundus of uterus and uterine tubes

Question 79

the uterine artery is where in relation to the ureter

Answer 79

superior (bridge over water)

Question 80

what is the name of the narrowing as the uterine tubes enter the uterus

Answer 80

isthmus

Question 81

name the parts of the uterine tube from the uterus

Answer 81

narrow isthmus to expanded area called ampulla which ends at a wide infundibulum

Question 82

describe the distal part of the uterine tube

Answer 82

divided into finger-like fimbrae which help gather the ovum released by the ovary and direct it to the uterine tube

Question 83

how is the ovum briefly suspended in the peritoneal cavity

Answer 83

no direct contact between fimbrae and ovary

Question 84

where is the ovum usually fertilised

Answer 84

along the uterine tube (ampulla)

Question 85

what is an ectopic pregnancy

Answer 85

when a fertilised ovum implants somewhere other than endometrium e.g. uterine tube - can lead to rupture

Question 86

why is the main support for the uterus at the cervix

Answer 86

allows uterus to expand and rise into the abdomen during pregnancy but still maintain relationship with the vagina and pelvic floor

Question 87

what are the 3 main ligaments at the cervix

Answer 87

transverse cervical (Cardinal) pubocervical (pubovesical) uterosacral (sacrocervical)

Question 88

what is the significance of the round ligament of the uterus

Answer 88

potential lymph pathway

Question 89

what is the most common uterine position

Answer 89

anteverted anteflexed

Question 90

what is anteversion

Answer 90

long axis of uterus bent forward on the long axis of vagina

Question 91

what is anteflexion

Answer 91

long axis of uterus bent forward at the internal os with the long axis of vagina

Question 92

in anteverted anteflexed the uterus lies over what

Answer 92

bladder

Question 93

what supports the uterus to prevent prolapse

Answer 93

pelvic floor muscles

Question 94

what part of the pelvic floor gives the main support to the uterus

Answer 94

pubococcygeus forms a sling around the vagina (pubovaginalis)

Question 95

what is the equivalent to pubovaginalis in males

Answer 95

puboprostaticus

Question 96

support for the uterus comes from where

Answer 96

ligaments at cervix bladder pelvic floor

Question 97

what is the function of the ovaries

Answer 97

ova and hormone production

Question 98

how are the ovaries held in place

Answer 98

attached to back of broad ligament by mesovarium

Question 99

what is the arterial supply of the ovaries

Answer 99

direct branches of abdominal aorta at L2

Question 100

what is the venous drainage of the ovaries

Answer 100

right: veins drain directly into IVC left: veins drain into left renal vein

Question 101

nerve supply of ovaries

Answer 101

aortic plexus

Question 102

what is the ligament of the ovary

Answer 102

passes between the uterus and the ovary

Question 103

what is the suspensory ligament of the ovary

Answer 103

carries ovarian artery and vein

Question 104

the ovarian and uterine arteries supply

Answer 104

the ovaries, uterine tubes and uterus

Question 105

the vaginal artery supplies

Answer 105

distal uterus and vagina

Question 106

the vaginal artery is a branch from where

Answer 106

either the uterine artery or a direct branch of anterior division of the internal iliac artery

Question 107

the vaginal artery is the equivalent to what in males

Answer 107

inferior vesical artery

Question 108

what artery supplies the distal vagina and perineum

Answer 108

internal pudendal

Question 109

lymph from where drains to aortic nodes at root of ovarian artery (L2)

Answer 109

ovaries uterine tube fundus

Question 110

lymph from where drains to the superficial inguinal nodes via the round ligament

Answer 110

where uterine tube meets uterus/isthmus

Question 111

lymph from where drains to external iliac nodes via the broad ligament

Answer 111

body of uterus

Question 112

lymph from where drains to internal iliac nodes (some to sacral)

Answer 112

cervix

Question 113

lymph from where drains to internal iliac then superficial inguinal nodes

Answer 113

vagina

Question 114

lymph from body of uterus drains where

Answer 114

external iliac nodes via the broad ligament

Question 115

lymph from cervix drains where

Answer 115

internal iliac nodes (some to sacral)

Question 116

lymph from vagina drains where

Answer 116

internal iliac then superficial inguinal nodes