Pelvic urinary tract and rectum anatomy

Question 1

where does bladder lie?

Answer 1

behind pubic symphysis

Question 2

apex of bladder? what arises here?

Answer 2

lies directly superior to pubic symphysis, most anterior portion of bladder
- median umbilical ligament (urachus) arises here

Question 3

where does ureter enter bladder?

Answer 3

superior-lateral edges

Question 4

where is bladder related to in males posteriorly?

Answer 4

• rectum, ductus deferens, seminal vesicles

Question 5

where is bladder related to in females posteriorly?

Answer 5

cervix and upper vagina

Question 6

trigone

Answer 6

prevents retrograde urine glow and helps compress ureter within bladder wall

• area between the orifices of the ureters superiorly and internal urethral orifice inferiorly
• sympathetically innervated

Question 7

arterial supply of bladder?

Answer 7

1. superior vesical aa. from umbilical a. (major supplier)
2. middle vesical aa.
3. inferior vesical aa.

Question 8

venous drainage of bladder?

Answer 8

• drains into dense venous plexus around base/neck
• prostatic venous plexus in males
• vesico-vaginal plexus in females
• these drain to deep dorsal v. of penis and internal iliac v.
• ** important with prostatic cancer***

Question 9

vascular supply of pelvic ureter?

Answer 9

common iliac a.
internal iliac a.
vasiculodeferential a. (male)
uterine/inferior viscal aa. (female)

Question 10

where does pelvic ureter cross?

Answer 10

crosses iliac vessels anteriorly

- however, in females, the uterine a. also crosses the ureter anteriorly

Question 11

uretal orifices

Answer 11

• where ureter opens into bladder at superior-lateral angles
• there are no valves
• pressure on bladder wall closes intramural ureters during distension and empyting of the bladder

Question 12

what are the four parts of the male urethra?

Answer 12

1. intramural portion: from bladder to upper portion of prostate
2. prostatic: portion passing through prostate
3. membranous: portion passing through UG diaphragm
4. penile: portion from inferior surface of UG diaphragm

Question 13

where are two luminal dilations of male penile urethra?

Answer 13

• bulb of penis

- glans of penis

Question 14

external urethral orifice

Answer 14

“meatus”

- opening thu glans penis

Question 15

what are 2 glans that open into penil urethra?

Answer 15

1. bulbourethral (Cowper’s gland): opens into bulbar portion

2. urethral glands: small glands located throughout spongy body

Question 16

what are two portions of female urethra?

Answer 16

1. superior: similar to male prostatic urethra

2. membranous: pierces UG diaphragm

Question 17

what vertebral level does rectum originate at?

Answer 17

3rd sacral vertebra at the rectosigmoid junction
- can be distinguished from sigmoid colon because it lacks mesocolon, teniae coli are spread out and surround the entire rectum.

Question 18

two curvatures of the rectum?

Answer 18

1. rectum proper: from origination to perineal flexure

2. anal canal: from perineal flexure to anus

Question 19

anatomical vs. clinical anal canal

Answer 19

anatomical: from level of upper surface of pelvic diaphragm to anus
clinical: from pectinate line to anal verge

Question 20

what portion of rectum contains peritoneum

Answer 20

ventral rectum

Question 21

layers of rectum?

Answer 21

1. muscular layer:
   - outer longitudinal mm. - blend with fibers of levator ani at anal region
   - inner circular mm: thickened to form internal anal sphincter
2. submucosal layer
3. mucosal layer

Question 22

Plica transversales

Answer 22

transverse rectal folds

3 folds: two left, one right

Question 23

rectal columns:

Answer 23

mucous membrane overlying submucosal aa. and vv.

Question 24

anal valves

Answer 24

archlike folds of mucous membrane connecting caudal ends of rectal columns

Question 25

pectinate line

Answer 25

line formed by anal valves and rectal columns dividing line for : 1. venous drainage: - superior drains to middle and superior rectal vv. - inferior drains to inferior rectal vv. 2. lymphatic drainage: - superior to pelvic nodes - inferior to inguinal nodes 3. nerve supply: - superior to autonomic nn. - inferior to somatic nn. 4. eptithelial lining

Question 26

pecten

Answer 26

stritified squamous non-keritonized | - area immediately below pectinate line

Question 27

anal verge

Answer 27

stratified sqamous keritonzsed | - caudal-most portion of anal canal

Question 28

superior rectal a.

Answer 28

- branch from IMA

Question 29

middle rectal a.

Answer 29

- usually branches from internal iliac anterior division

Question 30

inferior rectal aa.

Answer 30

from internal pudendal a.

Question 31

what comes off posterior trunk of internal iliac?

Answer 31

1. ilolumbar: supplies psoas/quadratus/iliacus m. 2. lateral sacral aa. 3. superior gluteal a.

Question 32

what comes off anterior trunk of internal iliac a. ?

Answer 32

``` umbilical a. middle rectal inferior rectal obturator internal pudendal a. inferior gluteal a. uterine and vaginal a. vesiculodeferential a. ```

Question 33

what are two pelvic vessels that don't arise from internal iliac a?

Answer 33

1. middle sacral a: arises from aorta along anterior surface of sacrum 2. superior rectal a: branch from IMA

Question 34

what makes up the lumbosacral plexus?

Answer 34

1. lumbar plexus: ventral rami L1-4 | 2. sacral plexus: ventral rami L4-S3

Question 35

what are five major nerves forming from lumbosacral plexus?

Answer 35

Anterior divisions: (supply flexors) - obturator n. - tibial n.(medial and lateral plantar n) Posterior divisions:(supply extensors) - common fibular n. - femoral n.

Question 36

general path of lymphatic drainage?

Answer 36

``` internal iliac nodes → external iliac nodes → common iliac nodes → lumbar nodes → cisternachyli → thoracic duct ```

Question 37

lymphatics of urinary bladder?

Answer 37

drain to external iliac nodes laterally internal iliac nodes sacral and common iliac nodes

Question 38

where do lymphatics of rectum drain?

Answer 38

below pectinate line - drain to superficial inguinal above pectinate line - parallel course of major arteries: - from rectal ampulla and sup. anal canal along inf. rectal artery to internal iliac nodes - from most of rectum via pararectal nodes along middle rectal artery to internal iliac nodes - from area of rectosigmoid junction along sup. rectal artery to inf. mesenteric nodes

Question 39

male genitalia lymphatic drainage?

Answer 39

external iliac nodes both int. & ext. iliac nodes sacral & common iliac nodes

Question 40

prostate lyphatics?

Answer 40

sacral nodes posteriorly and internal iliac nodes laterally

Question 41

female genitalia lymph drainage?

Answer 41

- drain along ovarian vessle to lumbar nodes

Question 42

where does parietal vs. visceral lymphatic drainage occur?

Answer 42

``` parietal – drain body wall lumbar nodes visceral – drain GI organs inf. mesenteric nodes sup. mesenteric nodes celiac nodes ```