Pelvic Viscera 1 Flashcards
5 structures created by the pelvic peritoneum?
- supravesical fossa (reflection over superior surface of bladder)
- paravesical fossae (on either side of the bladder to the lateral pelvic walls)
- utereric folds, and also folds over ductus deferens and seminal glands (superior ends)
- rectovesical pouch (from bladder to rectum)
- pararectal fossae (on either side of the rectum, lateral and posterior to the pouch)
What collects at the lowest point of the peritoneum?
abdominal fluid, so abscesses are likely to form here
in males, this pt is about 2cm above the seminal vesicles
3 male retrospaces/pouches?
- retropubic space: between pubis and bladder
- retrorectal (presacral) space: between rectum and sacrum
- rectovesical pouch/fossa: between bladder and rectum
Endopelvic fascia:
- continuous with what fascia?
- forms what ligaments (M and F)?
- and one more ligament for both sexes?
continuous with endoabdominal fascia forms puboprostatic (M) and pubocervical and pubovesical (F) ligaments and forms the lateral ligament (supports the bladder)
What does the cardinal ligament do?
supports cervix
What is the paracolpium?
thickened fascia from lateral vagina to tendinous arch
Describe the male viscera:
- relationship of ureter to vas deferens
- relationship of bladder and prostate
- relationship of seminal vesicles and bladder
- the bulbourethral gland is located within which structure?
- ureter travels under the vas deferens
- bladder is immediately superior to prostate
- seminal vesicles lie on the posterior surface of the bladder
- bulbourethral gland is located within the urogenital membrane
The ureters connect the ______ to the ______, and are ______ (relationship to peritoneum). The ureters pass over the ______ and enter the ______. They pass obliquely through the ________ in an inferomedial direction. Run inferior to ______ (2 answers: M/F).
kidneys to the bladder, retroperitoneal
pelvic brim, lesser pelvis
bladder wall
M: vas deferens; F: uterine artery
Which 4 arteries supply the ureter?
renal
gonadal
aortic
internal iliac branches
Which 3 nerve groups supply the ureter?
preaortic plexus
hypogastric plexus
pelvic splanchnic nn
Orientation of the bladder:
Apex points toward the ______ (bony structure) and the fundus is just opposite. The body lies between, and the ______ lies at the bottom.
pubic symphysis, neck.
The median umbilical ligament (urachus) goes from what to what?
apex of bladder to the umbilicus
The bladder rises above the _______ (feature) when filled
pelvic brim
the trigone is which aspect of the bladder?
floor
Describe the detrusor muscle:
- lines what viscera
- continuous with what 2 structures?
lines the bladder walls
continuous with internal urethral sphincter and ureteric sphincters
What senses bladder filling?
Stretch receptors of bladder wall and posterior urethra
What are the fiber types and innervations for (the male):
- internal urethral sphincter
- external urethral sphincter
internal: circular smooth muscle (continuous with detrusor); inferior hypogastric plexus; invol
external: skeletal fibers (posteriorly deficient); deep perineal branch of pudendal n; voluntary override
describe the urethral crest
a posterior ridge on the urethra as it passes through the prostate
describe the seminal colliculus
enlarged area on the urethral crest that the ejaculatory ducts open onto
(bringing sperm from the vas deferens and fluid from the seminal vesicle)
What is the prostatic utricle a remnant of?
paramesonephric system
Describe the prostatic sinuses
depressions on either side of the ridge into which the prostatic glands open and secrete an alkaline prostatic fluid
The prostate surrounds the ______.
It is 2/3 _____ and 1/3 _______ tissue.
Its base is close to the _______.
Its apex is in contact with fascia on the superior aspect of the urethral sphincter and deep perineal muscles.
It is the largest male repro accessory organ.
_______ open chiefly into the prostatic sinuses.
surrounds the prostatic urethra
2/3 gland, 1/3 fibromuscular tissue
base close to the neck of the bladder
prostatic ducts open onto the sinuses
Describe hypertrophy of the prostate
- common after middle age
- prostate projects into urinary bladder, impeding urination by distorting the prostatic urethra
- nocturia, dysuria, urgency
- increased risk of bladder infections (cystitis) and kidney damage
- enlargement and tumors detected by digital rectal exam
What’s the route of the vas deferens?
- enters the abdomen via deep inguinal ring
- passes superior to all structures
- passes superior + medial to the ureter –> expands into an ampulla –> narrows again –> joins the duct of the seminal vesicle
Generally describe the seminal vesicles
Where do the seminal vesicles sit, and what is their vascular supply?
Bilateral lobulated sacs
Sit lateral to the ampulla of the vas deferens
umbilical and inferior vesicular aa
What joins to form an ejaculatory duct?
ducts of the seminal vesicles and the vas deferens
3 general types of fibers supply the Male Repro organs….What are they?
SNS: T10-L2 via similar routes as the bladder
PSNS: pelvic splanchnics S2-s4
visceral afferents: most travel with PSNS; exceptions include testis–SNS to T10
Lymph from vas deferens and inferior seminal vesicles drains into what group of nodes?
internal iliac LN
Lymph from scrotal portion of vas deferens drains into what group of nodes?
external iliac LN
What 2 groups of lymph nodes drain the prostate?
mostly internal iliac, but some sacral
What 2 groups of lymph nodes drain the bladder?
external and internal iliac nodes
superolateral –> external; fundus and neck –> internal
