Pelvic viscera 1

Question 1

The ureter traverses the wall of the bladder in an……………… direction. Therefore, both pressure from a filling bladder and bladder contraction during micturition (urinating) inhibit reflux of urine into the ureter.

Answer 1

oblique

Question 2

In the pelvis, what is the blood supply of the ureters?

Answer 2

Arteries:

inferior vesicular a. (male) or uterine & vaginal a. (female)

Veins:

inferior vesicular v. (male) or uterine & vaginal v. (female)

Vesical venous plexus around inferior end

Question 3

What is the sympathetic innervation of the ureters in the pelvis?

Answer 3

Superior & inferior hypogastric plexuses (T11-12/ L1-L2)

Question 4

What is the parasympathetic innervation of the ureters in the pelvis?

Answer 4

S2-S4 pelvic splanchnic nerves

Question 5

When it comes to visceral afferent fibers coming from the ureters, Pain travels with……………, while others travel with……………….

Answer 5

sympathetic

parasympathetic

Question 6

What is important to know (regarding the ureters) when performing a hysterectomy?

Answer 6

Ureter is as risk during a hysterectomy because uterine artery passes over it (bridge over water)

Question 7

Ureters are innervated by GVA fibers that accompany GVE sympathetic fibers from the…………. spinal cord levels. This is why passage of a kidney stone produces “loin (abdomen) - to - groin (pelvis)” pain.

Answer 7

T11-L2

Question 8

The bladder receives the right and left ureters and urethra at the angles of the smooth-walled…………

Answer 8

trigone

Question 9

The…………….. ligament (which covers the urachus) runs upward from the apex of the bladder. If the lumen of the urachus persists in a newborn, urine leaks from their umbilicus!

Answer 9

Median umbilical

Question 10

The urinary bladder is supported by the…………………. ligaments in males and the…………………. ligaments in females.

Answer 10

puboprostatic

pubovesical

Question 11

The female urethra is short, located mostly in……………., and empties into a vestibule.

In the attached pic see the external urethral sphincter!

Answer 11

the perineum

Question 12

What are the 4 parts of the male urtethra, and where are they located? (pelvis or perineum)

Answer 12

– Preprostatic (intramural) part. PELVIS

– Prostatic part. PELVIS

– Membranous part. PERINEUM

– Spongy part. PERINEUM

Question 13

The internal urethral sphincter is located in what part of the male urethra?

Answer 13

Preprostatic (intramural) part

Question 14

The external urethral sphincter is located in what part of the male urethra?

Answer 14

Membranous part

Question 15

The urinary bladder is in the abdomen in children. In an adult, the empty bladder is in the pelvis, and when it is full it is in the abdomen! What clinical implications does this have?

Answer 15

– Can rupture if full in abdominal trauma

– Can be damaged in pelvis trauma when empty

Question 16

* The shorter urethra and the opening in vestibule in a female can increase susceptibility to bladder infections (cystitis).

Question 17

What gives the blood supply to the urinary bladder & proximal urethra?

Answer 17

• Superior vesical artery & vein: anterosuperior bladder
• Inferior vesical artery & vein (male) or vaginal artery & vein (female): fundus & neck of bladder & proximal urethra.
• Vesical veinous plexus: drains fundus of the bladder & proximal urethra.

Question 18

The vesical veinous plexus drains the fundus of the bladder & the proximal urethra via the:

• inferior vesical/vaginal veins to the internal iliac veins.
• sacral veins into the……………………… (this may provide a route for tumor metastasis to the vertebral column, pelvic bones and skull).

Answer 18

vertebral venous plexuses

Question 19

In a male, the vesical veinous plexus is continuous with the……… venous plexus & the………… vein of the penis.

Answer 19

prostatic

dorsal

Question 20

In a female, the vesical veinous plexus communicates with the…………. venous plexus & the dorsal vein of clitoris.

Answer 20

uterovaginal

Question 21

Note:

Male: vesical plexus for bladder & prostatic plexus for proximal urethra.

Female: vesical plexus for both the bladder & proximal urethra.

Question 22

When it comes to Visceral efferent nerve supply of the urinary bladder & proximal urethra:

– ………………. system is responsible for contraction of detrusor muscle and inhibitionof internal urethral sphincter (male)

– ………………… system is responsible for contraction of internal urethral sphincter (male) prevents urination in a shy male.

Answer 22

Parasympathetic

Sympathetic

Question 23

When it comes to v_isceral afferent_ nerve supply of the urinary bladder & proximal urethra, pain travels according to the pain line with………………. for the anterosuperior portions of the bladder, and ………………….. for the fundus & neck of the bladder & proximal urethra.

(Others are with parasympathetic).

Answer 23

sympathetic

parasympathetic

Question 24

Transport of urine to the bladder is via ↑………………

Answer 24

parasympathetic

Question 25

Describe the micturation reflex.

Answer 25

– Internal pressure of the filling bladder close ureters to prevent backflow. – Bladder wall stretching stimulates GVA fibers (S2-S4) going to the spinal cord. – Parasympathetic (GVE) fibers (S2-S4) cause urine to flow into the urethra. This is done by: * stimulation of detrusor muscle in the walls of the bladder. * relaxation of the internal urethral sphincter (males only).

Question 26

Voiding is voluntary relaxation of the external urethral sphincter, leading to urine leaving the body. It is due to what nerve?

Answer 26

pudendal nerve (GSE)

Question 27

Aside from relaxation of the external urethral sphincter, what else contributes to voiding?

Answer 27

- Relaxation of the levator ani during urination (GSE) - Abdominal muscle contracts (GSE) which leads to increased bladder pressure. - In a male, the final drops of urine are pushed out of the urethra by contraction of the bulbospongiosus muscle (GSE)

Question 28

The rectum is extraperitoneal. The lower part expands to form the............, which is essential for fecal continence.

Answer 28

rectal ampulla

Question 29

What is the lymph supply for the rectum?

Answer 29

internal iliac nodes

Question 30

What is the blood supply to the rectum?

Answer 30

–_Superior rectal artery & vein_ (inferior mesenteric artery & vein) supplies upper rectum – _Middle rectal artery & vein_ (internal iliac artery & vein) supplies lower rectum – _Inferior rectal artery & vein_ (internal pudendal artery & vein) supplies anorectal junction

Question 31

Rectal plexus visceral _efferent_: * parasympathetic fibers (S2-4)................ peristaltis * sympathetic fibers (L1-L2)................. peristaltis.

Answer 31

increase decrease

Question 32

The rectal plexus visceral _afferent_ portion is responsible for pain & other sensations. They travel with.................. fibers.

Answer 32

parasympathetic

Question 33

Process of defecation: ## Footnote * Sigmoid colon accumulates fecal material, distention stimulates the desire to defecate via GVA fibers * Sigmoid colon empties it’s contents into the rectum via a mass peristaltic movement (............. GVE fibers) * When feces enters the rectum, distention stimulates the desire to defecate via GVA fibers * Muscles of the rectum itself (................ GVE fibers), along w/ muscles of the abdominal wall (......... fibers) contract and increase pressure w/in the rectum * The puborectalis (.......... fibers) relaxes, decreasing the angle of the anorectal junction * The internal anal sphincter is opened (............... GVE fibers) in response to increased pressure (GVA fibers) * The external anal sphincter opens to allow stool outside of the anal canal.

Answer 33

parasympathetic parasympathetic GSE GSE parasympathetic

Question 34

During defecation, the external anal sphincter, which is normally closed under............... control from branches of the........... nerve (GSE fibers), opens to allow stool outside of the anal canal.

Answer 34

voluntary pudendal

Question 35

Colorectal cancer starts in the colon or rectum. A rectal tumor will spread to the internal iliac lymph nodes, and can spread to the nearby uterus or bladder. It can also metastasize to the liver via what vein?

Answer 35

superior rectal vein (portal circulation)

Question 36

Here is the overview chart stating the Sympathetic & Parasympathetic Innervation of the pelvic viscera:

Answer 36