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Repro! > Pelvic viscera 1 > Flashcards

Pelvic viscera 1 Flashcards

1
Q

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.

A

oblique

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2
Q

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

A

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

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3
Q

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

A

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

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4
Q

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

A

S2-S4 pelvic splanchnic nerves

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5
Q

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

A

sympathetic

parasympathetic

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6
Q

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

A

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

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7
Q

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.

A

T11-L2

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8
Q

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

A

trigone

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9
Q

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!

A

Median umbilical

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10
Q

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

A

puboprostatic

pubovesical

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11
Q

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

In the attached pic see the external urethral sphincter!

A

the perineum

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12
Q

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

A

– Preprostatic (intramural) part. PELVIS

– Prostatic part. PELVIS

– Membranous part. PERINEUM

– Spongy part. PERINEUM

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13
Q

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

A

Preprostatic (intramural) part

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14
Q

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

A

Membranous part

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15
Q

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?

A

– Can rupture if full in abdominal trauma

– Can be damaged in pelvis trauma when empty

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16
Q

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

A
17
Q

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

A
  • 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.
18
Q

The vesical veinous plexus drains the fundus of the bladder & the proximal urethra via the inferior vesical/vaginal veins to the internal iliac veins, and also via the sacral veins into the……………………… (this may provide a route for tumor metastasis to the vertebral column, pelvic bones and skull).

A

vertebral venous plexuses

19
Q

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

A

prostatic

dorsal

20
Q

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

A

uterovaginal

21
Q

Note:

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

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

A
22
Q

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.

A

Parasympathetic

Sympathetic

23
Q

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).

A

sympathetic

parasympathetic

24
Q

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

A

parasympathetic

25
Q

Describe the micturation reflex.

A

– 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).
26
Q

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

A

pudendal nerve (GSE)

27
Q

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

A
  • 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)
28
Q

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

A

rectal ampulla

29
Q

What is the lymph supply for the rectum?

A

internal iliac nodes

30
Q

What is the blood supply to the rectum?

A

–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

31
Q

Rectal plexus visceral efferent:

  • parasympathetic fibers (S2-4)……………. peristaltis
  • sympathetic fibers (L1-L2)…………….. peristaltis.
A

increase

decrease

32
Q

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

A

parasympathetic

33
Q

Process of defecation:

  • 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.
A

parasympathetic

parasympathetic

GSE

GSE

parasympathetic

34
Q

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.

A

voluntary

pudendal

35
Q

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?

A

superior rectal vein (portal circulation)

36
Q

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

A

Repro! (5 decks)

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