Pelvic Viscera Flashcards
What are ureters?
tubes that transport urine from the renal pelvis of the kidney to the bladder
What is ureteropelvic junction?
when the renal pelvis narrows to form the ureter
Where does each part of the ureter receive blood supply from?
- upper -> receives blood directly from renal arteries
- middle -> supplied by common iliac artery, abdominal aorta branch, & gonadal artery
- distal -> receives blood from internal iliac artery branches
Ureters run … the uterine artery
underneath
What is a hysterectomy?
where the uterus & uterine artery are removed
What are the 3 sites where kidney stones can lodge?
- junction of renal pelvis & ureter
- pelvic inlet
- entrance to bladder
What are kidney stones?
- formation of Ca2+
- pain from loin to groin
What are the 3 locations where ureters are at their narrowest?
- uretopelvic junction
- pelvic brim
- where ureter enters the bladder
What is the placement of the bladder in males vs females?
- male -> anterior to rectum
- female -> anterior to vagina & inferior to uterus
What are the walls of the bladder composed of?
detrusor muscle
What are the structures of the bladder?
- apex: located sup.; connected to umbilicus by med. umbilical lig.
- body: located b/w apex & fundus
- fundus: located post.
- neck: formed by the merging of fundus & 2 inferolateral surfaces; continuous with urethra
What is a trigone in the urethra?
- triangular area located within the fundus
- formed by 3 openings
What are the 2 urethral sphincters?
- internal -> involuntary; prevents flow of semen back into bladder during ejaculation
- external -> voluntary; controlled by pudendal nerve
What occurs during micturition (urination)?
when bladder is full, parasympathetic nerve fibers cause detrusor muscle to contract & int. urethral sphincter to relax
What are the main arteries that supply the bladder?
- branches of int. iliac art.
- males -> fundus & neck supplied by inf. vesical art.
- females -> fundus & neck vaginal art.
What is the role of the urethra?
transporting urine from bladder to ext. opening in perineum
What is the size of the urethra in male vs female?
- female -> short
- male -> long
What is Skene’s gland in the female urethra?
mucous glands that lie on either side of the urethra (homologous to male prostate)
What are the 4 parts of the male urethra?
- preprostatic: 1cm extends from base of bladder & ends before entering prostate gland
- prostatic: 3-4 cm encompassed in prostate gland; widest part of male urethra
- membranous: begins outside prostate & ends before entering buld of penis
- spongy (penile): travels enitre penis via corpus spongiosum
What are the 2 parts of the spongy urethra in males?
- bulba: located in bulb of penis
- penile: runs along length of penis
What is the membranous part of the urethra surrounded by?
skeletal muscle of the ext. urethral sphincter
Why are females more susceptible to bladder infections?
bacteria must travel farther in males due to longer urethra
What is the role of the rectum?
temporary store of feces
What is the final segment of the rectum that relaxes to accumulate & temporarily store feces until defecation occurs before being released by the anal canal?
ampulla
What does the rectum look like macroscopically?
absence of taenia coil, haustra, & omental appendices
The rectum is what type of structure?
retroperitoneal
In males, what is the rectovesical pouch?
double folding of peritoneum located b/w rectum & bladder
What are the 2 pouches of the rectum in females?
- rectouterine: double folding of peritoneum b/w rectum & post. wall of uterus
- vesicouterine: double folding of peritoneum b/w ant. surface of uterus & bladder
Is the peritoneum closed in males & females?
- male -> completely closed
- female -> not completely closed
What are the 3 main arteries that supply the rectum?
- sup. rectal: terminal continuation of inf. mesenteric art.
- middle rectal: branch of internal iliac art.
- inf. rectal: branch of int. pudendal art.
What type of muscles support the rectum?
pelvic floor -> levator ani muscles (iliococcygeus, pubococcygeus, & puborectalis)
What nerves is the internal anal sphincter controlled by?
parasympathetic
What nerves is the external anal sphincter controlled by?
somatic from pudendal nerve
What are the series of relexes that happen during defecation?
- relaxation of the ext. sphincter
- contraction of abdominal wall muscles
- relaxation of pelvic floor muscles
What is the msucle repsonsible for defecation?
puborectalis msucle
What are the 3 types of accessory glands?
- single prostate
- pair of seminal vesicles
- pair of bulbourethral glands
What are the functions of the penis?
sexual intercourse & micturition (urination)
What are the 3 parts of the penis?
- root: located in sup. perineal pouch
- body: located b/w root & glans
- glans: formed by distal expansion of corpus spongiosum
What is the root of the penis composed of?
- 3 erectile tissues -> 2 crura & bulb of penis
- 2 muscles -> ischiocavernosus & bulbospongiosus
What is the body of the penis composed of?
3 cylinders of erectile tissue -> 2 corpora cavernosa & corpus spongiosum
What does the glans of the penis contain?
opening of urethra
What forms the corpora cavernose in the body of the penis?
left & right cruras
The left & right cruras are located how & covered by what in the root of the penis?
located laterally & covered by ischiocavernosal muscles
What forms the corpus spongiosum in the body of the penis?
the bulb
What are the 4 msucles located at the root of the penis?
- bulbospongiosus (x2): contracts to empty the spongy urethra of any residual semen & urine
- ischiocavernosus (x2): contracts to force blood from the cavernous spaces in the crura into the corpora cavernosa -> helps maintain the erection
What are the contents of the superficial perineal pouch in males?
- root of penis -> bulbospongiosus & ischiocavernous
- sup. transverse perineal muscles
- bulbous part of spongy urethra
- deep perineal branches of int. pudendal vessels & nerves
What are the 2 ligaments of the penis?
- suspensory: connects erectile bodies of penis to pubic symphysis
- fundiform: runs down from the linea alba & attaches to pubic symphysis
The penis receives blood supply from where?
from int. pudendal art.
* dorsal art. of penis
* deep art. of penis
* bulbourethral art.
What is the innervation of the skin & glans penis?
dorsal nerve of penis from pudendal nerve
What are the 3 contents of the scrotum?
- testes: site of sperm production
- epidymis: storage of reservoir for sperm
- spermatic cord: collection of muscle fibers, vessels, & ducts that run to & from testes
What is the dartos muscle in the scortum?
- located beneath the skin
- decreases surface area by wrinkling skin-> conserves heat
What is the function of the scortum?
- protect testes
- thermoregulation of testes
The scrotum is biologically homologous to what in females?
labia majora
What is the arterial supply for the scrotum?
- ant scrotal art: from ext. pudendal art.
- post. scrotal art: from int. pudendal art.
What is the role of pampiniform plexus?
- drains testicular veins
- role in temp. regulation
What is the venous drainage of the testes?
left testicular vein -> into left renal vein -> IVC
What is the path of the spermatic cord?
passes through inguinl canal -> enters scrotum via superficial inguinal ring
What is the function of the cremaster muscle?
covers testes & spermatic cord
What is the path of the production of semen?
testes -> epididymis -> vas deferens -> seminal vesicle -> ejaculation duct -> urethra
What is the peripheral zone of the prostate?
- most post. zone
- high incidence of inflammation & carcinoma
- area felt on DRE
What lies posteriorly to the prostate?
ampulla of the scrotum
What is the central zone of the prostate?
surrounds ejaculatory duct
What is the transitional zone of the prostate?
- most ant. zone
- surrounds urethra
- indicated in BPH
What is the sympathetic & parasympathetic innervation of the scrotum?
- sympa: inf. hypogastric plexus -> contraction & ejaculation
- para: pelvic splanchnic -> causes dilation & erections
What are the seminal vesicles?
- located b/w bladder fundus & rectum
- combines with vas deferens to form ejaculatory duct which drains into prostatic urethra
What are the bulbourethral (Cowper’s) glands?
- pair of glands located posterolateral to membranous urethra
- main source of pre-ejaculation fluid
- lubrication
What is the external genitalia of females?
- mons pubis
- labia majora & minora
- clitoris
- vestibule
- gretaer vestibular glands
What is the internal genitalia of females?
- vagina
- uterus
- uterine tubes
- ovaries
What is the external genitalia of males?
penis & scrotum
What is the internal genitalia of males?
- testes & epididymis
- ductus deferens
- 3 accessory glands -> single prostate, pair of seminal vesicles, & pair of bulbourethral glands
What is the vulva?
- composed of mons pubis, labia, vestibule, & clitoris
- function: sensory tissue, urination, & prevent infection
What are the structures of the vulva?
- mons pubis
- labia majora: 2 ext. folds with hair
- labia minora: 2 int. folds w/o hair
- vestibule: enclosed by minora -> contains urethra + ext. vaginal orifice
- Bartholin’s glands: secrete lubricating mucus
- clit: erectile tissue= corpora cavernosa
What are the borders of the vagina?
- ant: bladder + urethra
- post: rectum, rectouterine pouch, & anal canal
- lat: ureters + levator ani muscle
What are the fornices of the vagina?
- ant: smaller & lower than post; closer to vesicouterine pouch.
- post: longest/deepest; closer to rectouterine pouch (Pouch of Douglas)
What fornix of the vagina acts as a reservoir for semen?
posterior
What are the 3 segments of the vagina?
- fundus: top -> connects uterine tubes
- body: middle -> site of implantation
- cervix: bottom -> connects to the vagina
What are the different positions of the uterus?
- anteversion -> normal position
- retroverted ->uterus tips backwards at the cervix
- retroflexed -> tilt of the cervix is severely backwards
- anteflexed -> ant. tilt of cervix is severe
What are the 3 broad ligaments of the uterus?
- mesometrium -> covers myometrium
- mesoalpinx -> covers uterine tubes
- mesovarium -> covers ovaries
What provides the primary support of the uterus?
tone of pelvic floor
What are the ligaments of the uterus? (R.O.C.U.S)
- round -> maintains anteverted position
- ovarian -> connects ovary to uterus
- cardinal -> attaches cervix to lat. walls
- uterosacral -> attaches from cervix to scrotum
- suspensory -> connects ovary to pelvic wall
What are the cervical structures of the uterus?
- endocervix: endocervial canal -> contains internal os leading to uterus
- ectocervix: connects to vagina -> contains external os leading to endocervix
What are the 4 parts of the fallopian tube?
- infundibulum -> has fimbrae
- ampulla -> widest section of uterine fibers
- isthmus -> narrow section of uterine tubes connecting ampulla to uterine cavity
- intramural (interstitial) part -> passes wall of uterus & opens to uterine cavity
What is the major cause of infetility in women?
blockage in uterine tubes
What are the 2 ligaments of the ovary?
- suspensory: form of peritoneum extending from mesovarium -> contains neurovascular structures
- ligament of ovary: extends from ovary to fundus -> continues as round ligament of uterus
What occurs during a transvaginal pudendal block?
needle is passed thorugh the vaginal mucous where the ischial spine is palpated through the wall of the vagina
Fertilization occurs in which part of the female reproductive tract?
ampulla of uterine tube
