Pelvic Viscera Flashcards
Trigone of the bladder
Smooth area on posterior surface of bladder w/ openings for the ureters
Detrusor muscles
Three-layered smooth muscle of the bladder wall that are parasympathetically innervated by the pelvic splanchnic nerves (S2-S4)
Internal Sphincter of Bladder
Involuntary sphincter muscle surrounding the neck of the bladder that is sympathetically innervated
Microtuition
Is a result of parasympathetic stimulation => Relaxation of internal sphincter of bladder and contraction of detrusor muscles
Suprapubic Cystostomy
Removal of urine from the bladder thru the anterior abdominal wall; performed if there is a blockage in the urethra and normal catheterization is not possible
*Distended bladder is reached above the pubis w/o breaching the peritoneal cavity
Referred pain of the bladder
S2-S4 = tip of the penis
L1= hypogastric region
Rectal Relations
Posterior: Coccyx, sacrum, piriformis, sympathetic trunk
Anterior: (M) prostate, urinary bladder, seminal vesicles
(F) Cervix, Uterus
Lateral : Ischial spine, ischial tuberosity, sacrospinous ligament,
Rectovesical Pouch
Lowest part of male peritoneal cavity; exudates will drain to here when sitting down
Rectouterine pouch
Lowest part of female peritoneal cavity; acid from duodenal ulcer or ruptured ectopic pregnancy leads to fluid accumulation here
=>Abdominal tenderness
Transverse rectal folds
2 to the left and middle to the right
*Hard stool or probe can tear these folds => infxn
Ejaculatory Duct
Formed by the distal part of the vas deferens and the seminal vesicle tube
Lobes of the prostate gland
Anterior: Secretes alkaline fluid to counter acidic environment of vagina (other lobes do this too)
Median: Primary site of BPH; causes nocturia
Posterior Lobe: Common site of carcinoma
Lateral lobes: May develop BPH
Route for metastatic prostate caricnoma
Prostate venous plexus => Vesical venous plexus => Internal iliac vein => Lateral sacral vein => internal vertebral plexus and radicular veins
Seminal colliculus
Rounded eminence on the urethral crest in the prostatic urethra; *contains openings for the ejaculation duct
Iatrogenically induced sterility
Disruption to sympathetic fibers of the prostate, vas deferens, and the seminal vesicles resulting in reduced emission
*Occurs during pelvic surgery
Parts of the uterus
- Fundus (superior)
- Body (thick walled)
- Cervix (opening to vagina is the external os)
Normal position of the uterus
Anteverted (90 degrees to vagina) and anteflexed (slight angle from cervix to fundus)
Broad ligament of the uterus
Two-layered reflection of peritoneum covering the uterus which includes the:
- Mesosalpinx
- Mesovarium
- Mesometrium (majority of ligament)
- Suspensory ligament of the ovary (contains NAV to ovary)
Contents of broad ligament of the uterus
Round ligament of the uterus (remnant of the gubernaculum)
Round ligament of ovary
Uterine and ovarian artery and vein
Uterine Tube
Lymphatic drainage of the uterus
Fundus => lumbar para-aortic nodes
Body and Cervix => Internal iliac nodes
Cervical ligaments
Consists of the transverse, pubocervical, and uterosacral ligaments; fnxns to prevent prolapse of uterus into vagina during childbirth
*Are thickenings of endopelvic fascia
Components of the uterine tube
- Fimbria
- Infundibulum
- Ampulla (widest part; where fertilization takes place)
- Isthmus
- Intramural
* Has pre-aortic lumbar drainage
Ectopic tubal pregnancy
Occurs during blockage of the uterine tube; can lead to fatal hemorrhage after rupture
*Test for w/ a hysterosalpingogram
Boundaries of the ovarian fossa
Superior: External illiac vessels
Inferior: Internal illiac vessels and ureter
*Obturator nerve passes along obturator internus; diseased ovary can compress causing pain
Ovariectomy
Ovarian vessels ligated as they cross the external iliac
Coverings of the ovary
Tunica albuginea and peritoneum
Hymen
Mucosal covering of the inferior vagina; found BELOW the pelvic diaphragm
Culdocentesis
Drainage of the rectouterine pouch by piercing the posterior fornix of the vagina
*Unqualified abortionists can accidentally puncture this wall and enter the peritoneal cavity => peritonitis
Cystocele
Prolapse of part of the urinary bladder into the vagina
Blood vessels that must be ligated during hysterectomy
Uterine and ovarian arteries
Landmark felt in transvaginal approach for pudendal anesthesia
Ischial spine thru the posterior fornix
*If going thru the skin, will be the ischial tuberosity
Structure incised and restitched during episiotomy
Perineal body
Only layer of abdominal wall not pierced by suprapubic cystotomy
Parietal peritoneum
What are anal columns derived from?
The embryonic hindgut
What do lumbar splanchnic nerves contain?
Preganglionic sympathetic fibers
Region of the uterine tube located w/ an opening to the peritoneal cavity
Infundibulum
Peritoneal coverings of the rectum
Top 1/3: both sides
Middle 1/3: Only anterior
Bottom 1/3: Nada
Seminal vesicle origin
Embryological Outgrowth of the ductus deferens
Ovarian arteries
Arise from the AORTA at level L2; cross over external iliac vessels to enter the Suspensory ligament of the ovary
