Pelvic viscera Flashcards
What are the boundaries of the pelvis?
- Pelvic inlet (superiorly)
- Pelvic wall (anteriorly, posteriorly, laterally)
- Pelvic floor (inferiorly)
What are the branches of the internal iliac artery?
Parietal branches:
- Superior/inferior gluteal arteries (buttocks/gluteal region)
- Obturator artery (inner leg)
- Internal pudendal artery (perineum)
Visceral branches:
- Superior/inferior vesical arteries (bladder)
- Middle rectal artery
- Uterine artery (uterus)
What are the peritoneal reflections in females?
- Recto- uterine pouch (of Douglas)
- Vesico-uterine pouch
What is the peritoneal reflection in males?
Rectovesical pouch
What structure make up the pelvic walls?
Bones:
- Hip (innominate) bone – Ilium, pubis, ischium
- Sacrum
- Coccyx
Muscles:
- Piriformis
- Obturator internus
Ligaments:
- Sacrospinous ligament
- Sacrotuberous ligament
Which muscles make up the pelvic diaphragm?
- Levator ani
- Coccygeus
What are the surfaces if the bladder?
- Superior
- Base
- Inferolateral (x2)
What is the smooth muscle in the wall of the baldder called?
Detrusor muscle
What are corners of the bladder?
- Apex: Attaches to the median umbilical ligament
- Lateral horns: Attachments of the ureters
- Inferior horn: Attachment of the urethra
What are the ligaments associated with the neck of the bladder?
- Men: Puboprostatic ligaments
- Women: Pubovesical ligaments
What is the blood supply to the bladder?
Arterial:
- Superior/inferior vesical arteries (from internal iliac)
- Uterine artery (female)
Venous;
- Vesical plexus (internal iliac veins)
- Prostatic plexus (males)
What is the innervation of the bladder?
- Parasympathetic: Pelvic splanchic (S2-4)
- Sympathetic: L1-2 (male, closes bladder neck during ejaculaton)
Where does the rectum begin?
S3
What is the structure of the rectum?
- Valves of Houston: Made up of mucosa and circular muscle
- Covered anteriorly and posteriorly by 2 bands of longitudinal muscle
How long is the rectum?
12 cm
What are the peritoneal relationships of the rectum?
Superior 1/3: Anterior and lateral
Middle 1/3: Anterior only
Inferior 1/3: No peritoneum
What is the pathway of the rectum?
- Begins as continuation as sigmoid colon
- Turns anteriorly at coccyx
- Turns posteriorly at pelvic diaphragm
What is the blood supply of the rectum?
- Superior rectal artery
- Middle rectal artery
What is the innervation of the rectum?
- Parasympathetic: Pelvic splanchnic (S2-4)
- Sympathetic: L1-2
What are the structures present in the verumontanum?
- Prostatic utricle
- Ejaculatory ducts
- Prostatic ducts
What is the blood supply of the prostate glands?
Arterial:
- Inferior vesical artery
2 Middle rectal artery
- Internal pudendal artery
Venous: Prostatic plexus
What structures does the vas deferens pass on along its path?
- Inguinal canal (superficial/deep ring, in spermatic cord)
- Inferior epigastric vessels (anterior)
- External iliac vessels (posterior)
- Medial umbilical ligament (posterior)
- Obturator neurovascular bundle
What is the blood supply of the vas deferens?
Artery to the vas (superior vesical artery)
What is the innervation of the vas deferens?
- Intrapelvic: Pelvic splanchnic
- Spermatic cord: Same as testes
What is the blood supply of the seminal vesicles?
Inferior vesical arteries
What is the innervation of the seminal vesicles?
Pelvic splanchnic
What is the structure of the testes?
- Elipsoid shaped structures suspended in scrotum by spermatic cords.
- Covered by thick layer of connective tissue called tunica albuginea.
- Anterior/lateral surfaces covered by double fold of peritoneum called the tunica vaginalis.
What is the blood supply of the testes?
- Arterial: Testicular arteries
- Venous: Pampinfiorm plexus → Testicular veins
What is the innervation of the testes?
- Parasympathetic: None
- Sympathetic: T10
What is the lymphatic drainage of the testes?
Para-aortic nodes
What is the structure of the epididymis?
- Head
- Body
- Tail
What is the structure of the uterus?
- Fundus: Superior part
- Body: Lateral part below where fallopian tubes connect.
- Cornua: Where the fallopian tubes attach.
- Isthmus: Narrowing of uterus before cervix.
- Cervix: Where the uterus connects to the vagina.
What is the blood supply of the uterus?
Arterial:
- Uternine arteries
- Ovarian arteries
Venous:
- Rectal venous plexus
- Vesical venous plexus
What is the innervation of the uterus?
- Parasympathetic: Pelvic splanchnic
- Sympathetic: T10-L1
What is the position of the uterus described as?
Anteflexed
What are the ligaments associated with the ovaries?
- Suspensory ligament: Extends from ovaries to pelvic walls and transmits ovarian arteries, veins and nerves.
- Ligament of the ovaries: Extends from the junction between uterus/fallopian tubes and ovaries
- Mesovarium: Attaches the ovaries to the broad ligament
- Mesosalphinx: Mesentery between the ovary and the fallopian tube
What is the blood supply of the ovaries?
Arterial: Ovarian arteries
Venous: Ovarian veins
What is the lymphatic drainage of the ovaries?
Para-aortic nodes
What are the ligaments associatedw with the uterus?
- Broad ligament
- Round ligament
- Ligament of the ovary
- Pubocervical ligament
- Cardinal ligament
- Uterosacral ligament
What are the lateral curvatures associated with the rectum?
- Right: Upper and lower curvatures
- Left: Middle curvature
How can the rectum distend?
- Upper 2/3: Distends into abdominal cavity
- Lower 1/3: Distends into ischioanal fossa
What are the different fuctions of the autonomic nerve supply to the rectum?
- Sympathetic:
1. Contracts smooth muscle sphincter
2. Relaxes bowel
3. Transmits pain - Parasympathetic:
1. Reaxes smooth muscle sphincter
2. Contracts bowel
3. Transmits ‘fullness’ sensation
What is the name of the fascia between the rectum and the prostate?
Rectoprostatic (Denonvillier’s) fascia
What is the remnants of the mesonephric duct in females?
Epoöphoron (in the mesosalphinx)
