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MD1 Reproduction > Pelvic Viscera > Flashcards

Pelvic Viscera Flashcards

1
Q

How do the bladder and uterus develop?

A

As 2 halves that come together in midline and fuse

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2
Q

What is the implication of the neurovascular supply for the bladder and uterus because of their development?

A

Neurovascular structures from each side wall; ie: paired

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3
Q

Where is the bladder?

A

Sits behind pubic bone
In adult, empty bladder sits low
As it fills, and in child, pushes up beyond pubic bone towards abdominal cavity, pushing peritoneal cavity above it

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4
Q

What is the retropubic space?

A

Small space between bladder and pubic bone

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5
Q

What is the shape of the bladder?

A

Pyramid tipped forwards
So apex points anteriorly, abutting pubic bone
Base of bladder directed posteriorly, sitting against rectum in male and genital tract in female

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6
Q

What is the triangular base of the bladder called?

A

Trigone

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7
Q

Describe the wall of the trigone

A

Smooth wall

Mucosa quite densely adherent to smooth muscular wall

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8
Q

What is the mucosa like in the bladder except for the trigone?

A

Thrown up into swirls and whorls over detrusssor muscle

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9
Q

In which direction is the apex of the trigone directed?

A

Downwards

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10
Q

Which structures enter or exit the trigone at each point?

A

Supralaterally: ureters enter

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11
Q

What is the course of the ureters?

A

From hilum of kidneys
Vertical descent over posterior abdominal wall on psoas, roughly aligning with tips of lumbar transverse processes
Tip over pelvic inlet
- Point of narrowing - external kinking rather than internal structure
Runs along side wall of pelvis
Crosses towards midline
Pierces muscular wall of bladder
Tunnels through wall at oblique angle, acting as functional sphincter

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12
Q

How does the functional sphincter of the ureters work in the wall of the bladder?

A

As bladder contracts, intramural portion of ureters pushed closed, therefore prevents retrograde flow of urine

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13
Q

Describe the neck of the bladder

A

Part of bladder surrounding where urethra exits bladder

Relatively stable

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14
Q

Describe the fundus of the bladder

A

Above neck

Expands

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15
Q

How do you stabilise the bladder?

A

Must stabilise fixed part
Neck of bladder stabilised
Ligaments going forward attach neck to pubic bone = pubovesical ligaments

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16
Q

What is associated with the posterior aspect of the bladder in the male?

A

Part of male reproductive tract

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17
Q

Where does the vas deferens originate?

A

At epididymis of testis in scrotum

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18
Q

What is the course of the vas deferens?

A 
Part of spermatic cord
Ascends and traverses inguinal canal
Passes along side wall of pelvis
Crosses side wall towards posterior aspect of bladder
Approaches base of bladder posteriorly
Joins ducts of seminal vesicles
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19
Q

What is the relationship between the vas deferens and the ureter?

A

Vas deferens crosses over ureter

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20
Q

Describe the ejaculatory duct

A

Paired/conjoined ducts form single duct

  • Vas deferens carries sperm from testis
  • Seminal vesicles secrete thick alkaline with fructose
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21
Q

What does the ejaculatory duct empty into?

A

Prostatic part of urethra

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22
Q

What does the common iliac artery divide into?

A

Internal iliac artery, which dips down into pelvis

External iliac artery, which is continuing along brim

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23
Q

What is the ureter crossed by in each sex on its course from the side wall to the bladder?

A

In males, crossed by vas deferens

In females, crossed by uterine artery

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24
Q

Describe the importance of the uterine artery as a surgical landmark

A

When surgeons performing hysterectomy, need t tie off uterine blood supply
When they put ligature around uterine artery, have to make sure they’ve clearly identified ureter, and make sure their ligature isn’t catching up ureter as well

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25
Q

Where is the prostate gland?

A

Situated between neck of bladder above, and levator ani and urogenital diaphragm below

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26
Q

What is the urethral crest?

A

Prostatic part of urethra has bulge in middle of it

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27
Q

What are the prostatic or urethral sinuses?

A

Urethral crest has grooves on either side of it
Ejaculatory duct opening onto crest in either side
Prostate gland opens into sinuses via ducts

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28
Q

What part of the prostate is palpable on a per rectum exam?

A

Posterior surface

Front of fingers directly related to posterior aspect of prostate gland

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29
Q

How does the consistency of the prostate gland change if it enlarges because of malignancy?

A

Hardens and loses normal lobulation

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30
Q

Which lobe of the prostate gland generally enlarged in benign prostatic hypertrophy?

A

Medial/middle lobe

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31
Q

Where is the middle lobe of the prostate gland?

A

Between ejaculatory duct and prostatic urethra

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32
Q

What does the middle lobe of the prostate gland impinge on as it enlarges?

A

Ejaculatory duct

Prostatic urethra

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33
Q

What are the middle midline structures in the female?

A

Uterus

Vagina

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34
Q

What is the size of the uterus?

A

Textbook size = 8 x 5 x 3 cm
Actual size variable
- Involutes post-menopause
- After carrying pregnancy to term, doesn’t decrease to size before

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35
Q

What is anteversion?

A

(Angulation on vagina)

Bent forward on vagina

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36
Q

What is anteflexion?

A

Uterus itself bent forward

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37
Q

What is the normal position of the uterus?

A

Anteverted and anteflexed

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38
Q

What are the variations in position of the uterus?

A

Less anteversion, no version, retroversion

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39
Q

What is retroversion of the uterus associated with?

A

Classically associated with back pain in pregnancy and often in periods
Can have implications on carrying pregnancy to term

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40
Q

How can you tell if the uterus is anteverted or retroverted?

A

On per vagina exam

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41
Q

What is the shape of the uterine cavity?

A

Roughly triangular

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42
Q

What does the uterus receive at each supralateral angle?

A

Uterine tube

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43
Q

What is the apex of the uterus continuous with?

A

Cervical canal

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44
Q

What demarcates the cervix?

A

Internal uterine opening = internal os

External uterine opening = external os

45
Q

Where is the fundus of the uterus?

A

Convex part above entry point of uterine tubes

46
Q

Where is the body of the uterus?

A

Below entry point of uterine tubes

47
Q

Where is the isthmus of the uterus?

A

Body tapers into isthmus

Isthmus becomes continuous with cervix

48
Q

In which direction is the uterus flattened?

A

A-P direction

49
Q

How long is the cervix?

A

2-3 cm

50
Q

Where do the external os and terminal portion of the cervix sit?

A

Sit down into superior part of vagina, such that vagina envelopes terminal portion of cervix

51
Q

What is a fornix?

A

Space in vagina on either side of cervix

52
Q

How do you directly related to the pouch of Douglas in a per vagina exam?

A

Stick fingers in posterior fornix

53
Q

What happens to the fundus of the uterus during pregnancy?

A

Pushes up, pushing peritoneal cavity above it

54
Q

What happens to the body and isthmus of the uterus during pregnancy?

A

Expand dramatically

55
Q

Which part of the uterus is fixed?

A

Cervix

56
Q

What are the ligaments that fix the cervix in place?

A

Lateral cervical ligaments
Uterosacral ligaments
Pubocervical ligaments

57
Q

Which ligaments fixing the cervix are the strongest?

A

Lateral cervical ligaments

58
Q

Where do the lateral cervical ligaments attach?

A

Side wall of pelvis

59
Q

Where do the uterosacral ligaments attach?

A

Sacrum, posteriorly

60
Q

Where do the pubocervical ligaments attach?

A

Pubis, anteriorly

61
Q

Which ligaments fixing the cervix are the weakest?

A

Pubocervical ligaments

62
Q

What are the lateral cervical ligaments made of?

A

Fascial condensations around neurovascular structures

63
Q

What artery do the lateral cervical ligaments transmit?

A

Uterine artery from internal iliac artery to uterus

64
Q

What does anything supporting the vagina also support?

A

Uterus, indirectly

65
Q

What supports of the vagina support the uterus from below?

A

Levator ani

Fascial supports of vagina

66
Q

Other than the ligaments, what else supports the cervix?

A

Perineal membrane

67
Q

How can the ligaments of the pelvic viscera slacken and weaken?

A

Stretching of childbirth and/or effects of loss of oestrogen at menopause

68
Q

What does weakening and slackening of the ligaments of the pelvic viscera do?

A

Prolapse of pelvic structures, especially uterus

69
Q

Describe prolapse of the uterus

A

Uterus can drop down into vagina
Grades of uterine descent
External os and terminal part of cervix can even appear at level of labia

70
Q

What happens when the fascial supports of the vagina become slack and weakened?

A

Bladder to fall back and encroach on front of vagina

Sometimes rectum can fall forwards and encroach on vagina from behind

71
Q

How long are the uterine tubes?

A

10-14 cm

72
Q

What are the different parts of the uterine tubes?

A

1st part, starting at uterus, = intramural
- Traverses muscular uterine wall to connect with uterine cavity
- Gets progressively wider as it heads for side wall of pelvis
Isthmus changes in diameter
Vast majority of uterine tube = ampulla
- Large and wide
Ends in series of finger-like projections = fimbria
- Related to ovary
- Catch ovum at time of ovulation

73
Q

What is the relationship between the uterus and the peritoneum?

A

Uterus covered by peritoneum in front, top, and back
Extends to walls of pelvis as double fold on either side
At side walls, sweeps front and back forming peritoneal lining of pelvis

74
Q

What is the double fold of peritoneum hanging off the uterus called?

A

Broad ligament

75
Q

What does the broad ligament hang off?

A

Uterine tubes - they’re like curtain rods

76
Q

What is the shape and size of the ovaries?

A

Almond sized

Almond shaped

77
Q

Where do the ovaries sit?

A

On back of posterior leaf of broad ligament

Inside peritoneal cavity

78
Q

Around which structure must the fimbria move to collect the ovum?

A

Go around back of broad ligament

79
Q

What are the three structures that come off the supralateral angles of the uterus?

A

Uterine tubes head off laterally
Ovarian ligament posteriorly
Round ligament anteriorly

80
Q

What is the ovarian ligament?

A

Proper ligament connecting ovaries to upper side of uterus

81
Q

What is the round ligament?

A

Remnant of gubernaculum
Equivalent of spermatic cord in males
Traverses inguinal canal and connects to labia
Pulls ovaries onto side wall of pelvis during development

82
Q

What is the vagina?

A

Long muscular tube

Longer posterior wall than anterior wall

83
Q

Where does the rectum sit in the pelvis?

A

Posteriorly, back within concavity of sacrum

84
Q

At what level is the rectosigmoid junction?

A

S3

85
Q

What happens at the rectosigmoid junction?

A

Taenia coli once more become continuous longitudinal coat over rectum

86
Q

What is the mucosal lining of the rectum like?

A

Make mucosal shelves

87
Q

What is the dilated terminal portion of the rectum called?

A

Ampulla

88
Q

Where is faeces stored until defecation?

A

In ampulla of rectum

89
Q

What is the main artery of the pelvis?

A

Internal iliac artery

90
Q

Since the internal iliac artery is the most variable artery in the body, how are the branches named?

A

By working back from structure they supply

91
Q

What are the two sources of blood vessels for the midline structures of the pelvis?

A

Those coming from above

Those coming off internal iliac arteries from side walls

92
Q

Where do the ovarian arteries come from?

A

From above: gonadal branches from side walls of abdominal aorta

93
Q

Where does the superior rectal artery come from?

A

Above

94
Q

What does the superior rectal artery supply?

A

Rectum

95
Q

Which branch of the internal iliac supplies the visceral structures/?

A

Anterior branch

96
Q

Which artery supplies the bladder?

A

Superior vesical artery

97
Q

What does the inferior vesical artery supply?

A

In males, and sometimes in females, reinforces blood supply to bladder, because it also supplies components of reproductive tract on back of bladder

98
Q

What is the blood supply to the vagina?

A

Uterine artery gives of vaginal branch that heads down

99
Q

What is the course of the uterine artery?

A

Comes off side wall from internal iliac artery
Runs in lateral cervical ligament towards cervix
Gives vaginal branch
Turns up and runs along lateral side of uterus
Meets and anastomoses with ovarian artery where uterine tube connects with uterus

100
Q

What is the blood supply to the uterine tube?

A

Ovarian artery, after it supplies ovary

101
Q

In females, what is the inferior vesical artery a branch of?

A

Vaginal artery, rather than internal iliac artery

102
Q

What reinforces the blood supply to the rectum?

A

Middle rectal artery, coming off internal iliac artery

Site of porto-systemic anastomoses

103
Q

What is the nerve plexus of the pelvic viscera?

A

Hypogastric plexus

104
Q

Where is the hypogastric plexus situated?

A

On either side of rectum

105
Q

What fibres does the hypogastric plexus contain?

A

Sympathetic and parasympathetic

106
Q

Where are the pelvic parasympathetic components from?

A

Sacral plexus, from S2-4

107
Q

Where are the pelvic sympathetic components from?

A

Thoracolumbar chain

108
Q

How do the parasympathetic and sympathetic components reach the pelvic viscera?

A

Sacral plexus and thoracolumbar chain feed into superior hypogastric plexus
Form hypogastric nerves on either side
Feed into inferior hypogastric plexus
To viscera

MD1 Reproduction (11 decks)

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