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Endo/Repro Final > Pelvic Viscera > Flashcards

Pelvic Viscera Flashcards

1
Q

The parietal peritoneum does not reach the pelvic floor — what is the lowest point in males?

A

Rectovesical pouch — about 2 cm above the seminal vesicles

[abdominal fluid collects here; abscesses are likely to form here]

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2
Q

Pelvic peritoneum in males descends anterior abdominal wall, with a loose attachment here for insertion of the bladder as it fills. The peritoneum reflects onto the superior surface of the bladder, creating the ________ ______.

Pelvic peritoneum covers the convex superior surface of the bladder and slopes down the sides of roof to ascend lateral wall of pelvis, creating a _____ _____ on each side. It descends th eposterior surface of the bladder as much as 2 cm

A

Supravesical fossa

Paravesical fossa

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3
Q

The pelvic peritoneum in males — laterally forms folds over what 3 structures?

A

Ureters (ureteric fold)
Ductus deferens
Superior ends of seminal glands

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4
Q

The pelvic peritoneum reflects from the bladder and seminal glands onto the rectum, forming the _____ _____, which extends laterally and posteriorly to form a _______ _____ on each side of the rectum

A

Rectovesical pouch; pararectal fossa

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5
Q

The pelvic peritoneum ascends the rectum from inferior to superior, so the rectum is initially subperitoneal, and then __________

It engulfs the sigmoid colon beginning at the ________ junction

A

Retroperitoneal; rectosigmoid

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6
Q

What is the named space in males between the pubis and bladder?

A

Retropubic space

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7
Q

What is the named space in males between the rectum and the sacrum?

A

Retrorectal (presacral) space

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8
Q

What is the named space in males between the bladder and rectum?

A

Rectovesical pouch/fossa

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9
Q

The levator ani and associated musculature supporting the pelvic floor is weak; what is the named CT assisting in this support?

A

Endopelvic fascia

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10
Q

The endopelvic fascia exists beneath the peritoneum and covers viscera, pelvic wall, and floor; it is continuous with _____ ______

A

Endoabdominal fascia

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11
Q

The endopelvic fascia is thickened in certain areas, particularly the tendinous arch of the ____ ____ musculature

A

Levator ani

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12
Q

The endopelvic fascia forms the _______ ligament in males

It forms the ________ and _______ ligaments in females

A

Puboprostatic

Pubovesical; pubocervical

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13
Q

The endopelvic fascia forms the lateral ligament of the ____ and _____

A

Bladder; rectum

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14
Q

The endopelvic fascia forms the ______ ligament which supports the cervix in females

A

Cardinal (transverse cervical)

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15
Q

The endopelvic fascia forms the _______ in females, which is the thickened fascia from lateral vagina to tendinous arch of levator ani

A

Paracolpium

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16
Q

In terms of anatomic relationships, the ureter travels _____ the vas deferens

The bladder is _____ to the prostate

The seminal vesicles lie on the _____ surface of the bladder

The bulbourethral gland is located ______ the UG membrane

A

Under

Superior

Posterior

Within

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17
Q

Where is the prostate located in reference to the bladder and the UG membrane?

A

The prostate is immediately below the bladder but superior to the UG membrane

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18
Q

The ureters connect the kidneys to the urinary bladder and are retroperitoneal; they pass over the pelvic brim and enter the ______ pelvis. The ureters pass obliquely through the urinary bladder wall in a ________ direction.

A

Lesser; inferomedial

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19
Q

In males, the ureters run inferior to the ______ ______; in females, they run inferior to the ______ ______

A

Vas deferens; uterine artery

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20
Q

The ureters receive blood supply from multiple arteries — what are the 4 main branches?

A

Renal, gonadal, aortic, and internal iliac branches

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21
Q

What nerves supply the ureters?

A

Preaortic plexus
Hypogastric plexus
Pelvic splanchnics (parasympathetics S2-4)

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22
Q

How is the bladder oriented in terms of apex, fundus, body, and neck?

A

The apex points toward the pubic symphysis, the fundus just the opposite

The body lies between the apex and fundus, and the neck lies at the bottom

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23
Q

What ligament connects the apex of the bladder to the internal umbilical region? What is the obliterated embryological structure?

A

Median umbilical ligament (obliterated urachus)

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24
Q

Besides the median umbilical ligament anteriorly, what other ligaments support the bladder?

A

Lateral ligament (endopelvic fascia)

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25
Q

The superior surface of the bladder is triangular and bounded by a line connecting the _______

A

Ureters

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26
Q

T/F: the bladder typically rises above the pelvic brim

A

False; the bladder only rises above the pelvic brim when full — if it is empty it does not

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27
Q

________ muscle lines the bladder walls and is continuous with the ____ _____ sphincter, as well as the _______ sphincters

A

Detrusor; internal urethral; ureteric

[detrusor m. is visceral smooth m.]

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28
Q

What is the purpose of the sensory receptors in the bladder wall and posterior urethra?

A

They sense stretch when the bladder fills with urine, and play a role in the micturition reflex

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29
Q

The internal urethral sphincter in males is made up of ________ fibers and is continuous with smooth muscle called the ______ m.

A

Circular; detrusor

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30
Q

The external urethral sphincter in males is made up of skeletal fibers that are deficient in the _____ region of the urethra. It is located primarily at the level of the _______ urethra in males, but extends superiorly around the _____ urethra

A

Posterior; membranous; prostatic

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31
Q

What innervates the internal urethral sphincter?

A

Inferior hypogastric plexus (mixed autonomic supply)

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32
Q

What innervates the external urethral sphincter?

A

Deep perineal branch of pudendal n. (Somatic innervation)

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33
Q

What are the 4 named parts of the male urethra (from bladder to external)

A

Intramural
Prostatic
Membranous
Spongy

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34
Q

The _____ ______ is simply a posterior ridge on the urethra as it passes through the prostate.

The ____ ______ is an enlarged area on the above structure onto which the 2 ejaculatory ducts open, bringing sperm from the ____ _____ and fluid from the ____ ____

A

Urethral crest

Seminal colliculus; vas deferens; seminal vesicle

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35
Q

The ____ ____ is a remnant of the paramesonephric system associated with the prostate gland

The ____ ____ are depressions on either side of the ridge into which prostatic glands open and secrete an alkaline prostatic fluid

A

Prostatic utricle

Prostatic sinuses

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36
Q

The prostatic urethra is surrounded by the walnut-size prostate, which is made up of 2/3 ______, 1/3 _______ tissue. The base is closely related to the neck of the _______.

A

Gland; fibromuscular; bladder

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37
Q

The apex of the prostate is in contact with fascia on the superior aspect of the ______ sphincter and deep _____ muscles. Prostatic ducts open chiefly into the ____ ____

A

Urethral; perineal; prostatic sinuses

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38
Q

What is the largest male reproductive accessory organ?

A

Prostate

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39
Q

What benign condition is common in males after middle age, in which urination may be impeded by distortion of the prostatic urethra?

A

Hypertrophy of prostate

40
Q

BPH is a common cause of what conditions?

A 
Urethral obstruction
Nocturia
Dysruia
Urinary urgency
Cystitis
Kidney damage
41
Q

How are prostatic enlargements or tumors commonly diagnosed?

A

Digital rectal exam — abnormal finding is hard and irregular shape, indicating malignancy

42
Q

The vas deferens enters the abdomen via the ______ inguinal ring. It passes superior to all structures, including the ureters and iliac vessels. It passes superiorly and medially to the ureter, expanding into an _______ before narrowing again and joining the duct of the ___ ____

A

Deep; ampulla; seminal vesicle

43
Q

_______ ______ are bilateral, lobulated sacs lying lateral to the ampulla of the vas deferens. Their ducts and the vas deferens join on each side to form an _____ ______

A

Seminal vesicles; ejaculatory duct

44
Q

What is the vascular supply to the seminal vesicles?

A

Umbilical aa.

Inferior vesicular aa.

45
Q

Which region of the prostate do the ducts of the seminal vesicle join the vas deferens to form the ejaculatory ducts?

A

Posterior/inferomedial region

46
Q

What supplies sympathetic innervation to the male reproductive organs in general?

A

Inferior hypogastric plexus T10-L2 via similar routes as bladder

47
Q

What supplies parasympathetic innervation to the male reproductive organs in general?

A

Pelvic splanchnic nn.

48
Q

Most visceral afferent fibers supplying the male reproductive organs travel with __________ fibers ___-___

A

Parasympathetic; S2-S4

49
Q

Most visceral afferent fibers supplying the male reproductive organs travel with parasympathetic fibers S2-S4. Which organs are the exception to this?

A

Testis — for which the visceral afferents travel with sympathetics to T10 (d/t their embryological development higher in abdominal cavity)

50
Q

Most lymphatic drainage from the vas deferens and inferior portion of the seminal vesicles is to the ____ ____ nodes; with the scrotal portion of the vas deferens draining into the ____ ____nodes

A

Internal iliac; external iliac

51
Q

The prostate drains lymph chiefly in the ___ ____ nodes with some to the _______ nodes

A

Internal iliac; sacral

52
Q

The superiolateral portion of the bladder drains lymph to the ____ nodes

The fundus and neck of the bladder drain to the _____ nodes

A

External iliac

Internal iliac

53
Q

What pelvic viscera is associated with the pelvic cavity in females?

A

Bladder
Uterus and ovaries
Uterine tubes
Vagina

54
Q

What 3 folds in the female pelvic cavity are comprised of 2 layers of peritoneum?

A

Rectouterine fold
Suspensory ligament of ovary
Broad ligament

55
Q

What 2 pouches exist in the female pelvic cavity and are continuous with the abdominopelvic cavity?

A 
Vesicouterine pouch
Rectouterine pouch (culdesac of douglas)
56
Q

What 3 spaces are associated with the female pelvic cavity?

A

Retropubic (prevesical) space
Retrovesical space
Retrorectal (presacral) space

57
Q

The rectouterine and vesicouterine pouches in females are separated by the _______ ligament and the uterus.

A

Round

58
Q

The _______ pouch can be surgically approached through the posterior fornix of the vagina

Note that the lateral extensions, which make up the _____ ____, can be the deepest.

Recesses lateral to the bladder are referred to as ________ ______, which get deeper as the bladder fills

A

Rectouterine

Pararectal fossa

Paravesical fossa

59
Q

What structures are contained within the broad ligament in females?

A 
Ovarian vessels (within the suspensory ligament itself)
Uterine tube
Ovary
Uterus
Proper ovarian ligament
60
Q

What structures lie in the base of the broad ligament in females?

A

Uterine artery and vein

Ureter

61
Q

What are the 3 named parts of the broad ligament in females?

A

Mesovarium - between ovary and round ligament of uterus

Mesosalpinx - between the uterine tube and round ligament of uterus

Mesometrium - going to the uterus

62
Q

Underneath the broad ligament is the ______ ______, which thickens in a certain area becoming the ______ ligament — which runs right below the uterine artery

A

Endopelvic fascia; cardinal

63
Q

The female endopelvic fascia is sometimes collectively referred to as the _____ ______. It supports the viscera and conducts neurovasculature to organs.

A

Hypogastric sheath

64
Q

What provides the main support for the uterus?

A

The cardinal ligament (aka the transverse cervical ligament)

65
Q

What ligament is found within the rectouterine fold?

A

Uterosacral ligament

66
Q

Although the cardinal ligament provides the MAIN support for the uterus, what other 3 ligaments are involved in supporting this organ?

A

Round ligament
Pubocervical ligament
Uterosacral ligament

67
Q

What blood vessels are found in the pubocervical ligament?

A

Superior vesicular artery and vein

68
Q

What vessels are found in the uterosacral ligament?

A

Middle rectal artery and vein

69
Q

The uterus is commonly divided into what 3 parts?

A

Fundus
Body
Cervix

70
Q

The ____ of the uterus protrudes into the vagina, forming the vaginal ________, as well as the internal and external os

A

Cervix; fornices

71
Q

The major changes that occur in the uterus during the menstrual cycle are primarily in the ______

A

Endometrium

72
Q

What are the 3 layers of the uterine wall?

A

Perimetrium
Myometrium
Endometrium

73
Q

When referring to uterine position, _______ refers to the angle between the cervix and vagina, and ______ refers to the angle between the uterine body and cervix.

The 2 normal positions of the uterus using the terms above are _____ and ______

A

Verted; flex

Anteverted; anteflexed

74
Q

A retroverted uterus is usually genetic — but can be caused by what other conditions?

A

Fibroids
Endometriosis
PID
Labor

75
Q

A retroverted uterus does not have an effect on fertility, but can be associated with what symptoms?

A

LBP
Dysuria
Dysparunia

76
Q

Although uncommon, pregnant retroflexed uterus can be trapped by the curve of the ____

A

Sacrum

77
Q

What condition concerning the uterus can occur when pelvic ligaments (especially the cardinal ligament) OR pelvic diaphragm weakens/tears?

A

Uterine prolapse — can be first, second, or third degree

78
Q

What is the main cause of pelvic organ prolapse in females? What are some other causes?

A

Pregnancy

Other causes include aging, menopause, and obesity

79
Q

What are the 3 histological layers of the uterine tubes?

A

Mucosa
Muscularis
Serosa

80
Q

The uterine tubes lie in the free edge of the _____ ligament and function to carry ova to the uterine cavity; assisted by motile _____ within the tube

The _____ layer folds change during menstruation, though not as dramatically

A

Broad; cilia

Mucosal

81
Q

What are the named regions of the uterine tubes? Where in the tube does fertilization typically occur?

A

Fimbria
Infundibulum
Ampulla (fertilization site)
Isthmus

82
Q

The ovaries lie on the lateral walls of the female pelvis. They are covered laterally by what structures?

A

Fimbrae of the uterine tubes

83
Q

What are the anterior, lateral, and medial attachments of the ovaries?

A

Anteriorly to broad ligament via mesovarium

Laterally to suspensory ligament

Medially to proper ovarian ligament

84
Q

The _______ is the recess between the cervix and vaginal wall

A

Fornix

85
Q

The opening to the vaginal vestibule can be partially closed by a membranous ______, which may be imperforate in 1:1000

A

Hymen

86
Q

The female urethra is adjacent to the _______ wall of the vagina. It penetrates the _____ membrane and opens anterior to the vaginal vestibule

A

Anterior; urogenital

87
Q

The female urethral sphincters differ from males in what ways?

A

The sphincter proximity and length differs — in females they are arranged superficial -> deep instead of proximal/distal

88
Q

Which urethral sphincter aids in reflex closure of the urethra during acute instances of increased intra-abdominal pressure d/t coughing, sneezing, laughing, etc.?

A

EUS

89
Q

In which part of the EUS is striated muscle length and thickness lost with age?

A

Proximal EUS

90
Q

Pelvic floor exercises can increase the size of what urethral sphincter?

A

External

91
Q

In the female pelvic viscera, most lymph drains to the __________ nodes

However there are exceptions:
The round ligament, fundus (+ external genitalia) drain to _____ nodes. The ovary, uterine tube, and fundus drain to _____ nodes

A

Iliac

Superficial inguinal; lumbar

92
Q

What provides primary efferent innervation to female internal viscera?

A

Inferior hypogastric plexus

93
Q

The ovarian plexus is composed of parasympathetics from _____ n. and sympathetics from _____

A

vagus; T10/11

94
Q

What imaginary line is considered the inferior limit of the peritoneum?

A

Pelvic pain line

95
Q

What provides general visceral afferents above the pelvic pain line?

A

Sympathetic to T12-L2

Includes structures within the broad ligament (body and fundus of uterus)

96
Q

What provides general visceral afferents below the pelvic pain line?

A

Parasympathetics to pelvic (S2-4)

97
Q

Anesthesia specifically targets pelvic pain line differences. What are the 3 types of nerve blocks utilized?

A

Spinal block or lumbar puncture — blocks from waist down (intra and sub-peritoneal plus somatic areas)

Caudal block — blocks sub-peritoneal and somatic areas innervated by pudendal n.

Pudendal nerve block — blocks areas innervated by the pudendal nerve

Endo/Repro Final (20 decks)

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