Pelvic Viscera Flashcards
How do the ureters enter the pelvis minor?
pass over pelvic brim from retroperitoneal, just anterior to internal iliac vessels
What crosses over the ureters in males?
vas deferens
What crosses of the ureters in females?
uterine A
The ureters travel posteroinferiorly to lie above ___________as they approach the bladder
levator ani
What angle do the ureters enter the bladder at?
posterosuperior angle
–>immediately above seminal vesicles and inferior to vas deferens in males
What prevents retrograde flow of urine into ureters?
intramural portion of ureters–>one way flap
What spinal levels detect pain in ureters?
T10-L2
–>referred ipsilateral to lower abd quadrant and groin
The mucosa of the bladder are loosely attached except at the ___
trigone (neck of bladder)
Describe the location of the urinary bladder
anteroinferior par of pelvis minor
below peritoneum
resting on pelvic diaphragm
Why can a needle be placed above the pubic symphysis to collect urine?
as bladder fills, it ascends in the abdomen–> can obtain urine via this method without entering abd cavity
How many muscle layers make up the bladder?
3 detrusor smooth muscle
In males, what is the peritoneum of the bladder reflected over the superior surface of?
peritoneum reflected from the bladder over superior surface of VAS DEFERENS and SEMINAL VESICLES
What separates the base of the bladder from the rectum?
base of bladder= posterior
vas deferens and seminal vesicles
What peritoneal recess separates the bladder from the rectum in males?
rectovesical pouch
Where is the apex of the bladder?
anterior
–>where neck jxns with urethra
What part of the bladder rests on the prostate gland?
neck of bladder
What sphincter prevents retrograde flow of semen into bladder during ejaculation?
internal urethral sphincter within the neck of the bladder
What lie posterior to the bladder in females?
vagina
uterine cervix
What lie superior to the bladder in females?
fundus and body of uterus
What peritoneal pouch is located between the superior surface of the bladder and the uterus?
vesicouterine pouch
What holds the neck of the bladder in position in males and females?
males: puboprostatic L
females: pubovesical L
What surrounds the lateral surfaces of the bladder?
vesical fascia that contains vesical venous plexus
What are the 4 parts of the male urethra?
1: intramural (through bladder wall)
2: prostatic (prostate gland)
3: membranous urethra (UG diaphragm)
4: penile/spongy (penis that terminates at ext urethral orifice)
What is contained in the posterior wall of the prostatic urethra in males?
urethral crest
2 prostatic sinuses
–>where prostatic ducts empty
seminal colliculus
–>rounded eminence of crest
prostatic utricle
–>homologous to uterus and vagina
openings of ejaculatory ducts just lateral to utricle
What surrounds the membranous urethra in males that is part of the UG diaphragm?
external urethral sphincter
–>relaxes during urination and ejaculation
Describe the passage of the female urethra to the external urethral opening
passes anterioinferiorly from internal urethral orifice of bladder POSTERIOR to pubic symphysis
–>external urethral orifice in the vestibule of vagina
What are BL paraurethral glands on either side of urethra homologs to?
prostate gland
Where do the paraurethral ducts open?
near external urethral orifice
What compresses the urethra in females?
external urethral sphincter in urogenital diaphragm
What is a thick tube that is the continuation of the epididymis?
vas deferens
Describe the anatomical position of the vas deferens
ascends in spermatic cord, passes through inguinal canal, in contact with parietal peritoneum as it approaches bladder
–>crosses ureter so it is superior to the seminal vesicle
–>medial portion expands to form ampulla and joins duct of seminal vesicle to form ejaculatory duct
What joins to form the ejaculatory duct?
- ampulla of vas deferens
- duct of seminal vesicle
near the neck of the bladder
What are seminal vesicles?
accessory sex glands that produce seminal fluid (fructose), constitutes majority of semen
–>coiled tubes on the posterior surface of bladder b/t vas deferens and prostate gland
What is the pathway of the ejaculatory ducts?
pass anteroinferiorly through prostate gland to open on seminal colliculus in prostatic urethra
Where is the prostate gland?
surrounds prostatic urethra
What is the largest accessory gland in males?
prostate gland
–>walnut sized
Is the prostate gland made of glandular or muscular tissue?
BOTH–>fibromuscular
2/3 glandular
1/3 muscular
fibrous tissue in anterior lobe
R and L lobes have muscular tissue
What comprises 20% of semen?
milky, alkaline fluid from prostate
–>helps neutralize acidity of vaginal secretions
What is the main source of energy for sperm?
fructose
What surrounds prostate gland?
visceral pelvic fascia
–>dense fascial sheath
Describe the shape of the prostate gland
conical
- > base near neck of bladder
- ->apex adjacent to UG diaphragm
- –>anterior, posterior and lateral surfaces
What space is anterior to the prostate gland?
retropubic space
–>filled with fat
What is posterior to the prostate gland?
ampulla of rectum
What is inferolateral to the prostate gland?
levator ani M
What is benign prostatic hypertrophy?
enlargement of posterior middle portion of prostate
–>narrows prostatic urethra
**usually older men
Where does 50% of all cancers originate in males?
prostate gland
–>mets to lymph or spine, liver and lungs
What pea-sized accessory sex glands are located in the UG diaphragm lateral to the membranous urethra?
bulbourethral glands
What is the passage/action of bulbourethral glands?
pass through perineal membrane to penetrate bulb of penis–>opens into proximal spongy urethra
–>produces mucous secretion that is released prior to ejaculation to lubricate urethra
What are on either side of the vagina?
levator ani and broad ligaments of uterus
What is anterior to the vagina?
bladder and urethra
What lie posterior to the vagina?
rectouterine pouch
rectum
anal canal
What are the subdivisions of the vagina?
anterior fornix
posterior fornix
2 lateral fornices
What fornix of the vagina is the deepest subdivision r/t peritoneum forming rectouterine pouch?
posterior fornix
Where is the uterus located?
pelvis minor
Where is the cervix of the uterus located?
between bladder and rectum
What is the external and internal os?
internal os: internal opening into cervix
external os: opening in cervix next to vagina
What surrounds the external os?
vaginal fornix
What are the layers of the uterus?
1: perimetrium
- ->peritoneum
2: myometrium
- ->smooth muscle
3: endometrium
- ->epithelium with glands
What is the anteroinferior surface of the uterus r/t>
urinary bladder
What is the posterosuperior surface of the uterus r/t?
intestines
What are the R and L borders of the uterus a/w?
broad ligaments of uterus
Describe the round L of the uterus
side of uterus to deep inguinal ring–>traverses inguinal canal
–>terminates in subq of labia majora after passing through superficial inguinal ring
Describe the transverse or lateral cervical ligament of the uterus
from cervix and lateral vaginal fornices to lateral walls of pelvis minor
Describe uterosacral L of uterus
sides of cervic toward sacrum b/t peritoneum and levator ani
What are the parts of the broad L of uterus?
2 layers of peritoneum draped over uterine tubes
1: mesometrium attached to uterus
2: mesosalpinx a/w uterine tubes (oviducts)
3: mesovarium a/w ovary
Describe the pathway of the broad L of uterus
from sides of uterus to lateral walls and floor of pelvis
Where are the ovaries located?
near later wall of pelvis minor in ovarian fossa
–>posterior side of broad ligament
What is the fxn of the ligament of the ovary?
attaches medial portion of ovary to lateral angle of uterus
What is the fxn of suspensory ligmanet of ovary?
thickening of CT that contains ovarian vessels and nerves
–>from lateral wall of pelvic cavity to ovary
Where is an epidural given?
L3-4
–>bathes pain fibers from cervix, superior vagina and pudendal N
How is a mother with epidural aware of uterine contractions?
epidural numbs everything EXCEPT pain fibers from the uterine body–> will still be aware of contractions
What block would you use if the mother can still feel uterine contractions?
pudendal nerve block (S2-4)
**doesn’t block pain from superior birth canal
–>with epidural, is only aware of contractions
