Pelvic Viscera (General and Male) Flashcards
apex of urinary bladder is attached to what?
median umbilical ligament
the outflow opening of the bladder is what?
internal urethral orifice
urinary bladder is found where
retroperitoneal
anterior pelvis
posterior to pubic bones
urinary bladder rest on what in males
prostate gland
urinary bladder rest on what in females
pelvic diaphragm
retropubic space of Retzius (what is it/what does it do)
space with a pad of fat that separates the urinary bladder from pubic bone
fat and fascia around the bladder allows what
it to expand
filled bladder can do what to anterior abdominal wall
peel peritoneum from the anterior abdominal wall
surgical approach to distended bladder (where can it be done and what about this location is good)
can be done above pubis without entering peritoneal cavity
reduces the risk of peritonitis
suprapubic cystostomy
suprapubic catheterization to draw urine from bladder if urethral catheterization not possible due to urethral obstruction
the wall of the bladder (what are its properties)
muscular and distensible
mucosa lining of the bladder (describe it, what does it allow for)
loose and folded to allow for stretching or contraction of bladder wall (except at trigone)
Trigone (what is it)
smooth area on inner surface of posterior wall of bladder
shaped like an upside-down triangle
upper corners of the trigone mark waht
openings of ureters
Ureters (course in bladder)
course through bladder wall obliquely
contraction of the muscles of the bladder wall presents what? (in terms of ureter)
reflux of urine from bladder into ureter
the bladder wall constricts the ureter resulting in what?
potential site where kidney stone can lodge
lower corner of trigone marks what
internal orifice of urethra
the urinary bladder is innervated by what
sympathetic fibers (trigonal muscle and internal sphincter of bladder) parasympathetic fibers via pelvic splanchnic nerves (detrusor and internal sphincter of bladder)
muscles of bladder (name them)
detrusor muscles
internal sphincter of bladder (sphincter vesicae)
trigonal muscle
detrusor muscles (what are they, innervation)
three layered, smooth muscular coats of bladder
stimulated by parasympathetic fibers of pelvic splanchnic nerves
internal sphincter of bladder (sphincter vesicae)
what is it, innervation
circular smooth muscle surrounding neck of bladder (area above prostate in males) and internal urethral orifice
stimulated by sympathetics
inhibited by parasympathetics
internal sphincter of bladder in females is?
rudimentary
internal sphincter of bladder (sphincter vesicae) is under what type of control
sympathetics but it is NOT voluntary
micturition (what is it)
exertion of urine
micturition (how is it accomplished)
contraction of the detrusor muscles and relaxation of the internal sphincter
micturition (is a result of what kind of stimulation)
parasympathetics (detrusor contacts and sphincter relaxes)
in infants bladder emptying is what?
involuntary reflex
in toilet-trained individuals the bladder emptying reflex is under control of what
cerebral cortex
afferents of the bladder are supplied by what
sacral nerves (S2-S4) via pelvic splanchnic nerves lumbar nerves (L1, L2)
referred pain from bladder is to where?
tip of penis (S2-S4)
hypogastric region of anterior abdominal wall (L1)
arterial supply to the urinary bladder is through what
superior and inferior vesical arteries
blood drainage from the urinary bladder is through what
vesical venous plexus (surrounding neck of bladder) which drain to superior and inferior vesicle veins
vesical veins drain into what
internal iliac veins
lymph from the urinary bladder drains where
internal iliac nodes
rectum (where does it arise, and course)
arises at level of S3 vertebra
follow curve of sacrum
ends near tip of coccyx
rectum (shape)
s-shaped with three sharp flexures in coronal plane
anorectal junction is locate where
pelvic diaphragm
what is found posterior to the rectum
sacrum and coccyx
piriformis
sympathetic trunk
what is found anterior to the rectum in males
posterior side of bladder
ductus deferens
seminal vesicles
prostate
Rectovesical Septum of Denonvilliers (what and where is it)
fused inferior end of peritoneum
lies between base of bladder and rectum
Rectovesical Septum of Denonvilliers (convenient plane for what?)
convienent plane for separating bladder and prostate from rectum when excising cancerous rectum
what is found anterior to the rectum in females
vagina
cervix of uterus
Rectoveginal Septum of Denonvilliers (what and where is it)
fused inferior end of peritoneum
separates vagina from rectum
Rectovaginal Septum of Denonvilliers (what can it limit)
limit the spread of infection or cancer
what is found lateral to the rectum
ischial spine
ischial tuberosity
sacrotuberous ligament
peritoneal coverings of the rectum (what do they cover and where)
cover anterior and lateral surfaces of superior 1/3 of rectum
only anterior surface of middle 1/3
lower 1/3 has not peritoneal coverings
rectovesical pouch (what is it)
in males
it is formed by the reflection of peritoneum from rectum to superior-posterior surface of bladder
lowest part of male peritoneal cavity is
rectovesical pouch
peritoneal exudates (resulting from peritonitis) will drain into where patient is in sitting or supine positions
rectovesical pouch
Rectouterine Pouch (of Douglas)
in females
formed by the reflection of peritoneum from rectum posterior vagina and uterus
lowest point in female peritoneal cavity
rectouterine pouch
peritoneal exudes, acid from perforated duodenal ulcer, or blood from rupture ectopic pregnancy will drain into what if the female is in sitting or supine positions
rectouterine pouch
transverse rectal folds (what are they and what are they due to)
three semicircular horizontal folds of rectal mucosa
due to underlying smooth muscle
transverse rectal folds (where are they)
two on left (superior and inferior transverse rectal folds)
one on right (middle transverse rectal fold)
located at each of the three sharp flexures of the rectum
arterial supply of the rectum is composed of how many arteries what relationship do they have with eachother
5 arteries that anastomose with each other
Superior rectal artery (1)
middle rectal arteries (2)
inferior rectal arteries (2)
superior rectal artery (where is it from, location)
one from inferior mesenteric artery
located posterior to rectum
major blood supply from rectum comes from where
superior rectal artery
middle rectal arteries (where are they from)
from internal iliac arteries
sometimes absent
inferior rectal arteries (where are they from)
from internal pudendal arteries
venous drainage from rectum (whats special about it)
anastomose forming a connection between portal (superior rectal vein) and and systemic (middle and inferior rectal vein) venous system
lymph from the rectum drains to what
ascend with superior rectal vessels inferior mesenteric nodes
innervation of rectum
parasympathetic fibers from pelvic splanchnic nerves via inferior hypogastric plexus
sympathetic fibers from superior and inferior hypogastric plexuses
rectal prolapse (what is it)
abnormal descent of rectum through anal canal
can occur in young children since sacrum is not curved as in adult
can occur if not enough support from puborectalis muscle of levator ani
ductus deferens (path)
enters pevis crossing over external iliac artery, crosses over ureter and posterolateral angle of bladder
descends posterior to surface of bladder
ampulla of ductus deferens (what is it)
dilated distal part of ductus deferens
ejaculatory duct (what forms it)
formed by terminal part of ductus deferens joining the duct of the seminal vesicle
ejaculatory duct (path)
peirces surface of prostate gland to enter prostatic urethra (on either side of the out pocketing of prostatic uretrha called prostatic utricle
prostatic utricle
out pocketing of prostatic urethra where the ejaculatory duct enters
seminal vesicle (what and where is it)
lobular sac
posterior surface of bladder
seminal vesicle ( how is it formed)
lateral outgrowth of ductus deferens
duct of seminal vesicle does what
joins ductus deferens to form ejaculatory duct
seminal vesicle (secretes what)
thick fluid that contains nutritive substances for sperm
fluid mixes with semen
superior border of the seminal vesicle (whats special about it)
covered in peritoneum
ductus deferens in pelvis has what around it
mostly covered by peritoneum
prostate gland (what and where is it)
large, accessory reproductive gland
surrounds prostatic part of urethra
prostate gland (what type of gland)
glandular and muscular
prostate gland (what does it produce)
alkaline secretion added to semen to neutralize the acidity of vagina
what is superior to the prostate gland
bladder
what is inferior to the prostate gland
urogenital gap in pelvic diaphragm and urogenital diaphragm
wat is posterior to the prostate gland
rectum
what is anterior to the prostate gland
pubic bones with intervening retropubic fat in retropubic space
capsule of prostate gland (what is it)
fibrous and on the surface of the gland
surrounded by endopelvic fascia
lobes of prostate gland (how many are there and what defines them)
5 of them defined by passage of urethra and two ejaculator ducts through prostate
median lobe of prostate (location)
between urethra and ejaculatory ducts
common location of benign prostatic hypertrophy (BPH)
median lobe of prostate
what triggers urination during night (nocturia)
median lobe bulging into bladder at internal urethral orifice resulting in dripping of urine into urethra
right and left lateral lobes of prostate (location)
separated by prostatic urethra
may become enlarged (BHP) and compress urethra
Posterior Lobe of Prostate (location)
located inferior to ejaculatory duct and posterior to prostatic urethra
common site for carcinoma in prostate
posterior lobe
Anterior Lobe of Prostate (location and contents)
located anterior to prostatic urethra
contains little glandular tissue
the arteries that supply the prostate come from where
inferior vesical artery
veins of the prostate drain into what
valveless prostatic venous plexus
prostatic venous plexus (waht does it drain into and communicate with)
drains into internal iliac vein
communicated with vesicle pleases of bladder and internal and external vertebral venous plexuses
spread of prostatic carcinoma
can potentially spread extensively via venous communications to spinal column and cord and to the brain
Route for metastatic prostatic carcinoma to vertebral column and spinal cord
prostatic venous plexus→vesical venous plexus→internal iliac vein→lateral sacral vein→internal vertebral venous plexus (vertebral column) and radicular veins (spinal cord)
lymph from the prostate gland drains where
internal iliac nodes
prostatic urethra (compared to rest of urethra is)
widest and most dilatable part (no problem inserting Foley catheter at this part)
posterior wall of prostatic urethra contains
urethral crest
prostatic sinus
seminal colliculus
urethral crest (what is it)
median ridge of posterior wall of prostatic urethra
prostatic sinus (what is it, what does it do)
groove on each side of urethral crest
receives 20-30 prostatic ducts
seminal colliculus (what is it, what does it do)
rounded eminence on urethral crest
has a slit-like orifice leading to small vestigial prostatic utricle and two openings for ejaculatory ducts on either side of prostatic utricle
prostatic utricle (what is it)
diverticulum from posterior wall of prostatic urethra
what is located on each side of orifice to prostatic utricle
openings for ejaculatory duct
emission (what is it)
involuntary discharge of semen
emission is dependent on what
sympathetic innervation (from spinal level L1) of the ductus deferens, seminal vesicle, and prostate gland
sympathetic stimulation during emission does what
smooth muscle of ductus deferens contracts to propel sperm towards prostatic urethra
glands of prostate and seminal vesicles release their secretions
internal sphincter of bladder contacts to prevent reflux of semen into urinary bladder
iatrogenically-induced sterility (what is it)
disruption of sympathetic nerve fibers to ductus deferens and seminal vesicles results in sterility because emission does not occur
iatrogenically-induced sterility occurs as a result of what
surgery in pelvis
iatrogenically-induced sterility (what effect on erection)
none- erection is under parasympathetic control
surgical enlargement of prostatic urethra (transurethral resection) in patient with BPH can result in what
damage to internal sphincter of bladder damage to internal sphincter of bladder resulting in reflux of semen into bladder
