Pelvic Viscera (General and Male) Flashcards
1
Q
apex of urinary bladder is attached to what?
A
median umbilical ligament
2
Q
the outflow opening of the bladder is what?
A
internal urethral orifice
3
Q
urinary bladder is found where
A
retroperitoneal
anterior pelvis
posterior to pubic bones
4
Q
urinary bladder rest on what in males
A
prostate gland
5
Q
urinary bladder rest on what in females
A
pelvic diaphragm
6
Q
retropubic space of Retzius (what is it/what does it do)
A
space with a pad of fat that separates the urinary bladder from pubic bone
7
Q
fat and fascia around the bladder allows what
A
it to expand
8
Q
filled bladder can do what to anterior abdominal wall
A
peel peritoneum from the anterior abdominal wall
9
Q
surgical approach to distended bladder (where can it be done and what about this location is good)
A
can be done above pubis without entering peritoneal cavity
reduces the risk of peritonitis
10
Q
suprapubic cystostomy
A
suprapubic catheterization to draw urine from bladder if urethral catheterization not possible due to urethral obstruction
11
Q
the wall of the bladder (what are its properties)
A
muscular and distensible
12
Q
mucosa lining of the bladder (describe it, what does it allow for)
A
loose and folded to allow for stretching or contraction of bladder wall (except at trigone)
13
Q
Trigone (what is it)
A
smooth area on inner surface of posterior wall of bladder
shaped like an upside-down triangle
14
Q
upper corners of the trigone mark waht
A
openings of ureters
15
Q
Ureters (course in bladder)
A
course through bladder wall obliquely
16
Q
contraction of the muscles of the bladder wall presents what? (in terms of ureter)
A
reflux of urine from bladder into ureter
17
Q
the bladder wall constricts the ureter resulting in what?
A
potential site where kidney stone can lodge
18
Q
lower corner of trigone marks what
A
internal orifice of urethra
19
Q
the urinary bladder is innervated by what
A
sympathetic fibers (trigonal muscle and internal sphincter of bladder) parasympathetic fibers via pelvic splanchnic nerves (detrusor and internal sphincter of bladder)
20
Q
muscles of bladder (name them)
A
detrusor muscles
internal sphincter of bladder (sphincter vesicae)
trigonal muscle
21
Q
detrusor muscles (what are they, innervation)
A
three layered, smooth muscular coats of bladder
stimulated by parasympathetic fibers of pelvic splanchnic nerves
22
Q
internal sphincter of bladder (sphincter vesicae)
what is it, innervation
A
circular smooth muscle surrounding neck of bladder (area above prostate in males) and internal urethral orifice
stimulated by sympathetics
inhibited by parasympathetics
23
Q
internal sphincter of bladder in females is?
A
rudimentary
24
Q
internal sphincter of bladder (sphincter vesicae) is under what type of control
A
sympathetics but it is NOT voluntary
25
micturition (what is it)
exertion of urine
26
micturition (how is it accomplished)
contraction of the detrusor muscles and relaxation of the internal sphincter
27
micturition (is a result of what kind of stimulation)
parasympathetics (detrusor contacts and sphincter relaxes)
28
in infants bladder emptying is what?
involuntary reflex
29
in toilet-trained individuals the bladder emptying reflex is under control of what
cerebral cortex
30
afferents of the bladder are supplied by what
```
sacral nerves (S2-S4) via pelvic splanchnic nerves
lumbar nerves (L1, L2)
```
31
referred pain from bladder is to where?
tip of penis (S2-S4)
| hypogastric region of anterior abdominal wall (L1)
32
arterial supply to the urinary bladder is through what
superior and inferior vesical arteries
33
blood drainage from the urinary bladder is through what
vesical venous plexus (surrounding neck of bladder) which drain to superior and inferior vesicle veins
34
vesical veins drain into what
internal iliac veins
35
lymph from the urinary bladder drains where
internal iliac nodes
36
rectum (where does it arise, and course)
arises at level of S3 vertebra
follow curve of sacrum
ends near tip of coccyx
37
rectum (shape)
s-shaped with three sharp flexures in coronal plane
38
anorectal junction is locate where
pelvic diaphragm
39
what is found posterior to the rectum
sacrum and coccyx
piriformis
sympathetic trunk
40
what is found anterior to the rectum in males
posterior side of bladder
ductus deferens
seminal vesicles
prostate
41
Rectovesical Septum of Denonvilliers (what and where is it)
fused inferior end of peritoneum
| lies between base of bladder and rectum
42
Rectovesical Septum of Denonvilliers (convenient plane for what?)
convienent plane for separating bladder and prostate from rectum when excising cancerous rectum
43
what is found anterior to the rectum in females
vagina
| cervix of uterus
44
Rectoveginal Septum of Denonvilliers (what and where is it)
fused inferior end of peritoneum
| separates vagina from rectum
45
Rectovaginal Septum of Denonvilliers (what can it limit)
limit the spread of infection or cancer
46
what is found lateral to the rectum
ischial spine
ischial tuberosity
sacrotuberous ligament
47
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
48
rectovesical pouch (what is it)
in males
| it is formed by the reflection of peritoneum from rectum to superior-posterior surface of bladder
49
lowest part of male peritoneal cavity is
rectovesical pouch
50
peritoneal exudates (resulting from peritonitis) will drain into where patient is in sitting or supine positions
rectovesical pouch
51
Rectouterine Pouch (of Douglas)
in females
| formed by the reflection of peritoneum from rectum posterior vagina and uterus
52
lowest point in female peritoneal cavity
rectouterine pouch
53
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
54
transverse rectal folds (what are they and what are they due to)
three semicircular horizontal folds of rectal mucosa
| due to underlying smooth muscle
55
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
56
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)
57
superior rectal artery (where is it from, location)
one from inferior mesenteric artery
| located posterior to rectum
58
major blood supply from rectum comes from where
superior rectal artery
59
middle rectal arteries (where are they from)
from internal iliac arteries
| sometimes absent
60
inferior rectal arteries (where are they from)
from internal pudendal arteries
61
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
62
lymph from the rectum drains to what
ascend with superior rectal vessels inferior mesenteric nodes
63
innervation of rectum
parasympathetic fibers from pelvic splanchnic nerves via inferior hypogastric plexus
sympathetic fibers from superior and inferior hypogastric plexuses
64
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
65
ductus deferens (path)
enters pevis crossing over external iliac artery, crosses over ureter and posterolateral angle of bladder
descends posterior to surface of bladder
66
ampulla of ductus deferens (what is it)
dilated distal part of ductus deferens
67
ejaculatory duct (what forms it)
formed by terminal part of ductus deferens joining the duct of the seminal vesicle
68
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
69
prostatic utricle
out pocketing of prostatic urethra where the ejaculatory duct enters
70
seminal vesicle (what and where is it)
lobular sac
| posterior surface of bladder
71
seminal vesicle ( how is it formed)
lateral outgrowth of ductus deferens
72
duct of seminal vesicle does what
joins ductus deferens to form ejaculatory duct
73
seminal vesicle (secretes what)
thick fluid that contains nutritive substances for sperm
| fluid mixes with semen
74
superior border of the seminal vesicle (whats special about it)
covered in peritoneum
75
ductus deferens in pelvis has what around it
mostly covered by peritoneum
76
prostate gland (what and where is it)
large, accessory reproductive gland
| surrounds prostatic part of urethra
77
prostate gland (what type of gland)
glandular and muscular
78
prostate gland (what does it produce)
alkaline secretion added to semen to neutralize the acidity of vagina
79
what is superior to the prostate gland
bladder
80
what is inferior to the prostate gland
urogenital gap in pelvic diaphragm and urogenital diaphragm
81
wat is posterior to the prostate gland
rectum
82
what is anterior to the prostate gland
pubic bones with intervening retropubic fat in retropubic space
83
capsule of prostate gland (what is it)
fibrous and on the surface of the gland
| surrounded by endopelvic fascia
84
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
85
median lobe of prostate (location)
between urethra and ejaculatory ducts
86
common location of benign prostatic hypertrophy (BPH)
median lobe of prostate
87
what triggers urination during night (nocturia)
median lobe bulging into bladder at internal urethral orifice resulting in dripping of urine into urethra
88
right and left lateral lobes of prostate (location)
separated by prostatic urethra
| may become enlarged (BHP) and compress urethra
89
Posterior Lobe of Prostate (location)
located inferior to ejaculatory duct and posterior to prostatic urethra
90
common site for carcinoma in prostate
posterior lobe
91
Anterior Lobe of Prostate (location and contents)
located anterior to prostatic urethra
| contains little glandular tissue
92
the arteries that supply the prostate come from where
inferior vesical artery
93
veins of the prostate drain into what
valveless prostatic venous plexus
94
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
95
spread of prostatic carcinoma
can potentially spread extensively via venous communications to spinal column and cord and to the brain
96
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)
97
lymph from the prostate gland drains where
internal iliac nodes
98
prostatic urethra (compared to rest of urethra is)
widest and most dilatable part (no problem inserting Foley catheter at this part)
99
posterior wall of prostatic urethra contains
urethral crest
prostatic sinus
seminal colliculus
100
urethral crest (what is it)
median ridge of posterior wall of prostatic urethra
101
prostatic sinus (what is it, what does it do)
groove on each side of urethral crest
| receives 20-30 prostatic ducts
102
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
103
prostatic utricle (what is it)
diverticulum from posterior wall of prostatic urethra
104
what is located on each side of orifice to prostatic utricle
openings for ejaculatory duct
105
emission (what is it)
involuntary discharge of semen
106
emission is dependent on what
sympathetic innervation (from spinal level L1) of the ductus deferens, seminal vesicle, and prostate gland
107
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
108
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
109
iatrogenically-induced sterility occurs as a result of what
surgery in pelvis
110
iatrogenically-induced sterility (what effect on erection)
none- erection is under parasympathetic control
111
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
