Pelvic Viscera I Flashcards
Peritoneum
- location
dips down out of abdomen into pelvis
Peritoneum in Male
-components
covers superior and lateral aspects of Urinary bladder and rectum
- paravesicle fossae (lines urinary bladder)
- pararectal fossae (lines rectum)
- rectovesicle pouch
( lines btw rectum and urinary bladder)
Characterisitcs of male pelvic peritoneum
-parietal peritoneum does not reach pelvic floor
- lowest point (2 cm above seminal vesicles)
- abdominal fluid collects here
- abscess are likely form here
Male retrospaces and pouch (3)
1) retropubic space- btw pubis and bladder
2) retrorectal (presacral) space- between rectum and sacrum
3) rectovesical pouch/fossa- between bladder and rectum
Endopelvic Fascia
- location
- what does it form (6)
- beneath peritoneum and covering viscera, pelvic wall and floor; continuous with transversalis
1) tedinous arch of levator ani
2) lateral ligament of bladder and rectum
3) puboprostatic (male) ligament
4) pubovesical (female)
5) cardinal (transverse cervical) ligament supporting cervix
6) paracolpium- thickened fascia from lateral vagina to tedinous arch
Male Viscera
- components and some description
- ureter
- travels under vas deferens - vas deferens
- bladder
- superior to prostate - seminal vesicles
- lie on posterior surface of the bladder - prostate (inferiorposterior lobe)
- positioned immediately below bladder but superior to perineal membrane - bulbourethral gland
- located within UG membrane - puboprostatic ligament
- retropubic space
- seminal gland
- levator ani
- obturator internus
Ureter
- location
- description ( what does it pass)
- male/female difference
connecting kidneys to urinary bladder
retroperitoneal
passes over pelvic brim and enters lesser pelvis
passes obliquely through urinary bladder wall in an inferomedial direction
Males
- runs inferior to vas deferenc
female
- runs inferior to uterine artery
Arterial supply for ureter
renal
gonadal
aortic
internal iliac branches
nerve supply for ureter
preaortic plexus
hypogastric plexus
pelvic splanchnics n.
Bladder orientation
- apex points toward the pubic symphysis
- fundus just opposite
- body lies between
- neck lies at bottom
median umbilical ligamenet (urachus) continues to the umbilicus
supported by lateral ligament (endopelvic fascia)
normally bladder does NOT rise above the pelvic brim when empty but does so when filled
Interior bladder
- components and description
- detrusor muscle
- visceral smooth m.
- lines bladder walls
- continuous with internal urethral sphincter and ureteric sphincters - ureteric orifices
- trigone
- internal urethral orifice
- internal urethral orifice
- prostatic urethra
- sensory stretch receptors sense when area begins to fill with urine
Male Urethral Sphincters
- internal urethral sphincter
- circular fibers continuous with detrusor (smooth m) - external urethral sphincter
- skeletal fibers
- located primarily at level of membranous urethra, but extends superiorly and around prostatic urethra
- same in female- except prostate gland
Urethral Sphincter innervation
internal urethral sphincter
- smooth muscle (inferior hypogastric plexus); involuntary
external urethral sphincter
- skeletal muscle (deep perineal branch of pudendal nerve); voluntary override
Male Prostatic Urethra
- layers and components
Superficial -> deep
1) Spongy
- bulbourethral
2) membranous
- bulbourethral gland
3) prostatic
- opening ( prostatic ducts, ejaculatory duct, prostatic utricle)
- seminal colliculus
- prostatic sinuses
4) intramural
- urethral crest
Urethral crest
posterior ridge on the urethra as it passes thru the prostate
seminal colliculus
enlarge area on the crest onto which open two ejaculatory ducts
- bringing sperm from the vas deferens and fluid from the seminal vesicle
prostatic utricle
remnants of paramesonephric system
prostatic sinuses
depressions on either side of the ridge into which prostatic glands open and secrete an alkaline prostatic fluid
Prostate
- size
- consist of
- location
• Walnut-size prostate surrounds the prostatic urethra.
• 2/3 gland, 1/3 fibromuscular tissue
• Base closely related to the neck of the bladder.
• Apex in contact with fascia on the superior aspect of the urethral sphincter and deep
perineal muscles.
• Prostatic ducts open chiefly into the prostatic sinuses
Prostate blood supply
branches of inferior vesicle and middle rectal arteries
innervation of prostate
prostatic plexus from inferior hypogastric plexus
Benign Hypertrophy of prostate
- age
- describe
- effect
common after middle age
- will affect every male who live long enough
projects into urinary bladder-> impedes urination by distorting the prostatic
common cause of urethral obstruction-> leading to nocturia ( need to void during the night), dysuria ( difficulty and/or pain during urination), and urgency ( sudden desire to void)
increases risk of bladder infections (cystitis) as well as kidney damage
enlargement and tumors detected by digital rectal examination
feels hard and irregular in shape if malignant
Vas Deferens Route
enter abdomen via inguinal ring-> passes superior to ureter and iliac vessels -> passes superior and medially to ureter, expanding into ampulla before narrowing again and joining the duct of seminal vesicle
Seminal Vesicles
- components and describe
- ampulla of vas deferens
- seminal vesicles
- ejaculatory duct
- bilateral, lobulated sacs lying lateral to ampulla of the vas deferens
- duct of seminal vesicle and vas deferens join on each side to form an ejaculatory duct
- dual vascular supply: branches of superior and inferior veisicular arteries
Innervation of Male reproductive organ
- Sympathetic fibers
- from T10-L2 via similar routes as bladder - Parasympathetic fibers
- from pelvic splanchnic nerves - visceral afferent fibers
- most travel with parasympathetic fibers to S2-S4
- exceptions include testis (sympathetic to T10)
Lymphatic drainage
internal iliac nodes
- vas deferens and inferior portion of seminal vesicles
External iliac node
- scrotal portion of vas deferens
Prostate terminate chiefly in internal iliac lymph nodes with some sacral nodes
bladder-> both external (superiolateral portion) and internal iliac nodes ( fundus and neck)
Lymphatic drainage pathway
internal iliac and external iliac nodes-> sacral nodes->lumbar nodes
Cytoscopy
- endoscopic procedure to check for problems in the bladder
- recommended if there is blood in urine, repeated infections, unusual cells in urine, or patient exhibits an irritable bladder
- diagnostic procedure for bladder cancer
