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FAB > Pelvis > Flashcards

Pelvis Flashcards

1
Q

What does the pelvis consist of

A

To hip bones which articulate with the sacred posteriorly at the sacroiliac joints and anteriorly with the pubic symphysis

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2
Q

What is another name for the hip bones

A

Innominate bones

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3
Q

Where does the bladder lie

What is it covered by

A

Posterior to the pubic

It is covered superiorly by peritoneum

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4
Q

What is the arterial supply and the bladder and what is its Venous drainage

A

Supplied by the superior and inferior vesical arteries from the internal iliac artery

Veins drain to the Venus plexus at its base and around the prostate gland

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5
Q

What is the detrusor muscle of the bladder supplied by

A

Parasympathetic fibres

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6
Q

Why do additional sympathetic fibres go to the male’s bladder neck

A

To close the bladder neck during ejaculation

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7
Q

What is the uterus comprised of

A

A fundus, body, and cervix

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8
Q

What is the usual position of the uterus

A

Anteflexed and anteverted

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9
Q

What are the pouches that lie anterior and posterior to the uterus

A

The vesicouterine Pouch and the rectouterine Pouch

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10
Q

What does each testis comprise

A

An anterior part, the body, and the posterior part, the epididymis

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11
Q

What is continuous with the tail of the epididymis

A

Vas deferens

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12
Q

What does the spermatic cord contain

A

The vas deferens, testicular artery, veins and lymphatics, the obliterated processus vaginalis, sympathetic nerves, and arteries to the vas deferens and cremaster

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13
Q

Where does the rectum commence

When does it become the anal canal

A

S3

At the level of the pelvic floor

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14
Q

The pelvic peritoneum encloses the sigmoid colon completely, what does this form

A

The sigmoid mesocolon (a mesentery)

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15
Q

What does the visceral peritoneum do in females

A

The visceroperitoneum on the posterior surface of the uterus continues down onto the posterior surface of the vagina and turned backwards onto the anterior surface of the rectum forming the rectouterine pouch

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16
Q

The patch between the uterus and the bladder is called what

A

The vesicouterine pouch

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17
Q

How does the rectovesical pouch form in males

A

The peritoneum is reflected from the rectum onto the base and upper part of the bladder

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18
Q

What may collect in the peritoneal pouches and why

A

Inflammatory exudate

Because the pouches are the most inferior point of the peritoneal cavity

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19
Q

Describe the course of the internal iliac artery

A

It arises from the bifurcation of the common iliac artery, anterior to the secret iliac joint, and descends on the posterior pelvic wall to the greater sciatic notch.

It then divides into anterior and posterior trunks, which give both parietal and visceral branches.

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20
Q

What does the internal iliac artery continue as in the fetus

A

The umbilical artery

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21
Q

Describe the umbilical artery in the fetus

A

It ascends up the abdominal wall to the umbilicus to reach the placenta via the umbilical cord

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22
Q

What happens to the umbilical artery at birth

A

It is obliterated to form a fibrous cord which is visible as the medial umbilical ligament

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23
Q

Name some of the visceral branches of the internal iliac artery

A

Superior and inferior vesical arteries, the middle rectal artery and the uterine artery

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24
Q

Name some of the parietal branches of the internal iliac artery

A

The obturator artery, the internal pudendal artery, and the superior and inferior gluteal arteries.

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25
Q

Where does the superior hypogastric plexus lie

What is it a continuation of

A

On the sacral promontory between the common iliac arteries

The aortic plexus, with branches from the third and fourth number sympathetic ganglion

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26
Q

Is the superior hypogastric plexus solely sympathetic

A

No it also contains parasympathetic fibres which are send from the inferior hypogastric plexuses

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27
Q

The superior hypogastric plexus gives branches to which other plexuses

A

The ureteric, gonadal, and common iliac practices

It also divides into the inferior hypogastric plexus

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28
Q

Give a brief overview of the inferior hypogastric plexus

A

In fact there are two: the right and left hypogastric practices which lie either side of the rectum

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29
Q

What kind of fibre do each of the right and left inferior hypogastric plexuses contain

A

Each plexus contains sympathetic fibres (Mainly postganglionic) from the superior hypo gastric plexus and sacral sympathetic ganglion, together with parasympathetic (preganglionic) fibres from the pelvic splanchnic nerves

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30
Q

What do the extensions from the left and right inferior hypogastric plexuses allow

A

Autonomic fibres to be distributed to the pelvic viscera, these are collectively known as the pelvic plexuses

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31
Q

Name the pelvic plexuses

A

Rectal, vesical, uterovaginal, prostatic

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32
Q

True or false urinary bladder is extraperitoneal

A

True

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33
Q

Which part of the urinary bladder is adherent to the pelvic floor

A

Its triangular base, the trigone

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34
Q

Describe the openings of the urinary bladder

A

The antero- inferior end of the trigone has the urethral opening (bladder neck),

where as the ureters enter at the 2 posterolateral angles

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35
Q

Describe the course of the ureters in the pelvis

A

They run down the posterolateral aspect of the pelvis, crossing its brim at the bifurcation of the common iliac arteries

They run anteromedially, inferior to the vas deferens in the male and to the broad ligament and uterine artery in the female to reach the base of the bladder

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36
Q

Why are the relation of the ureters in a female important

A

They run past the ovary, uterus, inferior to the uterine artery, and alongside the vaginal fornices

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37
Q

How do the ureters enter the bladder

A

Obliquely, running through the muscle and under the mucosa, creating a flap valve to prevent back flow of urine

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38
Q

What is vesicoureteric reflux

What prevents this

A

Back flow of urine into the ureter

A flap valve

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39
Q

How is the bladder neck anchored

Where is it anchored to

A

By pubovesical (female) or puboprostatic (Male) ligaments

To the pelvic floor and body of the pubis

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40
Q

What are the bladder walls composed of

A

The detrusor muscle

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41
Q

What happens to the detrusor muscle when the bladder is full in infants

A

Contracts reflexly

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42
Q

What relaxes when the bladder is full

A

The internal sphincter at the urethral opening

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43
Q

Which parasympathetic nerves supply the detrusor muscle

A

The pelvic splanchnics

S2–4

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44
Q

Why is there sympathetic flow to the bladder neck in males

A

For closure during ejaculation

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45
Q

The mucosa of the renal pelvis, ureter, bladder and proximal urethra is lined by what kind of epithelium?

Why

A

Transitional epithelium

It can withstand the toxicity of urine and accommodate a high degree of stretching

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46
Q

In females the base of the bladder supplied by which artery

A

Vesical branches from the uterine arteries

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47
Q

What is the venous drainage of the bladder

A

To a vesical plexus at the base of the bladder, and then to internal iliac veins. In the mail, there is also drainage via the prostatic Venus plexus

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48
Q

Describe the path of rectum

A

Begins anterior to S3. Passes downwards in the sacral concavity and turns forwards at the coccyx as the dilated ampulla. After a short course it bends sharply backwards to pass through the pelvic diaphragm and puborectal sling to become the anal canal in the perineum

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49
Q

What is the rectum mainly supplied by

A

The superior rectal artery, the middle rectal artery may give additional supply to the muscular wall

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50
Q

The superior rectal artery is a continuation of which artery

What about the middle rectal artery

A

The inferior mesenteric artery

The middle rectal artery is a branch of the internal iliac artery

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51
Q

Preganglionic fibres to the rectum arise from which spinal cord segments

Parasympathetic supply to the rectum is from where

A

L1 and L2

S2–4

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52
Q

In the Male , what does the urethra pass through after exiting the bladder

A

The prostate gland

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53
Q

What is the seminal colliculus

A

When the posterior wall of the prostatic urethra pushes forward into the urethral lumen

It is also called the verumontanum

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54
Q

What does the prostate do as the urethra passes through it

A

Adds its secretions to the seminal fluid via numerous ducts that open into the urethra on either side of the colliculus

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55
Q

What is the prostate gland connected to other than the urethra

How

A

It is connected to the posterior part of the pubis by the right and left puboprostatic ligaments

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56
Q

What is the arterial blood supply to the prostate

A

From the inferior vesical and middle rectal arteries

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57
Q

Describe the course of the vas deferens in the abdomen and pelvis

A

Enters the abdominal cavity at the deep inguinal ring and crosses the medial surfaces of the external iliac vessels and the pelvic brim to enter the pelvic cavity. At the posterosuperior corner of the bladder it turns medially and runs towards the midline. Posterior to the bladder is dilated to form the ampulla it’s narrow at the base of the prostate and two nights with the doctor at the salon all the circle at the same side to form the ejaculatory duct

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58
Q

Describe the course of the last ejaculatory duct through the prostate

A

The two ducks PS the prostate and run obliquely through it open onto the seminal colliculus

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59
Q

What is the vas deferens supplied by

A

“The artery to the vas “

Usually a branch of the superior vesical artery Which accompanies the lower pole of the epididymis

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60
Q

What supplies the seminal vesicles

A

Branches of the inferior vesical arteries

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61
Q

What is the nerve supply to the intrapelvic vas and the seminal vesicles

What about the vas in the spermatic cord

A

The same as the bladder

Same as the testes

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62
Q

What supports the testes

A

The pedicles of the spermatic cord

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63
Q

What do the testes produce

A

Spermatozoa and male hormones

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64
Q

What is the tunica vaginalis

A

As the testes descend from the past area abdominal wall in utero they draw with them the overlying peritoneum, forming a double layer around each testis

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65
Q

Describe the structure of the testis

A

The upper pole of the testis is the head of the epididymis, whose body lies posteriorly and his tail is continuous with the vas deferens

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66
Q

What covers the testis

A

A tough fibrous tunica albuginea which aids the movement of spermatozoa into the epididymis

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67
Q

What is the blood supply to the testes

Venous drainage? How does this differ from left to right?

A

The testicular artery

Via a pampiniform plexus to the testicular veins
Right: the testicular vein drains into the IVC
Left: drains into the left renal vein

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68
Q

Where do the lymphatics from the testis drain

A

To the para aortic nodes

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69
Q

Where is pain from the testis referred to?

Why?

A

Periumbilical region

Viscera afferents run with sympathetic efferents derived from T10

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70
Q

Describe the parasympathetic supply to the testes

A

There is no parasympathetic supply

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71
Q

Describe the uterine wall

A

Thick and fibromuscular

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72
Q

What does it mean to say the uterus is anteflexed

A

It is inclined forwards in relation to the cervix

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73
Q

How is the uterus divided? briefly describe each section

A

Fundus – the broad upper end which is covered by peritoneum

Body - where the uterine tubes are attached at the cornua

Cervix- which projects into the vagina

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74
Q

Describe the cervix

A

Upper and lower ends of cervical canal are called the internal and external os respectively

In most women, the lower cervix is invaginated into the anterior wall of the vagina at a right angle (ie anteverted)

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75
Q

True or false: the uterus is mobile

A

True

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76
Q

What is the fornix

A

Part of the vagina that envelopes the cervix and is circular in shape

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77
Q

How is the fornix divided for descriptive purposes

A

Anterior, posterior, and two lateral fornices

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78
Q

How is the fallopian tube divided for descriptive purposes

A
  1. Interstitial part
  2. Isthmus
  3. Ampulla
  4. Infundibulum
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79
Q

Describe the interstitial part of the uterine tubes

A

Lies within the uterine wall

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80
Q

Describe the isthmus part of the uterine tubes

A

Nearest to the uterus with a v narrow lumen

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81
Q

Describe the ampulla part of the uterine tubes

A

Lateral to the isthmus and characterised by gradual widening

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82
Q

Describe the infundibulum part of the uterine tubes

A

Widens significantly and opens into the peritoneal cavity

Contains fimbriae at its distal edge

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83
Q

What are fimbriae

A

Finger like projections in the infundibulum

One fimbria connects to the uterus

They are partly erectile and grasp the ovary at at the time of ovulation

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84
Q

Which artery supplies the uterus

Describe its course

Is there additional arterial supply?

A

The uterine artery

Passes medially and in the base of the broad ligament to reach the uterus, across and above the ureter

Yes from the ovarian branches of the abdominal aorta

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85
Q

Where does the sympathetic innervation to the uterine tubes come from

Parasympathetic?

A

Preganglionic axons originating in the T10 – L1 spinal-cord segments which synapse at the hypergastric plexuses

From pelvic splanchnics

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86
Q

What are the pelvic splanchnic nerves

A

parasympathetic outflow from S 2–4

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87
Q

What is the uterus covered by

On which surfaces

A

By visceral peritoneum

Anterior, superior, posterior

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88
Q

Where do the anterior and posterior ligaments meet on the uterus

What happens here

A

Inferior borders of the tubes
And
Lateral borders of body

The peritoneal layers meet and extend as a double fold to the parietal peritoneum at the pelvic floor and on the lateral pelvic wall. This is called the broad ligament

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89
Q

What is the bilayer made by the meeting of the anterior and posterior peritoneal layers in the uterus called

A

Broad ligament

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90
Q

Describe the round ligament

A

A ligament that extends from the junction of the uterus and the tube to the labia majora of the vulva

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91
Q

Describe the course of the round ligament

A

At first runs between the layers of the broad ligament, then crosses the pelvic brim to enter the deep inguinal ring and pass through the inguinal canal

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92
Q

What is the pubocervical ligament

A

Consists of fibres passing from the pubis anteriorly around the bladder to the cervix

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93
Q

What is the cardinal ligament also called

A

The transverse cervical ligament

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94
Q

Describe the Cardinal ligaments

A

Connective tissue bands which run in the broad ligament from the lateral pelvic wall to the junction of the cervix and vagina

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95
Q

Describe the uterosacral ligaments

A

They run both sides of the uterine isthmus to the sacrum. Each ligament runs lateral to the rectum and raises a visible ridge in the parietal peritoneum

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96
Q

What occurs below the ampulla of the uterine tube

A

The ovary bulges out from the posterior layer of the broad ligament

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97
Q

What is attached to the ovary below the ampulla of the uterine tube

A

A small mesentery, the mesovarium

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98
Q

What occupies the ovarian fossa

What is immediately behind that fossa

A

The mesovarium

The ureter

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99
Q

Where is the obturator neurovascular bundle

A

Lateral to the ovary right

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100
Q

What is the suspensory ligament of the ovary

A

A raised part of the broad ligament which transmits the ovarian vessels and lymphatics

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101
Q

Where does the ligament of the ovary run

A

Between the layers of the broad ligament,

it runs from the ovary to the uterus at the level of the uterine tube

It is then continuous with the round ligament

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102
Q

What is the female equivalent of the Male gubernaculum

A

The ligament of the ovary and the round ligament

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103
Q

What is the ovary supplies by, arterially

What does it anastomose with

A

Ovarian artery

The uterine artery

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104
Q

Which veins drain the ovary

A

A venous plexus in the mesovarium which drains into ovarian veins, accompanying the arteries

Drains into IVC on right and into left renal vein on right

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105
Q

Where do the lymphatics drain to from the ovaries

A

The para aortic nodes

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106
Q

What is the sympathetic supply of the ovaries

Where do they synapse

A

Arises from preganglionic axons from T10

In pre aortic ganglia at the origin of the ovarian artery

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107
Q

Where is ovarian pain referred

A

The periumbilical region

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108
Q

What is the parasympathetic supply to the ovary

A

There is none

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109
Q

How can you puncture a bladder in cases of urinary retention

A

When the bladder is fully distended it rises out of the pelvis into the abdomen, stripping the peritoneum upwards from the anterior abdominal wall. Therefore, an extra peritoneal suprapubic puncture can be made into a full bladder

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110
Q

How can the prostate be examined in men

What else can be examined

A

Digital rectal exam enables assessment of the posterior surface of the prostate gland

Seminal vesicles but is not always possible

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111
Q

When can a vaginal exam not be performed

What is done instead

A

Eg in children

Rectal examination is done primarily to provide info about the rectouterine pouch and lower part of the body of the uterus to

Rectal examination can give info about posterior wall of vagina

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112
Q

How common is a carcinoma of the rectum

A

Very, it is one of the most common of the GI tract

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113
Q

What can happen with a rectal carcinoma

A

Initially localised to rectal wall but if untreated can extend into surrounding structures

If it extends posteriorly it can affect the sacral plexus, causing severe pain down the sciatic nerve

Lateral extension may involve the ureter

Anterior extension in males can affect the prostate, seminal vesicles and bladder; or the vagina and uterus in females

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114
Q

What does Testicular torsion involve

Where is it common

How is it treated

A

Rotation of the testis around the spermatic cord within the scrotum

In children and active young men

Emergency surgery is required as occlusion of the testicular artery will lead to testicular necrosis

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115
Q

What does severe labour pain arise from

Where is it referred to

A

Sustained uterine contractions

T10-L1

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116
Q

What does mild labour pain arise from

How is it referred

A

Cervical distension as the foetus starts its descent

Along parasympathetic nerves from the uterus to reach S3/4

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117
Q

What is the pain of delivery

Where is it referred to

Which nerves carry it? Give the spinal root

A

Somatic pain from perineal stretching

Sacral region

Pudendal nerve (S2-4)

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118
Q

How can all labour and delivery pain be eliminated

What is the most popular method

How is it effectiveness tested

A

By anaesthetising spinal nerves T10-S4

A lumbar epidural block

On the skin from the umbilicus (T10) to the perineum

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119
Q

Is there a connection between the external environment and the peritoneal cavity

A

Only in females, via the vagina, uterus, uterine tube

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120
Q

How is the connection between the external environment and the peritoneal cavity usually kept closed

A

By the lining of the uterine tube, the narrow aperture of the uterus and the interdigitating folds of the cervical canal

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121
Q

Which muscles form the pelvic floor

A

The levator ani

Coccygeus

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122
Q

What are anococcygeal and perineal bodies

A

Thickenings of the midline raphé of lavator ani

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123
Q

True or false

The perineal body has no known function

A

False

It is indispensable to the support of the pelvic viscera

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124
Q

What does the perineum consist of

A

The part of the pelvic outlet that lies causal to the pelvic diaphragm

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125
Q

What divides the perineum

What is it divided into

A

A line joining the anterior parts of the ischial tuberosities

Into a large posterior triangle and a smaller anterior urogential triangle

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126
Q

In the female what do the urethra and vagina pass through anteriorly

A

Urogential hiatus

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127
Q

What does the anal canal pass through

A

The rectal hiatus

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128
Q

What are the Urogenital hiatus and the rectal hiatus known as collectively

Why

A

Levator hiatus

They line between the musculature of levator ani

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129
Q

What does the anal triangle contain

A

Anal canal and the ischioanal fossae

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130
Q

Where does the anal canal again

A

That’s the pelvic floor, at the level where the puborectalis muscle sling creates the anorectal angle

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131
Q

What are the three parts of the external anal sphincter

A

Deep, superficial, and subcutaneous

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132
Q

What are the ischioanal fossae

How are they separated medially

A

Pyramidal, Fatfield spaces between Levitor ani medially and the pelvic walls laterally

By the perineal body, anal canal and the anococcygeal body

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133
Q

What is the perineal membrane

What is its function

A

A thick fascial, triangular structure attached your pubic arch

To provide support for the external genitalia, which are attached to its inferior surface

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134
Q

What is each corpus cavernosum attached to

A

The ischiopubic ramus by a crus which is covered by the ischiocavernosus muscle

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135
Q

What does the urethra pass through in the penis?

A

Corpus spongiosum

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136
Q

When do the three bones of the hip fuse

A

16th year of life

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137
Q

How many vertebra are in the sacrum and coccyx respectively

A

Sacrum: 5
Coccyx: 3-4

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138
Q

Where does piriformis arise from

A

The middle three pieces of the sacrum and the adjoining lateral mass, extending medially between the anterior secret foramina

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139
Q

How does piriformis leave the pelvis

Where does it insert

A

By passing through the greater sciatic foramen

On the upper surface of the greater trochanter

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140
Q

What does obturator internus arise from

A

The membrane and bony margins of the obturator foramen

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141
Q

Describe the course of obturator internus

Include its insertion

A

Its tendon makes a sharp turn to pass through the lesser sciatic foramen, where a bursa lies between tendon and bone. It inserts onto the medial surface of the greater trochanter.

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142
Q

Describe levator ani

A

Sheet of muscle arising from the pubic bone and obturator internus fascia

It is subdivided into three parts: puborectalis; pubococcygeus; iliococcygeus.

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143
Q

Describe puborectalis

A

Arising from the posterior surface of the pubis to form a sling at the anorectal junction, it plays an important role in maintaining faecal continence

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144
Q

Where does pubococcygeus arise and insert

A

Arises from posterior surface of the pubic

Inserts into the anococcygeal raphé

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145
Q

What does pubococcygeus comprise

A

Puboprostaticus (Male)/ pubovaginalis (female)
And
Puboanalis

146
Q

Where does iliococcygeus arise and insert

A

Arises from the white line on the obturator internus and the ischium

Inserts into the anococcygeal raphé

147
Q

What is the arcus tendineus

A

The white line on the obturator internus fascia

148
Q

Where does coccygeus arise and insert

How is it arranged

A

Arise: ischial spine

Inserts: lower part of sacrum and coccyx

Its fibres lie parallel to the sacrospinous ligament but the muscle is anterior to it

149
Q

What is the nerve supply to coccygeus

A

From branches of S3 and S4 and from pudendal nerve

150
Q

What are the borders of the perineum

A

The pubic symphysis anteriorly, the ischial tuberosities laterally, and the coccyx posteriorly

151
Q

What does the perineal membrane stretch between

A

The ischiopubic rami

152
Q

Why is the apex of the perineal membrane missing

A

To leave a gap for the pubic symphysis

153
Q

What is the perineal membrane anchored to

A

Posteriorly to the perineal body in the midline and is attached to Colles’ fascia

154
Q

What is Colles’ fascia

A

The continuation of Scarpa’s fascia

155
Q

What pierces the perineal membrane

A

The urethra, the vagina in the females, and foramina the nerves and vessels

156
Q

What is the perineal body

What is it formed by (4)

A

A fibromuscular mass of tissue lying in the midline between the Urogenital and anal triangles

It is formed by the interdigitating fibres of puboprostaticus or pubovaginalis,
the superficial and deep transverse perineal muscles,
part of the external anal sphincter,
and bulbospongiosus

157
Q

What is the perineal body often known as

Why is it important

A

The central tendon of the perineum

Maintaining the integrity of the pelvic floor and perineum

158
Q

What are the spaces of the perineum described as

A

The deep and superficial perineal pouches

159
Q

What is the deep perineal pouch defined as

A

The space immediately superior to the perineal membrane

160
Q

What are the boundaries of a deep perineal pouch

A

It is bounded above by the inferior surface of Levator ani, but no distinct fascial layer exists here

161
Q

What does the deep perineal pouch contain

A

The membranous urethra
External anal sphincter
Bulbourethral/ Carper’s glands
Deep transverse perineal muscle
Anterior prolongations of the ischioanal fossae
Nerves and vessels of the penis and clitoris

162
Q

What defines the superficial perineal pouch

A

The space enclosed between the perineal membrane and Colles’ fascia

163
Q

What does the superficial perineal pouch contain

A

External genitalia, three muscles,

the great vestibular/Bartholin’s gland in the female

164
Q

What are the external genitalia

A

Testes, spermatic cord, penis, or clitoris

165
Q

What are the three muscles of the superficial perineal pouch

A

Ischiocavernosus,
bulbospongiosus,
superficial transverse perineal muscle

166
Q

What does the anal triangle contain

A

The anal canal and the ischio anal fossae

167
Q

What are the lateral boundaries of the anal triangle

A

The sacrotuberous ligaments

168
Q

What are the sacrotuberous ligaments covered by

A

The lower border of Gluteus maximus

169
Q

What is the base of the anal triangle

Apex?

A

A line joining the anterior part of the ischio tuberosities

the apex is the tip of the coccyx

170
Q

Where does the anal canal extend from to?

A

Extends from the right angled anorectal junction at the puborectalis sling of Levator ani to the anocutaneous junction

171
Q

What divides the anal canal

A

The pectiante line (AKA dentate line)

172
Q

How does the dentate line divide the anal canal

A

It divides the upper 2/3 which is lined with mucus membrane, from the lower 1/3 which is lined with skin

173
Q

What is the up at 2/3 of the anal canal covered with?

Lower 1/3?

A

Upper: mucous membranes

Lower: skin

174
Q

What does the division of the anal canal reflect

A

The different embryological origins of the two parts (endoderm versus ectodermal)

175
Q

What is different about the two different parts of the anal canal other than what it is covered in

A

Blood supply: superior versus inferior rectal arteries,

innervation: autonomic versus somatic

lymphatic drainage: internal iliac nodes versus superficial inguinal nodes

176
Q

Where is the internal anal sphincter

What is it

A

Surrounds the upper 2/3 of the anal canal

A thickening of the circular muscle of the rectum

177
Q

True or false: the internal anal sphincter are supplied by sympathetic fibres

A

True

178
Q

Describe the different parts of the external anal sphincter

A

Deep: fused posteriorly with puborectalis

superficial: attached anteriorly to the perineal body
subcutaneous: lying deep to the perianal skin

179
Q

What is the anal canal surrounded by on all sides? What does that allow?

A

Fatty connective tissue which allows it to expand easily as faecal matter and is it

The space containing the fatty tissue is ischioanal fossa

180
Q

What are the boundaries of the ischio anal fossa

A

The ischial tuberosities and the anal canal

181
Q

What important structure is in the lateral wall of each ischio anal fossa

What does the structure contain

A

The pudendal canal

Contains the internal pudendal vessels and the pudendal nerve

182
Q

What do the structures in the pudendal canal give

A

The inferior rectal vessels and nerves

183
Q

Are the ischio anal fossae continuous each other

A

Yes anterior and posterior to the anal canal

184
Q

What are the anterior recesses of the fossae

A

The fat within each ischio anal fossa extends forwards between the upper surface of the perineal membrane on the lower surface of the pelvic diaphragm on the lateral sides of the external urethral sphincter

185
Q

What is the Mons pubis

A

A fatty protuberance over the pubic symphysis

186
Q

Describe the labia majora

A

Hair bearing folds extending posteriorly from the mons

187
Q

Describe the labia minora

A

Inner hairless folds united posteriorly at the fourchette

188
Q

What is the vestibule

A

The space between the labia minora, into which the urethra opens anteriorly and the vagina posteriorly

189
Q

Describe the clitoris

A

A small mass of a erectile tissue, which lies anteriorly to the urethral opening and is attached to the ischio pubic ramus by the ischio cavernosus muscles.

It is homologous to the penis, with two corpora cavernosa and a small glans

190
Q

What does the vestibular bulb consist of

A

Two erectile tissue masses superficial to the perineal membrane on each side of the vaginal opening.

They are covered by bulbospongiosus.

Posterior to the bulb are the two mucus secreting greater vestibular glands which drain anteriorly

191
Q

Describe Bartholin’s glands

A

Also known as the greater vestibular glands

They are posterior to the vestibular bulb and up to mucus secreting glands which drain anteriorly

192
Q

How is the penis divided

A

Into the root, body, and glans

193
Q

Describe the root of the penis

A

The route is attached to the perineal membrane, the crura to the ischiopubic ray my and there is a suspensory ligament from the pubic symphysis

194
Q

What does the body of the penis consist of

A

Two lateral longitudinal columns of erectile tissue (corpora cavernosa) separated by an intervening septum, and the ventral corpus spongiosum which colour in gorge but it is not truly erectile

195
Q

Which parts of the penis are erectile

A

The corporate cavernosa (not the corpus spongiosum)

196
Q

Describe the crura of the penis

A

The corpora cavernosa diverge posteriorly to form the crura, which is covered by the ischio cavernosus muscle

197
Q

Where does the corpus spongiosum begin

How does it continue

A

At the perineal membrane as an enlargement (the bulb)

This runs forward in a groove on the inferior surface of the corpora cavernosa

198
Q

What surrounds the bulb of the penis

A

The bulbospongiosus muscle

199
Q

How is the glans of the penis formed

A

By an expansion of the corpus spongiosum over the corpora cavernosa

200
Q

What can you find on the tip of the glans of the penis

A

The external urethral meatus

201
Q

How is the foreskin of the penis attached

A

The prepuce Is attached to the glands below the meatus by the fraenulum

202
Q

What is the prepuce

A

The foreskin

203
Q

What is the scientific name for foreskin

A

Prepuce

204
Q

What is the fraenulum of the penis

A

A fold of mucous membrane that attaches the prepuce to the glans

205
Q

What’s around the entire body of the penis

A

A deep fascial sleep known as Buck’s fascia

206
Q

What is Buck’s fascia continuous with

A

The septum between the corpora cavernosa and suspensory ligament

207
Q

Where does the male urethra extend from

A

From the internal urethral meatus to the external urethral meatus on the tip of the glans of the penis

208
Q

How long is the male urethra?

A

15 to 20 cm long

209
Q

How is the male urethra divided for descriptive purposes?

A

Into three parts: the prostatic part, the membranous part, the spongy part

210
Q

Describe the prostatic part of the urethra

A

This is the widest part, which passes through the prostate gland.

There is an elevation, the seminal colliculus on the posterior wall. The ejaculatory ducts open onto its summit, while the prostatic ducts open into the grooves on the sides

211
Q

Where did the prostatic and ejaculatory duct open onto the urethra

A

Prostatic: into the grooves on the sides

Ejaculatory: onto the summit

212
Q

What is the vermontanum

A

The seminal colliculus of the Male urethra

213
Q

Describe the membranous part of the Male urethra

A

It is the shortest and most rigid part. It passes through the deep perineal pouch, where it is surrounded by the external urethral sphincter, and then through the perineal membrane to become the spongy urethra. Embedded in the sphincter muscle are the two bulbourethral glands which secrete secrete a lubricant fluid

214
Q

What are the bulbourethral glands

A

To gland is embedded in the external urethral sphincter which secrete a lubricant fluid

215
Q

Describe the spongy part of the urethra

A

It Is also known as the penile urethra, this part runs in the corpus spongiosum to the tip of the glans

It’s lumen is transverse, except at the external urethral meatus, the narrowest part of the urethra, where it is vertical, just giving a spiral stream of urine

216
Q

What makes the urine stream spiral

A

The lumen of the spongy part of the urethra is transverse except at the external urethral meatus, where it is vertical

217
Q

Urinary continence is largely dependent on what?

A

The external urethral sphincter

218
Q

What supplies the external urethral sphincter

A

The perineal branch of the pudenda nerve

219
Q

Describe the scrotum (3)

A

A pouch of thin rigid skin enclosing the testes

There is a median Raphé in the skin and a fibrous midline septum which separates the scrotum into two cavities

A layer of smooth muscle lies in the subcutaneous tissue

220
Q

What do you call the layer of smooth muscle in the scrotum

What is its action

A

The dartos

Contraction of this muscle is in voluntary and results in increased wrinkling of the scrotal skin

221
Q

Describe the innervation of the scrotum

A

The anterior one third of the scrotum is applied by a branch of the ilioinguinal nerve while the scrotal branch of the pudendal nerve surprise supplies the posterior 2/3

222
Q

The coccygeal plexus is formed by …?

A

A branch from us for, the anterior primary ramus of S5 and the coccygeal Nerve

223
Q

Which 2 nerve plexuses lie in the posterolateral wall of the pelvic cavity

What do they innervate

A

The sacred plexus and the coccygeal plexus

the lower limb, and the muscles of the pelvis and the perineum

224
Q

Where does the pudendal nerve come from

What dies this nerve supply

A

The anterior a mind of S2-4

The perineal muscles and skin

225
Q

Why must the pudendal nerve accept the pelvic cavity? How does it do this?

A

The perineum lies below the pelvic diaphragm

It leaves through the greatest sciatic foramen below with the lower border of piriformis

226
Q

Describe the course of the pudendal nerve after leaving the greatest sciatic foramen

A

It winds over the sacrospinous ligament to pass through the last sciatic fireman to enter the perineum. The nerve embeds itself within the obturator fascia in a fascial tunnel, the pudendal canal

227
Q

Give the old name for the pudendal canal

A

Alcock’s canal

228
Q

Give the three branches of pudendal nerve

A

Inferior rectal

, perineal,

dorsal nerve of the penis or clitoris

229
Q

Describe the inferior rectal nerve

A

Arises in the posterior part of the pudendal canal.

Passes medially over the roof of the ischioanal fossa and gives branches to supply the external anal sphincter are pairing how are you anal skin. Also gives branches to supply levator ani

230
Q

Describe the perineal nerve branches

A

It divides into the following branches: the scrotal/labial branches; Muscular branches; nerve to the bulb

231
Q

Describe the scrotal/labial branch of the perineal nerve

A

The medial branch passes with the scrotal or labial artery to supply the scrotum or labia; the lateral branch also gives crunches to the anus

232
Q

Discussed the muscular branches of the perineal nerve

A

supply the transverse perineal muscle

233
Q

What are the transverse perineal muscles

A

Ischiocavernosus
Bulbospongiosus
External urethral sphincter
Levator ani

234
Q

What does the nerve to the bulb from the perineal nerve supply

A

The bulb of corpus spongiosum

235
Q

What supplies the skin at the root of the penis/clitoris

What other Male part is supplied by this

A

The anterior scrotum/labial branches of the ilioinguinal nerve

The anterior part of the scrotum

236
Q

True or false

the erectile bodies of the penis supplied by its dorsal nerve

A

False: they are supplied by branches of the pelvic plexus

237
Q

What is episiotomy

A

The procedure of incising the posterior wall of the vagina, and the skin behind it, in order to prevent ragged tearing of the perineal tissue and the risk of anal incontinence during and after childbirth

238
Q

What is a vasectomy

What does it mean

A

When the vas deferens is ligated in the superior part of the scrotum.

Sperm production still continues but spermatozoa can’t reach the urethra

239
Q

Which nerve is often blocked during delivery

Why is this useful

A

The pudendal nerve

Provides analgesia, and pelvic floor relaxation in forceps delivery

240
Q

What does pain during the second stage of labour result from

A

Distension of the lower vagina, Vulva, and perineum

241
Q

When is a pudendal nerve block used other than delivery

A

To provide Anastasia of the perineum in order to create or repair an episiotomy

242
Q

What is the most common method to give a pudendal nerve block

A

The transvaginal approach: inserting a finger and needle, protected by God, into the vagina. The ischial spine Is palpated and the needle is pushed through the vagina mucosa and sacrospinous ligament in order to infiltrate the tissue around the pudendal nerve

243
Q

What can be dangerous during the transvaginal approach at applying a pudendal nerve block

A

While the position of the internal pudendal artery means crossing the ischial spine is usually safe, one must always withdraw the plunger of the syringe to verify that the artery or vein has not been entered

244
Q

True or false ischio anal abscess are relatively common

A

True

245
Q

How do you treat an ischio anal abscess

Is there danger?

A

They must be drained by incising the skin just lateral to the anal canal

Not really: the inferior rectal nerve and vessels are usually well out of harms way, what is their existence must be remembered

246
Q

Name a common site for traumatic urethral rupture

What are the signs of this

A

The junction of the mobile penile urethra with the fixed membranous urethra

This produces bruising and extravasation of urine into the superficial perineal pouch, giving a swimming trunks 🩳 appearance

247
Q

Why does bruising from perineal injury result in the appearance of a pair of swimming trunks

A

Colles’ and Scarpa’s fascia are continuous

248
Q

Why is the female urethra not subject to the same trauma as in males

A

It is straight and opens onto the surface almost immediately after piercing perineal membrane

249
Q

What are the Nervi erigentes

Why

What are they referred to surgically

A

The pelvic splanchnic nerves

They carry preganglionic parasympathetic axons that, upon simulation, produce erection

The cavernous nerves

250
Q

Describe the course of the pubic splanchnic nerves in males

A

Postganglionic fibres descend inferiorly along the posterolateral aspect of the prostate gland

They run next to a prostatic artery and vein forming a neurovascular bundle.

Below the apex of the prostate the nerves pass on to the lateral aspect of the external urethral sphincter and then on the membranous urethra which they follow through the perineal membrane to reach the corpora cavernosa

251
Q

Operations on the rectum and prostate may put which nerves at risk

A

The pelvic splanchnic nerves (Nervi erigentes)

252
Q

How is the term ‘pelvis’ commonly used

A

To denote the pelvic girdle and the cavity contained within the girdle

253
Q

What is the greater pelvis

A

Formed on each side by the wing of the sacrum and the fan shaped iliac fossa

AKA fake pelvis

254
Q

What is the true pelvis

A

Formed by the sacrum posteriorly, the pubic bones anteriorly and the inner surface of the ischium and a small part of the ileum laterally

AKA lesser pelvis

255
Q

What is the pelvic inlet

A

The plane separating the true and false pelvises, being the sacral promontory, the iliopectineal lines and the superior border of the pubic symphysis

256
Q

What is the pelvic outlet

A

The lower margin of the true pelvis, bounded by the coccyx, the ischial tuberosities and the inferior border of the pubic symphysis

257
Q

The pelvic girdle is made up of what

A

The pad bones and the single sacrum

258
Q

How is the weight of the upper body transferred in the pelvis

A

It is transferred from the fifth lumbar vertebra to the sacrum and then across the roof of the acetabulum and the head of the femur when standing

Or

To the ischial tuberosities when sitting

259
Q

To achieve the transfers of weight how is the pelvic girdle constructed

A

As a series of archers, with the kings of the bones along the lines of force while other parts of the bones are very thin

260
Q

Give an example of a thin part of the pelvic girdle

A

The ala of the ilium

261
Q

In both sitting and standing, weight is transmitted across which joint

What kind of joint is it

A

The sacroiliac joint

Synovial

262
Q

There is a tendency to wait to cause rotation of the sacrum around where?

What does this do

How is this resisted

A

S2

Drives the sacral promontory anteriorly and inferiorly

The sacrum is wedge shaped (wider posteriorly than anteriorly) and has an interlocking ridge and groove across the articular surface
It also has strong ligaments

263
Q

What are the strong ligaments that hold the sacrum in place

What happens to these during pregnancy

A

Sacroiliac
Sacrotuberous
Sacrospinous

They soften under the influence of progesterone to allow movement of the joint during childbirth

264
Q

Why do the ligaments of the sacrum soften during childbirth

A

By allowing rotation of the joint you can increase the dimensions of the pelvic outlet

265
Q

Describe the pelvic diaphragm

A

Closes off the inferior Boundry of the abdominal pelvic cavity

Concave superiorly, funnelling pressure towards the opening of the urethra, anal canal and vagina which perforate it in the midline

Comprised of levator ani and coccygeus

266
Q

Where do levator ani and coccygeus attach

A

From the body of the pubis to the ischial spine

267
Q

What do you projections of the ischial spines and the coccyx towards the centre of the pelvic diaphragm do

A

Increase the support available

268
Q

What does the pelvic floor support

A

The bladder and rectum and the muscle tone is important in the maintenance of continence

Also uterus in females to prevent prolapse

269
Q

What is the conflict in the female pelvis

A

Between providing bony support for the pelvic diaphragm and allowing space for the head of the human fetus

270
Q

Give five sex differences in the pelvis

A

Length of pubic ramus

Tightness of greater sciatic notch

Size and degree of inversion of the ischial spines

The width of the sacral ala

The curvature of the sacrum

271
Q

What is the longest dimension in the pelvic inlet in females

Outlet ?

A

The transverse diameter

Anteroposterior diameter

272
Q

How big is the biparietal diameter of the feral head

A

~9.5cm

273
Q

Where does the face point at birth

A

Posteriorly

274
Q

Why does the fetal head rotate 90° as it passes through the outlet

A

The shoulders of the next widest part of the fetus so must follow the same rotation through the pelvic inlet

275
Q

Why is a maternal diet important for delivery

A

Poor maternal diet leading to Rickets can cause defamation of the birth canal and obstruct labour

276
Q

What shape is the bladder

What is it covered by on its superior surface

A

Pyramid

Peritoneum

277
Q

When does the bladder rise above the pubic symphysis

A

And young children, in men with chronic obstruction of the urethra, and pregnant women

278
Q

What spinal level does the rectum begin

A

S3

279
Q

Which muscle maintains the anorectal junction angle

A

Puborectalis

280
Q

Describe the covering of the rectum

A

The upper third has peritoneum on the anterior and lateral aspects

The middle third on the anterior aspect only

And the lower third is retroperitoneal

281
Q

Why is it important to know the positions where the covering of the rectum changes

A

It is a common site for carcinoma and these reflections have an important bearing on the region that can be excised and end to end anastomosis performed

282
Q

How is the uterus divided simply

A

Body : upper 2/3

Cervix: lower 1/3

283
Q

What is the fornix

A

And annular recess created by the cervix projecting into the vagina

284
Q

Describe the cervical canal in nulliparous women

A

The canal is normally aligned at approximately 90° to that of the vagina, the anteverted position, so that the posterior part of the fornix is usually deeper than the anterior part

285
Q

Which ligaments support the cervix

Which wall of the pelvis does each run to

A

Uterosacral (to posterior wall of pelvis)
Transverse cervical (lateral)
Pubocervical (anterior)

286
Q

In pregnancy when does the uterus become palpable

Where

A

12 weeks

Above the pubic symphysis

287
Q

When does the uterus reach the xiphisternum

A

36 weeks into pregnancy

288
Q

After the uterus has reached the xiphisternum in pregnancy when does it drop again

A

It dropped a couple of centimetres once the fetal head has entered the pelvic cavity

289
Q

Which abdominal wall provides important support during pregnancy

A

Anterior

290
Q

What happens to the second arch formed by the pubic bones when standing and sitting

A

It is in compression in the standing position and in tension in the sitting position

291
Q

How is the pelvis rotated compare to other apes

A

It is rotated anticlockwise and flattened anteroposteriorly

292
Q

When does the sacroiliac joint fuse

A

~50years

293
Q

Plane of the pelvic inlet is inclined at what angle?

Outlet?

A

60°

10–15°

294
Q

How are the sacral wings and curvature of the sacrum different in females

How is the pubic ramus different? What does this mean?

How is the sciatic notch different

A

Increases width of wings
Less curvature

Length of ramus is greater than width of acetabulum (equal in males) meaning the suprapubic angle is >90 degrees in females and <90 in males

Greater opening of the greater sciatic notch and reduction in the size and inversion of the ischial spine in females

295
Q

What is the problem of bipedalism on the birth canal

A

Bipedalism evolved before the increase in the size of the human brain and skull could accommodate it

296
Q

What is it called when the human brain increased in size due to evolution

A

Encephalisation

297
Q

Does rotation occur in chimpanzee birth

A

No

298
Q

Give an abnormal fetal lie in the uterus which will not go through the pelvis

A

Brow presentation which is 14cm in diameter

299
Q

What is the danger in breech delivery

A

That the body may pass through but not the head so delivery delivery cannot be completed although placental circulation may have been cut off

300
Q

How come the size of the pelvic outlet be increased

A

By rotation of the sacroiliac joint permitted by softening of the ligaments during pregnancy

Squatting helps rotate the joint as does pulling up the legs

There is also a softening of the pubic symphysis that may increase the dimensions of the birth canal

301
Q

What tool can be used to fix malrotation of the head in delivery

A

Forceps

302
Q

What is obstructed or prolonged labour associated with

A

Fetal hypoxia

303
Q

Why is the recto uterine pouch important

A

It is important route for endoscopic access to the pelvis

Many procedures can be carried out by this route

304
Q

Do the bladder and uterus lie above or below the plane of the pelvic inlet

What does this mean

A

Below

They cannot normally be palpated abdominally

305
Q

Who discovered x-rays and when

What was the first ever radiograph of

What award did he win

A

Röntgen in November 1895

His wife’s hand

1901 Nobel Prize in physics

306
Q

How are x-rays generated

A

When electrons accelerated at high velocity collide with a metal target

307
Q

Materials with a high electron density tend to _____ an x Ray beam through absorption

A

Attenuate

308
Q

Name an element with high electron density that is readily found in the human body.

A

Calcium

309
Q

Give the four things which maintain rectal continence

A

Internal anal centre

External anal centre

Pelvic floor complex of muscles

Anal cautions in upper half of anal canal and general apposition of mucosal folds

310
Q

What is the first part of defecation

How is this felt

A

Mass movement into the rectum induced by a gastrocolic reflex

This induces a sensation of fullness (general visceral afferents in ANS)

311
Q

Give the steps of defaecation (6)

A

Mass movement

Sitting and relaxing the pelvic floor and external anal sphincter is to decrease anorectal angle

Valsalva Manoeuvre

Anal pressure reflexly increases and the colon and rectum continue to contract, distending the rectum

The pressure in the rectum reflexly relaxes the internal anal centre the rectum and shortened by its longitudinal muscle

Finally the external anal sphincter are reactors and the anal canal opens. Anal mucosa temporarily at everts and evacuation is completed

312
Q

What happens to the anal canal after evacuation is completed

Give the type of innervation necessary

A

The closing reflex

Contraction of the pelvic floor including puborectalis, (somatic) external anal sphincter (somatic), internal anal sphincter (sympathetic)

313
Q

How does faecal incontinence present

A

With either a sudden uncontrollable urge (suggesting a rectal contraction)

passive leaking without warning often on moving (likely sphincter weakness or senility)

Soiling (leaking or poor hygiene )

314
Q

How common is faecal incontinence

Describe the difference between the sexes

A

10 to 15% suffer and worsens with age

No sex differences over the age of 40 but in younger females it can be related to childbirth by vaginal delivery

315
Q

What is one of the major reasons for admission to residential care

A

Faecal incontinence

316
Q

What is often the cause of faecal incontinence in the elderly

How may it present

What is it associated with

A

General physical and/or cognitive decline

As diarrhoea or constipation, suggesting that consistency of faeces is an important factor

Inflammatory bowel disease, irritable bowel syndrome, drugs such as laxatives, antibiotics and some foods

317
Q

Which foods are associated with faecal incontinence

A

Prunes, beans, artichokes

318
Q

Sphincter problems later in continents in what percentage of women after vaginal delivery and for how long

What are aggravating factors

A

30%
3-6 months

Obesity
Use of forceps
Prolonged labour

319
Q

What percentage of women whose sphincters tear at delivery have ongoing faecal incontinence problems

A

85%

320
Q

Name some diseases that might lead to faecal incontinence (8)

A

Haemorrhoids

Neurological diseases e.g. MS, diabetes

Spina bifida

Anal atresia

Hirschsprung’s disease

Rectal prolapse

Degeneration of pelvic floor and prolapsing piles

Also surgery for cancer in the anal area

321
Q

How can you investigate the cause of faecal incontinence

A

Digital anorectal examination can give information on tone of symptoms, possible injury, constipation, pressure on rectum from other organs and tumour in prostate or rectum

Colonoscopy
Ultrasound and MRI
nerve and muscle conduction studies

Assessment of mental state is essential

Always consider the possibility of a central prolapsed disc

322
Q

What is the nonsurgical treatment for faecal incontinence (9)

A

Treat anxiety and depression

Diet (Low residue diet) and timing of meals (gastrocolic reflex)

Fibre supplements to give bulky stalls

Drugs (loperamide, codeine phosphate)

Treat overweight

Anal plug stimulation

Absorbent pads

Pelvic floor exercises

Rectal irrigation

323
Q

Give 4 surgical treatments for faecal incontinence

A

Sacral nerve stimulation

Sphincter repair

Artificial sphincters (gracilis sling)

Diversion with colostomy

324
Q

What are the four continence factors of urinary control

A

Muscles (pelvic floor, bladder, urethra)

Lateral pressure on urethra

Compliance

Nerve control

325
Q

Describe compliance in urinary control

A

Visco-elasticity gives the bladder The ability to relax and accommodate increasing amounts of urine with no rise in pressure

This viscoelasticity is different from normal or true elasticities as seen for instance one blowing up a balloon

326
Q

What limits the compliance of the bladder

A

Filling to fast

Filling to full

Too thick

Abnormal nerves

327
Q

What do we need for perfect urinary control

A

A good capacity bladder with viscoelasticity

Normal nerve control and adequate sphincters that can contract and relax

At least some of that urethra must be within the abdominal cavity to allow lateral intra abdominal pressure to act upon it

328
Q

Without abdominal pressure on the urethra what is likely to happen

A

Stress incontinence

329
Q

What is the bladder

A

Smooth-muscle organ that must collect and start urine at low pressure is then periodically expel it via a highly coordinated and sustained contraction

330
Q

What is needed for expulsion of urine

A

A long, coordinated, sustained contraction of the bladder and a reduction in resistance of the bladder neck and sphincters (i.e. an unobstructed urethra)

331
Q

What are the sequence of events for voiding urine

A

First there is either voluntary relaxation of pelvis muscles at the present of an over full bladder. Both can lead to a lowering of pressure in the urethra

The water pressure than reflexly increases and then bladder neck opens

Voiding begins and completes

The stream can be shut off midstream by contracting the voluntary sphincters

332
Q

Name the seven factors of urinary continence

A

Sphincters: around urethra and bladder neck

Intrinsic urethral mechanism

Elastic tension in urethra

Watertight seal of soft tissues

Pelvic floor muscles

Intra abdominal pressure acting laterally on urethra

Compliance with viscoelasticity

333
Q

What does it mean if someone presents with urinating too often with increased frequency and urgency

A

Either: unstable/overactive bladder or a small bladder

334
Q

Describe an unstable bladder

A

Very common

Bladder contract when it shouldn’t

Poorly understood

Possibly psychological or a nerve problem

335
Q

Why might someone have a small bladder

A

This is rare and will occur after infection or cancer or surgery or radiotherapy

336
Q

What does it mean if a patient finds urinating too difficult and there is a poor stream

A

There may be a mechanical obstruction or a weak bladder

337
Q

Describe mechanical obstruction leading to a poor stream of urine

A

Maybe prostate which is very common

Nerve problems stopping Sphincter relaxing

Narrowing of urethra (rare)

338
Q

Discuss having a weak bladder

A

There will be no pushing power which is fairly rare

The bladder will be big and floppy

The muscle may be overstretched

That might be poor nerve supply E.g. caused by slipped disc

Probable need for intermittent catheterisation

339
Q

What is the volume of a weak bladder

A

> 650ml

340
Q

What is the volume of a small bladder

A

<350ml

341
Q

What can lots of control of bladder and wetting be caused by

A

Loss of compliance

Massive contractions with normal sphincters

Can be caused by laughing, nerve problems

342
Q

An overactive bladder is particularly common in which kind of patient

A

Women

343
Q

What might cause the bladder to have a weak sphincters

A

Surgical or nerve damage

this may lead to stress incontinence

344
Q

What is stress incontinence

A

After childbirth very common

Incontinence occurs on coughing, laughing, straining and bending

345
Q

How to treat stress incontinence

A

Pelvic floor exercises

Pilates

Surgery to pull the urethra back into the abdomen

346
Q

Give five features of the sigmoid colon that stop before the rectum begins

A

Appendices epiploicae

Taenia coli

Sacculations

Haustrations

Mesentery

347
Q

How long is the perineum on the rectum

A

12cm (4 sides and front, 4 front only, 4 below)

348
Q

What are the shelves of mucosa and circular muscle in the rectum called

A

Valves of Houston

349
Q

In constipation where are faeces stored

A

PUp at 2/3 of rectum as it is distensible and inside the abdominal cavity

350
Q

Count the lower one third of the rectum distend

A

It can distend laterally into the ischio anal fossa during dedication

351
Q

What is the longitudinal muscle of the rectum

A

To wide bands anteriorly and posteriorly

352
Q

What is the anocutaneous reflex

A

Lightly Stroking the buttock skin near the anal canal should cause a reflex contraction of the voluntary external anal sphincter

353
Q

True or false

The rectum is capable of distinguishing between air, water and faeces

A

True

354
Q

Enlargement of what leads to haemorrhoids

Where are they

What do they do

What colour are they

A

Enlargement of the three spongy mucosal cushions that are in the upper half of the anal canal

At 3,7 and 11 o clock

They help with continents, airtightness and mucus production

Bright red with capillary blood

355
Q

Why might the venous plexuses in the rectum enlarge

A

Due to portosystemic anastomoses

356
Q

What is spurious diarrhoea

A

In severe constipation when the rectum is so blocked with hard faeces that only semi-fluid can reach the lower rectum

Sensation of fullness is disrupted by overdistention and there is leakage of thin faecal material

357
Q

What does the intrinsic urethral mechanism do

A

Milks back the urine to the bladder neck

358
Q

True or false

The bladder relaxes as it fills

A

True

359
Q

What is flaccidity

A

Usually due to peripheral nerve damage

Once muscles have no nerve control they will not contract

360
Q

What is spasticity

A

Brain or spinal injury e.g. in stroke

Fine control is lost but peripheral nerves can still function with no coordination this movement is jerky

361
Q

Why do children adopt funny positions when the bladder contracts unwontedly

A

The bladder has not yet fully developed so lacks viscoelasticity

362
Q

How can an enlarged prostate causing obstruction of the urethra be treated

A

Transurethral prostatectomy using a hot loop

FAB (10 decks)

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