Pelvis and Perineum 3 + 4

Question 1

the ovary is attached to the uterus by the _____

Answer 1

the ovary is attached to the uterus by the proper ovarian ligament

Question 2

the ovary is “suspended” in the pelvic cavity by the _____ of the _____

Answer 2

the ovary is “suspended” in the pelvic cavity by the suspensory ligament of the ovary

Question 3

the ovary is attached to the broad ligament by the ______

Answer 3

the ovary is attached to the broad ligament by the mesovarium

Question 4

blood supply of ovary is the ____ artery from the _____

Answer 4

blood supply of ovary is the ovarian artery from the abdominal aorta

Question 5

the venous drainage of the ovaries are the ____ veins into ____ on right and ____ on left

Answer 5

the venous drainage of the ovaries are the ovarian veins into IVC on right and renal vein on left

Question 6

the lymphatic drainage of the ovary are the ____ nodes via the ____ ____

Answer 6

the lymphatic drainage of the ovary are the lumbar nodes via the ovarian vessels

Question 7

the innervation of the ovaries are _____ and _____ transmitted along the _____ arteries, pain refers to ______

Answer 7

the innervation of the ovaries are sympathetics and visceral afferents transmitted along the gonadal arteries, pain refers to T10/11

Question 8

the ____ in the uterine tube/fallopian tube is where _____ takes place and is possible for ____ ____ to occur

Answer 8

the ampulla in the uterine tube/fallopian tube is where fertilization takes place and is possible for ectopic pregnancy to occur

Question 9

describe anteflexed vs anterverted

Answer 9

• anteflexed (bent forward): uterine body in relation to cervix
• anteverted (turned forward): cervix in relation to vagina

Question 10

Answer 10

The arrows in the circle show how there is an open connection between the fimbria of the uterine tubes/fallopian tubes and the peritoneal cavity

any infection in the tract can spread to the peritoneal cavity

Question 11

since the pelvic organs extend into the abdominal cavity, they are covered by ______

the fold of _____ over the uterus forms the ____ _____ that “drapes” over the uterus and tubes

Answer 11

since the pelvic organs extend into the abdominal cavity, they are covered by peritoneum

the fold of peritoneum over the uterus forms the broad ligament that “drapes” over the uterus and tubes

Question 12

the cervical ligaments are condensations of ____ _____ extending;

anteriorly: _____
lateral: _____
posterior: ______

Answer 12

the cervical ligaments are condensations of pelvic fascia extending;

anteriorly: pubocervical
lateral: transverse cervical/cardinal (uterine a. and v. lie within)
posterior: uterosacral

Question 13

describe the relationship between the rectum and vagina

Answer 13

the posterior wall of the vagina is closely associated with the anterior wall of the rectum forming the rectovaginal septum

any tear in this septum makes a connection between the 2

Question 14

describe a uterine prolapse (procidentia)

Answer 14

• due to loss of support by the cardinal/uterosacral/pubocervical ligaments and by levator ani

Question 15

the _____ is the lowest point in the abdominopelvic cavity in the upright position

a _____ can sample this fluid

Answer 15

the rectouterine pouch (pouch of Douglas) is the lowest point in the abdominopelvic cavity in the upright position

a culdocentesis can sample this fluid

Question 16

with the exception of the ____, all pelvic viscera are supplied by branches of the _____ arteries

Answer 16

with the exception of the ovaries, all pelvic viscera are supplied by branches of the internal iliac arteries

Question 17

the internal pudendal artery exits pelvis through ____ _____ _____ with ____ nerve

enters the ____ ____ ____ to pass anteriorly through the ____ ____ to finally reach the _____

gives rise to ____ _____ and _____ arteries

Answer 17

the internal pudendal artery exits pelvis through greater sciatic foramen with pudendal nerve

enters the lesser sciatic foramen to pass anteriorly through the ischiorectal fossa to finally reach the perineum

gives rise to inferior rectal and perineal arteries

Question 18

lymphatics

uterine fundus (with ovaries and uterine tubes) drains to _____

body of uterus and cervix drain to ____ nodes

upper (proximal) vagina drains to ____ nodes

lower (distal) vagina drain into ____ _____

Answer 18

uterine fundus (with ovaries and uterine tubes) drains to lumbar nodes

body of uterus, cervix and upper vagina drain to external iliac nodes

upper (proximal) vagina drains to internal iliac nodes

lower vagina drain into superficial inguinal (horizontal)

Question 19

explain what happens above the PPL

Answer 19

• above PPL = uterine tubes and uterine body
  
  • the visceral afferents for pain travel via the sympathetics
    
    • ​they travel in the inferior hypogastric plexus
    • pain is referred to the T10-L1 areas

Question 20

describe what happens below the PPL

Answer 20

• below PPL = lower portion of the cervix, urinary bladder, upper portion of vagina and large intestine after the middle of the sigmoid colon
  
  • the visceral afferents for pain travel via the parasympathetics (come from pelvic spanchnic nerves)

Question 21

the lower 1/4 of the vagina has ____ pain fibers that travel via _____ _____

Answer 21

the lower 1/4 of the vagina has somatic pain fibers that travel via pudendal nerve

Question 22

the ductus deferens passes in the spermatic cord through the ____ _____ towards the posterior aspect of the _____

it expands to form the _____ before joining the duct of the ____ _____ to form the ______

Answer 22

the ductus deferens passes in the spermatic cord through the inguinal canal towards the posterior aspect of the bladder

it expands to form the ampulla before joining the duct of the seminal vesical to form the ejaculatory duct

Question 23

Answer 23

A = ductus deferens

B = ampulla of DD

C = seminal vesicle

D = ejaculatory duct

Question 24

describe where BPH occurs

Answer 24

transitional zone

median lobe

Question 25

describe where prostate cancer occurs

Answer 25

peripheral zone

lateral lobes

Question 26

in a posterior urethral tear, the prostate is said to be ___ ____

Answer 26

in a posterior urethral tear, the prostate is said to be high riding

Question 27

transurethral resection can potentially damage _____

Answer 27

transurethral resection can potentially damage internal urethral sphincter

Question 28

the bladder neck and prostate are supplied by the ____ ____ ____

vesical and prostatic venous plexuses drain mainly to ____ ____ but also communicate with the ____ ____ ____ ____

which in turn communicate with the ____ ___ ___ (also called ___ ____), a valveless system. This allows prostate cancer to mestastasize to brain

Answer 28

the bladder neck and prostate are supplied by the inferior vesicle arteries

vesical and prostatic venous plexuses drain mainly to iliac veins but also communicate with the external vertebral venous plexus

which in turn communicate with the internal vertebral plexus (of Batson), a valveless system

Question 29

lymphatics:

testes drain to ___ ____

prostate, seminal vesicles, ductus deferens drain into ____ ____ ____

the bladder drains to ___ ____

Answer 29

testes drain to lumbar nodes

prostate, seminal vesicles, ductus deferens drain into internal iliac nodes

the bladder drains to external iliac

Question 30

describe the emission phase of ejaculation

Answer 30

• emission phase:
  
  • sympathetic innervation promotes secretion of fluids by the glands and smooth muscle contractions of the ductus deferens and ejaculatory ducts causing semen to accumulate in the urethral bulb
  • internal urethral sphincter contracts closing communication to bladder

Question 31

describe the expulsion phase of ejaculation

Answer 31

• expulsion phase
  
  • rhythmic contraction of the bulbospongiosus muscles (perineal nerves)