Pelvis Day 2

Question 1

pathway of the ureter

Answer 1

It begins retroperitoneal, then it is crossed by either the ductus deferens or uterine artery. It passes over the pelvic brim to run alongside the lateral walls of the pelvis. It then turns anteromedially to enter the bladder.

Question 2

What prevents retrograde flow of urine from the bladder to the ureter?

Answer 2

There is a one way flap in the bladder and the internal pressure of the bladder prevents this back flow.

Question 3

Which part of the bladder is covered by peritoneum?

Answer 3

The roof of it.

Question 4

Explain how the bladder grows when it is filling.

Answer 4

The bladder is actually sub peritoneal, but as it fills and distends it grows into the extraperitoneal tissue between the anterior abdominal wall and the peritoneum. At this point it is in the greater pelvis.

Question 5

What attache the apex of the bladder to the anterior abdominal wall?

Answer 5

The median umbilical ligament which was the urachus in the embryo.

Question 6

Where does the rectum begin?

Answer 6

Anterior to S3 at the rectosigmoid junction

Question 7

Where does the rectum end?

Answer 7

At the anorectal junction as the rectal ampulla. This occurs around the tip of the coccyx.

Question 8

What is the first flexure of the rectum?

Answer 8

The sacral flexure. It is in an anterior to posterior plane.

Question 9

What creates the perineal flexure of the rectum and why is this flexure important?

Answer 9

The coccygeus muscle creates this and it’s important for maintaining continence.

Question 10

Where does the anal canal begin?

Answer 10

The anal canal begins at the anorectal junction.

Question 11

Where does the anal canal end?

Answer 11

At the anus.

Question 12

What is the innervation of the internal anal sphincter?

Answer 12

Innervated by autonomic nerves from the superior rectal plexus.

Question 13

Describe the effects of sympathetics and parasympathetics on the rectum?

Answer 13

Sympathetic fibers stimulate contraction, parasympathetic fibers inhibit contraction.

Question 14

Describe the innervation of the external anal sphincter

Answer 14

It is innervated by the inferior rectal branch of the pudendal nerve. It is under somatic motor control!

Question 15

What junction does the pectinate line represent?

Answer 15

The junction between the superior and inferior anal canal

Question 16

Vessels above the pectinate line include:

Answer 16

Superior rectal arteries, superior rectal veins, internal iliac lymph nodes, autonomic innervation

Question 17

Vessels below the pectinate line include:

Answer 17

Inferior rectal arteries, inferior rectal veins, superficial inguinal lymph nodes, somatic innervation via inferior rectal nerve of pudendal nerve.

Question 18

Describe the pathway for sperm

Answer 18

Testis (seminiferous tubules to rete testis to efferent ductules)–> epididymis–> ductus deferens–> seminal vesicles–>ejaculatory duct–>prostrate–>urethra

Question 19

Describe the pathway of the ductus deferens

Answer 19

It ascends through the inguinal canal as part of the spermatic cord. Then it runs subperitoneally over the external iliac arteries and lateral wall o the pelvis. It then crosses superior to the ureter, and posterior to the bladder, it first lies superior to the seminal vesicle, then descends medial to the ureter and seminal vesicle. It enlarges to form the ampulla of ductus deferent before its termination in the ejaculatory duct.

Question 20

Relationships surrounding the seminal vesicles

Answer 20

Lateral to ampullae of ductus deferens, superior to the prostrate, and inferior to the ureters

Question 21

Relationships surrounding the prostate

Answer 21

lies between the neck of the bladder, the perineal membrane and posterior to the pubic symphysis, posterior surface related to the rectum

Question 22

What separates the two lateral lobes of the prostate

Answer 22

prostatic urethra

Question 23

What lobe of the prostate is palpable via the rectum

Answer 23

The posterior lobe. Also likely to become cancerous

Question 24

What is the clinical significance of the supravesical fossa?

Answer 24

When the bladder fills, it rises into this area (in males) therefore a catheter can be inserted into the bladder in this area without penetrating the peritoneal cavity.

Question 25

What is the lowest region of the peritoneal cavity in the erect position in a male?

Answer 25

The retrovesical pouch

Question 26

Proper ligament of the ovary aka ovarian ligament

Answer 26

Attaches the ovary to the uterus via a fibromuscular cord

Question 27

Suspensory ligament of the ovary

Answer 27

A ridge of peritoneum with ovarian artery and vein, lymphatics, and nerves as they traverse the posterior abdominal wall and cross the pelvic brim to reach the ovary.

Question 28

Where is an ectopic pregnancy most likely to occur?

Answer 28

The ampulla of the uterine tubes

Question 29

What is the normally position of the uterus

Answer 29

Anteverted and anteflexed

Question 30

What does it mean to be anteverted

Answer 30

The uterine body is tipped anteriorly relative to the axis of the vagina

Question 31

What does it mean to be anteflexed

Answer 31

The uterine body is flexed or bent anteriorly relative to the uterine axis.

Question 32

What tethers the uterus to the labia majora by passing through the inguinal canal

Answer 32

Round ligament of the uterus

Question 33

What conditions increase the chance of a prolapsed uterus?

Answer 33

Damaged perineal body, weak/atrophic pelvic muscles/ligaments, or retroverted uterus

Question 34

Relationships of the vagina

Answer 34

The anterior portion is directly related to the urethra and base of bladder. The posterior portion is directly related to the anal canal and the rectum

Question 35

Cystocele

Answer 35

Protrusion of bladder into the vagina

Question 36

Rectocele

Answer 36

Protrusion of the rectum into the vagina

Question 37

What might cause vaginal fistulas?

Answer 37

Obstetrical trauma in which weakness, necrosis or tears occur in the vaginal wall and abnormal passages subsequently develop between the vagina and the bladder, urethra, rectum or perineum.

Question 38

What is the lowest part of the peritoneal cavity in the erect position in a female

Answer 38

The rectouterine pouch

Question 39

Mesovarium

Answer 39

Mesentery of the ovary. The shelf

Question 40

Mesosalpinx

Answer 40

The portion of the broad ligament covering the uterine tube

Question 41

Mesometrium

Answer 41

The mesentery of the uterus.

Question 42

Perimetrium

Answer 42

Covers fundus and body of uterus.