Pelvis II

Question 1

The peritoneum drapes the pelvic organs, what does this do?

Answer 1

creates space where peritoneal fluid can accumulate

In females: vesicouterine and rectouterine pouches

In males: rectovesical pouch

Question 2

What are the pelvic organs common to both sexes?

Answer 2

the ureters and urinary bladder which are both primarily retroperitoneal

Question 3

Where do the ureters course?

Answer 3

inferior to the uterine artery in females and inferior to the ductus deferens in males (water under the bridge)

then pass obliquely through the posterosuperior bladder wall

Question 4

Where is the retropubic space?

Answer 4

posterior to the pubis and anterior to the bladder

Question 5

What kind of muscle makes up the bladder wall?

Answer 5

detrusor muscle, smooth muscle, highly distendable

Question 6

What kind of innervation does the detrusor muscle receive?

Answer 6

parasympathetic innervation- pelvic splanchnic nerves

stimulates contraction of the detrusor muscles (promoting micturition)

Question 7

What is rugae?

Answer 7

mucosal folds, prominent when bladder is empty

Question 8

Internal urethral sphincter

Answer 8

smooth muscle sphincter at the neck of the bladder that surrounds the opening of the urethra in males

Question 9

What kind of innervation does the internal urethral sphincter receive?

Answer 9

sympathetic innervation via lumbar sacral nerves

prevents micturition
prevents sperm from entering the bladder during ejaculation

Question 10

What is the trigone?

Answer 10

smooth triangle on the posterior wall of the bladder, very sensitive to stretch (visceral sensory innervation stimulates the urge to void)

Question 11

In males where is the bladder?

Answer 11

superior to the prostate, the prostate surrounds the opening of the urethra in males

Question 12

In babies and children (until puberty) where is the bladder?

Answer 12

the bladder (even when empty) extends superior to pubis, susceptible to injury

Question 13

In an adult, a distended bladder extends superior to the pubis, as a result…

Answer 13

a suprapubic incision can be made to access the bladder without transversing the peritoneum and entering the peritoneal cavity

highly susceptive to injury (MVCs, falls, heavy objects)

Question 14

What are the female pelvic organs?

Answer 14

uterus, vagina, ovaries, uterine (fallopian) tubes, broad ligament

Question 15

Where is the uterus located?

Answer 15

mostly intraperitoneal (suspended by broad ligament)

located between the bladder and rectum

Question 16

What is the myometrium?

Answer 16

smooth muscle of the uterus, can dramatically stretch especially during pregnancy

Question 17

What is the endometrium?

Answer 17

the internal lining of the uterus, made up of granular mucosa

site of implantation, shed each month

Question 18

Body of the uterus

Answer 18

superior 2/3rds of the uterus

fundus is the rounded superior portion of the body

Question 19

What is the cervix?

Answer 19

the cylindrical 1/3 of the uterus. Has internal os (opens superiorly) and external os (opens inferiorly, site of pap smear)

Question 20

Vagina

Answer 20

located between bladder and rectum, continuous with cervix at the external os. Courses superiorly and posteriorly

Question 21

What are vaginal fornices?

Answer 21

the cervix projects into the vagina at its superior end creating these recesses anteriorly, posteriorly and laterally

Question 22

What is special about the posterior fornix?

Answer 22

it is the deepest of all the fornices, related to the rectouterine pouch and rectum posteriorly

an incision can be made through the posterior fornix to examine the peritoneal cavity

Question 23

Where do the ovaries originate at? Where do they descend to?

Answer 23

the posterior abdominal wall, attached to the gubernaculum

into the pelvis and become attached to the posterior aspect of the broad ligaments

Question 24

ovaries are…

Answer 24

intraperitoneal

Question 25

Where are the ovarian vessels, nerves and lymphatics?

Answer 25

enclosed within the suspensory ligament of the ovary which is an extension of the broad ligament

Question 26

Where are oocytes expelled to?

Answer 26

the peritoneal cavity, towards the abdominal orifices of the uterine tubes (during ovulation)

Question 27

Uterine (fallopian) tubes

Answer 27

intraperitoneal open into the peritoneal cavity, fimbriae at opening lie in the superior edge of the broad ligament

Question 28

What is the most common site for ectopic pregnancies?

Answer 28

uterine tubes

Question 29

Why is pelvic inflammatory disease more common in females?

Answer 29

because the peritoneal cavity is open in the female and closed in the male. The vagina, uterus and uterine tubes provide a pathway into the peritoneal cavity

Question 30

What is the broad ligament?

Answer 30

double layer of peritoneum (mesentery) holds uterus to lateral walls and floor of pelvis encloses: uterine tubes, ovaries, suspensory ligament of the ovary and remnants of the gubernaculum

Question 31

What are the remnants of the gubernaculum?

Answer 31

ovarian ligament (between ovary and uterus) round ligament of the uterus (between uterus and labium majus)

Question 32

What are the male pelvic organs?

Answer 32

testes, epididymis, vas deferens, seminal vesicles, ejaculatory ducts, prostate

Question 33

Where do the testes originate? Where do they descend to?

Answer 33

posterior abdominal wall attached to the gubernaculum descend into the inguinal region, pass through the deep inguinal ring and the inguinal canal and exit through the superficial ring to enter the scrotum

Question 34

What is the tunica vaginalis

Answer 34

some of the parietal peritoneum that is drawn into the inguinal canal and scrotum

Question 35

What is the tough fibrous coat around the testes?

Answer 35

tunica albuginea

Question 36

What is a hydrocele?

Answer 36

an abnormal accumulation of fluid within the cavity of the tunica vaginalis

Question 37

Seminiferous tubules?

Answer 37

contained within the testes, where spermatozoa mature

Question 38

Pathway of sperm

Answer 38

seminiferous tubules > rete testes > efferent ductules > epididymis

Question 39

Epididymis

Answer 39

highly coiled tube located on the posterior surface of the testis, connects the testis to the ductus deferens

Question 40

Ductus deferens

Answer 40

muscular tube which ascends within the spermatic cord through the superficial ring and inguinal canal and into the abd via the deep inguinal ring. Courses superior to the ureter enlarges to form an ampulla when it reaches the posterior aspect of the bladder. The ampulla of each ductus deferens joins the duct of the seminal vesicle

Question 41

How is a vasectomy performed?

Answer 41

by making an incision in the superior aspect of the scrotum to expose and ligate the ductus deferens

Question 42

Seminal vesicles

Answer 42

thin walled tubes that are coiled to form a mass that lies between the posterior wall of the bladder and the rectum secrete fluid that mixes with spermatozoa ducts of the seminal vesicles join the ampullae of the ductus deferens to from the ejaculatory ducts

Question 43

What does the ejaculatory duct open into?

Answer 43

the prostatic urethra

Question 44

Prostate

Answer 44

gland surrounds the prostatic urethra, secretes fluid into the prostatic urethra via numerous ducts base (superior) surrounds neck of the bladder, apex (superior)

Question 45

What are the lobes of the prostate?

Answer 45

Anterior lobe (anterior to prostatic urethra) 2 lateral lobes median lobe (posterior to the prostatic urethra and superior to the ejaculatory ducts) posterior lobe (posterior to the prostatic urethra and inferior to the ejaculatory ducts)

Question 46

What lobe of the prostate is commonly involved in benign hypertrophy of the prostate?

Answer 46

the median lobe. When it is enlarged, it stretched the internal urethra sphincter (causing urine leakage), puts pressure on the trigone (urge to void, especially at night) and can obstruct the prostatic urethra making it difficult to void

Question 47

What lobe of the prostate is the most common site of prostatic carcinoma?

Answer 47

posterior lobe

Question 48

What can you palpate on a male rectal exam?

Answer 48

anterior wall of rectum- posterior lobe of prostate and seminal vesicles

Question 49

What can you palpate on a female rectal exam?

Answer 49

anterior wall of rectum- vagina

Question 50

Characteristics of individuals with Complete Androgen Insensitivity 46XY

Answer 50

phenotypically female, incompletely descended testes no uterus, cervix or fallopian tubes

Question 51

Trace the parasympathetic innervation of pelvic organs

Answer 51

Preganglionic cell bodies: intermediate gray matter of S2-S4 spinal cord preganglionic fibers: ventral root > spinal nerve > ventral rami > pelvic splanchnic nerves postganglionic cell bodies and fibers: walls of organs

Question 52

Trace the sympathetic innervation pathway of pelvic organs (except ovaries and testes)

Answer 52

Pre CB:lateral horn (of thoracolumbar spinal cord) > Pre CF: ventral root> spinal nerve> ventral rami> white ramus communicans> sympathetic trunk> lumbar and sacral splanchnic nerves> Post CB: superior or inferior hypogastric ganglia Post CF: follow arterial branches to target organ

Question 53

Trace the sympathetic innervation pathway of the ovaries and testes

Answer 53

``` Pre CB: lateral horn of thoracolumbar spinal cord Pre CF: ventral root> spinal nerve> ventral rami> white ramus communicans> sympathetic trunk> thoracic splanchnic nerves> Post CB: superior mesenteric ganglion Post CF: follow the gonadal vessels to the target organ ```

Question 54

visceral sensory innervation

Answer 54

fibers follow the sympathetic or parasympathetic pathways back to the CNS but enter the dorsal root ...route taken differs relative to the pelvic pain line (corresponding to the inferior limit of the peritoneum)

Question 55

What path do visceral sensory fibers follow for structures superior to the pelvic pain line?

Answer 55

sympathetic fibers back to the inferior thoracic and superior lumbar spinal cord levels

Question 56

What path do visceral sensory fibers follow for structures inferior to the pelvic pain line?

Answer 56

follow parasympathetic fibers (i.e. pelvic splanchnic nerves) back to the S2-S4 spinal cord

Question 57

For structures that lie in between the pelvic pain line, what path do visceral sensory fibers follow?

Answer 57

they follow both, those superior follow the sympathetic pathway and those inferior follow the parasympathetic pathway