pelvis viscera 1 of 2

Question 1

transverse the wall of the bladder in an oblique direction. How does this assist function?

Answer 1

ureters

1. transverses the wall of the bladder in the oblique direction
   
   1. two thing inhibit refluc of urine into the ureter
      
      1. ​pressure from a filling bladder
      2. bladder contraction during micturition

Question 2

posterior to vas deferens(male) or pass below uterine artery(female)

retroperitoneal in both sexes

Answer 2

ureters

Question 3

what arteries supply the plvic region of the ureter?

Answer 3

1. arteries
   
   1. male
      
      1. inferior vesicular artery
   2. female
      
      1. uterine and vaginal

Question 4

what are are the veins and lymphatic structure/desitination for the palvic portion of the ureter

Answer 4

1. veins
   
   1. vesical venous plexus around inferior end
   2. sex dpendent
      
      1. male
         
         1. inferior vesicular
      2. female
         
         1. uterine and vaginal
2. lymphatic
   
   1. internal iliac nodes

Question 5

describe the GVE, parasympathetic, and GVA

Answer 5

1. Sympathetic
   
   1. T11-T12/ L1-L2
      
      1. superior hypogastric plexus
      2. inferior hypogastric plexus
2. parasympathetic
   
   1. S2-S4
      
      1. pelvic slanchnic nerve
3. visceral afferents
   
   1. travel with
      
      1. pain with sympathetic and parasympathetic

Question 6

Why would the ureter be at risk durin a hysterectomy?

Answer 6

ureter is at risk during hysterectomy because uterine artery pass over it

Question 7

loin to groin pain is a reflection on which nerve fibers?

How could a ureter be involved?

Answer 7

T11-L2

ureters are innervated by GVA fibers that accompany GVE sympatheric fibers from the T11-L2 spinal cord levels.

Passage of a kidney stone produces loin-groin pain (abdomen->pelvis)

Question 8

explain and diagram the urinary bladder

Answer 8

1. components
   
   1. body
   2. fondus(base)
   3. spex
   4. neck(surroung the urethra)

Question 9

where does the urethra meet the bladder?

Answer 9

urethra meets the bladder at the angles of the smooth walled trigone

Question 10

this remnant runs upward from the apex of the bladder. What happens if it does not seal off?

Answer 10

median umbilical ligament (remnant of urachus) run upward from apex of the bladder

if the lumen of the urachus persists in newborn, urine leaks from umbilicus

Question 11

what are the ligaments that support urinary bladder? sex specific

Answer 11

1. male
   
   1. puboprostatic ligament
2. female
   
   1. pubvesical ligaments

Question 12

explain the urethral structture and distinguish between sexes

Answer 12

1. female
   
   1. short, mostly in perineum
   2. empties into vestibule
   3. external urethral sphincter (perineum)
2. male
   
   1. preprostatic
      
      1. internal uretthral sphincter
   2. prostatic part
      
      1. where urinary and reproductivetract merge
   3. membrenous part
      
      1. enternal urethral sphincter
   4. spongy part
      
      1. ends in navicular fossa

Question 13

differentiate the location of the urinary bladder between age groups

Answer 13

urinary bladder is in

1. adult
   
   1. in pelvis
   2. can be damaged in pelvis trauma when empty
2. child
   
   1. abdomen
   2. can rupture if full in abdominal trauma

Question 14

shorter urethra and opeining in vesitbule leaves females…what about hospilization?

Answer 14

increase susceptible to bladder infection (cystitis)

make it easier for passage of catheters and cystoscopes/wall of urthral bulb can be damaged in males

Question 15

why is bladder cancer a concern?

Answer 15

can invade ureter, rectum, uterus, seminal vesicles and prostat as well as lateral wall of pelvic cavity.

Question 16

what arteries/veins are located anteriosuperior to the bladder?

Answer 16

superior vesical artery and vein

Question 17

artery/vein found near fundus and neck of bladder and pelvic urethra

Answer 17

sex specific

1. male
   
   1. inferior vesical artery and vein
2. female
   
   1. vaginal artery and vein

Question 18

what drains the fundus of the bladder and proximal urethra? how?

Answer 18

vesical veinous plexus

• drain fundus of the bladder and proximal urethra
  
  • ​Inferior vesical/vaginal veins
    
    • to the internal ilac vein
  • sacral veins** into the **vertebral venous plexuses
    
    • may provide a route for tumor metastasis to the vertebral column, pelvic bones and skull
• male
  
  • vesical veinous plexus is continuous with the
    
    • prostatic venous plexus
    • dorsal vein of penis
• female
  
  • communicates with
    
    • uterovaginal venous plexus
    • dorsal vein of clitoris

Question 19

describe the nerve supply of urinarybladder and proximal urethra. differentiate only between sympathetic and parasympathetic

Answer 19

sex

1. male
   
   1. vesical pplexus for bladder and prostatic plexus
2. female
   
   1. vesical plexus for bladder and proximal urethra

visceral difference

1. visceral efferents
   
   1. parasympathetic
      
      1. contraction of detrusor muscle
      2. male
         
         1. inhibition of internal urethral sphincter
   2. sympathetic
      
      1. male
         
         1. contraction of internal urethral sphincter
            
            1. prevent urination in shy male- when the sympathetic tone is high
2. visceral afferents - pain trave laccordin to pain line
   
   1. parasympathetic
      
      1. fundus and neck of bladder and proximal urethra
   2. sympathetic
      
      1. anteriosuperior portions of bladder

Question 20

how does urine pass to by the ureters to the bladder?

Answer 20

peristaltic contractions of the ureters via - increase in parasympathetic tone

Question 21

explain the nerves involved in the process of micturation reflex

Answer 21

mituriction

1. internal pressure ofthe filling bladder close ureters to prevent backflow
2. bladder wall stretching stimulate GVA fibers (S2-S4) going to spinal cord
3. parasympatheticGVE fibers S2-S4 cause urine to flow in urethra
   
   1. stimulation of detrusor muscle in wall of bladder
   2. male only
      
      1. relaxation of the internal urethral sphincter

voiding

1. relaxation of levator ani during urination (GSE)
2. abdominal muscle contracted (GSE) leading to an increase in bladder pressure

Question 22

stimulation of detrusor muscle in walls of bladder is caused by?

Answer 22

parasympathetic fibers S2-S4 cause uring to flow in urethra

1. sitmulation of detrusor muscle in walls of bladder
2. male only
   
   1. relaxation of the interna lurethral sphincter

Question 23

what does voiding involve?

Answer 23

1. relaxation of the levator ani during urination (GSE)
2. abdominal muscle contracted (GSE) increasing the bladder pressure
3. pudendal nerve (GSE
   
   1. volunatary relaxation of external urethral sphincter
   2. branches of pudendal nerve lead to release of urine outside of the body
4. male only
   
   1. final drops pushed out of urethra by conraction of bulbospongiosus muscle controlled by branches of pudendal nerve(GSE)

Question 25

bulbospongiosus muscle is controlled and located where?

Answer 25

• in male
  
  • final drops of urine are pushed out of the urethra by contraction of bulbospongiosus muscle (located in perineum) controlled by branches of pudendal nerve

Question 26

rectum is located at what vertebral level? explain the flow of structure

Answer 26

continuous with sigmoid colon proximally (begins at about S3 vertebral level) and the anal canal distally

1. normally
   
   1. the rectum is empty
      
      1. rectosigmoid junction acts as a functional sphincter
      2. accumulates and temporally stores feces
2. lower part expand to form rectal ampulla
   
   1. essential for fecal continence
3. extraperitoneal

Question 27

essential for fecal continence, where is it with regard to the peritoneum?

Answer 27

rectum

1. lower part expand to form RECTAL AMPULLA
   
   1. ​rectal ampulla IS ESSENTIAL FOR FECAL CONTINENCE
2. extraperitoneal

Question 28

describe the vasculature nadlymphatics to the rectum

Answer 28

blood vessels

1. superior rectalartery and vein
   
   1. inferior mesenteric artery and vein
   2. upper rectum recieves vasculature
2. middle rectal artery and vein
   
   1. internal iliac artery and vein
   2. lower rectum recieves vasculature
3. inferior rectal artery and vein
   
   1. internal pudendal artery and vein
   2. anorectal junction receive vasculature

lymphatic

1. internal iliac nodes

Question 29

what blood vessels supply the following

1. upper rectum
2. lower rectum
3. anorectal junction

Answer 29

1. inferior mesenteric ->superior rectal ->upper rectum
2. Internal iliac ->middle rectal->lower rectum
3. internal pudendal->inferior rectal artery->anorectal junction

Question 30

Descreribe the venous flow in the blood vessels involved with the rectum

Answer 30

1. upper rectum->inferior mesenteric vein->portal system
2. lower rectum-> internal iliac vein->caval system
3. anorectal junction->internal pudendal vein->caval system

Question 31

describe the nerve supply to the rctum

Answer 31

1. rectal plexus
   
   1. visceral efferents
      
      1. parasympathetic
         
         1. S2-S4
      2. sympathetic
         
         1. L1-L2
         2. decrease peristalsis
   2. visceral afferents
      
      1. pain and other sensations travel with parasympathetic
         
         1. ​S2-S4

Question 32

explain the steps and processes in defecation- 7 steps

Answer 32

1. sigmoid colon accumulates fecal material
   
   1. stimulate desire to deficate via GVA fibers
2. sigmoid colon empties into the rectum
   
   1. mass peristaltic movement- parasumpathetic GVE fibers
3. feces enters the rectum it stimulates the desire to defecate
   
   1. GVA FIBERS
4. muscles of rectum contract and increase pressure with in rectum
   
   1. muscles of rectum - parasympathetic GVE fibers
   2. muscles of the abdominal wall GSE fibers
      
      1. contract and increase pressure
5. decrease angle of anoreactal junction
   
   1. puborectalis (GSE) relaxes
6. internal anal sphincter opens
   
   1. relaxes uner parasympathetic control via GVE fibers
   2. relaxes from response to increased pressure transmitted via GVA fibers( in perineum
7. external anl sphincter relaxes
   
   1. under volunatary control from branches of pudendal nerve (GSE fibers)
   2. open to allow stool outside of body (in perineum)

Question 33

3rs most common cancer. where does it start and how does it spread?

Answer 33

colorectal cancer

1. start in colon or rectum
2. spreading
   
   1. rectal tumor will spread to internal iliac lymph nodes
   2. can spread to nearby structures
      
      1. baldder
      2. uterus
   3. can metastasize to liver
      
      1. by superior rectal vein (portal circulation)

Question 34

describe the action, type of fibers and function of blood vessels of the viscera pertaining to the urinary and gastrointestinal organ

Answer 34

1. blood vessels of viscera
2. fiber type-action-function
   
   1. sympathetic-vasoconstriction-control of blood
   2. parasympathetic-vasodilation

Question 35

describe the type of fibers-action-function of the ureter

Answer 35

ureter

1. fibers-action-function
   
   1. parasympathetic-increase perstalsis-urine transport
   2. sympathetic-decrease peristalsis

Question 36

describe the fiber-action and function of the detrusor muscle of bladder

Answer 36

1. detrusor muscle of bladder
2. fiber-action
   
   1. parasympathetic-contraction
3. function
   
   1. micturition

Question 37

desceribe the fiber-action-function of the internal urethral sphincter

Answer 37

male only

1. internal urethral sphincter
2. fiber - action - function
   
   1. sympathetic-contraction-inhibit urination and retrograde ejaculation
   2. parasympathetic-relaxation (open)-micturition

Question 38

desceribe the fiber-action-functtion of the rectum

Answer 38

1. rectum
2. fiber-action-function
   
   1. parasympathetic-increase motility-defecation
   2. sympathetic-decrease motility-inhibit defacation