SUGER Anatomy Flashcards
1
Q
What are the functions of the kidneys?
A
They act to filter and excrete waste products from the blood. They are also responsible for H2O and electrolyte balance.
2
Q
What are the posterior relations to the kidneys?
A
Diaphragm, psoas major, quadratus lumborum and transversus abdominis.
3
Q
What are the anterior relations to the right kidney?
A
Liver and duodenum, coils of intestine.
4
Q
What are the anterior relations to the left kidney?
A
Stomach, spleen, pancreas, coils of intestine.
5
Q
What is found at the renal hilum?
A
Renal arteries and veins, ureter, nerves and lymphatics.
6
Q
Which kidney is often positioned lower in the abdomen and why?
A
The right kidney, this is due to the presence of the liver.
7
Q
What are the renal arteries a branch of?
A
The abdominal aorta just below the SMA.
8
Q
Which renal artery is longer?
A
The right renal artery, this is due to the position of the aorta being slightly to the left.
9
Q
Which artery crosses the IVC posteriorly?
A
The right renal artery.
10
Q
Describe the branching of the renal artery.
A
Renal artery -> interlobar artery -> arcuate artery -> interlobular artery -> afferent arteriole.
11
Q
Where do the renal veins drain?
A
Into the IVC.
12
Q
How would you describe the shape of the:
a) right adrenal gland?
b) left adrenal gland?
A
a) Tetrahedral.
b) Crescent-shaped.
13
Q
Which adrenal gland does the IVC lie anteriorly to?
A
The right adrenal gland.
14
Q
What are the 3 main layers of an adrenal gland?
A
- An outer connective tissue capsule.
- A cortex.
- A medulla at the centre.
15
Q
Adrenal glands: What are the 3 layers of the cortex?
A
- Zona glomerulus.
- Zona fasciculata.
- Zona reticularis.
16
Q
Adrenal glands: What cells are contained within the medulla and what do they secrete?
A
Chromaffin cells - they secrete catecholamines e.g. adrenaline. This is a ‘fight or flight’ response.
17
Q
What are the 3 arteries that supply the adrenal glands?
A
- Superior adrenal artery.
- Middle adrenal artery.
- Inferior adrenal artery.
18
Q
What is the superior adrenal artery a branch of?
A
The inferior phrenic artery.
19
Q
What is the middle adrenal artery a branch of?
A
The abdominal aorta.
20
Q
What is the inferior adrenal artery a branch of?
A
The renal arteries
21
Q
What does the right adrenal vein drain into?
A
The IVC.
22
Q
What does the left adrenal vein drain into?
A
The left renal vein (and then into the IVC).
23
Q
What section of the spine is found in the posterior abdominal wall?
A
The lumbar section.
24
Q
What muscle lies superficially to psoas major?
A
Quadratus lumborum.
25
What is the origin of quadratus lumborum?
Iliac crest and the iliolumbar ligament.
26
What is the insertion of quadratus lumborum?
The transverse processes of L1 to L4 and the 12th rib.
27
What is the action of quadratus lumborum?
Extension and flexion of the vertebral column.
28
What is the innervation of quadratus lumborum?
T12-L4 nerves.
29
What is the origin of psoas major?
T12-L5 vertebrae.
30
What is the insertion of psoas major?
The lesser trochanter of the femus.
31
What is the action of psoas major?
Flexion of the hip.
32
What is the innervation of psoas major?
L1-3 nerves.
33
What nerves lies on the anterior surface of psoas major?
The genitofemoral nerve.
34
Where does the femoral branch of the genitofemoral nerve go?
It passes under the inguinal ligament and supplies sensory innervation to the inner thigh.
35
Where does the genital branch of the genitofemoral nerve go?
It passes through the deep inguinal ring to enter the inguinal canal. It supplies the cremaster muscle.
36
Why can renal tumours become very large before invading adjacent structures?
The tumour has to grow through multiple tough layers: fibrous capsule, perirenal fat, renal fascia and pararenal fat.
37
What vein does the right gonadal vein drain into?
The IVC.
38
What vein does the left gonadal vein drain into?
The left renal vein (and then the IVC).
39
Where would you palpate an abdominal aortic aneurysm?
In the epigastrium, above the umbilicus.
40
What is the origin of psoas major?
T12-L5.
41
What is the insertion of psoas major and iliacus muscles?
Lesser trochanter of femur.
42
What is the origin of iliacus muscle?
Iliac fossa and anterior inferior iliac spine.
43
What is the innervation of iliacus muscle?
Femoral nerve (L2-4).
44
What nerve lies in the groove between the iliacus and psoas major?
The femoral nerve.
45
What nerve emerges from psoas major medially?
Obturator nerve.
46
What does the femoral nerve give motor innervation to?
The anterior thigh muscles that flex the hip and extend the knee.
47
What is the action of iliacus?
Flexion of the hip.
48
What does the femoral nerve give sensory innervation to?
Cutaneous branches pass to the antero-medial thigh. The terminal branch, saphenous nerve, supplies the medial side of the leg and foot.
49
What are the nerve roots for the femoral and obtruator nerves?
L2-L4.
50
What does the obtruator nerve give motor innervation to?
The medial thigh muscles inolved in adduction.
51
What does the obtruator nerve give sensory innervation to?
The skin of the medial thigh.
52
What are the sciatic nerve roots?
L4 - S3 (lumbosacral plexus).
53
What is the largest nerve in the body?
The sciatic nerve.
54
What does the sciatic nerve give motor innervation to?
Muscles of the posterior thigh and hamstring of adductor magnus.
55
When the sciatic nerve terminates it bifurcates into 2 nerves. What are they?
- Tibial.
| - Common fibular.
56
What are the walls of ureters composed of and why?
Smooth muscle walls. When the muscle contracts it produces peristaltic waves that propels the urine into the bladder.
57
What is the name of the point at which the renal pelvis narrows?
The ureteropelvic junction.
58
What is the significance of the ureters piercing the bladder obliquely?
It creates a physiological valve that acts to prevent the back flow of urine.
59
Do the ureters cross the ovarian arteries and the ductus deferens anteriorly or posteriorly?
Posteriorly. (Water (ureters) under the bridge (artery)
60
What is the function of the bladder?
Collection, temporary storage and expulsion of urine.
61
Give 3 ways in which the bladder is specialised for storage
1. Rugae give the bladder a great capacity to expand.
2. Detrusor muscle relaxes in storage, increasing bladder volume.
3. Urethral sphincters contract.
62
What is the interureteric bar?
A ridge of muscle between the two ureteric orficies.
63
What is the significance of the trigone?
It marks the two ureteric orifices and the urethral orifice. It is located in the fundus and it has a smooth wall in contrast to the rest of the bladder.
64
Which urethral sphincter is composed of skeletal muscle?
The external urethral sphincter.
65
Which urethral sphincter is under voluntary control?
The external urethral sphincter.
66
Which urethral sphincter is composed of smooth muscle?
The internal urethral sphincter.
67
Which urethral sphincter is under autonomic control?
The internal urethral sphincter.
68
What is the specialised smooth muscle of the bladder wall called?
The detrusor muscle.
69
What is the blood supply to the bladder?
The internal iliac arteries.
70
What nerve provides sympathetic innervation to the bladder?
The hypogastric nerve (T12-L2).
71
What is the affect of sympathetic innervation on the bladder?
Relaxation of the detrusor muscle and constriction of the internal urethral sphincters - this promotes urine retention.
72
What is the affect of parasympathetic innervation on the bladder?
Contraction of the detrusor muscle and relaxation of the internal urethral sphincters - this promotes micturition.
73
What is the role of the sensory nerves in the bladder wall?
They signal the need to urinate to the brain when the bladder becomes full.
74
Name 3 locations where the ureter narrows and renal stones may be present.
1. Ureteropelvic junction.
2. As the ureter passes the pelvic brim.
2. Where the ureters enter the bladder
75
Why is the ureter at danger of being damaged in a hysterectomy?
The uterine artery is ligated in a hysterectomy. The ureter passes immediately posteriorly to the uterine artery and so may be damaged.
76
What two lumbar plexus nerves have the same nerve roots?
Femoral and Obtruator - L2,3,4.
77
What 3 bones make up the hip bone?
1. Ilium.
2. Pubis.
3. Ischium.
78
What is the socket called formed from the fusion of the ilium, pubis and ischium?
The acetabulum.
79
What bone articulates with the acetabulum?
The head of the femur.
80
Name 2 important ligaments that attach from the sacrum to the ischium.
1. sacrospinous ligament.
| 2. sacrotuberous ligament
81
Where does the sacrospinous ligament run between?
The sacrum to the ischial spine.
82
Where does the sacrotuberous ligament run between?
The sacrum to the ischial tuberosity.
83
Why are female pelvis' different to males?
Female pelvis' have special adaptations for childbirth.
84
What are the 3 main differences between male and female pelvis'?
1. The female has a larger angled sub-pubic arch.
2. The pelvic outlet is rounder in females.
3. The ischial spine projects further into the male pelvic cavity.
85
What do the left gonadal veins (ovarian and testicular) drain into?
The left renal vein!
86
What forms the floor of the inguinal canal?
The inguinal ligament.
87
What does the inguinal canal transmit in males?
The spermatic cord.
88
What does the inguinal canal transmit in females?
The round ligament of the uterus.
89
What are the nerve roots for the ilio-inguinal nerve?
L1.
90
What does the ilio-inguinal nerve give sensory innervation to?
- Skin on the upper middle thigh.
- In males it supplies the skin over the penis and scrotum.
- In females it supplies the skin over the mons pubis and labium majora.
91
How do the testes move from the posterior abdominal wall to the scrotum?
The paired gubernacula aid in the descent of the testes. The testes are guided through the inguinal canal and then into the scrotum.
92
Define hernia
Protusion of an organ through the wall of cavity that normally contains it.
93
What type of hernia is lateral to the inferior epigastric artery?
An indirect hernia.
94
Where does the inferior epigastric artery lie?
Immediately medial to the deep inguinal ring.
95
What are the 3 layers of tissue surrounding the spermatic cord?
1. External spermatic fasica.
2. Cremaster muscle and fascia.
3. Internal spermatic fascia.
96
What layer of the abdominal wall is the external spermatic fascia derived?
Derived from the aponeurosis of external oblique.
97
What layer of the abdominal wall is the internal spermatic fascia derived?
Transversalis fascia.
98
What layer of the abdominal wall is the cremaster muscle and fascia derived?
Internal oblique.
99
What is the function of the cremaster muscle?
To raise and lower the testes in order to regulate scrotal temperature for optimum spermatogenesis.
100
What is the vas deferens?
The duct that transports sperm from the epididymis to the ejaculatory ducts.
101
What 3 arteries are contained within the spermatic cord?
1. Testicular artery.
2. Cremasteric artery.
3. Artery of the vas.
102
What 3 veins are contained within the spermatic cord?
1. Testicular vein.
2. Cremasteric vein.
3. Vein of the vas.
103
What 3 nerves are contained within the spermatic cord?
1. Ilio-inguinal nerve.
2. Genitofemoral nerve.
3. Sympathetic plexus.
104
What are '3 others' contained within the spermatic cord?
1. Vas deferens.
2. Lymphatics.
3. Tunica vaginalis.
105
What is the midline fusion of the scrotum called?
The midline raphe.
106
Where is the dartos muscle located?
Immediately underneath the scrotal skin.
107
What is the function of the dartos muscle?
It helps to regulate temperature by wrinkling the skin of the scrotum - this decreases SA and reduces heat loss.
108
What are the 3 erectile tissues contianed within the root of the penis?
1. 2x Crura (form corpus cavernosum in body).
| 2. 1x Bulb (forms corpus spongiosum in body).
109
What is the glans of the penis?
The most distal part of the penis formed by the expansion of the corpus spongiosum. It contains the urethral orifice.
110
Is ejaculation caused by parasympathetic or sympathetic innervation?
Sympathetic.
111
What is a varicocele?
Pampiniform plexus of veins has dilated in the testicle.
112
Where will inguinal hernias lie in relation to the pubic tubercle?
Superiorly and medially.
113
What is a hydrocele?
Swelling of the scrotum caused by distension of the tunica vaginalis.
114
Which nerves provide sensory innervation to the scrotal skin?
- Ilio-inguinal.
- Genital branch of genitofemoral.
- Branches from the perineal nerve.
115
What are the two hiatuses of the pelvic floor?
1. Urogenital hiatus.
| 2. Rectal hiatus.
116
What passes through the urogenital hiatus of the pelvic floor?
The urethra and the vagina.
117
What passes through the rectal hiatus of the pelvic floor?
The anal canal.
118
Give 3 functions of the pelvic floor muscles.
1. They support abdomino-pelvic viscera.
2. They resist increases in intra pelvic pressures.
3. They maintain urinary and faecal continence.
119
What are the 2 main muscles of the pelvic floor?
1. Levator ani muscles.
| 2. Coccygeus muscle.
120
What is the innervation to the levator ani muscles?
Branches of the pudendal nerve, S2, 3, 4 roots.
121
What is the function of levator ani?
Maintains faecal continence, during defecation this muscle relaxes.
122
Which muscles of levator ani are prone to injury in childbirth?
Pubococcygeus and puborectalis due to their medial position.
123
What is the innervation of coccygeus?
Ventral rami of S4 and 5.
124
What can happen if you damage the pelvic floor?
You may get prolapse of pelvic viscera
125
What risk factors can increase the chance of prolapse?
1. Increasing age.
2. Number of vaginal deliveries.
3. Family history.
4. Being overweight.
5. Chronic coughing e.g. a lung disorder.
126
What is the perineum?
An anaotmical space located below the pelvic diaphragm; it is diamond shaped and contains urinary, GI and reproductive viscera.
127
What divides the perineum into anterior and posterior triangles?
An imaginary line drawn between the ischial tuberosities.
128
What 2 triangles are formed by the imaginary line dividing the perineum?
1. The posterior anal triangle.
| 2. The anterior urogenital triangle.
129
What line separates the deep and superficial perineal pouches in the urogenital triangle?
The perineal membrane - a sheet of fibrous tissue.
130
Where will urine accumulate if the male urethra is ruptured?
In the superficial perineal pouch.
131
What does the superficial perineal pouch contain?
Erectile tissue that forms the penis and the clitoris.
132
What is the deep perineal pouch?
A space deep to the perineal membrane. It contains part of the urethra.
133
What is the superficial perineal pouch?
An area superficial to the urogenital diaphragm.
134
True or False: the perineal membrane covers the urogenital diaphragm?
True.
135
What perforates the perineal membrane?
The urethra and the vagina.
136
What is the perineal body?
The centre of the perineum located at the junction between the urogenital and anal triangles.
137
Why does the uterus need to be capable of expansion?
So it can accommodate the growth of a foetus.
138
What are the 3 sub-divisions of the uterus?
1. Fundus.
2. Body.
3. Cervix.
139
What is a fornix?
A space between the vagina and the cervix
140
What are the 2 orifices of the cervix?
1. The internal orifice - communicates with the uterus.
| 2. The external orifice - communicates with the vagina.
141
The uterus is described as anteverted with respect to the vagina, what does this mean?
It is rotated towards the anterior surface of the body.
142
How does the uterus lie with respect to the bladder?
Posterior-superior.
143
What are the three tissue layers that make up the uterus?
1. Peritoneum.
2. Myometrium: smooth muscle layer.
3. Endometrium: inner mucous membrane lining.
144
What are the two divisions of the endometrium?
1. Stratum basalis.
| 2. Stratum functionalis.
145
Which layer of the endometrium is shred in menstruation?
The stratum functionalis.
146
What is the broad ligament?
A double peritoneum layer that attaches the uterus to the pelvis; it acts a mesentery.
147
What is the round ligament and what is its function?
A remnant of the gubernaculum.
| Its function is to maintain the anteverted position of the uterus.
148
What does the cardinal ligament contain?
The uterine artery and vein.
149
What is the uterine artery a branch of?
The internal iliac artery.
150
What ligament do the uterine tubes lie in?
The broad ligament
151
What is the function of the uterine tubes?
They assist in the transport and transfer of ovum from the ovary to the uterus.
152
Give 2 ways in which the uterine tube is adapted for the transport of ovum to the uterus.
1. Ciliated columnar epithelium wafts the ovum to the uterus.
2. Contraction of the smooth muscle layer.
153
What is the most medial part of the uterine tube?
The isthmus.
154
Where in the uterine tube does fertilisation normally occur?
In the ampulla, this is the widest part of the tube and is lateral to the isthmus.
155
What is the final part of the uterine tube?
The fimbriae, finger-like projections coming off the infundibulum.
156
What is the function of the fimbriae?
To capture the ovum.
157
What is the blood supply to the uterine tubes?
The ovarian and uterine arteries.
158
What is the ovarian artery a branch of?
The abdominal aorta.
159
What forms the ovarian fossa?
The angle between the internal and external iliac arteries.
160
What are the female gonads?
The ovaries.
161
Where do the ovaries lie in relation to the broad ligament?
Posterior.
162
Give 2 functions of the ovaries.
1. To produce oocytes.
| 2. To produce oestrogen and progesterone.
163
Where are the follicles containing oocytes found in the ovary?
In the cortex
164
What is the epithelium surface of the ovary?
Simple cuboidal epithelium.
165
What area of the ovary contains the neurovascular tissues?
The medulla.
166
What does the ovarian ligament connect?
The ovary to the uterus.
167
What is the blood supply to the ovaries?
Ovarian arteries (branch of the abdominal aorta).
168
What does the left ovarian vein drain into?
The left renal vein.
169
What ligament does the neurovasculature tissue travel through to reach the hilum of the ovary?
The suspensory ligament of the ovary.
170
Give 3 functions of the vagina.
1. It receives the penis in sexual intercourse.
2. It expands providing a delivery channel in childbirth.
3. It serves as a canal for menstrual fluid to leave the body.
171
What 2 things comprise the vaginal mucosa?
1. Stratified squamous epithelium.
| 2. Elastic lamina propria.
172
What is the blood supply to the vagina?
Uterine and vaginal arteries (branches of the internal iliac artery).
173
What are female external genitalia collectively known as?
Vulva.
174
Give 3 functions of the vulva.
1. Sensory tissue in sexual intercourse.
2. Assist in micturition.
3. Defend the internal female reproductive tract from infection.
175
What is the mons pubis?
A mass of fatty tissue lying over the pubis symphysis.
176
What are the labia majora?
Hair bearing external folds that fuse posteriorly and extend anteriorly to the mons pubis.
177
What are the labia minora?
Hairless folds that lie within the labia majora. They fuse anteriorly to form the prepuce (hood) of the clitoris.
178
What is the vestibule?
An area between the labia, the external vagina and urethral orifice are found here.
179
Where are the great vestibular glands located and what is their function?
Glands located either side of the vaginal orifice, they secrete mucous during sexual arousal.
180
What is the main blood supply to the vulva?
Pudendal arteries.
181
What 2 structures combine to form the ejaculatory ducts?
The vas deferens and the seminal vesicle.
182
List in sequence the tubular structures along which spermatozoa pass to the exterior?
Testes -> epididymis -> vas deferens (goes through inguinal canal and along the lateral pelvic wall to the posterior bladder) -> seminal vesicle -> ejaculatory duct -> prostate gland -> prostatic urethra -> membranous urethra -> penile urethra.
183
What is the ampulla of vas?
A large dilation of the vas deferens on the posterior aspect of the bladder.
184
True or False: the seminal vesicles store spermatozoa.
False - they do NOT store spermatozoa.
185
What is the function of the prostate glands?
They secrete proteolytic enzymes which break down clotting factors in the ejaculate and so allowing the semen to remain fluid.
186
What does the prostate lie inferior to?
The neck of the bladder.
187
What does the prostate lie superior to?
The external urethral sphincter.
188
What is the blood supply to the prostate?
Prostatic arteries (derived from internal iliac arteries).
189
Name 2 vessels that pierce the prostate
The urethra and the ejaculatory ducts.
190
How long is the male urethra?
15-20cm.
191
How long is the female urethra?
4cm.
192
What is the prostatic part of the male urethra
Where the urethra descends through the prostate (3cm).
193
What is the membranous part of the male urethra?
Where the urethra transverses the urogenital diaphragm (1cm).
194
What is the penile part of the male urethra?
Where the urethra travels through the bulb, corpus spongiosum and glans of the penis (15cm).
195
What dilation in the glans my impede a urethral catheter?
The navicular fossa.
196
Why might inflammation of the ovary cause medial thigh pain?
Inflammation may irritate the obtruator nerve causing medial thigh pain - REFERRED PAIN!
197
What is a retroverted uterus?
One that is rotated towards the posterior abdominal wall, it would lie on the rectum
198
Give some signs and symptoms of an enlarged prostate gland.
An enlarged prostate would press on the bladder and so cause an increase in urinary frequency, urinary urgency, dribbling, and difficulty initiating micturition.
199
Why might a malignant tumour of the prostate spread to the vertebral column?
The prostatic venous plexus of veins is in direct continuation with the venous plexus of the vertebra and so this represents a possible route of tumour spread.
200
2. Where would you palpate the ductus deferens? By palpation alone, how would you
identify the ductus deferens?
The ductus deferens commences at the lower pole of the testis and runs up the posterior
surface of the testis and through the spermatic cord to enter the superficial inguinal ring. The best
place to palpate it is between the upper pole of the testis and superficial inguinal ring. It has a
very thick wall and feels hard but flexible (like a rubber cord).
201
What is a varicocele?
Dilated veins in the pampiniform plexus.
202
Some indirect inguinal hernias are congenital (meaning “present at birth”) even though
they may not appear until later in life. Explain the embryology of these hernias.
The testis develops just below the kidney and travels down into the scrotum
during inter-uterine development. As it passes from the abdomen through the abdominal
wall it takes a pouch of peritoneum with it. Usually this pouch becomes disconnected
from the peritoneal cavity and forms the tunica vaginalis. However, sometimes the pouch
remains connected and bowel can enter the pouch to form a hernia
203
Where would you try to palpate lymph nodes to assess the spread of testicular
cancer?
In the epigastrium. Lymphatics follow the arteries
backwards, hence the lymphatics from the testis follow the testicular artery back to the
upper abdominal aorta in the epigastrium. This is where cancer of the testis spreads to.
204
Where might you look for an undescended testis? Is it worth surgically correcting this
anomaly?
The testis develops just below the kidney and travels down the posterior
abdominal wall, through the inguinal canal and into the scrotum during inter-uterine
development. An undescended testis will be somewhere along this path. Spermatogenesis
needs to take place at lower than body temperature so moving an undescended testis to
the scrotum is worthwhile
205
Testicular pain may radiate to the loin. Why?
The nocioceptive (pain sensation) nerve fibers to the testis are sympathetic and
follow the testicular artery from the aortic sympathetic plexus which is formed from the
T11 and T12 nerve roots. Pain is felt in the distribution of the cutaneous nerve of these
segments as a referred pain.
206
Which nerves provide sensory innervation to the scrotal skin?
The anterior 1/3 of the scrotum is lumbar 1 nerve root and the ilioinguinal nerve.
The posterior 2/3 is the sacral 2, 3, and 4 nerves through the pudendal nerve.
207
Renal tumors can become very large before they invade adjacent structures. What
anatomical features explain this?
```
Fibrous capsule (inner layer) closely applied to the renal substance, perirenal fat,
renal fascia (encloses the kidney and adrenal glands together), pararenal fat. So the tumor
has to grow through multiple tough layers before invading adjacent structures.
```
208
Describe two common variations in the anatomy of the renal pelvis and ureter.
Duplex system, pelvoureteric junction obstruction
209
What veins do the right and left gonadal veins drain into?
Right into the inferior vena cava, left into the left renal vein.
210
. What is a polar artery? Explain why polar arteries exist
An accessory renal artery usually supplying the lower pole of the kidney. The
kidney develops as a number of separate kidneys which fuse together during
development, if this fusion is incomplete duplex kidney can occur or part of the kidney
can have a separate blood supply
211
Where would you palpate an abdominal aortic aneurysm?
In the epigastrium (above
| the umbilicaus).
212
Describe the relationship of the ureter to bony landmarks of the abdomen and pelvis
(useful for finding the ureter on an X-ray).
The ureter runs anterior to the tips of the transverse processes on the lower three
lumbar vertebrae, over the sacroiliac joints and just medial to the lateral pelvic side wall
213
Where do the femoral, obturator and sciatic nerves pass from the abdomen into the
thigh?
Femoral nerve; under the inguinal ligament half way between the pubic tubercle
and anterior superior iliac spine.
Obturator; through the obturator canal.
Sciatic; posteriorly through the greater sciatic foramen into the buttock and then
the thigh.
214
What feature stops urine passing back up the ureter to the kidney when bladder pressure in
high during urination?
The ureter passes through the bladder wall obliquely forming a flap valve
215
Which muscle maintains the angle between the anal canal and rectum?
Levator ani is the whole sheet of muscle and it is the anterior fibers called
puborectalis which maintains the angle.
216
Where does the bladder lie when full?
The fundus of the bladder lies immediately above the pubis symphysis and there
is no peritoneum between the abdominal wall and bladder.
217
A 25 year old woman involved in a car crash suffered complete transection of her
spinal cord at the level of T6. Do you think she is able to tell when her bladder is full?
Does her bladder empty via muscle contraction or does it simply “overflow”?
No sensation is possible as the spinal cord has been disconnected from the higher
centers.
Her bladder will empty by muscle contraction via the spinal micturition reflex. As
the bladder fills it is detected by the sensory nerves entering the cord at S2-4. Once the
bladder is sufficiently full these sensory nerves will stimulate the motor nerves to
contract the detrusor muscle and relax the sphincters, this is an automatic reflex bladder
and is the same as found in pre potty trained children. It is a spinal cord reflex and once
micturition is initiated it cannot be suppressed.
218
Why may inflammation of the ovary may cause pain along the medial aspect of the
thigh?
The ovary sits alongside the lateral pelvic side wall where the obturator nerve
runs, irritation of the nerve leads to medial thigh pain as a REFERRED pain.
219
What is a retroverted uterus?
The uterus normally lies tilted forwards over the bladder, retroversion is when it
lies further away from the bladder and may impinge on the anterior wall of the rectum or
sacrum.
220
What maintains the normal position of the uterus?
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Tone in the levator ani muscles
Transverse cervical ligaments (cardinal)
Pubocervical ligaments
Sacrocervical ligaments
Broad ligaments
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221
What structures may be palpable during examination through the vagina?
Anteriorly, base of bladder, urethra, lower ureters (if they contain a stone)
Laterally, ureter, levator ani muscle, ovary by bimanual palpation
Posteriorly, rectum, Pouch of Douglas, perineal body.
222
What do you understand by the terms “superficial perineal pouch” “perineal
membrane” “urogenital diaphragm”?
superficial perineal pouch – Area of the perineum superficial to the urogenital
diaphragm
perineal membrane – superficial layer of fascia covering the urogenital diaphragm
urogenital diaphragm – Complex of tissues forming a triangle of tissue closing the
anterior pelvic outlet.
223
If there was a rupture of the penile urethra where would the urine collect?
Superficial perineal pouch
