The Pelvic Viscera I & II Flashcards by Heather Acuff

the rectum:

begins at the ___ in front of the ___ vertebra as a continuation of the ___

passes downward following the curve of the ___ & ___

ends at the ___ in front of the ___ as the rectum pierces the ___

lower part of the rectum is ___ forming the ___

recto-sigmoid junction
third sacral
sigmoid colon

sacrum
coccyx

anorectal junction
tip of the coccyx
pelvic diaphragm

dilated
rectal ampulla

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the rectum:
changes at the rectosigmoid junction:

the bowel loses its ___ & becomes closely applied to the ___

___ broaden out & form a complete outer longitudinal layer of smooth muscle

disappearance of ___ & ___

mesentery
curvature of the sacrum

taenia coli

haustra
epiploic appendances

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the rectum:
blood supply:

supplied by the ___ artery

the ___ arteries contribute to the lower part of the rectum

___ arteries supply the lower half of the anal canal rather than the rectum

venous drainage follows ___ supply

superior rectal

middle rectal

inferior rectal

arterial

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the ureters:
retroperitoneal course of the ureters:

descend on the surface of the ___ muscle

cross into the pelvis over the ___

females: crossed in the pelvis by the ___
males: crossed in the pelvis by the ___

enters the ___ at the superolateral angle, courses obliquely through the wall for approximately 3/4 inch before opening into the ___

psoas major

bifurcation of the common iliac arteries

uterine artery

ductus deferens

urinary bladder
bladder

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the ureters:
constrictions:

potential sites of obstruction (e.g., ureteric calculi)

junction of ___ & ___

where ___ crosses the pelvic brim

passage through the ___

ureter & renal pelvis

ureter

urinary bladder

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the urinary bladder:

adults: lies posterior to the ___, but rises into the ___ as it fills lifting ___ off the inner surface of the ___ wall

separated from the pubis by the ___

infancy & early childhood: empty bladder lies above the ___ (___)

males: neck of the bladder rests on the ___

pubis
abdomen
peritoneum
anterior abdominal

retropubic space

pelvic brim (abdominal organ)

prostate gland

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the urinary bladder:
structure:

superior surface: ___ shaped, covered by ___

posterior surface (base): ___ shaped

apex: points ___ lying behind the upper margin of the ___

triangular
peritoneum

triangular

anteriorly
symphysis pubis

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the urinary bladder:
structure:

superolateral angles joined by ___

inferior angle (neck of bladder) gives rise to the ___

neck held in position by the ___ ligaments in males & ___ ligaments in females

ureters

urethra

puboprostatic
pubovesical

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the urinary bladder:
internal features:
rugae

mucosal folds

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the urinary bladder:
internal features:
trigone:

internal surface of ___

lacks ___ (mucosa firmly adherent to muscular coat)

borders orifices of ___ & ___

base of bladder

rugae

ureters & urethra

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the urinary bladder:
internal features:
uvula:

only in ___

smooth eminence at the inferior corner of the ___ just above the ___ orifice

advancing age, it becomes ___ due to growth of the underlying ___ tissue

males

trigone
urethral

enlarged
prostate gland

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the urinary bladder:
internal features:
detrusser muscle

three layers of interlacing smooth muscle

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the urinary bladder:
internal features:
sphincter vesicae

thickening of circular layer of smooth muscle at neck of bladder

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the urinary bladder:
blood supply:

females: ___ & ___
males: ___ & ___

superior vesical & vaginal branches

superior & inferior vesical arteries

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innervation of the urinary bladder:

parasympathetic: ___ nerves (levels ___)
- motor to the ___
- inhibitory to the ___

sympathetic: levels ___
- ___ effects

pelvic splanchnic nerves (S2 - S4)

detrussor muscle
sphincter vesicae

T11 - L2
- opposite

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innervation of the urinary bladder:
pain fibers:

follow ___ nerves

note: pain from the superior surface follows ___ fibers back to ___ levels of the spinal cord

pelvic splanchnic nerves

sympathetic
T11 - L2

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the female internal organs:
the vagina:

___ tube extending ___

approximately ___ cm long

___ - vaginal recesses at upper end formed around the vaginal portion of the ___

because of the angle formed b/n the vagina & cervix, the posterior vaginal wall is ___ than the anterior wall & the posterior fornix is ___ than the anterior & lateral fornices

fibromuscular
anteroinferioly

fornices
cervix

longer
deeper & longer

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the vagina:
blood supply (3)

uterine arteries
vaginal arteries
internal pudendal artery

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the vagina:
innervation:

superior 3/4 - ___ fibers follow ___ nerves to ___ levels

inferior 1/3 - ___ via the ___ nerve

visceral pain
pelvic splanchnic
S2 - S4

somatic pain afferents
pudendal

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the vagina:
relations:

___ above
___ below

posterior

upper third - ___
middle third - ___
lower third - ___

bladder
urethra

uterorectal pouch of douglas
rectal ampulla
perineal body (which separates it from the anal canal)

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the female internal organs:
the uterus (3)

fundus - above entrance of the uterine tubes

body - beneath entrance of the uterine tubes

cervix - narrow inferior portion

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the uterus:
cervix:

cervical canal communicates with the body through the ___ & with the vagina through the ___

the cervix protrudes through the uppermost anterior wall of the ___ demarcating ___ & ___ portions of the cervix

lower portion of the body of the uterus adjoining the ___ segment of the cervix: ___ (___)

internal os
external os

vagina
supravaginal & intravaginal

supravaginal
isthmus of the uterus (lower uterine segment)

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the uterus:

fornices (3)

vaginal ___ encircling the ___ portion of the cervix

anterior
posterior
lateral

recesses
intravaginal

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orientation of the uterus (normal):

anteversion - longitudinal axis of the uterus is bent ___ approximately ___ degrees relative to the vagina

anteflexion - body of the uterus is bent ___ at the junction of the ___ & the ___

forward
90

forward
internal os & cervical canal

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orientation of the uterus (normal): factors responsible for the normal orientation: anteversion - pull exerted on the ___ by the ___ ligaments anteflexion - intrinsic to the fibromuscular walls of the ___ & ___

cervix uterosacral body & cervix

uterine tubes (approximately 10 cm long): located on either side of the ___ immediately below the ___ in the free edge of the ___ ligament

uterus fundus broad

``` uterine tubes (approximately 10 cm long): segments: ``` infundibulum - funnel shaped ___ end - fimbriae - ___ processes of the ___ - ovarian fimbria - attached to the ___ ampulla - ___ part of tube & usual site of ___ isthmus - ___ part of tube closest to ___ intramural part - segment piercing the ___

lateral - fingerlike, infundibulum - ovary widest fertilization narrowest uterine wall uterine wall

pelvic inflammatory disease: pathogenic organisms may enter the body through ___ & ascend through the ___, ___, ___, & into the ___ ___ may follow with leakage of pus into the peritoneal cavity causing ___

sexual contact vagina, cervix, uterus, uterine tubes salpingitis pelvic peritonitis

ectopic pregnancy: refers to implantation & growth of a ___ outside the ___ this commonly occurs in the ___ the eroding action of the ___ quickly destroys the wall of the tube this is followed by an effusion of a large quantity of blood which pours down into the ___ or the ___

fertilized ovum uterine cavity uterine tube trophoblast uterovesical pouch uterorectal pouch of douglas

ligaments of the uterus: broad ligament: two layered fold of ___ extending from lateral margins of the ___ to the ___ walls the ovary is attached the the posterior layer by the ___ the part of the broad ligament forming the mesentery of the uterine tube is called the ___ the major part of the broad ligament below the other two is the ___

peritoneum uterus lateral pelvic mesovarium mesosalpinx mesometrium

ligaments of the uterus: broad ligament: the lateral-most part of the road ligament which encloses the ovarian vessels, nerves, & lymphatics is called the ___ structures enclosed by the broad ligaments (3)

suspensory ligament of the ovary ``` uterine tubes (in upper free border) ovarian ligaments round ligaments ```

ligaments of the uterus: derivatives of the gubernaculum (___ ligament): ovarian ligament - runs in the ___ lamina of the broad ligament from the uterine pole of the ___ to the ___ just below the ___ junction round ligament of the uterus - runs in the ___ lamina of the broad ligament from a point just below the ___ junction to the ___ via the ___

genitoinguinal posterior ovary uterus uterotubal anterior uterotubal labia majora inguinal canal

ligaments of the uterus: ligaments formed by pelvic fascia: ___ ligaments - cervix & upper vagina to sacrum ___ ligaments - cardinal ligament, mackenrodt's ___ ligaments - connect cervix to pubic bones

sacrouterine (sacrocervical) lateral (transverse) cervical pubovesical

chief supports of the uterus (4)

levator ani muscles perineal body trasnverse cervical ligaments sacrouterine ligaments (sacrocervical ligaments)

``` the uterus: blood supply (___ artery): ``` passes medially within the ___ ligament below the base of the ___ ligament crosses the ___ near the ___ of the vagina

uterine cardinal broad ureter lateral fornix

``` the uterus: blood supply (___ artery): ``` at the lateral side of the cervix, it divides into a large superior branch (supplies the ___) & a smaller vaginal branch (supplies the ___ & anastomses w/ ___) the superior branch ends by dividing into ___ & ___ branches which anastomose w/ the ___ & ___ branches of the ovarian artery within the layers of the ___ ligament

uterine body & fundus of the uterus cervix & vagina vaginal artery ovarian & tubal ovarian & tubal broad

``` the uterus: nerve supply (___ innervation): ``` body of uterus - follow ___ fibers & enter cord at ___ levels cervix & upper vagina - follow ___ fibers & enter cord at ___ levels lower vagina - receives ___ innervation through the ___ nerve

afferent sympathetic T11 - T12 parasympathetic S2 - S4 somatic pudendal

uterine prolapse refers to downward ___ of the uterus may be caused by damage or weakening of the ___, ___, or ___ supporting the uterus during childbirth or due to general poor ___ it most commonly occurs during menopause when the pelvic ___ tend to atrophy along with the pelvic ___ in advanced cases, the cervix descends the length of the ___ prolapse of the uterus is always accompanied by some prolapse of the ___

displacement levator ani perineal body ligaments muscle tone fascias organs vaginal canal vagina

the ovary: attached to the back of the ___ ligament by the ___ connected to the uterus by the ___ ligament (upper part of ___) suspensory ligament - lateral most part of the ___ ligament containing ___ vessels, nerves, & lymphatics

broad mesovarium ovarian gubernaculum broad ovarian

``` the ovary: ovarian fossa (position of ovary in young nulliparous women): ``` anterior border: ___ posterior border: ___ the ___ nerve passes along the ovarian fossa b/n the pelvic wall & the ovary

external iliac artery internal iliac vessels & ureter obturator

the ovary: innervation: sympathetic: ___ parasympathetic: ___ visceral afferent pain fibers: follow ___ fibers back to the ___ levels of the spinal cord

T10 - T11 ? sympathetic T10 - T11

referred pain: sensory fibers accompany the sympathetic nerves so ___ pain can be ___ it is often perceived in the right or left ___ due to local inflammation ovarian pain can also be perceived on the medial side of the ___ in the cutaneous distribution of the ___ nerve, presumably b/c the ovary lies close to the ___ nerve in the ___ fossa any inflammation of the ovary may affect the ___ nerve

ovarian periumbilical iliac fossa thigh obturator obturator obturator obturator

the ovary: | lymphatic drainage

to para-aortic (lumbar) nodes

the male urethra: prostatic portion: urethral crest: ___ prostatic sinuses - shallow ___ on each side of the crest - perforated by the openings of 15-20 ___ seminal colliculus (verumontanum): ___

longitudinal midline fold of mucosa - depressions - prostatic ducts expanded center of the urethral crest

the male urethra: prostatic portion: prostatic uricle - small blind-ending ___ at center of ___ - homologue of ___ ejaculatory ducts: open into ___ on either side of the ___

- pouch opening, seminal colliculus - uterus seminal colliculus prostatic utricle

the male urethra: membranous urethra: pierces the ___ which contains the ___ glands

urogential diaphragm | bulbourethral

the male urethra: penile (___, ___): passes through the ___, ___, & ___ receives the ducts of the ___ glands in the bulb glans of littre: ___ navicular fossa: terminal ___ within the ___

cavernous, spongy bulb corpus spongiosum glans penis bulbourethral mucous secretion dilation glans penis

the female urethra: homologue to the male ___ & ___ portions

prostatic | membranous

the ductus deferens: thick walled ___ approximately 18 inches in length emerges from the lower end of the ___ & passes through the ___ into the ___ descends into the pelvis & crosses the ___ to reach the posterior surface of the ___ where it expands to form the ___ then joins the duct of the seminal vesicle to form the ___

tube ductus epididymis inguinal canal abdomen ureter bladder ampulla ejaculatory duct

``` the ductus deferens: blood supply (3) ```

artery of the ductus deferens inferior vesical arteries middle rectal arteries

the seminal vesicles: paired, highly coiled ___ situated on the posterior surface of the ___ separated from each other by ___ of the ductus deferens ejaculatory ducts pierce the ___

tubes bladder ampullae prostate gland

``` the seminal vesicles: blood supply (2) ```

inferior vesical arteries | middle rectal arteries

prostate gland: apex: applied to the ___ base: applied to the neck of the ___ traditionally described as being divided into ___ lobes now recognized that these are no longer present after ___ of fetal development

urogenital diaphragm urinary bladder five 20 weeks

prostate gland: the adult glandular tissue is more accurately divided into three zones: ___

central zone transitional zone peripheral zone

prostate gland: central zone: surrounds the ___

ejaculatory ducts

prostate gland: transitional zone: lies around the central part of the ___ clinical note: usual site of ___

prostatic urethra benign prostatic hypertrophy

prostate gland: peripheral zone: surrounds the ___ & ___except the ___ region, which is filled by the ___ clinical note: usual site of ___

central & transitional zones anterior fibromuscular stroma (non-glandular) carcinomas of the prostate

``` prostate gland: blood supply (2) ```

inferior vesical arteries | middle rectal arteries

the peritoneum (males): passes down from the ___ wall onto the upper surface of the ___ goes down a short distance on the posterior surface of the ___ reaching the upper ends of the ___ sweeps backwards to reach the ___ forming the ___ pouch passes up on front of the middle third of the ___ & front & lateral sides of the upper third of the ___ becomes continuous w/ the ___ of the ___ wall

anterior abdominal urinary bladder bladder seminal vesicles anterior rectum rectovesical rectum rectum parietal peritoneum posterior abdominal

the peritoneum (females): passes down from the ___ wall onto the upper surface of the ___ runs directly onto the anterior surface of the ___ at the level of the ___ forming the ___ pouch now passes upward over the anterior surface of the ___ & ___ of the uterus down posterior surface of the ___ & ___ of the vagina sweeps backward to reach the anterior surface of the ___ forming the ___ pouch passes onto the front of the ___ as in the male note: in females, the lowest part of the peritoneal cavity in the erect position is the ___

anterior abdominal urinary bladder uterus internal os uterovesical body & fundus uterus & posterior fornix ``` rectum uterorectal (rectouterine) pouch of douglas ``` rectum uterorectal pouch