The Pelvic Viscera I & II Flashcards
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
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
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
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
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
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
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
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
the urinary bladder:
internal features:
rugae
mucosal folds
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
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
the urinary bladder:
internal features:
detrusser muscle
three layers of interlacing smooth muscle
the urinary bladder:
internal features:
sphincter vesicae
thickening of circular layer of smooth muscle at neck of bladder
the urinary bladder:
blood supply:
females: ___ & ___
males: ___ & ___
superior vesical & vaginal branches
superior & inferior vesical arteries
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
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
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
10
fornices
cervix
longer
deeper & longer
the vagina: blood supply (3)
uterine arteries
vaginal arteries
internal pudendal artery
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
the vagina:
relations:
anterior
- ___ 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)
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
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)
the uterus:
fornices (3)
vaginal ___ encircling the ___ portion of the cervix
anterior
posterior
lateral
recesses
intravaginal
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
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
