The Pelvic Viscera I & II

Question 1

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 ___

Answer 1

recto-sigmoid junction
third sacral
sigmoid colon

sacrum
coccyx

anorectal junction
tip of the coccyx
pelvic diaphragm

dilated
rectal ampulla

Question 2

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 ___ & ___

Answer 2

mesentery
curvature of the sacrum

taenia coli

haustra
epiploic appendances

Question 3

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

Answer 3

superior rectal

middle rectal

inferior rectal

arterial

Question 4

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 ___

Answer 4

psoas major

bifurcation of the common iliac arteries

uterine artery

ductus deferens

urinary bladder
bladder

Question 5

the ureters:
constrictions:

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

junction of ___ & ___

where ___ crosses the pelvic brim

passage through the ___

Answer 5

ureter & renal pelvis

ureter

urinary bladder

Question 6

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 ___

Answer 6

pubis
abdomen
peritoneum
anterior abdominal

retropubic space

pelvic brim (abdominal organ)

prostate gland

Question 7

the urinary bladder:
structure:

superior surface: ___ shaped, covered by ___

posterior surface (base): ___ shaped

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

Answer 7

triangular
peritoneum

triangular

anteriorly
symphysis pubis

Question 8

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

Answer 8

ureters

urethra

puboprostatic
pubovesical

Question 9

the urinary bladder:
internal features:
rugae

Answer 9

mucosal folds

Question 10

the urinary bladder:
internal features:
trigone:

internal surface of ___

lacks ___ (mucosa firmly adherent to muscular coat)

borders orifices of ___ & ___

Answer 10

base of bladder

rugae

ureters & urethra

Question 11

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

Answer 11

males

trigone
urethral

enlarged
prostate gland

Question 12

the urinary bladder:
internal features:
detrusser muscle

Answer 12

three layers of interlacing smooth muscle

Question 13

the urinary bladder:
internal features:
sphincter vesicae

Answer 13

thickening of circular layer of smooth muscle at neck of bladder

Question 14

the urinary bladder:
blood supply:

females: ___ & ___
males: ___ & ___

Answer 14

superior vesical & vaginal branches

superior & inferior vesical arteries

Question 15

innervation of the urinary bladder:

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

sympathetic: levels ___
- ___ effects

Answer 15

pelvic splanchnic nerves (S2 - S4)

• detrussor muscle
• sphincter vesicae

T11 - L2
- opposite

Question 16

innervation of the urinary bladder:
pain fibers:

follow ___ nerves

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

Answer 16

pelvic splanchnic nerves

sympathetic
T11 - L2

Question 17

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

Answer 17

fibromuscular
anteroinferioly

10

fornices
cervix

longer
deeper & longer

Question 18

the vagina:
blood supply (3)

Answer 18

uterine arteries
vaginal arteries
internal pudendal artery

Question 19

the vagina:
innervation:

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

inferior 1/3 - ___ via the ___ nerve

Answer 19

visceral pain
pelvic splanchnic
S2 - S4

somatic pain afferents
pudendal

Question 20

the vagina:
relations:

anterior

• ___ above
• ___ below

posterior

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

Answer 20

bladder
urethra

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

Question 21

the female internal organs:
the uterus (3)

Answer 21

fundus - above entrance of the uterine tubes

body - beneath entrance of the uterine tubes

cervix - narrow inferior portion

Question 22

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: ___ (___)

Answer 22

internal os
external os

vagina
supravaginal & intravaginal

supravaginal
isthmus of the uterus (lower uterine segment)

Question 23

the uterus:

fornices (3)

vaginal ___ encircling the ___ portion of the cervix

Answer 23

anterior
posterior
lateral

recesses
intravaginal

Question 24

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 ___

Answer 24

forward
90

forward
internal os & cervical canal

Question 25

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 ___ & ___

Answer 25

cervix
uterosacral

body & cervix

Question 26

uterine tubes (approximately 10 cm long):

located on either side of the ___ immediately below the ___ in the free edge of the ___ ligament

Answer 26

uterus
fundus
broad

Question 27

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 ___

Answer 27

lateral

• fingerlike, infundibulum
• ovary

widest
fertilization

narrowest
uterine wall

uterine wall

Question 28

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 ___

Answer 28

sexual contact
vagina, cervix, uterus, uterine tubes

salpingitis
pelvic peritonitis

Question 29

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 ___

Answer 29

fertilized ovum
uterine cavity

uterine tube

trophoblast

uterovesical pouch
uterorectal pouch of douglas

Question 30

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 ___

Answer 30

peritoneum
uterus
lateral pelvic

mesovarium

mesosalpinx

mesometrium

Question 31

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)

Answer 31

suspensory ligament of the ovary

uterine tubes (in upper free border)
ovarian ligaments
round ligaments

Question 32

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 ___

Answer 32

genitoinguinal

posterior
ovary
uterus
uterotubal

anterior
uterotubal
labia majora
inguinal canal

Question 33

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

Answer 33

sacrouterine (sacrocervical)

lateral (transverse) cervical

pubovesical

Question 34

chief supports of the uterus (4)

Answer 34

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

Question 35

the uterus:
blood supply (\_\_\_ artery):

passes medially within the ___ ligament below the base of the ___ ligament

crosses the ___ near the ___ of the vagina

Answer 35

uterine

cardinal
broad

ureter
lateral fornix

Question 36

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

Answer 36

uterine

body & fundus of the uterus
cervix & vagina
vaginal artery

ovarian & tubal
ovarian & tubal
broad

Question 37

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

Answer 37

afferent

sympathetic
T11 - T12

parasympathetic
S2 - S4

somatic
pudendal

Question 38

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 ___

Answer 38

displacement

levator ani
perineal body
ligaments
muscle tone

fascias
organs

vaginal canal

vagina

Question 39

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

Answer 39

broad
mesovarium

ovarian
gubernaculum

broad
ovarian

Question 40

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

Answer 40

external iliac artery

internal iliac vessels & ureter

obturator

Question 41

the ovary:
innervation:

sympathetic: ___
parasympathetic: ___

visceral afferent pain fibers: follow ___ fibers back to the ___ levels of the spinal cord

Answer 41

T10 - T11

?

sympathetic
T10 - T11

Question 42

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

Answer 42

ovarian
periumbilical

iliac fossa

thigh
obturator
obturator
obturator

obturator

Question 43

the ovary:

lymphatic drainage

Answer 43

to para-aortic (lumbar) nodes

Question 44

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): ___

Answer 44

longitudinal midline fold of mucosa

• depressions
• prostatic ducts

expanded center of the urethral crest

Question 45

the male urethra:
prostatic portion:

prostatic uricle

• small blind-ending ___ at center of ___
• homologue of ___

ejaculatory ducts: open into ___ on either side of the ___

Answer 45

• pouch opening, seminal colliculus
• uterus

seminal colliculus
prostatic utricle

Question 46

the male urethra:
membranous urethra:

pierces the ___ which contains the ___ glands

Answer 46

urogential diaphragm

bulbourethral

Question 47

the male urethra:
penile (___, ___):

passes through the ___, ___, & ___

receives the ducts of the ___ glands in the bulb

glans of littre: ___

navicular fossa: terminal ___ within the ___

Answer 47

cavernous, spongy

bulb
corpus spongiosum
glans penis

bulbourethral

mucous secretion

dilation
glans penis

Question 48

the female urethra:

homologue to the male ___ & ___ portions

Answer 48

prostatic

membranous

Question 49

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 ___

Answer 49

tube

ductus epididymis
inguinal canal
abdomen

ureter
bladder
ampulla

ejaculatory duct

Question 50

the ductus deferens:
blood supply (3)

Answer 50

artery of the ductus deferens
inferior vesical arteries
middle rectal arteries

Question 51

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 ___

Answer 51

tubes
bladder

ampullae

prostate gland

Question 52

the seminal vesicles:
blood supply (2)

Answer 52

inferior vesical arteries

middle rectal arteries

Question 53

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

Answer 53

urogenital diaphragm

urinary bladder

five

20 weeks

Question 54

prostate gland:

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

Answer 54

central zone
transitional zone
peripheral zone

Question 55

prostate gland:
central zone:

surrounds the ___

Answer 55

ejaculatory ducts

Question 56

prostate gland:
transitional zone:

lies around the central part of the ___

clinical note: usual site of ___

Answer 56

prostatic urethra

benign prostatic hypertrophy

Question 57

prostate gland:
peripheral zone:

surrounds the ___ & ___except the ___ region, which is filled by the ___

clinical note: usual site of ___

Answer 57

central & transitional zones
anterior
fibromuscular stroma (non-glandular)

carcinomas of the prostate

Question 58

prostate gland:
blood supply (2)

Answer 58

inferior vesical arteries

middle rectal arteries

Question 59

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

Answer 59

anterior abdominal
urinary bladder

bladder
seminal vesicles

anterior rectum
rectovesical

rectum
rectum

parietal peritoneum
posterior abdominal

Question 60

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 ___

Answer 60

anterior abdominal
urinary bladder

uterus
internal os
uterovesical

body & fundus
uterus & posterior fornix

rectum
uterorectal (rectouterine) pouch of douglas

rectum

uterorectal pouch