The pelvic visceral and Perineium Flashcards
1
Q
the pelvic viscera differs between..
A
males and females
2
Q
describe the differences in the pelvic viscera between males and females
A
- males have more space in the pelvic viscera as there reproductive organs are outside whereas females have less space as there reproductive organs are in the pelvic viscera
- the female bladder is smaller than the male bladder as there is less space within the pelvis
3
Q
where does the urinary bladder sit
A
- sits behind the behind pubic symphysis, any damage to the pubic symphsysis puts the bladder at risk
4
Q
what muscle is the urinary bladder made out of
A
- hollow organ
- made up of specialised smooth muscle (detrusor muscle)
- In between the ureters draining to the bladder and urethra draining out of the bladder there is the trigone which is a smooth surface
5
Q
how is the urinary bladder attached to the kidneys
A
- Functionally it is linked to the kidneys
- Kidneys sit on posterior abdominal wall and produce urine and drain into the bladder via the ureter
6
Q
what nervous system is in the urinary bladder
A
- It is under autonomic control, sympathetic innervation relaxes the smooth muscle and allows filling of the bladder
7
Q
how does urine exit the body
A
- through the urethra
8
Q
describe the difference between male and female urethra
A
Male
- longer
- travels through the prostate gland in the pelvic floor and then through the penis
female
- shorter
- – travels from bladder through pelvic floor into the peritoneum
9
Q
why are women more likely to get urinary tract infections
A
- because the urethra is shorter than in males
10
Q
describe the differences in sphincters in the urethra of males and females
A
- In both sexes there is an external urethral sphincter (skeletal muscle – under voluntary control, this is at the level of the pelvic floor)
- internal urethral sphincter only in males (smooth muscle – this is at the base of the bladder just before the prostate gland)
11
Q
why do males have an external and internal urethral sphincter
A
- Only have two in men and one in women, men it has a dual purpose for urination and ejuacutation whereas women its just where urine flows
- contracts during ejaculation in order to prevent semen going to the bladder and peeing during ejaculation
12
Q
what is the dual purpose of the internal urethral sphincter
A
- contracts during ejaculation in order to prevent semen going to the bladder and peeing during ejaculation
13
Q
what are the three parts of the male urethra
A
- Prostatic
- Membranous
- Spongy/penile
14
Q
describe the three parts of the male urethra
A
- Prostatic – part that passes through the prostate gland
- Membranous – passes through the pelvic floor
- Spongy/penile – longest part travels through the penis
15
Q
what is the nerve supply to the bladder and internal urethral sphincter
A
- autonomic - both sympathetic and parasympathetic
- Sympathetic input is from descending sympathetic fibres from T12 to L2 –
- Parasympathetic fibres are from S2-S4, they form an autonomic plexus with the descending fibres
- Sympathetic nerves act on the bladder to allow relaxation of detrusor muscles and contracts the internal urethral sphincter
- Whereas parasympathetic innervation causes contraction of bladder via the detrusor muscles and relaxation of the internal urethral sphincter
16
Q
what is the external urethral sphincter controlled
A
- somatic control
- pudendal nerve (S2-S4)
17
Q
what is the pathway that sperm take
A
- Testis
- Epididymis
- Vas deferens
- Seminal vesicles
- Ejaculatory duct
- Prostate gland
- Urethra
18
Q
How do the gonads descend
A
- The gonads develop in the abdomen and during foetal development they descend in to the scrotum or pelvis
- They descend through the inguinal canal
19
Q
describe the blood supply to the testes
A
- They get their blood, nerve and venous drainage and lymphatic drainage from the abdomen
- Artery is at the level of L1
- Testicular artery comes from the abdominal aorta
20
Q
what blood supply does the scrotum take
A
- Scrotum takes local pattern of blood and nerve supply form that area whereas the testes is from the abdomen
21
Q
what do the testes sit in
A
- the scrotum
22
Q
what does the tunica vaginalis do
A
pouch of peritoneum, this allows free movement of the testes
23
Q
describe the structure of the testes
A
- There is a tunica vaginalis – pouch of peritoneum, this allows free movement of the testes
- Seminiferous tubules – within the testes itself this is the site of spermatozoa production,
- Rete tests – drains into the epididymis
- Epididymis - long coiled tube that becomes continuous with the vas deferns at the inferior part of the testes, storage site of sperm
- Sperm then travel along the vas deferens
24
Q
what does the epididymis do
A
stores sperm
25
describe the structure of the vas deferns
- Muscular tube that connects the epididymis from the testes to the prostate gland and ejaculatory gland
- Vas deferens travel up from the spermatic cord to the inguinal canal to enter the abdomen
- It passes over the superior surface of the bladder to reach the posterior surface of the bladder
- The vas deferns joins with the seminal vesicles and these reduce and add seminal fluid
26
what does the vas deers do
propels the spermatozoa from the epididymis, through the spermatic cord, inguinal canal, towards the back of the bladder where it joins the seminal vesicles.
27
what is a vasectomy
surficial cutting of the vas deferns and this stops any sperm getting from the testes into the ejaculate but ejaculate is still produced without any sperm due to seminal fluid being produced
28
describe where the seminal vesicles are and how the vas deferns get to them
- Vas deferns travel over the superior aspect of the bladder to get to the posterior surface
- Seminal vesicle are on either side of the bladder
- Seminal vesicle on the left joins with the vas defernets on the left
- Where they join together they form an ejacutlatory duct so you have an ejaculatory duct on either side
29
where do the seminal vesicles go into
- They them go into the prostate gland and through the urethra
30
what is the prostate gland
- Small gland that is just underneath the bladder
- It is only in men
- The urethra and ejaculatory gland runs through it
31
what causes change in shape of the prostate gland
- When you go from middle aged to elderly the prostate glands enlarge and they start to compress the urethra
- Can have enlargement due to prostate cancer
- These two changes happen in different regions of the prostate gland
- Posterior aspect is where cancerous changes can happen
32
how do you diagnose prostate cancer
- One of the way to help to diagnose is by a rectal exam
| - The prostate gland sits anterior to the rectum therefore you can palpitate the posterior aspect of the rectum
33
how does the prostate gland impinge on the urethra
- The prostate gland is directly inferior to the male bladder. The urethra transverses the prostate and so any enlargement of the gland can impinge on the urethra.
34
describe the structure of the uterus
- Thick walled pear shaped organ
- It is composed of smooth muscle (myometrium)
- an outer layer of connective tissue and peritoneum (perimetrium)
- an inner highly vascular mucous layer (endometrium).
- Cervix is the neck of the womb
- Vagina is underneath the cervix
- Continuous with the uterus on either side is the fallopian tube
35
describe how shape varies in the uterus
- Size varies a lot over age
- It is small before puberty and then gets larger in puberty and then expands in pregnancy
- it shrinks in menopause
36
what is the endometrial layer
The endometrial layer is where embryos implant, and the layer lost during menstruation
37
what does the position of the uterus depend on
- Position of the uterus depends on how full the bladder or rectum is, the uretus doesn’t have one fixed position,
38
what is the normal positions of the uterus
anteverted and anteflexed
39
what does anteverted describe
means that the cervix is anteriorly positioned in respect to the vagina
40
what does ante flexed describe
- Flexion describes the position of the fundus – it is anterior positioned with respect to the cervix
41
what is retroverted and retroflexed in respect to the uterus positions
- retroverted - this is where the cervix is inline with the vagina, it gives the uterus less protection against prolapse
- retroflexed - – uterus is flexing posteriorly and this impacts the rectum
42
what is the blood supply to the female reproductive organs
- Blood supply to the female reproductive system is derived from the uterine artery (int. iliac artery) and the ovarian artery (abdominal aorta)
43
what are the three parts of the fallopian tube
- most lateral part has the fimbrae - not a named part of the Fallopian tube,
- then it narrows into the infundibulum
- then you have ampulla, (site for fertilisation),
- narrowed portion that goes into the uretine wall and this is the isthmus
44
where does the ovarian artery originate from
- Ovarian artery originates from the abdominal aorta – it differs from the uterine artery which is a branch of the internal illac artery
45
what artery does the uterine artery give of
vagina artery
46
what happens if you have a historectomy
- If you have a hysterectomy you close of the uterine artery, it can be easier to mistake it form the ureter and ligate the ureter instead
47
what lines the abdomen wall
- Lining the abdomen is the peritoneum and is on the abdominal wall, it doesn’t enclose the organs of the pelvis and instead is just on top of them
- This creates two pouches
48
what are the two puches that the peritoneum creates in the female reproductive system
- The veiscouterine pouch
- Rectourterine pouch of Douglas = posterior and most interior point of periotenum so fluid such as blood accumulates here
49
what does the broad ligament of the uterus do
- covers most of the repruduct system
50
what does the suspensory ligament do
- Where the ovarian artery is covered in peritoneum it is called the suspensory ligament of the ovary
– contains the ovarian artery and vein
51
what does the ovarian ligament do
links ovary to the uterus
52
what does the round ligament of the uterus do
connects uterus to the anterior abdominal wall
53
what are the ligaments involved in the female reproductive system
- broad ligament
- ovarian ligament
- round ligament
- suspensory ligament
54
what ligaments are involved in the development of the ovaries
- Ovarian and round ligament are involved in the development of the ovaries and the descent of the ovaries
55
describe the cervix
- It acts a little bit like a sphincter of the uterus
| - There is an external opening and intneral opening (internal and external os)
56
what is the role of the cervic
- It helps keep bacteria out of the uterus and keeps the baby in the uretus
57
what closes the pelvic outlet
the pelvic floor
58
what is levator ani made out of
puborectailis, pubcoccoygenous, illeococcygenous
59
what is below the pelvic floor
the perineum
60
what is the perineum divided into
two triangles -
- anterior - urogenital triangle
- posterior - anal triangle
61
what is in the urogenital triangle
- Below the pelvic floor is the perineal membrane, it is found in the urogenital triangle,
62
where is the deep and superficial perineal pouch
in between the pelvic floor and perineal membrane there is a space called the deep perineal pouch
- In between the perineal membrane and the skin there is superficial perineal pouch
63
what is in the deep perineal pouch
- There are a few small muscles
| - External urethral sphincter is inside this pouch
64
what is in the superficial perineal pouch
- where the external genital is
| - Perineal membrane – on top is the rectal tissue – this is vascular tissue
65
describe the superficial perineal pouch in females
– bulb of vestibule – either side of the vagina
- you have the crura of the clitoris this is continuous with the clitoris itself
- also have Bartholin glands/ Greater vestibular glands
66
describe the superficial perineal pouch in males
- bulb of the penis this is continuous with the rectal tissue that continuous within the penis itself this is called
corpus spongiosum
- Corpus spongiosum becomes expanded at the end of the penis to become the glnads of the penis
- crura of the penis which goes into the corpus cavernorsa
67
what are the muscles in the superficial perineal pouch in males
- ischiocarvernous
- Bulbospongious
- These are important in maintains erection
- Have transvers perineal muscles
- Posterior in the anal triangle there is the external and anal sphincter
68
what are the muscles in the superficial perineal pouch in females
- Same muscles with the same name but they are smaller
- Ischiocarvernous
- Bulbospongious
- Transverse perional msucles
- External anal sphincter
69
where do the muscles in the superficial perineal pouch converge
- They all converge at the perineal body – this is an important site for attachment so it is important for the stabilisation of the pelvic floor – it is directly behind the vagina so it is suspectible to damage to vagina
70
what happens if the tearing of the vagina happens
- If tearing occurs posteriorly then it can go through the perionetal body and continue back towards the anus
- This increases the chance of prolapse of the pelvic viscera. following childbirth
71
what is the perineal body
- The perineal body is a fibromuscular mass which is the site of convergence of perineal and pelvic floor muscles
72
what is done in childbirth to prevent the perineal body from tearing
an episiotomy may be performed
73
what are the female skin that covers the superficial perineal pouch
- External fold that can be covered in hair these are called labia majora
- Internal to that is the labia minor – hairless
- Where the labia minor meet each other anterior is where the clitoris is formed
74
what is between the labia majoria and minor
the vestibule of the vagina – thisis the entrance of the vagina
75
what is within the vestibular of the vagina
- Within the vestibule of the vagina there is the external urethral orifice and the vagina itself
76
describe the pathway of the pudendal nerve
The pudendal nerve is a SOMATIC NERVE which emerges from spinal roots S2-S4
- It branches from the sacral plexus and leaves the pelvis through the greater sciatic foramen, before turning back to enter the lesser sciatic foramen.
- The pudendal nerve then runs through the pudendal canal (on top of obturator internus) to enter the perineum
77
what does the pudendal nerve innervate
sensory and motor innervation to the perineum and is therefore sensory to the genitals and motor to the external urethral and anal sphincters
