Urinary bladder and oesophagus

Question 1

What is the blood supply to the urinary bladder?

Answer 1

Arterial: Superior and inferior vesical arteries from internal iliac artery

Venous: to vesical venous plexus –> Internal iliac vein

Question 2

Answer 2

Question 3

Nerve supply to detrusor muscle

Answer 3

-Sympathetic: inhibit contraction of the muscle (from L1, L2)
-Parasympathetic: stimulate contraction of the muscle (from S2-S4)

Question 4

What is the most common bladder ca?

Answer 4

-TCC western world
-SCC worldwide
-Mixed
-Adenocarcinoma

Question 5

What is the presenting complaint of bladder ca?

Answer 5

Painless haematuria

Question 6

What are the risk factors for bladder cancer?

Answer 6

-Aniline dyes
-Smoking
-Beta naphtylamine
-Schistosoma haematobium

Question 7

How does the ureter enter the bladder?

Answer 7

-At the base of the bladder at the corner of the trigone

Question 8

What are the peritoneal relations of the bladder?

Answer 8

-Covers superior surface and upper part of posterior surface

Question 9

What are the layers encountered during suprapubic catheterisation?

Answer 9

-Skin
Subcutaneous tissue
-Scarpa’s fascia
-Linea alba
-Fascia transversalis
-Preperitoneal fat

Question 10

What are the anatomical relations of the bladder?

Answer 10

Anterior:
-Pubic symphysis

Posterior:

Male
-Rectovesical pouch
-Two vas deferens
-Terminal part of the 2 ureters

Female
-Vesicouterine pouch, with uterus and vagina behind. Posterior to uterus is rectouterine pouch of douglas, then the rectum
-Terminal part of the two ureters

Question 11

Answer 11

Question 12

Answer 12

Question 13

Where is the urinary bladder located in males and females?

Answer 13

-Males: between symphysis pubis and the rectum
-Females: Between sympysis pubis and vagina

Question 14

Where does the vas deferens run, and what is its function?

Answer 14

Epididymis–> inguinal canal –> ejaculatory ducts

It transfers sperm from epididymis to ejaculatory ducts

During ejaculation smooth muscle in wall of vas contracts, causing peristalsis which propels sperm into urethra

There it joins secretions from seminal vesicles, prostate gland and bulbourethral glands to form semen

Question 15

At what angle do the ureters enter the bladder?

Answer 15

-Ureters enter bladder wall in oblique manner travelling for 2cm through detrusor muscle
-This creates one way valve where detrusor tone in bladder wall collapses ureters preventing reflux of urine
-Ureters open on posterior aspect of bladder in trigone region

Question 16

What is the blood supply to the ureter?

Answer 16

Abdominal aorta
–> renal artery, gonadal arteries, ureteral branches form abdominal aorta

Pelvic
–> superior and inferior vesical arteries

Question 17

What is thought to be responsible for the high prevalence of SCC in developing nations?

Answer 17

-Persistent inflammation caused by schistosoma haematobium leading to squamous metaplasia –> carcinoma

Question 18

Describe the muscular arrangement in the bladder

Answer 18

The detrusor muscle is a layer of smooth muscle fibres arranged in longitudinal, spiral and circular bundles

Question 19

What supplies voluntary control of micturition?

Answer 19

-External sphincter is formed from striated muscle, and is supplied by the pudendal nerve (S2-S4)