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Genitourinary Anatomy > Urinary Tract, Posterior Abdominal Wall And Pelvis > Flashcards

Urinary Tract, Posterior Abdominal Wall And Pelvis Flashcards

1
Q

Other potential names of adrenal glands

A

Suprarenal glands

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2
Q

Location of adrenal glands

A

Upper pole of each kidney

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3
Q

Location of right adrenal glands

A

Behind the liver and inferior vena cava

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4
Q

Location of left adrenal glands

A

Behind the stomach and pancreas

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5
Q

Number of arteries that supply the adrenal glands

A

3

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6
Q

3 arteries supplying the adrenal glands

A

Superior adrenal artery
Middle adrenal artery
Inferior adrenal artery

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7
Q

Superior adrenal artery

A

Branch of inferior phrenic artery

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8
Q

Middle adrenal artery

A

Branch of abdominal aorta

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9
Q

Inferior adrenal artery

A

Branch of renal artery

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10
Q

Venous drainage of adrenal glands

A

By a single vein on each side

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11
Q

Where does the right adrenal vein drain into

A

Directly into inferior vena cava

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12
Q

Where does the left adrenal vein drain into

A

Initially left renal vein, which then joins the inferior vena cava

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13
Q

2 parts of adrenal glands

A

Cortex
Medulla

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14
Q

Function of adrenal cortex

A

Produces steroid hormones including cortisol, aldosterone and testosterone

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15
Q

Function of adrenal medulla

A

Produces adrenaline

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16
Q

Dimensions of kidneys

A

11cm long
7cm wide
3cm thick

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17
Q

Are the kidneys Intraperitoneal or retroperitoneal

A

Retroperitoneal

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18
Q

What is the kidney embedded in

A

Perinephric fat covered by a renal fascia
Paranephric fat outside renal fascia

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19
Q

Location of renal hilum

A

Medial border of kidney

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20
Q

What enters and exits at the renal hilum

A

Renal artery and vein
Nerves
Lymphatics
Ureter

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21
Q

Left and right renal arteries

A

Branches of abdominal aorta

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22
Q

Left and right renal veins drain into

A

Inferior vena cava

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23
Q

Components of internal aspect of kidney

A

Cortex
Medulla (arranged in pyramids)
Calyces

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24
Q

Functional unit of kidney

A

Nephron
Responsible for filtering blood, reabsorbing water and solutes, and secreting and excreting waste products as urine

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25
Q

Parts of nephron in outer cortex

A

Glomeruli
Bowman’s capsule
Proximal tubule
Distal tubule
Part of collecting duct

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26
Q

Parts of nephron in inner medulla pyramids

A

Loop of henle
Rest of collecting duct

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27
Q

Passage of urine after collecting ducts

A

Down the pyramid towards the renal papilla where it enters a minor calyx
They merge to form major calyx
They merge to form renal pelvis- continuous with ureter

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28
Q

Renal papilla

A

Apex of medullary pyramids

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29
Q

What merge to form the renal pelvis

A

Major calyx

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30
Q

What is the renal pelvis continuous with

A

Ureter

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31
Q

Function of ureter

A

Narrow tubes with muscular walls which transport urine by peristalsis to urinary bladder

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32
Q

Location of ureters

A

Run anterior to psoas major on the posterior abdominal wall
Cross the pelvic brim to enter the pelvis

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33
Q

Urinary bladder

A

Hollow muscular organ
Walls contain smooth muscle -detrusor

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34
Q

Infra-peritoneal organ

A

Urinary bladder located in the pelvis below the peritoneum

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35
Q

Location of urinary bladder

A

Posterior to pubic symphysis
Anterior to vagina and rectum

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36
Q

Function of urinary bladder

A

Stores urine and helps to squeeze urine out during micturition

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37
Q

Detrusor muscle

A

Smooth muscle in walls of bladder
Contracts to forcibly expel urine

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38
Q

Trigone

A

Triangular area of bladder with a smooth internal wall
Where ureters enter the bladder

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39
Q

Location of trigone (where ureters enter bladder)

A

Posterior aspect near base of bladder

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40
Q

Rudimentary valve

A

Ureters enter the trigone at an angle
Prevents reflux of urine into the ureters when bladder is full

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41
Q

Rugae

A

Inside wall of bladder corrugated with folds to allow bladder to stretch without tearing when it’s full

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42
Q

Bladder when empty

A

Can squash down completely

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43
Q

Bladder when full

A

Superior aspect may extend above the pubic symphysis

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44
Q

How much urine can the bladder accommodate in an adult

A

400-600 ml

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45
Q

Which arteries supply to bladder

A

Vesical arteries

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46
Q

Vesical arteries

A

Branches of the internal iliac artery

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47
Q

Venous drainage of bladder

A

Vesical veins

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48
Q

Vesical veins drain into

A

Internal iliac vein

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49
Q

What controls the release of urine

A

2 sphincters
Internal and external urethral sphincters

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50
Q

Location of internal urethral sphincter

A

Base of bladder where it opens into the urethra

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51
Q

Control of internal urethral sphincter

A

Smooth muscle
Involuntary control

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52
Q

Location of external urethral sphincter

A

Just inferior to prostate in males
In the deep perineal pouch in females

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53
Q

Control of external urethral sphincter

A

Skeletal muscle
Voluntary control

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54
Q

Somatic innervation of the urinary bladder and urethral sphincter

A

Via branches of pudendal nerve (S2-S4)
Allows conscious control of the external urethral sphincter

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55
Q

Sympathetic innervation of the urinary bladder and urethral sphincter

A

Via branches of the hypogastric nerve (sympathetic chain T12-L2)
Causes relaxation of the detrusor and contraction of the internal urethral sphincter = storage of urine

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56
Q

Parasympathetic innervation of the urinary bladder and urethral sphincter

A

Via the pelvic splanchnic nerve (S2-S4)
Causes contraction of detrusor and relaxation of internal urethral sphincter - initiation of micturition

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57
Q

Function of urethra

A

Carries urine from the internal urethral orifice of the bladder to the external urethral orifice

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58
Q

Location of external urethral orifice in males

A

Tip of penis

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59
Q

Location of external urethral orifice in females

A

Vestibule

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60
Q

length of female urethra

A

3-4cm

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61
Q

Is the male or female urethra longer

A

Male

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62
Q

Subdivisions of male urethra

A

Pre-prostatic
Prostatic
Membranous
Penile

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63
Q

What does the male urethra carry

A

Urine
Semen

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64
Q

Borders of posterior abdominal wall

A

Region behind the abdominal cavity
Extends from attachments of the diaphragm superiorly to pelvic brim inferiorly

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65
Q

What makes up the posterior abdominal wall

A

Lumbar spine
Psoas and quadratus lumborum muscles

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66
Q

Structures associated with the posterior abdominal wall

A

Aorta
Inferior vena cava
Sympathetic trunks
Ureters
Gonadal vessels

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67
Q

Which muscle does the ureter descend down from the kidney to pelvis

A

Psoas muscle

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68
Q

What do the gonadal vessels descend down to supply the gonads

A

Ureters

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69
Q

Which nerves form the lumber plexus

A

L1-L4
+ contribution from T12

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70
Q

What does the lumbar plexus innervate

A

Skin and muscles of abdominal wall and thigh

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71
Q

Notable branches of lumbar plexus

A

Iliohypogastric and ilioinguinal nerves
Genitofemoral nerve
Lateral femoral cutaneous nerve
Femoral nerve
Obturator nerve

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72
Q

Iliohypogastric and ilioinguinal nerves

A

Supply the anterior abdominal wall muscles and skin of external genitalia

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73
Q

Lateral femoral cutaneous nerve

A

Skin over lateral thigh

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74
Q

Genitofemoral nerve

A

Skin of external genitalia

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75
Q

Femoral nerve

A

Muscles and skin of anterior thigh

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76
Q

Obturator nerve

A

Muscles and skin of medial thigh

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77
Q

Which nerve is targeted to provided pain relief for lower limb fractures of surgery

A

Femoral nerve

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78
Q

Locating the femoral nerve

A

Ultrasound in inguinal region

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79
Q

Termination of abdominal aorta

A

Bifurcates into left and right common iliac arteries just to left of midline at level of L4

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80
Q

At what level does the abdominal aorta bifurcate

A

L4

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81
Q

Paired branches of abdominal aorta

A

Renal
Adrenal
Gonadal
Lumbar

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82
Q

Unpaired branches of abdominal aorta

A

Coeliac trunk
Superior mesenteric
Inferior mesenteric

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83
Q

Formation of inferior vena cava

A

Union of left and right common iliac veins at level of L5

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84
Q

At what level does the inferior vena cava form

A

L5

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85
Q

Location of inferior vena cava

A

Ascends in posterior abdominal wall to right of midline

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86
Q

Veins that drain into inferior vena cava

A

Renal
Adrenal
Gonadal (left gonadal vein drains into left renal vein first)
Lumbar
Hepatic veins

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87
Q

Urinary tract infections (UTIs)

A

UTIs are almost always caused by bacteria (most commonly E. Coli) entering the urinary bladder via the urethra. They are more common in females than males as the female urethra is much shorter. Infection of the urinary bladder is called cystitis and symptoms include burning pain on passing urine (dysuria) and the sensation of needing to pass urine much more frequently. Infection may spread superiorly to the kidney - this is called pyelonephritis. Pyelonephritis is a more serious infection and often requires intravenous antibiotics. Symptoms include fever, flank pain, and nausea and vomiting in addition to the symptoms of cystitis.

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88
Q

Why are UTIs more common in women

A

Urethra is much shirter

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89
Q

Renal cancer

A

Cancer of the kidneys can be divided into three main types, based on their histological origin. Renal cell carcinomas (RCC) originate from the lining of the nephron, transitional cell carcinomas (TCC) arise from the epithelial lining inside the kidney, and Wilms’ tumours originate from renal stem cells. Renal cancers may present with a triad of symptoms: pain in the flank, a palpable mass in the abdomen and haematuria (blood in the urine). As the kidneys are encased in a renal capsule, perinephric fat, renal fascia and paranephric fat, a renal cancer must grow very large and penetrate these layers before it is able to invade adjacent organs and structures.

90
Q

Abdominal aortic aneurysm (AAA)

A

An aneurysm is the bulging of a blood vessel caused by a weak point in the blood vessel wall. Risk factors for development of an abdominal aortic aneurysm (AAA) include smoking, alcohol, hypertension, and atherosclerosis. AAAs are diagnosed if the diameter of the aorta is wider than 3cm. If a AAA ruptures, significant intra-abdominal bleeding occurs rapidly, and mortality is high. If a small AAA is found incidentally (unexpectedly found during examination or imaging for another reason), they are monitored to see if they increase in size, and treatment, including surgery or stenting, may be offered if they become too large.

91
Q

Width of aorta to diagnose an AAA

A

Wider than 3cm

92
Q

Kidney stones (calculi)

A

Hard stones (calculi) can form in the kidneys and pass into the ureter. Kidney stones are most often composed of calcium oxalate and risk factors for developing them include high urine-calcium levels, dehydration, obesity, and certain medications. Smaller stones can pass into the ureter and out of the body via the bladder and urethra without causing any problems, but larger stones can obstruct the ureter. The typical presentation of an obstructing stone in the ureter is excruciating, pulsatile pain felt from ‘loin to groin’. This is because the pain fibres supplying the ureters originate from the T12 to L2 nerves, so pain is referred and felt in the T12 - L2 dermatomes. If the flow of urine from the kidney is obstructed, the kidney will fill with urine and swell (hydronephrosis). This can injure the kidney and may also lead to infection.

The ureter narrows in three places, and these are the regions where stones are most likely to get stuck:
1. Pelvi-ureteric junction (PUJ) – between the renal pelvis and ureter.
2. Pelvic brim - where the ureter runs over the pelvic brim, anterior to the iliac artery.
3. Vesico-ureteric junction (VUJ) - where the ureter joins the bladder.

93
Q

3 places where ureter narrows

A
  1. Pelvi-ureteric junction (PUJ) – between the renal pelvis and ureter.
  2. Pelvic brim - where the ureter runs over the pelvic brim, anterior to the iliac artery.
  3. Vesico-ureteric junction (VUJ) - where the ureter joins the bladder.
94
Q

Where do kidney stones commonly get stuck

A
  1. Pelvi-ureteric junction (PUJ) – between the renal pelvis and ureter.
  2. Pelvic brim - where the ureter runs over the pelvic brim, anterior to the iliac artery.
  3. Vesico-ureteric junction (VUJ) - where the ureter joins the bladder.
95
Q

Pelvi-ureteric junction

A

Between renal pelvis and uretr

96
Q

Pelvic brim

A

Where ureter runs over the pelvic brim, anterior to iliac aretry

97
Q

Vesico-ureteric junction

A

Where ureter joins the bladder

98
Q

What are kidney stones composed of

A

Calcium oxalate

99
Q

Where is kidney stone pain felt

A

loin to groin’. This is because the pain fibres supplying the ureters originate from the T12 to L2 nerves, so pain is referred and felt in the T12 - L2 dermatomes.

100
Q

Hydronephrosis

A

If the flow of urine from the kidney is obstructed, the kidney will fill with urine and swell (hydronephrosis). This can injure the kidney and may also lead to infection.

101
Q

Phaeochromocytoma

A

This is a rare hormone-producing tumour of the adrenal medulla. Secretion of excess adrenaline causes symptoms and signs related to hyperactivity of the sympathetic nervous system which are typically hypertension, tachycardia, and excessive sweating.

102
Q

Bladder stretch reflex

A

Urination is controlled by centres in the cerebral cortex, brainstem and sacral spinal cord. The sacral spinal cord contains the sacral micturition centre. As the bladder fills, stretch of the bladder wall is detected and this is relayed to the sacral spinal cord via visceral afferent fibres. In the sacral spinal cord these fibres synapse directly onto motor neurons.

The motor neurons (via parasympathetic fibres in the pelvic splanchnic nerves) stimulate bladder contraction. This simple relay through the spinal cord, where bladder filling initiates bladder emptying, is a type of stretch reflex and is referred to as a reflex arc. In older children and adults, the reflex arc is inhibited by inputs from the cerebral cortex meaning older children and adults are aware of bladder filling and can consciously control when and where they urinate. This is achieved through ‘potty-training’ in early childhood, during which infants learn to consciously recognise bladder filling and develop descending pathways that inhibit the reflex when it is not convenient to urinate.

103
Q

Injuries to the spinal cord and bladder stretch reflex

A

Injuries of the spinal cord produce different patterns of bladder dysfunction, depending on the level of the injury. If a patient suffers an injury to their spinal cord above the sacral level (e.g. a spinal cord transection at the level of T10), two important pathways are interrupted:
1. ascending pathways conveying the sensation of bladder filling to the brain (so the patient is no longer aware of bladder filling).
2. descending pathways that exert voluntary, inhibitory control over the external urethral sphincter (so the external sphincter is permanently relaxed).

The reflex arc still functions below the injury, but the patient does not have any inhibitory control over it. The patient does not realise they need to pass urine and the bladder automatically empties as it fills, so the patient is incontinent of urine.

If a patient suffers an injury to the spinal cord or cauda equina at or below the level of the sacral micturition centre, the reflex arc itself is disrupted and the bladder fills with urine without emptying. The internal urethral sphincter is permanently contracted. As the bladder continues to fill, the pressure in the bladder eventually exceeds the strength of the internal urethral sphincter and urination will occur. This type of incontinence is ‘overflow incontinence’. If the pressure inside the bladder does not overcome the sphincter, the patient develops urinary retention. Eventually urine may back up to the ureters and kidneys if a urinary catheter is not placed.
 

104
Q

Spinal cord injury above sacral level

A

Eg. a spinal cord transection at the level of T10), two important pathways are interrupted:
1. ascending pathways conveying the sensation of bladder filling to the brain (so the patient is no longer aware of bladder filling).
2. descending pathways that exert voluntary, inhibitory control over the external urethral sphincter (so the external sphincter is permanently relaxed).

The reflex arc still functions below the injury, but the patient does not have any inhibitory control over it. The patient does not realise they need to pass urine and the bladder automatically empties as it fills, so the patient is incontinent of urine.

105
Q

injury to the spinal cord or cauda equina at or below the level of the sacral micturition centre

A

reflex arc itself is disrupted and the bladder fills with urine without emptying. The internal urethral sphincter is permanently contracted. As the bladder continues to fill, the pressure in the bladder eventually exceeds the strength of the internal urethral sphincter and urination will occur. This type of incontinence is ‘overflow incontinence’. If the pressure inside the bladder does not overcome the sphincter, the patient develops urinary retention. Eventually urine may back up to the ureters and kidneys if a urinary catheter is not placed.
 

106
Q

Functions of bony pelvis

A

Support the spine, torso and upper body
Locomotion
Housing and protecting the pelvic viscera

107
Q

Which bones make up the pelvis

A

Sacrum
Left and right hip bones

108
Q

Which bones make up the hip bone

A

Ilium
Ischium
Pubis

109
Q

Number of bones in pelvis

A

3

110
Q

Number of fused bones in hip bone

A

3

111
Q

Number of articulations of bony pelvis

A

5

112
Q

5 articulations of bony pelvis

A

Hip joint
Sacroiliac joint
Pubic symphysis
Lumbosacral joint
Sacrococcygeal joint

113
Q

Hip joint

A

Between the head of the femur and the acetabulum (socket) of pelvis

114
Q

Acetabulum

A

Socket of pelvis
Where ilium, ischium and pubis of hip bone fuse

115
Q

Sacroiliac joint

A

Between sacrum and ilium of hip bone
Very strong and stable- supported by many ligaments

116
Q

Pubic symphysis

A

Between the two pubic bones at front of pelvis
Very little movement is permitted

117
Q

Lumbosacral joint

A

Between L5 vertebra and sacrum
Intervertebral disc lies between

118
Q

Sacrococcygeal joint

A

Between sacrum and coccyx

119
Q

Surface landmarks of bony pelvis

A

Iliac crest
Anterior superior iliac spine
Iliac tubercle
Pubic tubercle
Inguinal ligament
Mid-inguinal point

120
Q

Iliac crest

A

when palpating the iliac crests from the back, a line drawn between them at their highest point (the intercristal line) marks the level of the L4/L5 disc space. This is useful as this is a position where a lumbar puncture can be performed, or an epidural injection given.

121
Q

Anterior superior iliac spine

A

this is the most anterior point of the ilium and is palpable in almost all patients.

122
Q

Iliac tubercle

A

this is the most lateral point of the ilium. A line drawn between the iliac tubercles (the ‘intertubercular line’) marks the division of the lower third of the abdomen from the middle third, thereby delineating the suprapubic region from the umbilical, and the iliac fossae from the flanks.

123
Q

Pubic tubercle

A

again palpable in most people, this is the most medial point of the pubic bone.

124
Q

Inguinal ligament

A

runs from the anterior superior iliac spine to the pubic tubercle.

125
Q

Mid-inguinal point

A
  • the mid-point of a line drawn from the anterior superior iliac spine to the pubic symphysis (not the pubic tubercle). The femoral artery is palpable here.
126
Q

What is palpable at the mid-inguinal point

A

Femoral artery

127
Q

Differences between male and female pelves

A

Wider, circular pelvic inlet in females for child birth and narrower heart-shaped pelvic inlet in males
Obtuse angle formed by the inferior pubic rami in females, acute angle in males
Wider and shorter sacrum in females and narrower and longer sacrum in males

128
Q

Pelvic inlet : females vs males

A

Wider, circular pelvic inlet in females (for childbirth) narrower, heart-shaped pelvic inlet in males.

129
Q

Angle formed by inferior pubic rami : females vs males

A

Obtuse = females
Acute = males

130
Q

Sacrum : females vs males

A

Wider and shorter = females
Narrower and longer = males

131
Q

What does the pelvis contain

A

Bladder
Rectum
Uterus, ovaries and vagina/ prostate and seminal vesicles

132
Q

Pelvic floor

A

Several muscles that support the pelvic organs from below
Separate the pelvis from the perineum

133
Q

Shape of pelvic floor

A

Bowl/funnel

134
Q

What separates the pelvis and perineum

A

Pelvic floor

135
Q

Functions of the pelvic floor

A

Prevent herniation of pelvic organs inferiorly out of the pelvis

Control continence of urine and faeces by providing a sphincter action on the urethra and rectum

Aid in increasing intra-abdominal pressure

136
Q

Which muscles make up the pelvic floor

A

Levator ani
Coccygeus

137
Q

What is the Levator ani composed of

A

3 smaller paired muscles

138
Q

3 paired muscles of Levator ani

A

Puborectalis
Pubococcygeus
Iliococcygeus

139
Q

Innervation of Levator ani

A

Branch of S4 nerve
Some branches of pudendal nerve (S2-S4)

140
Q

Puborectalis structure

A

U-shaped muscle that attaches to the pubic bones anteriorly and forms a sling around the rectum
Most anterior Levator ani muscle

141
Q

Puborectalis function

A

When it contracts, pulls on the rectum so a sharp angle is formed between the rectum and anal canal= prevents defecation
When it relaxes, path from rectum to anal canal straightens and faeces can pass through
Also contributes to control of micturition

142
Q

Pubococcygeus muscle

A

Lies posterior and lateral to Puborectalis
Attaches to pubic bone anteriorly and coccyx/sacrum posteriorly

143
Q

Iliococcygeus muscle

A

Lies lateral to Pubococcygeus
Attaches to the spines of the ischium and coccyx

144
Q

Arterial supply to pelvis

A

Left and right internal iliac arteries

145
Q

Internal iliac arteries

A

Supply pelvic viscera
Perineum and gluteal region

146
Q

Branches of internal iliac arteries

A

Vesical arteries
Uterine and vaginal arteries in females
Middle rectal artery
Internal pudendal artery
Superior and inferior gluteal arteries
Obturator artery

147
Q

Vesical artery

A

Supply the bladder in both sexes
Prostate and seminal vesicles in males

148
Q

Middle rectal artery

A

Supplies rectum

149
Q

Internal pudendal artery

A

Exits pelvis to supply the perineum

150
Q

Obturator artery

A

Exits the pelvis to supply the lower limb

151
Q

Obturator artery

A

Exits the pelvis to supply the lower limb

152
Q

Superior and inferior gluteal arteries

A

Exit the pelvis to supply the gluteal region

153
Q

Venous drainage of the pelvis

A

Venous plexuses drain organs into internal iliac vein

154
Q

Nervous supply to the pelvis

A

Somatic, parasympathetic and sympathetic
Sacral plexus

155
Q

Branches of sacral plexus

A

Sciatic nerve
Pudendal nerve
Superior and inferior gluteal nerve
Pelvic splanchnic nerves

156
Q

Sciatic nerve

A

Formed by the lower lumbar and sacral spinal nerves L4-S3
Exits the pelvis to supply the lower limbs

157
Q

Pudendal nerve

A

Somatic nerve
S2-S4
Major nerve for perineum

158
Q

Superior and inferior gluteal nerves

A

Innervate gluteal fegiom

159
Q

Pelvic splanchnic nerves

A

Parasympathetic
S2-S4
Innervates pelvic viscera

160
Q

Lumbar splanchnic nerves

A

Sympathetic
Innervate pelvic viscera

161
Q

Spinal level of sciatic nerve

A

L4-S3

162
Q

2 notable flexure of rectum

A

Sacral flexure
Anorectal flexure

163
Q

Location of sacral flexure of rectum

A

Anteriorly

164
Q

Location of anorectal flexure

A

Posteriorly

165
Q

Length of adult rectum

A

12cm

166
Q

Function of rectum

A

Storage of faeces prior to defecation

167
Q

Arterial supply of rectum

A

Superior, middle and inferior rectal arteries

168
Q

Superior rectal artery

A

Branch of inferior mesenteric artery

169
Q

Middle rectal artery

A

Branch of internal iliac aretry

170
Q

Inferior rectal artery

A

Branch of internal pudendal artery

171
Q

Venous drainage of rectum

A

Superior, middle and inferior rectal veins
Anastomoses to form a venous plexus around the rectum and anus- portosystemic anastomoses

172
Q

Location of perineum

A

Immediately superficial and inferior to pelvic floor
The superficial region between the pubic symphysis and coccyx
Between medial surfaces of the thighs

173
Q

Shape of perineum

A

Roughly diamond shaped (viewed from above)
Split into 2 triangles by drawing an imaginary line between the ischial tuberosities

174
Q

2 triangles of perineum

A

Urogenital triangle- anteriorly
Anal triangle- posteriorly

175
Q

What line separates the 2 triangles of the perineum

A

Between the ischial tuberosities

176
Q

Urogenital triangle

A

Anterior
Contains the urethral and vaginal openings, the erectile tissues that unite to form the clitoris or penis and the overlying muscles

177
Q

Layers of urogenital triangle

A

Skin
Perineal fascia
Superficial perineal pouch
Perineal membrane

178
Q

Superficial perineal pouch

A

A potential space that contains the erectile tissues of the penis or clitoris and three muscles: ischiocavernosus, bulbospongiosus and the superficial transverse perineal muscles.

179
Q

3 muscles in superficial perineal pouch

A

Ischiocavernosus
Bulbospongiosus
Superficial transverse perineal muscles

180
Q

Perineal fascia

A

Continuation of fascia overlying the abdominal wall muscles

181
Q

Perineal membrane

A

A strong fibrous membrane that provides support for the attachment of ischiocavernosus and bulbospongiosus muscles.
The urethra and vagina pass through it.

182
Q

Which muscles attach to the perineal membrane

A

Ischiocavernosus and bulbospongiosus muscles

183
Q

What does the anal triangle contain

A

Anal canal
Anus
External anal sphincter

184
Q

Anal canal length

A

4cm

185
Q

2 anal sphincters

A

Control defecation
Internal and external anal sohincters

186
Q

Internal anal sphincter

A

Smooth muscle
Involuntarily controlled

187
Q

External anal sphincter

A

Skeletal muscle
Voluntarily controlled

188
Q

What divides the anal canal into superior and inferior parts

A

Pectinate (dentate) line

189
Q

Superior part of anal canal embryology

A

Part of Hindgut
Derived from endoderm

190
Q

Superior part of anal canal lining

A

Columnar epithelium (intestinal mucosa)

191
Q

Superior part of anal canal arterial supply

A

Inferior mesenteric artery —> superior rectal artery

192
Q

Superior part of anal canal venous drainage

A

Portal venous system to liver

193
Q

Superior part of anal canal encircled by and innervated

A

Internal anal sphincter - sympathetic = sympathetic trunk
Parasympathetic = pelvic splanchnic nerves

194
Q

Inferior part of anal canal embryology

A

Derived from ectoderm

195
Q

Inferior part of anal canal lining

A

Stratified squamous epithelihm

196
Q

Inferior part of anal canal arterial supply

A

Internal iliac arteries —> Middle and inferior rectal arteries

197
Q

Inferior part of anal canal venous drainage

A

Enters systemic venous system

198
Q

Inferior part of anal canal encircled by and innervated

A

External anal sphincter
Pudendal nerve (somatic)

199
Q

What sits between the 2 triangles of the perineum

A

Perineal body

200
Q

Perineal body structures

A

Dense mass of fibrous tissue and muscle

201
Q

Perineal body function

A

acts as an attachment for almost all the perineal and pelvic floor muscles, including levator ani, the external anal sphincter, the external urethral sphincter, and muscles associated with the erectile tissues of the perineum.

202
Q

Pelvic floor weakness

A

The pelvic floor muscles support the pelvic organs, but they can be stretched, damaged, or weakened by childbirth, ageing, straining or obesity. Pelvic floor weakness can lead to incontinence of urine or faeces. It can also lead to pelvic organ prolapse where the uterus prolapses into the vagina, or the rectum prolapses out of the anus, because they are no longer supported.

203
Q

Episiotomy

A

During childbirth, the perineal body may be damaged due to stretching or tearing of perineal tissues. This can lead to incontinence or pelvic floor weakness. During labour, a pre-emptive incision - an episiotomy - can be made just lateral to the perineal body. This avoids injury to the perineal body or an uncontrolled tear through the anal sphincter.

204
Q

Haemorrhoids

A

The walls of the anal canal are lined with an abundance of veins that form ‘cushions’ which aid faecal continence. These cushions are known as haemorrhoids, or ‘piles’. They can become swollen and inflamed and, depending on whether they become inflamed above or below the pectinate line, they may be painless (above the pectinate line) or painful (below pectinate line).

If they are pathological, they often bleed when passing stool. If they are painless haemorrhoids, the presence of blood on wiping or blood dripping into the toilet after defecation may be the first sign that they are present. Increased intra-abdominal pressure, for example, in excessive straining, constipation, squatting or pregnancy, increases pressure in the pelvic veins and can lead to haemorrhoids becoming swollen and problematic.

205
Q

Haemorrhoids above the pectinate line

A

Painless

206
Q

Haemorrhoids below the pectinate line

A

Painful

207
Q

Order of pubic bones top to bottom

A

Sacrum
Ilium
Pubis
Ischium

208
Q

Shape difference of 2 adrenal glands

A

Right is more triangular
Left is flatter due to presence of spleen

209
Q

Which kidney rest lower and why

A

Right due to liver

210
Q

Which hormone is produced by the glomerular part of adrenal cortex

A

Aldosterone (mineral corticosteroid )

211
Q

Which hormone is produced by the fasiculate part of the adrenal cortex

A

Cortisol (glucocorticosteriod)

212
Q

Which hormone is produced by the reticularis part of the adrenal cortex

A

Testosterone (androgen)

213
Q

Go For Rex, Make Good Sex

A

Glomerular = mineral corticosteroids- aldosterone
Fasiculate = glucocorticosteriod - cortisol
Reticularis = sex/androgen - testosterone

214
Q

Which ribs overlie the kidneys

A

10, 11, 12

215
Q

Nerve root of Obturator nerve

A

L2, L3, L4

216
Q

Function of psoas muscle

A

Divides pelvis into regions and flexes thigh onto trunk or vice versa

217
Q

Function of quadratus lumborum muscle

A

Fixes or depresses 12th rib
Lateral flexion

218
Q

What could cause colicky pain in right flank

A

Kidney stones

219
Q

In females, what is the venous drainage of the bladder

A

Vesicouterine plexus

220
Q

At what level does the renal artery branch from the abdominal aorta

A

L2

221
Q

What is the correct order of urine flow from the kidneys to the bladder?

A

Renal pyramids, minor calyx, major calyx, renal hilum, ureter

222
Q

The structure indicated by the yellow arrow, commonly becomes blocked by kidney stones. Which of the following options is a place where a kidney stone may become lodged?

A

Where the ureter’s cross the iliac vessels

Genitourinary Anatomy (3 decks)

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