Urinary Tract, Posterior Abdominal Wall And Pelvis Flashcards
1
Q
Other potential names of adrenal glands
A
Suprarenal glands
2
Q
Location of adrenal glands
A
Upper pole of each kidney
3
Q
Location of right adrenal glands
A
Behind the liver and inferior vena cava
4
Q
Location of left adrenal glands
A
Behind the stomach and pancreas
5
Q
Number of arteries that supply the adrenal glands
A
3
6
Q
3 arteries supplying the adrenal glands
A
Superior adrenal artery
Middle adrenal artery
Inferior adrenal artery
7
Q
Superior adrenal artery
A
Branch of inferior phrenic artery
8
Q
Middle adrenal artery
A
Branch of abdominal aorta
9
Q
Inferior adrenal artery
A
Branch of renal artery
10
Q
Venous drainage of adrenal glands
A
By a single vein on each side
11
Q
Where does the right adrenal vein drain into
A
Directly into inferior vena cava
12
Q
Where does the left adrenal vein drain into
A
Initially left renal vein, which then joins the inferior vena cava
13
Q
2 parts of adrenal glands
A
Cortex
Medulla
14
Q
Function of adrenal cortex
A
Produces steroid hormones including cortisol, aldosterone and testosterone
15
Q
Function of adrenal medulla
A
Produces adrenaline
16
Q
Dimensions of kidneys
A
11cm long
7cm wide
3cm thick
17
Q
Are the kidneys Intraperitoneal or retroperitoneal
A
Retroperitoneal
18
Q
What is the kidney embedded in
A
Perinephric fat covered by a renal fascia
Paranephric fat outside renal fascia
19
Q
Location of renal hilum
A
Medial border of kidney
20
Q
What enters and exits at the renal hilum
A
Renal artery and vein
Nerves
Lymphatics
Ureter
21
Q
Left and right renal arteries
A
Branches of abdominal aorta
22
Q
Left and right renal veins drain into
A
Inferior vena cava
23
Q
Components of internal aspect of kidney
A
Cortex
Medulla (arranged in pyramids)
Calyces
24
Q
Functional unit of kidney
A
Nephron
Responsible for filtering blood, reabsorbing water and solutes, and secreting and excreting waste products as urine
25
Parts of nephron in outer cortex
Glomeruli
Bowman’s capsule
Proximal tubule
Distal tubule
Part of collecting duct
26
Parts of nephron in inner medulla pyramids
Loop of henle
Rest of collecting duct
27
Passage of urine after collecting ducts
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
28
Renal papilla
Apex of medullary pyramids
29
What merge to form the renal pelvis
Major calyx
30
What is the renal pelvis continuous with
Ureter
31
Function of ureter
Narrow tubes with muscular walls which transport urine by peristalsis to urinary bladder
32
Location of ureters
Run anterior to psoas major on the posterior abdominal wall
Cross the pelvic brim to enter the pelvis
33
Urinary bladder
Hollow muscular organ
Walls contain smooth muscle -detrusor
34
Infra-peritoneal organ
Urinary bladder located in the pelvis below the peritoneum
35
Location of urinary bladder
Posterior to pubic symphysis
Anterior to vagina and rectum
36
Function of urinary bladder
Stores urine and helps to squeeze urine out during micturition
37
Detrusor muscle
Smooth muscle in walls of bladder
Contracts to forcibly expel urine
38
Trigone
Triangular area of bladder with a smooth internal wall
Where ureters enter the bladder
39
Location of trigone (where ureters enter bladder)
Posterior aspect near base of bladder
40
Rudimentary valve
Ureters enter the trigone at an angle
Prevents reflux of urine into the ureters when bladder is full
41
Rugae
Inside wall of bladder corrugated with folds to allow bladder to stretch without tearing when it’s full
42
Bladder when empty
Can squash down completely
43
Bladder when full
Superior aspect may extend above the pubic symphysis
44
How much urine can the bladder accommodate in an adult
400-600 ml
45
Which arteries supply to bladder
Vesical arteries
46
Vesical arteries
Branches of the internal iliac artery
47
Venous drainage of bladder
Vesical veins
48
Vesical veins drain into
Internal iliac vein
49
What controls the release of urine
2 sphincters
Internal and external urethral sphincters
50
Location of internal urethral sphincter
Base of bladder where it opens into the urethra
51
Control of internal urethral sphincter
Smooth muscle
Involuntary control
52
Location of external urethral sphincter
Just inferior to prostate in males
In the deep perineal pouch in females
53
Control of external urethral sphincter
Skeletal muscle
Voluntary control
54
Somatic innervation of the urinary bladder and urethral sphincter
Via branches of pudendal nerve (S2-S4)
Allows conscious control of the external urethral sphincter
55
Sympathetic innervation of the urinary bladder and urethral sphincter
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
56
Parasympathetic innervation of the urinary bladder and urethral sphincter
Via the pelvic splanchnic nerve (S2-S4)
Causes contraction of detrusor and relaxation of internal urethral sphincter - initiation of micturition
57
Function of urethra
Carries urine from the internal urethral orifice of the bladder to the external urethral orifice
58
Location of external urethral orifice in males
Tip of penis
59
Location of external urethral orifice in females
Vestibule
60
length of female urethra
3-4cm
61
Is the male or female urethra longer
Male
62
Subdivisions of male urethra
Pre-prostatic
Prostatic
Membranous
Penile
63
What does the male urethra carry
Urine
Semen
64
Borders of posterior abdominal wall
Region behind the abdominal cavity
Extends from attachments of the diaphragm superiorly to pelvic brim inferiorly
65
What makes up the posterior abdominal wall
Lumbar spine
Psoas and quadratus lumborum muscles
66
Structures associated with the posterior abdominal wall
Aorta
Inferior vena cava
Sympathetic trunks
Ureters
Gonadal vessels
67
Which muscle does the ureter descend down from the kidney to pelvis
Psoas muscle
68
What do the gonadal vessels descend down to supply the gonads
Ureters
69
Which nerves form the lumber plexus
L1-L4
+ contribution from T12
70
What does the lumbar plexus innervate
Skin and muscles of abdominal wall and thigh
71
Notable branches of lumbar plexus
Iliohypogastric and ilioinguinal nerves
Genitofemoral nerve
Lateral femoral cutaneous nerve
Femoral nerve
Obturator nerve
72
Iliohypogastric and ilioinguinal nerves
Supply the anterior abdominal wall muscles and skin of external genitalia
73
Lateral femoral cutaneous nerve
Skin over lateral thigh
74
Genitofemoral nerve
Skin of external genitalia
75
Femoral nerve
Muscles and skin of anterior thigh
76
Obturator nerve
Muscles and skin of medial thigh
77
Which nerve is targeted to provided pain relief for lower limb fractures of surgery
Femoral nerve
78
Locating the femoral nerve
Ultrasound in inguinal region
79
Termination of abdominal aorta
Bifurcates into left and right common iliac arteries just to left of midline at level of L4
80
At what level does the abdominal aorta bifurcate
L4
81
Paired branches of abdominal aorta
Renal
Adrenal
Gonadal
Lumbar
82
Unpaired branches of abdominal aorta
Coeliac trunk
Superior mesenteric
Inferior mesenteric
83
Formation of inferior vena cava
Union of left and right common iliac veins at level of L5
84
At what level does the inferior vena cava form
L5
85
Location of inferior vena cava
Ascends in posterior abdominal wall to right of midline
86
Veins that drain into inferior vena cava
Renal
Adrenal
Gonadal (left gonadal vein drains into left renal vein first)
Lumbar
Hepatic veins
87
Urinary tract infections (UTIs)
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.
88
Why are UTIs more common in women
Urethra is much shirter
89
Renal cancer
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
Abdominal aortic aneurysm (AAA)
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
Width of aorta to diagnose an AAA
Wider than 3cm
92
Kidney stones (calculi)
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
3 places where ureter narrows
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
Where do kidney stones commonly 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.
95
Pelvi-ureteric junction
Between renal pelvis and uretr
96
Pelvic brim
Where ureter runs over the pelvic brim, anterior to iliac aretry
97
Vesico-ureteric junction
Where ureter joins the bladder
98
What are kidney stones composed of
Calcium oxalate
99
Where is kidney stone pain felt
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
Hydronephrosis
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
Phaeochromocytoma
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
Bladder stretch reflex
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
Injuries to the spinal cord and bladder stretch reflex
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
Spinal cord injury above sacral level
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
injury to the spinal cord or cauda equina at or below the level of the sacral micturition centre
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
Functions of bony pelvis
Support the spine, torso and upper body
Locomotion
Housing and protecting the pelvic viscera
107
Which bones make up the pelvis
Sacrum
Left and right hip bones
108
Which bones make up the hip bone
Ilium
Ischium
Pubis
109
Number of bones in pelvis
3
110
Number of fused bones in hip bone
3
111
Number of articulations of bony pelvis
5
112
5 articulations of bony pelvis
Hip joint
Sacroiliac joint
Pubic symphysis
Lumbosacral joint
Sacrococcygeal joint
113
Hip joint
Between the head of the femur and the acetabulum (socket) of pelvis
114
Acetabulum
Socket of pelvis
Where ilium, ischium and pubis of hip bone fuse
115
Sacroiliac joint
Between sacrum and ilium of hip bone
Very strong and stable- supported by many ligaments
116
Pubic symphysis
Between the two pubic bones at front of pelvis
Very little movement is permitted
117
Lumbosacral joint
Between L5 vertebra and sacrum
Intervertebral disc lies between
118
Sacrococcygeal joint
Between sacrum and coccyx
119
Surface landmarks of bony pelvis
Iliac crest
Anterior superior iliac spine
Iliac tubercle
Pubic tubercle
Inguinal ligament
Mid-inguinal point
120
Iliac crest
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
Anterior superior iliac spine
this is the most anterior point of the ilium and is palpable in almost all patients.
122
Iliac tubercle
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
Pubic tubercle
again palpable in most people, this is the most medial point of the pubic bone.
124
Inguinal ligament
runs from the anterior superior iliac spine to the pubic tubercle.
125
Mid-inguinal point
- 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
What is palpable at the mid-inguinal point
Femoral artery
127
Differences between male and female pelves
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
Pelvic inlet : females vs males
Wider, circular pelvic inlet in females (for childbirth) narrower, heart-shaped pelvic inlet in males.
129
Angle formed by inferior pubic rami : females vs males
Obtuse = females
Acute = males
130
Sacrum : females vs males
Wider and shorter = females
Narrower and longer = males
131
What does the pelvis contain
Bladder
Rectum
Uterus, ovaries and vagina/ prostate and seminal vesicles
132
Pelvic floor
Several muscles that support the pelvic organs from below
Separate the pelvis from the perineum
133
Shape of pelvic floor
Bowl/funnel
134
What separates the pelvis and perineum
Pelvic floor
135
Functions of the pelvic floor
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
Which muscles make up the pelvic floor
Levator ani
Coccygeus
137
What is the Levator ani composed of
3 smaller paired muscles
138
3 paired muscles of Levator ani
Puborectalis
Pubococcygeus
Iliococcygeus
139
Innervation of Levator ani
Branch of S4 nerve
Some branches of pudendal nerve (S2-S4)
140
Puborectalis structure
U-shaped muscle that attaches to the pubic bones anteriorly and forms a sling around the rectum
Most anterior Levator ani muscle
141
Puborectalis function
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
Pubococcygeus muscle
Lies posterior and lateral to Puborectalis
Attaches to pubic bone anteriorly and coccyx/sacrum posteriorly
143
Iliococcygeus muscle
Lies lateral to Pubococcygeus
Attaches to the spines of the ischium and coccyx
144
Arterial supply to pelvis
Left and right internal iliac arteries
145
Internal iliac arteries
Supply pelvic viscera
Perineum and gluteal region
146
Branches of internal iliac arteries
Vesical arteries
Uterine and vaginal arteries in females
Middle rectal artery
Internal pudendal artery
Superior and inferior gluteal arteries
Obturator artery
147
Vesical artery
Supply the bladder in both sexes
Prostate and seminal vesicles in males
148
Middle rectal artery
Supplies rectum
149
Internal pudendal artery
Exits pelvis to supply the perineum
150
Obturator artery
Exits the pelvis to supply the lower limb
151
Obturator artery
Exits the pelvis to supply the lower limb
152
Superior and inferior gluteal arteries
Exit the pelvis to supply the gluteal region
153
Venous drainage of the pelvis
Venous plexuses drain organs into internal iliac vein
154
Nervous supply to the pelvis
Somatic, parasympathetic and sympathetic
Sacral plexus
155
Branches of sacral plexus
Sciatic nerve
Pudendal nerve
Superior and inferior gluteal nerve
Pelvic splanchnic nerves
156
Sciatic nerve
Formed by the lower lumbar and sacral spinal nerves L4-S3
Exits the pelvis to supply the lower limbs
157
Pudendal nerve
Somatic nerve
S2-S4
Major nerve for perineum
158
Superior and inferior gluteal nerves
Innervate gluteal fegiom
159
Pelvic splanchnic nerves
Parasympathetic
S2-S4
Innervates pelvic viscera
160
Lumbar splanchnic nerves
Sympathetic
Innervate pelvic viscera
161
Spinal level of sciatic nerve
L4-S3
162
2 notable flexure of rectum
Sacral flexure
Anorectal flexure
163
Location of sacral flexure of rectum
Anteriorly
164
Location of anorectal flexure
Posteriorly
165
Length of adult rectum
12cm
166
Function of rectum
Storage of faeces prior to defecation
167
Arterial supply of rectum
Superior, middle and inferior rectal arteries
168
Superior rectal artery
Branch of inferior mesenteric artery
169
Middle rectal artery
Branch of internal iliac aretry
170
Inferior rectal artery
Branch of internal pudendal artery
171
Venous drainage of rectum
Superior, middle and inferior rectal veins
Anastomoses to form a venous plexus around the rectum and anus- portosystemic anastomoses
172
Location of perineum
Immediately superficial and inferior to pelvic floor
The superficial region between the pubic symphysis and coccyx
Between medial surfaces of the thighs
173
Shape of perineum
Roughly diamond shaped (viewed from above)
Split into 2 triangles by drawing an imaginary line between the ischial tuberosities
174
2 triangles of perineum
Urogenital triangle- anteriorly
Anal triangle- posteriorly
175
What line separates the 2 triangles of the perineum
Between the ischial tuberosities
176
Urogenital triangle
Anterior
Contains the urethral and vaginal openings, the erectile tissues that unite to form the clitoris or penis and the overlying muscles
177
Layers of urogenital triangle
Skin
Perineal fascia
Superficial perineal pouch
Perineal membrane
178
Superficial perineal pouch
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
3 muscles in superficial perineal pouch
Ischiocavernosus
Bulbospongiosus
Superficial transverse perineal muscles
180
Perineal fascia
Continuation of fascia overlying the abdominal wall muscles
181
Perineal membrane
A strong fibrous membrane that provides support for the attachment of ischiocavernosus and bulbospongiosus muscles.
The urethra and vagina pass through it.
182
Which muscles attach to the perineal membrane
Ischiocavernosus and bulbospongiosus muscles
183
What does the anal triangle contain
Anal canal
Anus
External anal sphincter
184
Anal canal length
4cm
185
2 anal sphincters
Control defecation
Internal and external anal sohincters
186
Internal anal sphincter
Smooth muscle
Involuntarily controlled
187
External anal sphincter
Skeletal muscle
Voluntarily controlled
188
What divides the anal canal into superior and inferior parts
Pectinate (dentate) line
189
Superior part of anal canal embryology
Part of Hindgut
Derived from endoderm
190
Superior part of anal canal lining
Columnar epithelium (intestinal mucosa)
191
Superior part of anal canal arterial supply
Inferior mesenteric artery —> superior rectal artery
192
Superior part of anal canal venous drainage
Portal venous system to liver
193
Superior part of anal canal encircled by and innervated
Internal anal sphincter - sympathetic = sympathetic trunk
Parasympathetic = pelvic splanchnic nerves
194
Inferior part of anal canal embryology
Derived from ectoderm
195
Inferior part of anal canal lining
Stratified squamous epithelihm
196
Inferior part of anal canal arterial supply
Internal iliac arteries —> Middle and inferior rectal arteries
197
Inferior part of anal canal venous drainage
Enters systemic venous system
198
Inferior part of anal canal encircled by and innervated
External anal sphincter
Pudendal nerve (somatic)
199
What sits between the 2 triangles of the perineum
Perineal body
200
Perineal body structures
Dense mass of fibrous tissue and muscle
201
Perineal body function
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
Pelvic floor weakness
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
Episiotomy
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
Haemorrhoids
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
Haemorrhoids above the pectinate line
Painless
206
Haemorrhoids below the pectinate line
Painful
207
Order of pubic bones top to bottom
Sacrum
Ilium
Pubis
Ischium
208
Shape difference of 2 adrenal glands
Right is more triangular
Left is flatter due to presence of spleen
209
Which kidney rest lower and why
Right due to liver
210
Which hormone is produced by the glomerular part of adrenal cortex
Aldosterone (mineral corticosteroid )
211
Which hormone is produced by the fasiculate part of the adrenal cortex
Cortisol (glucocorticosteriod)
212
Which hormone is produced by the reticularis part of the adrenal cortex
Testosterone (androgen)
213
Go For Rex, Make Good Sex
Glomerular = mineral corticosteroids- aldosterone
Fasiculate = glucocorticosteriod - cortisol
Reticularis = sex/androgen - testosterone
214
Which ribs overlie the kidneys
10, 11, 12
215
Nerve root of Obturator nerve
L2, L3, L4
216
Function of psoas muscle
Divides pelvis into regions and flexes thigh onto trunk or vice versa
217
Function of quadratus lumborum muscle
Fixes or depresses 12th rib
Lateral flexion
218
What could cause colicky pain in right flank
Kidney stones
219
In females, what is the venous drainage of the bladder
Vesicouterine plexus
220
At what level does the renal artery branch from the abdominal aorta
L2
221
What is the correct order of urine flow from the kidneys to the bladder?
Renal pyramids, minor calyx, major calyx, renal hilum, ureter
222
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?
Where the ureter's cross the iliac vessels
