Urogenital System and Pelvic Structures

Question 1

Where is the ureter system located?

Answer 1

completely outside of the peritoneum

Question 2

What is the relation of the kidney to the ribs?

Answer 2

1/2 of kidney is contained w/i the 12th rib.

Question 3

Due to the relationship w/ the kidney and 12th rib, what do you test in possibly kidney disease?

Answer 3

CVA (costovertebral angle) - will have pain there if any kidney disease is present

Question 4

What is the asymmetry of the renal vein?

Answer 4

left renal vein is longer than the right

Question 5

Where do the gonadal veins drain?

Answer 5

left: drains to left renal vein
right: drains to IVC

Question 6

Renal fascia

Answer 6

surrounds kidney and suprarenal gland; have fat on both sides of it (order would be fat, renal fascia, then fat again)

Question 7

The anterior renal fascia blends with that?

Answer 7

coverings of the renal vessels

Question 8

The posterior renal fascia blends with what?

Answer 8

psoas fascia

Question 9

medulla of kidney

Answer 9

the collecting parts

Question 10

What is the makeup of the cortex of the kidney?

Answer 10

Arranged in pyramids which come to a cone (cribriform area) which drain urine into minor calyces, which drain into major calyces which drain into renal pelvis then on into ureter

Question 11

What is the reationship, in both males and females, between the ureter and other structures?

Answer 11

water under the bridge:

males: ureter passes beneath ductus deferens
females: ureter pases under the uterine a.

Question 12

What is responsible for the wave-like pain in kidney stones?

Answer 12

peristalsis in the ureter; if pain is constant, likely not a ureter problem

Question 13

Trigone

Answer 13

non-distensible part of bladder wall b/w the entrance of the ureters and exit of urethra

Question 14

What is the contractile portion of the bladder?

Answer 14

detrusor muscle

Question 15

bladder cancer is almost always due to what?

Answer 15

nicotene exposure

Question 16

What prevents ureteral reflux? aka urine backing up into the ureter

Answer 16

the ureters course indie of the muscle before opening into the bladder

Question 17

When autonomics say the bladder is full, which sphincter is released out of our control?

Answer 17

the internal urethral sphincter at the bladder outlet

Question 18

Which sphincter is under somatic control?

Answer 18

external urethral sphincter

Question 19

In females, the tone of the external urethral sphincter is dependent on what?

Answer 19

estrogen; between menopause and giving birth it loses a lot of tone causing incontinence issues

Question 20

What innervates the internal urethral sphincter?

Answer 20

sympathetics

Question 21

What innervates the detrusor muscle?

Answer 21

parasympathetics via pelvic splanchnics S2-4; synapse right by muscle

Question 22

What innervates the external urethral sphincter?

Answer 22

pudendal n.; (voluntary and somatic) through SOMATIC S2-4

Question 23

What is inhibited while peeing?

Answer 23

sympathetics to the internal sphincter

Question 24

Renal calculi

Answer 24

aka kidney stones; pain starts in CVA and as stone travels down ureter, pain shifts to flank then into labia or scrotum. Pain is gone when stone reaches bladder.

Question 25

Where is the new kidney placed during transplant?

Answer 25

the pelvic area; the bad kidney is left in place unless gangrenous

Question 26

What is one of the most common anomilies related to the kidneys?

Answer 26

the kidney never loses it's original blood supply

Question 27

pelvic kidney

Answer 27

one that never ascended

Question 28

horseshoe kidney

Answer 28

kideny never separated into 2 different elements so wraps around the front of IVC and aorta; can compress arteries and need correction

Question 29

What is the vascular supply to the suprarenal aka adrenal glands?

Answer 29

huge vascular supply; from inferior phrenic, aorta and renal arteries

Question 30

Where does the suprarenal vein drain?

Answer 30

Right: IVC Left: left renal vein

Question 31

What are the two parts of the adrenal gland?

Answer 31

cortex: under hormonal control so not highly vacularized medulla: highly vascularized

Question 32

How is the medulla innervated?

Answer 32

sympathetics synapse in celiac ganglion then travel via blood vessels to adrenal medulla

Question 33

What is the effect of sympathetics to the adrenal medulla?

Answer 33

dumping a ton of epinephrine into suprarenal vein which goes to heart and gives you the "heart skips a beat" feeling

Question 34

All the major nerves of the pelvis (like obturator, femoral, subcostal, etc.) are what?

Answer 34

ventral primary rami

Question 35

What nerve supplies the skin of the thigh?

Answer 35

lateral femoral cutaneous

Question 36

What nerve supplies the cremaster muscle?

Answer 36

genitofemoral

Question 37

What divides the false and true pelvis?

Answer 37

arcuate line aka pelvic inlet

Question 38

What is the anterior deficit in the pelvic floor?

Answer 38

perineum

Question 39

perineal body

Answer 39

behind scrotum/vagina and infront of anus (whole are is perineum itself)

Question 40

The acetabular fossa is formed by what 3 bones?

Answer 40

ischium ileum and pubic bones

Question 41

What is the difference in the shape of the infrapubic angle for males and females?

Answer 41

males: more V shaped females: more U shaped

Question 42

Where does the growth plate sit in relation to the coxal bone?

Answer 42

at the top of the wing (ala) of the ilium

Question 43

What is significant about the growth plate above the ilium?

Answer 43

it is the last to close at 19 y/o

Question 44

What come out of the foramena of the sacrum?

Answer 44

VPR and DPR

Question 45

sacral promontory

Answer 45

S1; can feel when doing a pelvic exam

Question 46

What muscles make up the levator ani?

Answer 46

pubococcygeus/puborectalis | ileococcygeus

Question 47

What are the 3 muscles that form the pelvis diaphragm?

Answer 47

pubococcygeus/puborectalis ileococcygeus ischiococcygues aka coccygeus

Question 48

Where is the pelvic diaphragm suspended from?

Answer 48

the tendonous arch of obturator internus

Question 49

What innervates the pelvic diaphragm?

Answer 49

(somatic) pudendal n. S2-4 (keeps pelvis off the floor)

Question 50

There is a pelvic defect anteriorly for what?

Answer 50

urethra and vagina

Question 51

Almost everything leaving the pelvis does so via what?

Answer 51

greater sciatic foramen

Question 52

What ligament forms the greater sciatic foramen?

Answer 52

sacrospinous ligament

Question 53

What does the obbturator n. innervate?

Answer 53

adductors of the thigh

Question 54

What muscle runs w/ the greater sciatic foramen?

Answer 54

pyriformis muscles

Question 55

What is unique about the way the pundendal n., internal pudendal a and v travel?

Answer 55

they leave the pelvis through greater sciatic foramen then turn and go back through the lesser sciatic foramen

Question 56

What is the control of the internal and external anal sphincters?

Answer 56

external: somatic internal: autonomic

Question 57

What vein drains the rectal area?

Answer 57

superior rectal v. - part of inferior mesenteric vein

Question 58

What is the anastomses around the rectum?

Answer 58

superior rectal vein, middle rectal and inferior rectal

Question 59

internal vs external hemorrhoids

Answer 59

internal: autonomic external: somatic unless you can see that the blood is coming driectly from an external hemorrhoid, refer to GI

Question 60

What are the rectal arteries branches of?

Answer 60

superior: inf. mes middle: internal iliac inferior: pudendal

Question 61

What give parasympathetic innervation to the rectum?

Answer 61

pelvic splanchnics - defecation

Question 62

What gives somatic innervation to skin and external sphincter (below pectinate line)

Answer 62

inferior rectal branches of the pudendal

Question 63

What gives visceral innervation to the internal sphincter and mucous membranes?

Answer 63

hypogastric plexus

Question 64

broad ligament

Answer 64

parietal peritoneum reflection over the pelvic organs in the female

Question 65

top of the uterus

Answer 65

fundus

Question 66

Rectouterine pouch of Douglas

Answer 66

b/w the uterus and rectum - if there is fluid in peritoneal cavity (like from ovarian cancer) it will collect in this pouch. Can sample fluid by passing need through fornix of vagina into pouch

Question 67

Where do secretions tend to collect in the female pelvis?

Answer 67

posterior fornix

Question 68

What anchors the ovary to the back wall?

Answer 68

suspensory ligament

Question 69

What is contained w/i the suspensory ligament?

Answer 69

ovarian a. and v.

Question 70

Where does most ferilization occur?

Answer 70

ampulla

Question 71

What are the variations of the external os?

Answer 71

mulaiparous (had kids) is flattened oval | nulliparous (no kids) round hole

Question 72

Round ligament

Answer 72

attaches to labia majora; stretches w/ pregnancy and can get lateral pain

Question 73

What is the relationship between the ureter and uterine a.?

Answer 73

ureter goes under the uterine a. ureter is often clipped when removing uterus - need to watch for peristalsis before cutting

Question 74

cardinal ligament

Answer 74

connects cervix laterally to pelvic wall; supports uterus; if lax can get prolapse

Question 75

What is the route of the ductus deferens?

Answer 75

through the superficial and deep ring, wraps around bladder, goes under ureter where it picks up duct from seminal vesicle to form ejaculatory duct

Question 76

Any injury above the pubic bone in a male runs risk of what?

Answer 76

penetrating bladder, especially if it's full

Question 77

What holds the prostate to the pubic bone?

Answer 77

puboprostatic ligament

Question 78

unable to urinate and blood at tip of penis could indicate what?

Answer 78

ruptured urethra

Question 79

What is the relationship b/w the ductus deferens and seminal vesicles?

Answer 79

ureter goes under the ductus deferens

Question 80

Why are the renal a. and testicular a. close together?

Answer 80

b/c the testicles develop from mesoderm near the kidney and move anterior over the ureters

Question 81

What can happen in males w/ a deceleration injury?

Answer 81

rip the urethra at the prostate - never try to cath someone w/ blood coming ut of penis

Question 82

prostatic hyperplasia

Answer 82

overgrown prostate; can obstruct prostatic urethra and get problems w/ hesitancy of urination and decreaesed force of stream

Question 83

What arteries go out the superior sciatic foramen to supply the gluteal region?

Answer 83

sup and inf gluteals

Question 84

How does the superior gluteal a. travel?

Answer 84

it passes above the pyriformis and then out the greater sciatic foramen

Question 85

Where do the inferior gluteal and internal pudendal travel?

Answer 85

below the pyriformis and exit the greater sciatic foramen

Question 86

What does the obturator a. pass through?

Answer 86

obturator foramen

Question 87

Where do pelvic organs drain lymphatics?

Answer 87

internal iliac nodes

Question 88

Where do gonads drain lymphatics?

Answer 88

toward channels along the aorta