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Pelvic Viscera

The Pelvic Viscera

* Where does the rectum begin? Where does it end? Begins at rectosigmoid junction in front of third sacral vertebra as a continuation of the sigmoid colon; passes down along curve of sacrum and coccyx; ends at anorectal junction in front of coccyx tip as rectum pierces pelvic diaphragm
What are the (4) major changes of the rectum as it passes through the rectosigmoid junction? Bowel loses mesentery, becomes closely applied to the curvature of the sacrum; taenia coli broaden out and form a complete outer longitudunal layer of smooth muscle; haustra dissapears; epiploic appendages dissapear
The lower part of the rectum is dilated, forming the _____ _____. Rectal ampulla
The blood supply to the rectum is supplied by the ______. Superior rectal artery
What do the middle and inferior rectal arteries supply? Middle: contribute to lower part of rectum; Inferior: lower half of anal canal rather than rectum
Describe the venous drainage of the rectum Follows the same blood supply as the rectum
* * Describe the course of the ureters, pointing out major landmarks and differences between males and females On surface of the psoas major; cross into pelvis over bifurcation of the common iliac a.'s; fem: crossed by uterine a.; male: crossed by ductus deferens; enters bladder at superolateral angle, courses obliquely through the wall for ~3/4in, into bladder
* Where are the major possible constrictions points of the ureter? Junction of ureter and renal pelvis; where ureter crosses over the pelvic brim; passage through the urinary bladder
Describe the innervation of the ureters Visceral afferents: pain relay in segments T11-L2; pain referred over wide area including parts of abdominal wall above illiac crests, suprapubic region, genitals, medial aspects of the thigh and leg
Where does the urinary bladder sit? Behind the posterior of the pubis (superated by retropubic space); rises into abdomen as it fills; lifts peritoneum off inner surface of anterior abdominal wall; males: neck of bladder rests on prostate gland
Describe the shape of the empty bladder in an adult Superior: triangle covered in peritoneum. Posterior (base): triangle. Apex: points anteriorly lying behind upper margin of symphisis pubis. Superolateral angles joined by ureters. Inferior (neck): gives rise to urethra
What ligaments hold up the neck of the bladder? Males: puboprostatic ligaments. Females: pubovesical ligaments
What are rugae? Mucosal folds found inside bladder
What is the trigone? Internal surface of base of the bladder; lacks rugae, mucosa firmly adherent to muscular coat. Borders: orifices of ureters and urethra
What is the detrusser muscle? Three layers of interlacing smooth muscle found inside of the bladder
What is the sphincter vesicae? Thickening of circular layer of smooth muscle at neck of the bladder (inside)
Describe the blood supply to the bladder Females: superior vesical and vaginal branches; Males: superior and inferior vesical arteries
Describe the innervation to the urinary bladder (parasympathetic, sympathetic, and pain fibers) Para: pelvic splanchnics S2-S4, motor to detrussor muscle, inhibits sphincter vesicae. Sympa: T11-L2 (opposite effects). Pain fibers: follow pelvic splanchnics; pain from superior surface follows sympathetic fibers back to T11-L2 levels of spinal cord
What are the vaginal fornices? Vaginal recesses at the upper end formed around the vaginal portion of the cervix; because of angle, posterior wall is longer than anterior wall and posterior fornix is deeper than anterior and lateral fornices
* Describe the four arteries that supply the vagina Uterine arteries, vaginal arteries, internal pudental arteries, and middle rectal arteries
Describe the innervation of the vagina Superior 3/4: visceral pain follows pelvic splanchnic nerves to S2-S4 levels. Inferior 1/4: somatic pain afferents via pudental nerve
Describe the relations of the vagina to structures around it (anterior vs. posterior) Anterior: bladder above, urethra below. Posterior: uterorectal pouch of Douglas in upper 1/3; rectal ampulla in middle 1/3, perineal body in lower 1/3 (separates from anal canal)
Describe the general features of the following uterine structures: fundus, body, cervix Fundus: above entrance of uterine tubes. Body: beneath entrance of uterine tubes. Cervix: narrow inferior portion
* The cervical canal communicates with the body through the _____ __ and with the vagina with the through the ____ __. Internal os; external os
What demarcates the supravaginal and intravaginal cervix? The cervix potrudes through the uppermost anterior wall of the vagina, splitting it into two parts
* The lower portion of the body of the uterus adjoining the supravaginal segment of the cervix is called the _____ of the _____. Isthmus of the uterus (lower uterine segment)
When the longitudinal axis of the uterus is bent forward approximately 90 degrees relative to the vagina, the uterus is said to be in _____ anteversion
When the body of the uterus is bent forward at the junction of the internal Os and the cervical canal, it is said to be in _____. Anteflexion
What factors are responsible for normal orientation of the uterus? Anteversion: pull exerted by the uterosacral ligaments. Anteflexion: intrinsic to the fibromuscular walls of the body and cervix
Where is the uterine tube located? Located on either side of uterus immediately below the fundus in the free edge of the broad ligament
Where are the following segments of the uterine tube located? Infundibulum (and fimbriae and ovarian fimbria), ampulla, isthmus, intramural part (1) funnel shaped lateral end, fingerlike processes of the infundibulum, attached to ovary. (2) widest part of tube and usual site of fertilizaation. (3) narrowest part of tube closests to uterine wall (4) segment piercing the uterine wall
In pelvic inflammatory disease, pathogenic organisms may enter body, ascend vagina, cervix, uterus, and uterine tubes. ______ may follow with leakage of pus into the _____ cavity, causing pelvic peritonitis Salpingitis, peritoneal
What is an ectopic pregnancy? Refers to the implantation and growth of a fertilized ovum outside of the uterine cavity; commonly in uterine tube (quickly destroys wall of tube); followed by effusion of blood which pours into uterovesical pouch or uterorectal pouch of Douglas.
What are the three primary ligaments of the Uterus? Broad ligament, derivatives of the gubernaculum, and the ligaments formed by the pelvic fascia
The broad ligament is composed of a two-layer fold of what layer? Peritoneum
Where does the broad ligament sit? Extends from the lateral margins of the uterus to the lateral pelvic walls
The ovary is attached to the posterior layer of the broad ligament by the _____. Mesovarium
The part of the broad ligament forming the mesentery of the uterine tube is called the _____. Mesoalpnix
The major part of the broad ligament below the mesovarium and the mesoalpnix is the ______. Mesometrium
The lateral-most part of the broad ligament which encloses the ovarian vessels, nerves, and lymphatics is called the _____ _____ of the ovary. Suspensory ligament
What structures are enclosed by the broad ligaments? Uterine tubes, ovarian ligaments, round ligaments
What two ligaments are derived from the gubernaculum? The ovarian ligament and the round ligament of the uterus
Where is the ovarian ligament? Runs in the posterior lamina of the broad ligament from the uterine pole of the ovary to the uterus just below the uterotubal junction
Where is the round ligament of the uterus? Runs in the anterior lamina of the broad ligament from a point just below the uterotubal junction to the labia majora via the inguinal canal
What ligaments are formed by the pelvic fascia? The sacrouterine ligaments (cervix and upper vagina to sacrum), the lateral cervical ligaments (cardinal, mackenrodt's), and the pubovesical ligaments (connect cervix to pubic bones)
* What are the chief supports of the uterus? Levator ani muscles, perineal body, transverse cervical ligaments, sacrotuterine ligaments (sacrovertical ligaments)
* * Describe the blood supply to the uterus Primarily from uterine artery: passes medially within CARDINAL LIGAMENT below base of broad ligament. Crosses URETER near lateral fornix (water runs under bridge); divides on lateral side of cervix into large sup. branch and smaller vaginal branch
At the lateral side of the cervix, the uterine artery divides into a large superior branch that supplies the ____ and the ____ of the uterus; a smaller vaginal branch supplies _____ and ____ and anastomoses with the _____ artery. body and fundu so futerus; cervix and vagina; vaginal artery
The superior branch ends by dividing into ____ and ___ branches which anastomose with the ____ and ____ branches of the ovarian artery within the boundaries of the _____ ligament. ovarian and tubal; ovarian and tubal; broad ligament
Describe the nerve supply for the uterus: body of uterus, cervix and upper vagina, lower vagina Body: follow sympathetics and enter cord at T11,T12. Cervix and upper vagina: follow parasympathetics and enter cord at S2-S4. Lower vagina: receives somatic innervation through pudental nerve
What is uterine prolapse? Refers to downward displacement of uterus. May be caused by weakening/damaging of the levator ani, perineal body, or ligaments supporting uterus. Most commonly occurs during menopause (pelvic fascias atrophy); cervix may descend length of vaginal canal
How is the ovary attached to the broad ligament? Mesovarium
The ovary is connected to the uterus by the _____ ligament. Ovarian ligament (upper part of the gubernaculum)
Lateral most part of the broad ligament containing ovarian vessels, nerves, and lymphatics Suspensory ligament
What is the ovarian fossa? Where the ovary is located in young mulliparous woman. Anteriorly bordered by external iliac arter, posteriorly bordered by the internal iliac vessels and ureter
Where does the obturator nerve pass with respect to the ovarian fossa? Passes along ovarian fossa between the pelvic wall and the ovary
What innervates the ovaries? Sympathetic: T10-T11; parasympathetic: ???; Visceral pain fibers: follow sympathetic fibers back to T10-T11 levels of the spinal cord
Where does pain in the ovaries refer? Periumbilical; may also cause pain in right or left iliac fossa due to inflammation; may be perceived on the medial side of the thigh due to stimulation of the obturator nerve
Where do the ovaries drain? Para-aortic lumbar nodes
What are the three main sections of the male urethra? Prostatic portion, membranous, and penile
What is the colliculus seminalis? the expanded center of the urethral cres
What is prostatic uricle? center of the colliculus seminalis
Where are the ejaculatory ducts? In the prostatic portion; open into the colliculus on either side of the prostatic utricle
What are the prostatic sinues? Grooves along either side of the urethral crests receiving the openings of the 15-20 prostatic ducts
What is the membranous urethra? Pierces the urogenital diaphragm; UG diaphragm contains the bulbourethral glands
What is the final part of the urethra called? What structures is it associated with? passes through the bulb, corpus spongiousum, and glans penis; receives the ducts of the bulbourethral glands in the bulb; glans of littre (mucous secretion)
What two portions of the male urethra is the female urethra similar to? The male prostatic and the membranous portions
Describe the course of the ductus deferens Emerges from low end of the ductus epididymis; passes through inguinal canal into abdomen; descends into pelvis and crosses ureter to reach posterior surface of the bladder (expands to form AMPULLA); joins duct of seminal vesicle (forms EJACULATORY DUCT)
Describe the blood supply of the ductus deferens Artery of the ductus deferens; inferior vesical and middle rectal arteries
Describe the general structure of the seminal vesicles: shape, where they are relative to bladder; relation to prostate gland paired, highly coiled tubes on the posterior surface of bladder; separated by ampullae of ductus deferens; ejaculatory ducts pierce prostate gland
What is the blood supply for the seminal vesicles? Inferior vesical and middle rectal arteries
Describe the structure of the prostate gland (i.e. apex, base, and lobe positions) Apex: on urogenital diaphragm; Base: on neck of urinary bladder; Five lobes: anterior, median, posterior, and two lateral lobes
What is the blood supply for the prostate gland? Inferior vesical and middle rectal arteries
What is the usual site for benign prostatic hypertrophy? Median lobe
What is the usual site for carcinoma of the prostate? Posterior lobe
Draw an image showing the following structures relative to each other: bladder, median lobe, posterior lobe, urethra, anterior lobe, ejaculatory duct, anal canal see page 141
Describe the path of the peritoneum in males and females See pg. 141 and p 142
Created by: karkis77



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