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Anatomy Exam 2 > Pelvis II > Flashcards

Pelvis II Flashcards

1
Q

The peritoneum drapes the pelvic organs, what does this do?

A

creates space where peritoneal fluid can accumulate

In females: vesicouterine and rectouterine pouches

In males: rectovesical pouch

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2
Q

What are the pelvic organs common to both sexes?

A

the ureters and urinary bladder which are both primarily retroperitoneal

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3
Q

Where do the ureters course?

A

inferior to the uterine artery in females and inferior to the ductus deferens in males (water under the bridge)

then pass obliquely through the posterosuperior bladder wall

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4
Q

Where is the retropubic space?

A

posterior to the pubis and anterior to the bladder

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5
Q

What kind of muscle makes up the bladder wall?

A

detrusor muscle, smooth muscle, highly distendable

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6
Q

What kind of innervation does the detrusor muscle receive?

A

parasympathetic innervation- pelvic splanchnic nerves

stimulates contraction of the detrusor muscles (promoting micturition)

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7
Q

What is rugae?

A

mucosal folds, prominent when bladder is empty

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8
Q

Internal urethral sphincter

A

smooth muscle sphincter at the neck of the bladder that surrounds the opening of the urethra in males

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9
Q

What kind of innervation does the internal urethral sphincter receive?

A

sympathetic innervation via lumbar sacral nerves

prevents micturition
prevents sperm from entering the bladder during ejaculation

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10
Q

What is the trigone?

A

smooth triangle on the posterior wall of the bladder, very sensitive to stretch (visceral sensory innervation stimulates the urge to void)

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11
Q

In males where is the bladder?

A

superior to the prostate, the prostate surrounds the opening of the urethra in males

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12
Q

In babies and children (until puberty) where is the bladder?

A

the bladder (even when empty) extends superior to pubis, susceptible to injury

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13
Q

In an adult, a distended bladder extends superior to the pubis, as a result…

A

a suprapubic incision can be made to access the bladder without transversing the peritoneum and entering the peritoneal cavity

highly susceptive to injury (MVCs, falls, heavy objects)

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14
Q

What are the female pelvic organs?

A

uterus, vagina, ovaries, uterine (fallopian) tubes, broad ligament

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15
Q

Where is the uterus located?

A

mostly intraperitoneal (suspended by broad ligament)

located between the bladder and rectum

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16
Q

What is the myometrium?

A

smooth muscle of the uterus, can dramatically stretch especially during pregnancy

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17
Q

What is the endometrium?

A

the internal lining of the uterus, made up of granular mucosa

site of implantation, shed each month

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18
Q

Body of the uterus

A

superior 2/3rds of the uterus

fundus is the rounded superior portion of the body

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19
Q

What is the cervix?

A

the cylindrical 1/3 of the uterus. Has internal os (opens superiorly) and external os (opens inferiorly, site of pap smear)

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20
Q

Vagina

A

located between bladder and rectum, continuous with cervix at the external os. Courses superiorly and posteriorly

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21
Q

What are vaginal fornices?

A

the cervix projects into the vagina at its superior end creating these recesses anteriorly, posteriorly and laterally

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22
Q

What is special about the posterior fornix?

A

it is the deepest of all the fornices, related to the rectouterine pouch and rectum posteriorly

an incision can be made through the posterior fornix to examine the peritoneal cavity

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23
Q

Where do the ovaries originate at? Where do they descend to?

A

the posterior abdominal wall, attached to the gubernaculum

into the pelvis and become attached to the posterior aspect of the broad ligaments

24
Q

ovaries are…

A

intraperitoneal

25
Q

Where are the ovarian vessels, nerves and lymphatics?

A

enclosed within the suspensory ligament of the ovary which is an extension of the broad ligament

26
Q

Where are oocytes expelled to?

A

the peritoneal cavity, towards the abdominal orifices of the uterine tubes (during ovulation)

27
Q

Uterine (fallopian) tubes

A

intraperitoneal

open into the peritoneal cavity, fimbriae at opening

lie in the superior edge of the broad ligament

28
Q

What is the most common site for ectopic pregnancies?

A

uterine tubes

29
Q

Why is pelvic inflammatory disease more common in females?

A

because the peritoneal cavity is open in the female and closed in the male. The vagina, uterus and uterine tubes provide a pathway into the peritoneal cavity

30
Q

What is the broad ligament?

A

double layer of peritoneum (mesentery) holds uterus to lateral walls and floor of pelvis

encloses: uterine tubes, ovaries, suspensory ligament of the ovary and remnants of the gubernaculum

31
Q

What are the remnants of the gubernaculum?

A

ovarian ligament (between ovary and uterus)

round ligament of the uterus (between uterus and labium majus)

32
Q

What are the male pelvic organs?

A

testes, epididymis, vas deferens, seminal vesicles, ejaculatory ducts, prostate

33
Q

Where do the testes originate? Where do they descend to?

A

posterior abdominal wall attached to the gubernaculum

descend into the inguinal region, pass through the deep inguinal ring and the inguinal canal and exit through the superficial ring to enter the scrotum

34
Q

What is the tunica vaginalis

A

some of the parietal peritoneum that is drawn into the inguinal canal and scrotum

35
Q

What is the tough fibrous coat around the testes?

A

tunica albuginea

36
Q

What is a hydrocele?

A

an abnormal accumulation of fluid within the cavity of the tunica vaginalis

37
Q

Seminiferous tubules?

A

contained within the testes, where spermatozoa mature

38
Q

Pathway of sperm

A

seminiferous tubules > rete testes > efferent ductules > epididymis

39
Q

Epididymis

A

highly coiled tube located on the posterior surface of the testis, connects the testis to the ductus deferens

40
Q

Ductus deferens

A

muscular tube which ascends within the spermatic cord through the superficial ring and inguinal canal and into the abd via the deep inguinal ring. Courses superior to the ureter

enlarges to form an ampulla when it reaches the posterior aspect of the bladder. The ampulla of each ductus deferens joins the duct of the seminal vesicle

41
Q

How is a vasectomy performed?

A

by making an incision in the superior aspect of the scrotum to expose and ligate the ductus deferens

42
Q

Seminal vesicles

A

thin walled tubes that are coiled to form a mass that lies between the posterior wall of the bladder and the rectum

secrete fluid that mixes with spermatozoa

ducts of the seminal vesicles join the ampullae of the ductus deferens to from the ejaculatory ducts

43
Q

What does the ejaculatory duct open into?

A

the prostatic urethra

44
Q

Prostate

A

gland surrounds the prostatic urethra, secretes fluid into the prostatic urethra via numerous ducts

base (superior) surrounds neck of the bladder, apex (superior)

45
Q

What are the lobes of the prostate?

A

Anterior lobe (anterior to prostatic urethra)

2 lateral lobes

median lobe (posterior to the prostatic urethra and superior to the ejaculatory ducts)

posterior lobe (posterior to the prostatic urethra and inferior to the ejaculatory ducts)

46
Q

What lobe of the prostate is commonly involved in benign hypertrophy of the prostate?

A

the median lobe. When it is enlarged, it stretched the internal urethra sphincter (causing urine leakage), puts pressure on the trigone (urge to void, especially at night) and can obstruct the prostatic urethra making it difficult to void

47
Q

What lobe of the prostate is the most common site of prostatic carcinoma?

A

posterior lobe

48
Q

What can you palpate on a male rectal exam?

A

anterior wall of rectum- posterior lobe of prostate and seminal vesicles

49
Q

What can you palpate on a female rectal exam?

A

anterior wall of rectum- vagina

50
Q

Characteristics of individuals with Complete Androgen Insensitivity 46XY

A

phenotypically female,

incompletely descended testes

no uterus, cervix or fallopian tubes

51
Q

Trace the parasympathetic innervation of pelvic organs

A

Preganglionic cell bodies: intermediate gray matter of S2-S4 spinal cord

preganglionic fibers: ventral root > spinal nerve > ventral rami > pelvic splanchnic nerves

postganglionic cell bodies and fibers: walls of organs

52
Q

Trace the sympathetic innervation pathway of pelvic organs (except ovaries and testes)

A

Pre CB:lateral horn (of thoracolumbar spinal cord) >
Pre CF: ventral root>
spinal nerve>
ventral rami>
white ramus communicans>
sympathetic trunk>
lumbar and sacral splanchnic nerves>
Post CB: superior or inferior hypogastric ganglia
Post CF: follow arterial branches to target organ

53
Q

Trace the sympathetic innervation pathway of the ovaries and testes

A 
Pre CB: lateral horn of thoracolumbar spinal cord 
Pre CF: ventral root> 
spinal nerve> 
ventral rami> 
white ramus communicans> 
sympathetic trunk> 
thoracic splanchnic nerves> 
Post CB: superior mesenteric ganglion 
Post CF: follow the gonadal vessels to the target organ
54
Q

visceral sensory innervation

A

fibers follow the sympathetic or parasympathetic pathways back to the CNS but enter the dorsal root …route taken differs relative to the pelvic pain line (corresponding to the inferior limit of the peritoneum)

55
Q

What path do visceral sensory fibers follow for structures superior to the pelvic pain line?

A

sympathetic fibers back to the inferior thoracic and superior lumbar spinal cord levels

56
Q

What path do visceral sensory fibers follow for structures inferior to the pelvic pain line?

A

follow parasympathetic fibers (i.e. pelvic splanchnic nerves) back to the S2-S4 spinal cord

57
Q

For structures that lie in between the pelvic pain line, what path do visceral sensory fibers follow?

A

they follow both, those superior follow the sympathetic pathway and those inferior follow the parasympathetic pathway

Anatomy Exam 2 (10 decks)

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