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SFIV Test 3 > Pelvic Viscera I > Flashcards

Pelvic Viscera I Flashcards

1
Q

What is the urinary bladder?

A

Muscular, pyramidal shaped sac for urine storage

Apex attached to median umbilical ligament

Located in anterior pelvis, filling extends bladder superiorly into abdominal cavity

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2
Q

What is a suprapubic cystostomy?

A

Suprapubic catheterization to draw urine from bladder

Doesn’t enter peritoneal cavity

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3
Q

What are the muscles of the bladder?

A

Detrusor muscles - three layered smooth musccular coat, stimulated by parasympathetic fibers of pelvic splanchnic nerves, inhibits by sympathetic fibers from T12-L2

Internal urethral sphicter of Bladder - males only, stimulated by sympathetics, inhibited by parasympathetics

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4
Q

What is the trigone?

A

Smooth triangular area on inner surface of posterior wall of bladder

Upper corners mark openings of ureters

Lower corner marks inernal origice of urethra

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5
Q

What is micturition?

A

Excretion of urine

Result of PNS stimulation causing detrusor contraction

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6
Q

What is the innervation to the bladder?

A

Pelvic splanchnic nerves - detrusor and IUS

Afferents are supplied by S2-S4 via pelvic splanchnic nerves and T11-L2 (inferior thoracic and upper lumbar)

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7
Q

What is a neurogenic bladder?

A

Dilated, flaccid bladder due to spinal cord injury at S2-S4 (loss of PNS)

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8
Q

Where is referred pain from the bladder?

A

Tip of penis (S2-S4) or hypogastric region of anterior abdominal wall (L1)

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9
Q

What is the blood supply to the bladder?

A

Superior and inferior vesical arteries

Vesical venous plexus - surrounds neck of bladder, drain into inernal superior/inferior vesical veins

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10
Q

Where do the lymphatics from the bladder drain?

A

Internal Iliac nodes

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11
Q

What are key characteristics of the female urethra?

A

Anterior to vagina

External urethral sphincter under voluntary control by perineal branch of pudendal nerve

Bladder infections (cystitis) are common since it is only 1.5” long

Injury to vagina can involve urethra

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12
Q

What is the rectum?

A

Continuation of sigmoid colon arising at S3

No taenia coli, haustra, or appendices epiploicae

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13
Q

What structures lie posterior to the rectum?

A

Sacrum/Coccyx

Piriformis

Sympathetic trunk

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14
Q

What structures lie anterior to the rectum in males?

A

Posterior Bladder

Ductus deferens

Seminal Vesicles

Prostate

Rectovesical spetum lies between base of bladder and rectum

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15
Q

What structures lie anterior to the rectum in females?

A

Vagina and Cervix

Rectovaginal septum separates vagina from rectum, can limit spread of infection

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16
Q

What structures lie lateral to the rectum?

A

Ischial spine

Ischial tuberosity

Sacrotuberous ligament

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17
Q

What is the rectovesical pouch (male)?

A

Formed by the reflection of peritoneum from rectum to superior-posterior bladder

Lowest part of male peritoneal cavity

Peritoneal exudates (peritonitis) will drain into this pouch in sitting or supine positions

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18
Q

What is the rectouterin pouch (females)?

A

Formed by reflection of peritoneum from rectum to posterior vagina and uterus

Peritoneal exudates, acid from duodenal ulcer, or blood from rptured ectopic pregnancy willd rain here in siting or supine positions

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19
Q

What are the transverse rectal folds?

A

3 semicircular horizontal folds of rectal mucosa

Hard stool or proctoscope can tear folds; leads to infection of rectal wall

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20
Q

What is the blood supply to the rectum?

A

Superior rectal artery

Middle rectal arteries (2)

Inferior rectal arteries (2)

Anastomose with each other

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21
Q

Where do lymphatics from the rectum drain?

A

Inferior mesenteric nodes

22
Q

What is the innervation to the rectum?

A

PNS from pelvic splanchnic nerves fia inferior hypogastric plexus

SNS from superior and inferior hypogastric plexuses

23
Q

What is rectal prolaspe?

A

Abnormal descent of rectum through anal canal

Can occur in young children

24
Q

What is the anal canal?

A

Terminal part of large intestine

Two sphincters that surround canal

25
Q

What is the internal anal sphincter?

A

involuntary control

Thickening of smooth circular muscle of upper part of anal canal wall

PNS stimulation relaxes sphincter

26
Q

What is the external anal sphincter?

A

Voluntary control

Striated muscle surrounding lower part of canal

Deep/Superficial/and subcutaneous parts

Innervated by inferior rectal nerve - closes canal

27
Q

What is the anorectal junction?

A

Demarcation between the rectum above and the anal canal below

Location of puborectalis muscle sling

28
Q

What is the puborectalis?

A

Surrounds anorectal junction

Aids closure of anorectal junction by drawing posterior wall of anal canal anteriorly

29
Q

What are anal columns?

A

Characteristic vertical folds of mucous membrane in upper anal canal

Location of portal-caval anastomoses

30
Q

What are the anal valves?

A

Semilunar epithelial folds joining inferior ends of anal columns

Indicate the pectinate line

31
Q

What are the anal sinuses?

A

Recesses superior to anal valve between anal columns

32
Q

What is the innervation to the upper half of anal canal?

A

Stretch receptors and other visceral afferents to hypogastric plexus of autonomic system

No somatic sensory

33
Q

What is the blood supply to the upper interior half of anal canal?

A

Superior rectal artery and vein

34
Q

Where do the lymphatics from the upper half of the anal canal drain?

A

Inferior mesenteric nodes

35
Q

What is the innervation to the lower half of the anal canal?

A

Somatic sensory from inferior rectal nerve

Pain/touch/temperature

Very sensitive

36
Q

What is the blood supply to the lower half of the anal canal?

A

Inferior rectal artery and veins

37
Q

Where do the lymphatics from the lower half of the anal canal drain?

A

medial nodes of the Superficial inguinal nodes

38
Q

What are internal hemorrhoids?

A

Varicosities of tributaries of superior rectal veins in anal columns

Not as painful as external hemorrhoids

39
Q

What are external hemorrhoids?

A

Varicosities of tributaries of inferior rectal veins

Very painful

40
Q

What are the clinical complications of the anal valves?

A

Can be torn by hard stools in constipation

Results in infection and fistula in wall into ischiorectal fossa

Results in perianal abscess

41
Q

How does the ductus deferens enter the pelvis?

A

Crosses over external iliac artery and ureter

Ejaculatory duct is formed by the terminal part of the ductus deferens joining the duct of the seminal vesicl

42
Q

What is the seminal vesicle?

A

Lobular sac on posterior surface of bladder

Secretes thick fluid that contains nutritive substances for sperm

43
Q

What is the prostate gland?

A

Accessory reproductive gland that produces alkaline secretion which is added to semen to neutralize acidity of vagina

44
Q

What is the clinical significance of the median lobe of the prostate?

A

Common site for benign prostatic hyperplasia

Bulges into bladder at internal urethral orifice, causes nocturia

45
Q

What is the clinical significance of the right and left lateral lobes of the prostate gland?

A

May become enlarged in BPH and compress urethra

46
Q

What is the clinical significance of the posterior lobe of the prostate?

A

Common site for carcinoma

47
Q

What is the vascular supply to the prostate?

A

Branche sof inferior vesical artery

Prostatic venous plexus - valveless

*Prostatic carcinoma can spread extensively via venous communications

48
Q

Where do the lymphatics from the prostate drain?

A

Internal Iliac nodes

49
Q

What is the prostatic urethra?

A

Widest and most dilatable part of urethra

Contains urethral crest, prostatic sinus, seminal colliculus

50
Q

What is Iatrogenically induced sterility?

A

Disruption of SNS to ductus deferens, prostate and seminal vesicles results in sterility due to no emission

Occurs as a result of pelvic surgery

SFIV Test 3 (14 decks)

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