Common Pelvic Viscera, Innervation, And Vasculature

Question 1

What are the peritoneal spaces/fossa of the female?

Answer 1

• supravesical fossa
• paravesical fossa
• vesicouterine pouch
• rectouterine pouch
• pararectal fossa

Question 2

What allows the bladder to expand in the abdominal wall?

Answer 2

-peritoneum from the anterior abdominal wall reflecting loosely over the bladder

Question 3

What are the peritoneal spaces/fossa in the male?

Answer 3

• supravesical fossa
• paravesical fossa
• ureteric fold
• rectovesical pouch
• pararectal fossa

Question 4

What are the two layers of the pelvic fascia?

Answer 4

• parietal: transversalis fascia, membranous

- visceral: loose CT, compressible

Question 5

What is the prevesical space/retropubic?

Answer 5

• between pubic symphysis and bladder
• potential space
• filled with endo pelvic fat and CT

Question 6

What is the retrorectal/presacral space?

Answer 6

• between sacrum and rectum

- potential space

Question 7

What is the endopelvic fascia do?

Answer 7

-condenses to form ligaments

Question 8

What ligaments are found in the body cavity?

Answer 8

• pubovesical ligaments
• transverse cervical ligaments
• sacrouterine ligaments
• pubovesical ligaments (female) or puboprostatic ligaments (male) -> condensations of visceral endopelvic fascia

Question 9

What is the rectovesical septum?

Answer 9

• separates the rectum from the prostate and the seminal vesicles
• condensed endopelvic fascia

Question 10

What ischioanal abcesses?

Answer 10

-infections from within the anal canal, pelvic infections, etc can spread into the ischioanal fossa. Infection can spread through the superficial and deep postanal spaces to the other side

Question 11

Describe the ureters.

Answer 11

• retroperitoneal
• muscular tubes
• peristalsis pushes urine toward the bladder
• several sets of blood vessels and nerves
• 3 places where urinary calcului catch
• cross the pelvic brim where the common iliacs bifurcate
• enter the bladder wall obliquely

Question 12

What is the relationship between the ureter and the uterine artery?

Answer 12

-ureter runs medially to the uterine artery and then is crossed by it

Question 13

Relationship between the ureter and ductus deferens in the male.

Answer 13

-ductus deferens crosses anterior to the ureter, ureter goes inferior to the ductus to enter the bladder

Question 14

Where is the urinary bladder?

Answer 14

-located in the retropubic space inferior to the peritoneum and posterior to the pubic symphysis

Question 15

What the structures of the bladder?

Answer 15

• apex
• base
• body
• neck

Question 16

Describe the bladder.

Answer 16

• walls of the bladder are primarily detrusor muscles
• inside of the bladder is lined with transitional epithelium that form rugae when empty
• the trig one is an internal smooth thickened area defined by the openings of the 2 ureters and the urethra

Question 17

What vessels supply the superior bladder?

Answer 17

-superior vesical a from the internal iliac

Question 18

What vessels supply the inferior/posterior bladder?

Answer 18

• inferior vesical a (male)

- vaginal or inferior rectal a (female)

Question 19

What is the innervation of the bladder and inferior ureters???

Answer 19

• T11-L2
• superior. Hypogastric plexus
• inferior hypogastric plexus
• vesical n plexus
• parasympathetics are motor to the detrusor m

Question 20

What are the four parts of the male urethra?

Answer 20

1. Intramural part
2. Prostatic urethra
3. Membranous urethra
4. Spongy urethra

Question 21

Name the 4 male features of the urethra.

Answer 21

• urethral crest
• urethral sinus
• seminal colliculus
• prostatic utricle

Question 22

Describe the female urethra.

Answer 22

• begins at the internal urethral orifice of the bladder
• no internal urethral sphincter
• passes through the pelvic diaphragm, external urethral sphincter and perineal membrane

Question 23

Where is the rectum?

Answer 23

-between sigmoid colon and anal canal

Question 24

How many rectal folds are there?

Answer 24

3 (superior, intermediate, inferior)

Question 25

What is the rectal ampulla?

Answer 25

- dilated terminal part of rectum - superior to ano-rectal junction - a line joining the tops of the anal columns

Question 26

What does the puborectalis part of the levator ani form?

Answer 26

-a sling at the anorectal junction and forms the anorectal angle

Question 27

What is the anorectal line?

Answer 27

-a line joining the tops of the rectal columns

Question 28

What is the pectinate line?

Answer 28

-a line joining the inferior ends of the anal valves

Question 29

What is superior to the pectinate line?

Answer 29

- superior rectal artery - internal venous plexus drains superiorly - lymphatics drain to internal iliac nodes - nerves are visceral - pain fibers travel with parasympathetics to S2-3

Question 30

What is inferior to the pectinate line?

Answer 30

- inferior rectal artery - internal venous plexus drains into inferior rectal veins - lymphatics drain to superficial inguinal lymph nodes - nerves are somatic so canal is sensitive to pain, touch, and temperature

Question 31

Pelvic arteries

Answer 31

-ovarian a +from aorta, cross anterior to ureter, over the bifurcation of the common iliac arteries, run in the suspensory ligament -median sacral a +from aorta, at bifurcation -iliolumbar a -> anastomoses with the deep circumflex iliac arteries -superior rectal a +from inferior mesenteric

Question 32

What are the veins of the pelvis?

Answer 32

- rectal plexus (internal and external) - vesical plexus - prostatic plexus (male) - uterine plexus (female) - vaginal plexus (female) ALL DRAIN INTO INTERNAL ILIAC VEINS

Question 33

Superior rectal veins empty into what?

Answer 33

Inferior mesenteric vein -> portal vein

Question 34

Middle rectal vein empties into what?

Answer 34

Internal iliac veins -> IVC

Question 35

Inferior rectal veins drain into what?

Answer 35

Internal pudental veins -> internal iliac

Question 36

What may causes hemorrhoids?

Answer 36

- may be related to cirrhosis or high bp - internal hemorrhoids are prolapsed rectal mucosa containing veins of the internal rectal plexus -> prolapse into anal canal and strangulate - external hemorrhoids are clots in veins of the external rectal venous plexus (fed by branches of the inferior rectal veins) -> usually caused by increased abdominal pressure if straining

Question 37

Where do the prostate and uterus drain into? What does the bladder drain into? What do perineal structures drain into? LYMPHATICS

Answer 37

- Prostate and uterus: internal iliac nodes - bladder: external iliac nodes - perineal: superficial inguinal nodes

Question 38

What are the branches of the pudental nerve in the male?

Answer 38

- perineal nerve - posterior scrotal nerves - dorsal nerve of penis

Question 39

Branches of pudental nerve in female.

Answer 39

- dorsal nerve of clitoris - deep perineal nerve - superficial perineal nerve - dorsal nerve of clitoris - perineal nerve

Question 40

What are the sympathetics of the pelvis?

Answer 40

- sacral plexus - on the pelvic surface of the piriformis muscle - lumbosacral trunk (L4-S5) - sacral splanchnics -> sympathetics - coccygeal plexus

Question 41

Autonomic so and afferents of the pelvis.

Answer 41

- superior hypogastric plexus - hypogastric nerves -inferior hypogastric plexus +made up of pelvic plexuses (rectal, prostatic, vesical, uterovaginal) -pelvic splanchnics +parasympathetics, S2-4

Question 42

What is the inferior part if the vagina innervated by?

Answer 42

-somatic branches from internal pudental n

Question 43

What is the middle and superior part so fat evaginations innervate by?

Answer 43

-visceral n +uterovaginal plexus +sympathetics from lumbar splanchnics +parasympathetics from S2-4

Question 44

What does the pelvic pain line follow?

Answer 44

- follows the peritoneum - pain from viscera above the line follows sympathetics - pain from viscera below the line follows parasympathetics

Question 45

How does the peritoneum lie?

Answer 45

- peritoneum lies over pelvic structures so they are not covered on all sides - peritoneum forms folds over some structures - peritoneum forms fossa or pouches