Flashcards in Lecture 19 DA Deck (47)
Name 4 paired viscera in the pelvis for males.
Name 4 unpaired viscera in the pelvis for males.
Are paired viscera at the midline?
Some are, others are non-midline.
Where do paired viscera refer pain to?
The same side of the body.
Where do unpaired viscera refer pain to?
To the midline, as they have nerve supply from both sides of the spinal cord.
What are the layers of the ureters?
-Serosa, most superficial
-Muscularis, circular and longitudinal
Does continence depend on gravity? How is this clinically relevant?
No, one can pee upside down. If a surgeon is unsure of a structure, a peristaltic wave can be felt.
How do the ureters pierce the bladder?
Posterolaterally, entering obliquely.
What is the ureter called when within the bladder?
Intramural ureter, a functional sphincter.
Where does the ureter enter the bladder?
Through ureteral orifices.
What happens when urine fills the bladder?
Bladder walls stretch, and close the intramural ureter, which is a functional sphincter.
Where does the ureter get its blood supply?
From every vessel it comes close to.
What crosses the ureter in males and females?
In males, it is crossed only by the vas deferense, just as it enters the bladder.
In females, uterine arteries cross over it at the pelvic brim, also just as it enters the bladder.
Aside from that, it is the most anterior structure in both males and females.
What is a consequence of a high calcium diet on the urinary system?
High calcium can result in uretery calculi - kidney stones.
They can lodge at narrowings of the ureter:
Proximal to intramural ureter
Why are uretery calculi (kidney stones) so painful?
When they lodge at a narrowing, they cause the muscle to spasm, causing referred pain to overlying dermatome, the loin area, up to the scrotum in males, and vulva in females.
Are pain fibres involved in uretery calculi symathetic or parasympathetic?
They are sympathetic, referring to T11-L1 dermatomes.
Why can't opioids be used as an analgesic in uretery calculi pain?
It stimulates further ureter muscle spasm, worsening the pain.
What are two anatomical variations in the ureter?
1% - bifed ureter, that terminate as one before reaching the bladder, endangered in surgery.
0.2% - pelvic horseshoe kidney, kidneys are merged inferiorly.
How does pelvic horseshoe kidney occur?
As kidneys develop in the pelvic cavity, they start at the midline, but as the body elongates, the can't get to the appropriate spot and the horseshoe structure stays within the pelvis.
Is there any pathology associated with a pelvic horseshoe kidney?
No, but it can be mistaken for another structure.
Where does the bladder lie in women? Why is this significant?
Lies anteriorly, resting in part on the vagina. Vaginal prolapse means less support for the bladder,
Does the bladder have a peritomeum?
Yes, it does on its superior surface, which descends berween the rectum and uterus, and between the bladder and uterus. As the bladder fills, the perotineal coat is pushed upwards.
What happens to the bladder neck? What supports it?
It becomes continuous with the urethra. It needs most support from the vagina, as well as some from the levator ani.
What happens to continence of urine during childbirth and why?
When the levator ani is stretched, it leads to urine incontinence.
What is the urachus? What does it become?
At embryonic stages, the apex of the bladder is connected to the umbilicus via a duct, called urachus.
What becomes the median umbilical ligament?
Before it degenerates after birth, the urachus is called the median umbilical ligament, and connects the bladder's apex to the umbilicus. It is patent/open, and urine passes from the bladder out the umbilicus.
How is the urachus clinically signifcant?
It can remain patent in adulthood, urine will leak out of the umbilicus.
Is the bladder abdominal or pelvic?
It is abdominal in children as their pelvis is too small. They can pee longer distances due to their abdominal muscles. It sinks after 6 years.
What are the layers of the bladder?
It has a mucosa lining it, and its muscle layer is called the detrusor urinae muscle.