Pelvic Viscera I Flashcards
(50 cards)
What is the urinary bladder?
Muscular, pyramidal shaped sac for urine storage
Apex attached to median umbilical ligament
Located in anterior pelvis, filling extends bladder superiorly into abdominal cavity
What is a suprapubic cystostomy?
Suprapubic catheterization to draw urine from bladder
Doesn’t enter peritoneal cavity
What are the muscles of the bladder?
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
What is the trigone?
Smooth triangular area on inner surface of posterior wall of bladder
Upper corners mark openings of ureters
Lower corner marks inernal origice of urethra
What is micturition?
Excretion of urine
Result of PNS stimulation causing detrusor contraction
What is the innervation to the bladder?
Pelvic splanchnic nerves - detrusor and IUS
Afferents are supplied by S2-S4 via pelvic splanchnic nerves and T11-L2 (inferior thoracic and upper lumbar)
What is a neurogenic bladder?
Dilated, flaccid bladder due to spinal cord injury at S2-S4 (loss of PNS)
Where is referred pain from the bladder?
Tip of penis (S2-S4) or hypogastric region of anterior abdominal wall (L1)
What is the blood supply to the bladder?
Superior and inferior vesical arteries
Vesical venous plexus - surrounds neck of bladder, drain into inernal superior/inferior vesical veins
Where do the lymphatics from the bladder drain?
Internal Iliac nodes
What are key characteristics of the female urethra?
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
What is the rectum?
Continuation of sigmoid colon arising at S3
No taenia coli, haustra, or appendices epiploicae
What structures lie posterior to the rectum?
Sacrum/Coccyx
Piriformis
Sympathetic trunk
What structures lie anterior to the rectum in males?
Posterior Bladder
Ductus deferens
Seminal Vesicles
Prostate
Rectovesical spetum lies between base of bladder and rectum
What structures lie anterior to the rectum in females?
Vagina and Cervix
Rectovaginal septum separates vagina from rectum, can limit spread of infection
What structures lie lateral to the rectum?
Ischial spine
Ischial tuberosity
Sacrotuberous ligament
What is the rectovesical pouch (male)?
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
What is the rectouterin pouch (females)?
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
What are the transverse rectal folds?
3 semicircular horizontal folds of rectal mucosa
Hard stool or proctoscope can tear folds; leads to infection of rectal wall
What is the blood supply to the rectum?
Superior rectal artery
Middle rectal arteries (2)
Inferior rectal arteries (2)
Anastomose with each other
Where do lymphatics from the rectum drain?
Inferior mesenteric nodes
What is the innervation to the rectum?
PNS from pelvic splanchnic nerves fia inferior hypogastric plexus
SNS from superior and inferior hypogastric plexuses
What is rectal prolaspe?
Abnormal descent of rectum through anal canal
Can occur in young children
What is the anal canal?
Terminal part of large intestine
Two sphincters that surround canal
