Pelvis and perineum 5.1-5.3

Question 1

Explain the course of the peritoneum in males. (9)

Answer 1

-Descends at the ant abd wall.
-Reflects over the sup surface of bladder (supravesical fossa)
-Covers the sup surface of bladder and slopes down to asc at the pelvic wall (paravesical fossa).
-Descends at post surface of bladder.
-Lat form ureteric folds over the ureters, duc def and sup ends of seminal glands.
-Reflects from bladder onto rectum forming a rectovesicle pouch.
-The rectovesicle pouch extends lat and post to form a pararectal fossa.
-Ascends rectum (inf to sup)
-Engulfs the sigmoid colon at rectosigmoidal junction.

Question 2

In which part of the male peritoneum does fluid accumulates when there is an infection?

Answer 2

The rectovesicle pouch

Question 3

Explain the course of the female peritoneum.

Answer 3

-Descends ant abd wall
-Reflects over the sup surface of bladder (supravesical fossa).
-Covers the sup surface of bladder and slopes down sides to ascend at the lat wall of pelvis (paravesical fossa)
-Reflects from bladder to uterine body (vesico-uterine pouch)
-Covers the uterine body, fundus and post fernix (broad lig which suspends the uterine tubes, ovaries and round lig of uterus)
-Extends lat from uterus.
-Reflects from vagina onto rectum (recto-uterine pouch)
-The recto-uterine pouch extends lat and post to form the pararectal fossa.
-Asc rectum (inf to sup)
-engulfs the sigmoid colon at rectosigmoidal junction.

Question 4

Where does fluid accumulate in the female peritoneum during an infection?

Answer 4

Recto-uterine pouch

Question 5

What is the male equivalence of the recto-uterine pouch?

Answer 5

Recto-vesicle pouch

Question 6

Another name for the recto-uterine/vesicle pouch?

Answer 6

Pouch of douglas

Question 7

What is the retropubic space?

Answer 7

-A space between the pubic symphysis and the urinary bladder.

Question 8

What makes up the ff for the retropubic space:
a. Medial border
b. Lateral
c. Ant
d. Post
e. Roof
f. Floor

Answer 8

a. Inferolateral surface of bladder.
b. Pubic bone ad obturator internus fascia.
c. Pubic symphysis and post surface of pubic bone.
d. Cord of connective tissue and internal iliac veins.
e. Covering peritoneum
f. Pelvic fascia, puboprostatic lig/ pubovesical lig, pelvic diaphragm.

Question 9

What is the course of the ureters? (3)

Answer 9

-Runs over the external iliac vessels.
-Btwn the pelvic peritoneum and internal iliac artery.
-Enters at the base of bladder.

Question 10

Blood supply and venous drainage of the ureters?

Answer 10

Upper portion: Renal artery and vein.
Lower portion: Vesical artery and vein.

Question 11

Lymphatic drainage of the ureters?

Answer 11

From sup to inf:
-Common, internal and external iliac nodes.

Question 12

Innervation of the ureters?

Answer 12

Adjacent plexuses, aortic, renal, sup and inf hypogastric.

Question 13

Briefly explain the structure of the bladder.

Answer 13

-Has a superior and inferolateral surfaces which meet at the apex, which has the median umbilical lig attached to it.
-It has a base which consist of the openings for the ureters.
-The two openings as well as the internal urethral orifice form a trigone, which has transitional epithelium (urothelium).
-Most inf structure is the neck of the bladder which is continous with the urethra.

Question 14

Which structures help to keep the urine in the bladder?

Answer 14

Mucosal folds

Question 15

Muscular thickening btwn ureteric orifices?

Answer 15

Inter-ureteric torus

Question 16

Evagination post to internal urethral orifice, for the prostate gland?

Answer 16

Uvula

Question 17

Supporting ligaments of the bladder (2)

Answer 17

M- Puboprostatic lig
F- Pubovesical lig

Question 18

What are the relations of the bladder in a female:
-Sup
-Post
-Lat
-Ant
-Neck
-Apex

Answer 18

Sup- Peritoneum, vesico-uterine pouch, paravesical fossa.
Post- Vagina, supravaginal part of cervix.
Lat- Ureters
Ant- Retropubic space
Neck- Pelvic and urogenital diaphragm
Apex- Connected to umbilicus via urachus

Question 19

What are the relations of the male bladder:
-Sup
-Neck
-Post
-Ant
-Apex

Answer 19

Sup-Covering peritoneum
Neck- Pelvic diaphragm
Post-Seminal vesicles, duc def, rectum and rectovesicle pouch.
Ant- Retropubic space and contents.
Apex- connected to umbilicus via urachus

Question 20

Blood supply of the bladder

Answer 20

Sup and inf vesical aa. which are branches of the internal iliac artery.

Question 21

Venous drainage of the bladder

Answer 21

Vesical venous plexus.

Question 22

Name the four parts of the male urethra.

Answer 22

-Preprostatic
-Prostatic
-Membraneous
-Spongy part

Question 23

Which part is the most elastic and which one is least elastic?

Answer 23

Most-Prostatic part
Least-Membraneous

Question 24

Into which part do the prostate gland and ejaculatory duct pour their contents?

Answer 24

The prostatic part

Question 25

Which part is the longest?

Answer 25

Spongy part

Question 26

Which structure do we have towards the end of the spongy part?

Answer 26

Navicular fossa

Question 27

Arterial supply of the male urethra (3)

Answer 27

-Inf. vesical a. -A. to bulb of penis -Urethral a.

Question 28

Venous drainage of the male urethra (3)

Answer 28

-Inf. vesical v. -V. to bulb of penis -Urethral v.

Question 29

Innervation of the male urethra

Answer 29

Autonomic-Inf hypogastric plexus Somatic-Pudendal nerve

Question 30

What keeps the prostate in place?

Answer 30

-Puboprostatic ligament

Question 31

Arterial supply of the prostate

Answer 31

-Inf vesical, middle rectal and internal pudendal aa.

Question 32

Venous drainage of the prostate

Answer 32

-Prostatic venous plexus

Question 33

What is the blood supply for the ductus deferens?

Answer 33

Artery to ductus deferens

Question 34

Venous drainage for ductus deferens

Answer 34

Testicular vein and vesical venous plexus

Question 35

Blood supply for the ejaculatory ducts

Answer 35

Inf vesical and middle rectal arteries

Question 36

Venous drainage of the ejaculatory ducts

Answer 36

Vesical and prostatic venous plexuses

Question 37

Briefly describe the structure of the uterus. (5)

Answer 37

Sup 2/3 is the body: -Consist of fundus, uterine tubes and isthmus. -Lies btwn the layers of broad ligament. -Has two surfaces, vesical and intestinal. Inf 1/3 is the cervix: -Narrow and cylindrical. -Has two parts; supravaginal and vaginal.

Question 38

What are the differences btwn the supravaginal and vaginal parts of the cervix? (6)

Answer 38

Supravaginal: -Btwn the isthmus and vagina. -Surrounds the internal os of uterus. -Separated from the bladder anteriorly and the rectum posteriorly. Vaginal: -Protrudes into the vagina. -Surrounds the external os. -Surrounded by the vaginal fornix.

Question 39

Which ligament: a. Attaches the ovaries to the uterus. b. Attaches the ovaries to the pelvis. c. Attaches the cervix of the uterus to the sacrum.

Answer 39

a. Ligament of ovaries b. Suspensory ligament c. Uterosacral ligament

Question 40

Mesentery of: a. uterus b. ovaries c. uterine tubes

Answer 40

a. Mesometrium b. Mesovarium c. Mesosalpinx

Question 41

Ligament that supports the uterus during pregnancy?

Answer 41

Round ligament of the uterus

Question 42

What are the relations of the uterus: A. Anteriorly B. Posteriorly C. Laterally

Answer 42

A. Vesico-uterine pouch and superior surface of bladder. B. Rectouterine pouch and the rectum. C. Ureters and the broad lig of uterus.

Question 43

Blood supply and venous drainage of the uterus

Answer 43

Uterine a. and v.

Question 44

Supporting structures of the uterus (4)

Answer 44

-Ligaments, pelvic diaphragm, urogenital diaphragm and surrounding organs.

Question 45

Four parts of the uterine tubes

Answer 45

-Infundibulum -Ampulla -Isthmus -Uterine part

Question 46

Finger-like projections found in the infundibulum

Answer 46

Fimbriae

Question 47

Relations of the ovaries: a. ant b. post c. lat d. med e. sup f. inf

Answer 47

a. Attachment of mesovarium b. Ureters and uterine tubes c. Parietal peritoneum, obturator nerve and blood vessels d. Uterine tubes and ilial loops e. Suspensory lig ad ovarian vessels. f. Ligament of ovary

Question 48

Blood supply of the ovaries and uterine tubes

Answer 48

O- Ovarian arteries UT- Uterine arteries

Question 49

Venous drainage of the overies and uterine tubes

Answer 49

O- Pampiniform plexus which merges with the ovarian vein. UT- Uterine veins

Question 50

What are the four muscles that compress the vagina?

Answer 50

-Pubovaginalis -External urethral sphincter -Urethrovaginal sphincter -Bulbospongiosus

Question 51

Blood supply of the vagina (2)

Answer 51

Sup part- Uterine and vaginal aa. Inf part- Internal pudendal a.

Question 52

Venous drainage of the vagina

Answer 52

Vaginal veins

Question 53

Normal positions of the: a. uterus b. body c. fundus

Answer 53

a. Anteflexed and anteverted b. Retroflexed, anteflexed or retrocession c. Anteversion, and retroversion

Question 54

Which muscle forms the anorectal sling?

Answer 54

Puborectalis m.

Question 55

Ant. relations of the male rectum

Answer 55

-Recto-vesical pouch, fundus part of bladder, terminal parts of ureters, ductus deferens, seminal glands, prostate.

Question 56

Ant. relations of the female rectum

Answer 56

-Recto-uterine pouch, vagina and uterus

Question 57

Blood supply of the rectum (4)

Answer 57

Prox part- Sup rectal a. Mid and distal part- Middle recal aa. Anorectal jx and anal canal- Inf rectal aa. Median sacral a.

Question 58

Venous drainage of the rectum

Answer 58

Sup, mid and inf rectal aa. Portacaval anastomosis

Question 59

Innervation of the rectum

Answer 59

SYMPATHETIC: Lumbar splanchnic nerves and hypogastric plexus (root: lumbar spinal cord) PARASYMPATHETIC: Pelvic splanchnic nerves (root: S2-S4 spinal cord)

Question 60

Ant relations of the anal canal in males (4)

Answer 60

-Perineal body -Bulb of penis -Urogenital diaphragm -Membranous urethra

Question 61

Ant relations of the anal canal in females (3)

Answer 61

-Lower part of vagina -Perineal body -Urogenital diaphragm

Question 62

Lateral and posterior relations of the anal canal

Answer 62

Post- Anococcygeal raphe Lat- Ischio-anal fossae

Question 63

Differences btwn the internal and external anal sphincters (2)

Answer 63

INT- Has smooth muscles (involuntary) -Covers the sup part of the anal canal. EXT- Has striated muscles (voluntary) -Covers the lower part of the anal canal.

Question 64

Three parts of the external anal sphincter

Answer 64

-Subcutaneous -Superficial -Deep

Question 65

Innervation of the anal canal

Answer 65

Inf rectal nerve