Pelvis & Reproductive Organs

Question 1

what structure is important to identify during pelvic surgery?

Answer 1

ureters; they have multiple blood supplies, but sometimes it isn’t enough if one of these is ligated during surgery

Question 2

what is the major cause of obstruction of the ureters?

Answer 2

ureteric calculi

Question 3

where are the three most likely sites of ureteric calculi?

Answer 3

• renal pelvis
• where the ureters cross external iliac vessels
• passage into bladder

Question 4

how are ureteric calculi removed?

Answer 4

lithoscopy or endoscopy; found with CT

Question 5

what is a cystocele?

Answer 5

hernia of bladder onto the anterior vaginal wall

Question 6

what causes a cystocele?

Answer 6

• damage to pelvic floor during childbirth
• laceration of perineal muscles (or nerves)
• rupture of paracolpium

Question 7

where does the bladder extend when it fills?

Answer 7

superior to pubic symphysis into loose areolar tissue between parietal perintoneum & anterior abdominal wall

Question 8

if the bladder ruptures superiorly, where can urine escape into?

Answer 8

peritoneal cavity

Question 9

if the bladder ruptures inferiorly, where can urine escape into?

Answer 9

perineum

Question 10

how can you view the interior bladder and its three orifices?

Answer 10

cystoscope

Question 11

why is the rectovesical septum clinically important?

Answer 11

in males, during a rectum resection, the prostate and urethra can be separated from the rectum because of this fascial septum that extends superiorly from the perineal body

Question 12

what’s the most common method of male sterilization?

Answer 12

deferentectomy or vasectomy

Question 13

why is a vasectomy successful?

Answer 13

ligation of vas deferens in superior scrotum so sperm aren’t expelled and they die in epididymis

Question 14

abscesses in seminal glands can rupture it’s contents into?

Answer 14

peritoneal cavity

Question 15

almost every male who lives long enough experiences?

Answer 15

benign hypertrophy of the prostate

Question 16

which lobule of the prostate enlarges to constrict the urethra?

Answer 16

middle lobule

Question 17

BHP can clinically cause?

Answer 17

• nocturia
• dysuria
• urgency

Question 18

how can prostatic cancer metastastize?

Answer 18

• lymphatic: internal iliac/sacral nodes

- venous: internal vertebral venous plexus to vertebrae and brain

Question 19

obstruction of the prostate is relieved by?

Answer 19

• transurethral resection of prostate

- radical prostatectomy

Question 20

why is it important to preserve nerves and vessels through prostate during TURP and radical prostatectomy?

Answer 20

to increase possibility that the patient will retain sexual functions after surgery & to restore normal urinary control

Question 21

infections of the vagina, uterus, and tubes can result in?

Answer 21

peritonitis (communicates through abdominal ostia of tubes)

Question 22

what is salpingitis?

Answer 22

• inflammation of a uterine tube

- major cause of blockage of tube –> infertility

Question 23

how can you check for patency of the uterine tubes?

Answer 23

• hysterosalpingography

- gas bubbles in pararectal fossae = patent tubes

Question 24

what is a surgical method of birth control for a female?

Answer 24

surgical ligation of uterine tubes

Question 25

where is an incision for an abdominal tubal ligation?

Answer 25

suprapubic (pfannenstiel)

Question 26

where is the incision for a laparoscopic tubal ligation?

Answer 26

small incision near umbilicus

Question 27

what is pyosalpinx?

Answer 27

collection of pus in a uterine tube

Question 28

what can pyosalpinx cause?

Answer 28

ectopic tubal pregnancy

Question 29

where is the common site of an ectopic pregnancy?

Answer 29

ampullae of tubes

Question 30

a ruptured tubal pregnancy and resulting peritonitis can be misdiagnosed as?

Answer 30

appendicitis

Question 31

Gartner duct cysts are the result from?

Answer 31

accumulation of fluid in a persistant duct of epoophoron

Question 32

incomplete fusion of embryonic paramesonephric ducts causes?

Answer 32

congenital anomalies of the uterus

Question 33

what causes uterine prolapse?

Answer 33

- increased intra-abdominal pressure - disrupted perineal body - atrophic pelvic floor ligaments/muscles

Question 34

where can cervical cancer spread? why?

Answer 34

to the bladder because no peritoneum intervenes between anterior cervix and base of the bladder

Question 35

what is the lymphogenous spread of cervical cancer?

Answer 35

external/internal iliac nodes or to sacral nodes

Question 36

how can cervical cancer be spread through the blood?

Answer 36

through iliac veins or internal vertebral venous plexus

Question 37

what is a hysterectomy?

Answer 37

surgical removal of the uterus

Question 38

what kind of fistulas can result from difficult labor?

Answer 38

vesicovaginal, urethrovaginal, or rectovaginal

Question 39

what is culdocentesis?

Answer 39

drainage of a pelvic abscess in the recto-uterine pouch through an incision in the posterior part of the vaginal fornix

Question 40

what is endometriosis?

Answer 40

presence of functioning endometrial tissue outside of uterus

Question 41

what's important about a caudal epidural block during childbirth?

Answer 41

it anesthetizes subperitoneal structures and the somatic areas innervated by the pudendal nerve; pain fibers from uterine body are superior to pelvic pain line (unaffected by anesthetic, so uterine contractions are felt by mother to know when to push)

Question 42

why is a spinal block via lumbar puncture not a top choice for anesthesia during childbirth?

Answer 42

mother can't feel uterine contractions & it usually causes a "spinal headache"