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Yr 2 - Renal > SDL - Midline Pelvis > Flashcards

SDL - Midline Pelvis Flashcards

1
Q

Describe course of peritoneum as it comes down anteriorly in males?

A

In the male, the peritoneum comes down anteriorly, just below the upper margin of the symphysis pubis (when the bladder is empty). From the anterior abdominal wall it passes to the fundus of the bladder, forming a shallow fold in between.

From the posterior surface (base) of the bladder, the peritoneum descends in a fold before ascending over the rectum.

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2
Q

What does the shallow fold between the anterior abdominal wall and the fundus roof?

A

Roofs the potential retropubic space

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3
Q

What is the rectovesical pouch?

A

Created as peritoneum descends over bladder and then ascends over rectum

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4
Q

What forms the broad ligament in females?

A

Peritoneum is draped over the uterus and uterine tubes, forming a double layered sheet of peritoneum either side of the uterus

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5
Q

Why does pus in the peritoneal cavity tend to accumulate in the rectovesical or rectouterine pouch?

A

It is the lowest point when supine, also connected via the left colic gutter.

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6
Q

Where does an empty bladder lie?

A

Entirely within the pelvis

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7
Q

As the bladder fills, where does it bulge?

A

It bulges upwards behind the lower part of the anterior abdominal wall, separating the peritoneum from the abdominal wall

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8
Q

What is a supraphrenic catheterisation?

A

Catheter is inserted in to the bladder by passing above the pubic symphysis

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9
Q

What is advantage of supraphrenic approach to bladder?

A

This avoids having to pass the catheter through the urethra, especially in male. And allows greater quality of life for longer periods of catheterisation.

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10
Q

Describe sections of an empty bladder

A

Apex (uppermost anterior part)

Fundus (triangular superior surface)

Base (posteriorly)

2 inferolateral surfaces

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11
Q

Where do the bade and 2 inferorlateral surfaces meet?

A

Meet at neck of bladder which leads into urethra

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12
Q

What is the median umbilical ligament?

A

Fibrous cord that contains the urachus and extends from the apex of the bladder to the umbilicus

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13
Q

What forms the posterior relation of the base of the bladder in females?

A

Vagina and cervix

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14
Q

What forms the posterior relation of the base of the bladder in males?

A

Rectum

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15
Q

The ureters enter the posterolateral angles of the bladder. They pierce the bladder wall obliquely. Why?

A

Serves as a valve which prevents retrograde flow of urine back up through the ureters.

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16
Q

Describe the interior of the bladder

A

Area of bladder wall bounded by the two ureteric openings superolaterally and by the urethral opening inferiorly is called the trigone

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17
Q

How does the wall of the trigone differ from the rest of the bladder?

A

Smooth whereas rest of empty bladder is covered by rugae

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18
Q

What smooth muscle fibres does the bladder wall contain?

A

Detrusor muscle

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19
Q

Around the neck of the bladder, how are these smooth muscles fibres arranged?

A

Circularly –> forming involuntary urethral sphincter

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20
Q

In males, which structure separates the bladder neck from the pelvic floor?

A

Prostate gland

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21
Q

What is the normal capacity of the bladder?

A

Approx 500ml

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22
Q

What is the blood supply to the bladder?

A

Superior vesical arteries

Males: inferior vesicle arteries supply fundus and neck

Females: Vaginal replace inferior vesicle

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23
Q

What is the nerve supply to the bladder?

A

Parasympathetic: via pelvic splanchnic nerves

Sympathetic: via hypogastric plexuses

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24
Q

What does parasympathetic supply of bladder control?

A

The contraction of which causes bladder emptying

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25
Q

What does sympathetic supply of bladder control?

A

Bladder filling

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26
Q

What effects does parasympathetic stimulation have on the muscle of the bladder?

A

Constriction of upper detrusor muscle. Relaxation of lower trigone region, and internal urethral sphincter

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27
Q

During bladder emptying, describe detrusor muscle and trigone region

A

Contraction of upper detrusor muscle

Relaxation of lower trigone

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28
Q

How do secretions of prostate reach the urethra?

A

Via prostatic ducts which open into the prostatic sinuses either side of the seminal colliculus

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29
Q

What is the prostate surrounded by?

A

Fibrous capsule and then a thick sheath derived from the pelvic fascia

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30
Q

What lies between the fibrous capsule of the prostate and the thick sheath?

A

The prostatic venous plexus

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31
Q

How is clinical examination of the prostate carried out?

A

Digital rectal examination

32
Q

What can be palpated in a normal prostate?

A

A palpable posterior midline sulcus (2 firm lobes with a furrow between)

33
Q

When may this prostatic sulcus be obliterated?

A

During prostatic enlargement

34
Q

Prostatic enlargement is common in old men. What is the most common symptom of such enlargement?

A

Impediment of urination, nocturia, dysuria, urgency, cystitis risk increased.

35
Q

How might the prostate be approached surgically without opening the peritoneal cavity?

A

Transurethral (TURP)

36
Q

By what route does prostatic cancer sometimes spread to the vertebral column?

A

The prostatic venous plexus is continuous with the internal vertebral venous plexus.

37
Q

Where does the vas deferens originate and where does it enter the abdomen?

A

Epididymis of testes, passes within spermatic cord through superficial ring, canal and deep ring. Then passes over pelvic brim towards badder base where it dilates to form ampulla and unites with seminal vesicle to form the ejaculatory duct. This opens into prostatic urethra.

38
Q

Where do the seminal vesicles lie? What do they produce?

A

Lie at base of bladder and produce seminal fluid

39
Q

What is a vasectomy?

A

Ligation of the vas deferens within the scrotum.

40
Q

What is the fundus of the uterus?

A

Part above the entrance of the uterine tubes

41
Q

Where does the cervix open into the vagina?

A

External os

42
Q

What 3 layers does the uterine wall consist of?

A

Epimetrium (outer), myometrium, endometrium (inner)

43
Q

What is the outer serosal layer of the uterine wall derived from?

A

Peritoneum

44
Q

Describe the middle layer of the uterine wall

A

Smooth muscle

45
Q

Describe the inner layer of the uterine wall

A

Glandular layer that undergoes cyclical, hormone-driven thickening and breakdown.

46
Q

What structures provide mechanical support for the uterus within the pelvis? What may happen if these structures are weakened?

A

Round ligament, ovarian ligament, broad ligament, suspensory ligament

Prolapse

47
Q

What are fibroids?

A

Benign tumour of fibrous or muscular wall of uterus

48
Q

Describe the broad ligament of the uterus

A

A double layer of peritoneum immediately lateral to the uterus with the uterine tubes located within its upper margin on each side.

49
Q

What are the sections of the uterine tube?

A
  1. Infundibulum: surrounded by fimbriae
  2. Ampulla: widest part
  3. Isthmus: portion of tube adjoining uterine wall (narrow)
50
Q

Why is the relationship between the ureter and uterine artery iportant?

A

So the patient doesn’t bleed out during surgery and the procedure is successfully performed.

51
Q

What is the course of the round ligament of the uterus?

A

Passes from uterus, over pelvic brim, through deep ring, canal and superficial ring to attach to labia majora

52
Q

What is the round ligament of the uterus a remnant of?

A

Gubernaculum

53
Q

What is the remnant of the gubernaculum in males and what does it do?

A

Scrotal ligament - holds the inferior pole of the testes in the scrotum.

54
Q

Fertilisation normally occurs in the uterine tube. In which part?

A

Ampulla

55
Q

What is the mesovarium?

A

The portion of the broad ligament (double fold of peritoneum) of the uterus that suspends the ovaries.

56
Q

How is the ovary attached to the posterior leaf to the broad ligament?

A

By mesovarium

57
Q

How is the ovary attached to the upper part of the uterus?

A

Via the ovarian suspensory ligament

58
Q

Where does the ovarian suspensory ligament run?

A

Between the layers of the broad ligament

59
Q

Where do the ovarian arteries originate? What do they supply?

A

Aorta, L2

Ovaries

60
Q

What do branches of the ovarian arteries anastomose with?

A

Branches of the uterine arteries

61
Q

Which nerve lies adjacent to the ovary on the lateral wall of the pelvis?

Why might this relationship be useful in diagnosing an ovarian tumour?

A

Obturator

Sensation of pain radiating down medial thigh

62
Q

How are the fornices created?

A

The lower part of the cervix projects into the upper part of the anterior wall of the vagina, creating a gutter or recess called the fornix around the cervix (anterior, lateral, posterior fornices)

63
Q

During vaginal examination, which structures can be palpated anterior to the vagina?

A

Bladder fundus and urethra

64
Q

During vaginal examination, which structures can be palpated posterior to the vagina?

A

Rectum

65
Q

During vaginal examination, which structures can be palpated lateral to the vagina?

A

Ischial spines

66
Q

The posterior fornix is closely related to which part of the peritoneal cavity?

Why might this be useful clinically?

A

Rectouterine pouch

Remove free fluid or pus from the abdominal cavity without creating an open entry point which would increase the risk of infection.

67
Q

Why might this relationship of the posterior fornix be a problem clinically eg. when attempting to insert surgical instruments or an intrauterine contraceptive device (IUD) into the uterus via the vagina?

A

May be accidentally passed through the posterior fornix into the peritoneal cavity.

68
Q

What route is used to ‘harvest’ eggs for in vitro fertilisation?

A

Transvaginal and into each ovary

69
Q

What is the lymphatic drainage of the vagina and uterus?

A

Superficial inguinal lymph nodes

70
Q

What is the rectum a direct continuation of?

A

The sigmoid colon

71
Q

Where does the rectum run to/from?

A

The rectum runs from the hollow of the sacrum, (level with S3) to the ano-rectal junction which lies at the level of the pelvic floor, about 3cm above the cutaneous margin of the anus

72
Q

What are the transverse folds of the rectum?

A

Two of these folds project from the left with the one between them projecting from the right.

73
Q

What is the arterial supply of the rectum?

A

Superior, middle and inferior rectal arteries

74
Q

What is the superior rectal artery a branch of?

A

Terminal continuation of the inferior mesenteric artery

75
Q

What is the middle rectal artery a branch of?

A

Branch of the internal iliac artery

76
Q

What is the inferior rectal artery a branch of?

A

Branch of the internal pudendal artery.

77
Q

Which region of GI tract is supplied by the inferior rectal artery?

A

Lower third of anus, beneath pectinate line.

Yr 2 - Renal (16 decks)

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