Ureters (361-371) + extra Flashcards
Name the constrictions of the ureter;
- Pelvi-ureteric junction (origin).
- Pelvic brim (when it crosses external iliac artery).
- Uretero-vesical junction (end).
Descibe the blood supply to the ureter;
(Follows where ureter is during course).
Upper 1/3rd- renal artery (branch of abdo aorta).
Middle 1/3rd- Gonadal artery (testicular or ovarian - branch of abdo aorta).
Lower 1/3rd- superior vesical artery (branch of anterior division of internal iliac artery)
What are the types of renal stones and what is the commonest?;
Calcium oxalate (most common 85% - radio-opaque), Calcium phosphate (most radio-dense - associated with renal tubular acidosis), Urate (low pH urine, radiolucent) , Struviate (stag horn calculi, associated with chronic infection, slightly radio-opaque), Cystine (Inherited recessive disorder, radiodense due to sulphur)
What are the anatomincal relations of the right and left ureters?;
Origin (pelvi-ureteric junction)- most posterior to renal vein [most ant] and renal artery).
Abdominal part- descend along anterior surface of psoas major (retroperitoneal)- testicular/ovarian artery crosses anteriorly.
Pelvic brim (sacroiliac joints)- enters pelvic cavity at which point they cross anteriorly to common iliac arteries.
Pelvic part- travel along lateral pelvic wall, then at level of ischial spines turn anteriomedially towards bladder.
Ureto-vesical junction- enterx bladder obliquely (creates one way valve preventing reflux of urine)
How would you distinguish the ureters intraoperatively?;
Visible peristalsis. Clear fluid. Most reliable place to identify ureter is over iliac bifurcation at pelvic brim.
Which muscles form the pelvic floor?;
Levator ani (puborectalis, pubococcygeus, Iliococcygeus), coccygeus.
Which nerve innervates the pelvic floor muscles?;
Pudeneal nerves (S2, S3, S4)
What is the significance of the perineal body?;
The perineal body (aka common tendon) is a central attachment for perineal muscles, and functions to support the pelvic floor, it is where the urogential and anogential muscles meet. Childbirth can lead to damage (stretching/tearing) of the perineal body, thus leading to possible prolapse of pelvic viscera.
What is Buck’s fascia?;
The deep fascia of the penis. Continuation of the deep perineal fascia.
What is Colle’s fascia?;
The superficial fascia of perineum and penis (the external fascia of Colles). Continuation of Scarpas fascia
How would you suspect that someone has a uretral injury following trauma?;
Discolouration around scrotum (haematoma), blood at tip of ureathral meatus, high riding prostate on PR
What are the anatomincal and surface borders of the perineum?;
Anterior- pubic symphysis. Posterior- tip of coccyx. Laterally- inferior pubic rami, inferior ischial rami and sacrotuberous ligament. Roof- pelvic floor muscles. Base- skin and fascia.
What are the contents of the anal triangle?;
Posterior half of perineum- anal aperature, external anal sphicter, ischioanal fossae x2
What are the layers of the urogential triangle?; https://teachmeanatomy.info/pelvis/areas/perineum/
Deep to superficial- deep perineal pouch, perieneal membrane, superficial perineal pouch, perineal fascia, skin
What are the contents of each layer of the urogential triangle?;
Deep perineal pouch- contains part of the urethra, external urethral sphincter, and the vagina in the female, in males, it contains the bulbourethral glands and the deep transverse perineal muscles. Perineal membrane- a layer of tough fascia, which is perforated by the urethra (and the vagina in the female). Perineal membrane- contains the erectile tissues that form the penis and clitoris, and three muscles – the ischiocavernosus, bulbospongiosus and superficial transverse perineal muscles. Perineal fascia- deep and superficial fascia. Skin– The urethral and vaginal orifices open out onto the skin
