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urinary bladder Flashcards

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1
Q

describe the size and position of bladder in young children?

A

abdominal organ

neck of the bladder lies at the level of upper border of symphysis pubis

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2
Q

what is the size and position of bladder in adults?

A

it is pelvic organ when empty

neck lies js above the plane of the lower border of symphysis

WHEN DISTENDED IT BECOMES ABDOMINO PELVIC but when empty = pelvic organ

So it varies with the amount of urine and age

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3
Q

what is the shape of urinary bladder?

A

tetrahedral when empty

ovoid when distended

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4
Q

what are the parts of urinary bladder?

A

apex —–> points anteriorly

base –> opposite to the apex = posterior

4 surfaces

4 borders

Neck

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5
Q

what are the borders of the bladder?

A

Anterior border running below the apex

two lateral borders ( on each side )

Posterior borders —> found on the bas

4 borders

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6
Q

what are the surfaces of the bladder?

A

4 surfaces

Posterior surface ( same as the base )

two inferolateral surfaces ( anteroinferior surface )

Superior surface

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7
Q

what is the structure attached to the apex?

A

median umbilical ligament

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8
Q

what is the structure attached to the SUPERO LATERAL ANGLES?

A

Ureters

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9
Q

what is the structure attached to the inferior angle?

A

Urethra

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10
Q

what is found on the neck of the bladder?

A

Prostate

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11
Q

what is the relation of posterior surface/base/fundus of the bladder in MALES?

A

Upper part ——> covered by peritoneum —> forms anterior wall of the rectovesical pouch

Lower part —-> separated from the rectum

the peritoneum comes from the anterior abdominal wall covering the superior surface of bladder then going to the posterior surface stopping at the upper part

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12
Q

what separates the lower part of posterior surface of bladder from the rectum in male?

A

Pair of seminal vesicles

van deferens

rectovesical fascia

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13
Q

why does the peritoneum stop at the upper part of posterior sruface?

A

when the peritoneum reaches the lower parts of the posterior surface of the urinary bladder it meets the following structure :

Seminal vesicles and van deferens —> cannot cover them with peritoneum instead it reflects to form —-> RECTOVESICAL POUCH

they are seen in sagittal view separated from the RECTUM by A FASCIA CALLED RECTOVESICAL FASCIA

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14
Q

what is the relation of the posterior surface of the bladder in FEMALES?

A

separated from the rectum BY THE UPPER OF VAGINA

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15
Q

what is ductus deferens ?

A

Highly convoluted duct behind the testis

Muscular tube

conveys sperms from the epididymis to the VAS DEFERENS

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16
Q

what is the location of ductus deferens ?

A

Posterior surface of the bladder :

Hooks over the ureter and runs medially to approach its opposite one

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17
Q

what happens to the terminal part of ductus deferens ?

A

get dilated to form :

Ampulla of the vas

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18
Q

what happens to the inferior of ampulla of the vas?

A

inferior end of ampulla joins the ducts of the seminal vesicle to :

Form ejaculatory duct which passes through the prostate to open into PROSTATIC URETHRA

We have ampullas and seminal vesicles on on each side and they both join together to form the ejaculatory ducts

Ampulla + seminal vesicles = ejaculatory ducts

on each side

eventually they open into the urethra

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19
Q

describe seminal vesicles?

A

two lobulated sacs

Lie on the posterior surface of the bladder

Their upper ends are WIDELY SEPARATED

their lower ends ARE CLOSE TOGETHER

join the ampulla of vas ( terminal part of ductus deferes ) —-> forms ejaculatory duct

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20
Q

what is the location of the terminal part of ampulla of vas?

A

medial side of the seminal vesicles

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21
Q

what are the features of the posterior wall of the prostatic urethra ?

A

urethral crests

seminal colliculus

prostatic utricle

prostatic sinus

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22
Q

what is urethral crest?

A

elevation in the middle of the urethra

medial longitudinal mucosal fold

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23
Q

what is urethral sinuses ?

A

since we have an elevation we have a depression on the sides

the depression is called urethral sinuses

mucosal gutters on each sides of the crest

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24
Q

what surrounds the urethra ?

A

prostate

which is a gland and it secretes and empties into the URETHRAL SINUSES

So the urethral sinuses receive openings of the ducts of prostatic glands

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25
what is seminal colliculus ?
a swelling and a further elevation in the center of urethral crest rounded eminence
26
what can we see in the seminal colliculus ?
opening of the right and left ejaculatory ducts
27
what is found above the openings of the ejaculatory ducts?
Prostatic utricle Minute depression in the center of the urethral crest
28
what is prostatic utricle ?
Remnant of the vagina or female uterus
29
describe internal trigone?
triangular area inside the bladder that looks different compared to other interior its the area where 2 ureters are opening into the bladder from above urethra opens inside below its a shiny area because it doesnt have a submucosa rest of the interior has folds that allow it to distend whenever
30
what is the situation of external trigone ?
situated on the external aspect of the base of male bladder ONLY FOUND IN MALES
31
what is the base of the external trigone ?
Posterior border of the bladder
32
what is the apex of the external trigone ?
Neck of the bladder
33
what forms the sides of the external trigone ?
seminal vesicles vas deferens
34
what are the relations of the superior surface of the bladder in MALES?
empty bladder : Triangular and covered with peritoneum ( Full bladder = oval shape ) Related to : Sigmoid colon , coils of small intestine
35
what is the superior surface of the bladder related to in FEMALES??
Uterovesical pouch peritoneum comes from the anterior abdominal wall , it covers the superior surface of the urinary bladder meets the uterus so it covers the anterior surface of the uterus ------> FORMING THE UTEROVESICAL POUCH ( in males its called rectovesical pouch )
36
what does the uterovesical pouch separates?
the superior superior surface of the bladder from Body of the uterus
37
why is the pouch empty except when the uterus is retroverted?
if the uterus is going to be retroverted ( leaning posteriorly on the ano rectal canal instead of urinary bladder ) the pouch will be covered by coils of small intestine
38
what is suprapubic puncture ?
as the bladder fills the superior surface enlarges and enters the abdomen peeling off peritoneum from the anterior abdominal wall so the bladder comes into direct contact with the anterior abdominal wall Suprapubic puncture ( cystostomy ) can be performed without entering the peritoneum Urinary calculi , small tumors , foreign bodies may also be removed from the bladder through a suprapubic extraperitoneal approach
39
what are the relations of the inferior lateral surfaces of the bladder?
Non PERITONEAL = no peritoneum Related to the body of : Pubis Pubic symphysis Fascia covering levator ani muscle
40
what separates the bladder from pubis, pubic symphysis , fascia covering levator ani muscle ?
space of retzius
41
what is found in the space of retzius ?
retropubic pad of fat Vesical venous plexus
42
what is the importance of space of retzius ?
in surgical operation the bladder and prostate are approached through this space
43
what supports the bladder from the sides?
levator ani and its fascia covering it More lateral to it LEVATOR ani is OBTURATOR INTERNUS
44
what is the neck ?
anatomical it is the lowest point from where urethra begins
45
describe the neck of the bladder in males?
Lodges the prostate below the prostate gland we have urogenital diaphragm
46
describe the neck of the bladder in FEMALES?
lies at the lower level and comes in contact with the superior fascia of urogenital diaphragm Cuz no prostate , the bladder is with direct contact with urogenital diaphragm
47
what is are 2 pouches found in the perineal region ?
Superficial space / pouch Deep space/ pouch deep pouch = we have deep transverse perineal muscle -----> FORMS UROGENITAL DIAPHRAGM on top of this muscle we have ----> superficial fascia of urogenital diaphragm Below this muscle ------> FASCIA = DEEP UROGENITAL DIAPHRAGM
48
describe the bladder interior mucous membrane?
mucous membrane of the greater part of the empty bladder ( the rest of the bladder is the trigone which is always smooth ) is drawn into folds the folds disappear when the bladder is full
49
what is the trigone?
internal surface of the base of the bladder
50
describe the mucous membrane of the trigone?
mucous membrane ---> always smooth even when empty ( the other part of the bladder is folded when empty and smooth when full ) has different embryological origin that the rest of the bladder
51
what makes the mucous membrane of the trigone always smooth?
firmly adherent to the underlying muscle coat has no submucosa
52
what is the superior angle of the trigone of the bladder?
ureters
53
what is the inferior angle of the trigone of the bladder ?
internal urethral meatus
54
what forms the superior limit of the trigone?
interureteric ridge Ureters pierce the bladder wall obliquely muscular ridge which runs between the opening of the 2 ureters
55
what is interureteric ridge?
line between the 2 openings of the ureters into the bladder
56
what is the uvula vesicae ?
small elevation behind the urethral orifice in the male
57
what is the urethral orifice?
opening of the urethra in the bladder
58
what produces the uvula vesicae ?
underlying median lobe of the prostate it could inflame and push upwards into the urinary bladder to form swelling into the ureteric orifice
59
what is the bladder bed?
number of structure upon which bladder rests on
60
what are the structures which the bladder rest on?
Symphysis pubis Fascia of levator ani obturator internus Base of prostate ( M ) / superior fascia of urogenital diaphragm ( F ) ampulla of rectum ( M ) / anterior wall of vagina (F)
61
what is sphincter vesicae ?
involuntary muscle formed by the Destrusor muscle at the neck surrounds the urethra
62
what is the function of sphincter vesicae ?
CONTRACTS ---> during ejaculation to prevent retrograde ejaculation of semen into the bladder prevent urine from going into the urethra
63
what is uvula?
projection of the trigone , prominent in males formed by median lobe of prostate projects into the interior and causes obstruction to easy flow of urine in benign prostatic hypertrophy ( BPH )
64
what are the arteries supplying the bladder?
Superior vesical artery Inferior vesical artery BRANCHES OF THE INTERNAL ILIAC ARTERY
65
what does the superior vesical artery supply?
superior part of the urinary bladder
66
what does the inferior vesical artery supply ?
Posterior inferior part of the bladder prostate seminal vesicles artery to the ductus deference
67
What does the inferior vesical artery corresponds to in females?
Vaginal artery in the females
68
what is the venous supply of the bladder?
Correspond to the arteries Form vesical venous plexus ---> ALONG the INFEROLATERAL SURFACE OF THE BLADDER finally drains into ---> INTERNAL ILIAC VEIN TUMOR CELLS CAN SPREAD VIA THE VENOUS PLEXUS
69
what is the lymphatic drainage of bladder ?
External lymph nodes Internal lymph nodes Common iliac lymph nodes Sacral lymph nodes
70
what happens if cancer is in the prostate gland ?
1- the vein drainage is very closely associated to the venous drainage of the urinary bladder so they get to the vesical venous plexus 2- Behind the vertebral column so some of the veins drain/connected to the vertebral column and cancer can spread there
71
whats the nerve supply of bladder?
Vesicle plexus of nerves contain both symp and parasymph components
72
what is the sympathetic nerve supply of the bladder?
T11-L2 from lateral horn cells ---> SACRAL SPLANCHNICS Spinal cord: Superior hypogastric plexus (found near the bifurcation of the common iliac, single plexus ) --->THEN Hypogastric nerve THEN inferior hypogastric plexus ( at both sides of the bladder ) then after that the post ganglionic fibers supply the bladder
73
whats the motor sympathetic supply of the bladder?
Internal sphincter inhibitory to detrusor ( NERVE OF FILLING cuz it relaxes the shpincter allowing urine to go from bladder to urethra and when it contracts it prevent that.) Seminal vesicles and ejaculatory ducts
74
where does the hypogastric plexus, hypogastric nerve, inferior hypogastric plexus RELAY ALONG?
ALONG THE VESICAL ARTERY BLADDER
75
what conveys painful sensation from the bladder?
sensory sympathetic fibers the cells bodies in dorsal root ganglia of T11-L2 spinal NERVES SUPERIOR SURFACE OF THE BLADDER IS COVERED BY PERITONEUM SO BY SYMPATHETIC OTHER PARTS THAT DOESNT HAVE PERITONEUM WILL BE BY PELVIC SPLANCHNIC NERVE
76
what is the parasympathetic supply of the bladder?
Pre-ganglionic fibers from : S2,3,4 segment of the spinal cord Pelvic splanchnic nerves ( NERVI ERIGENTES ) then reach the body and neck of the bladder by post ganglionic fibers
77
where are the cell bodies of parasympathetic supply located at?
Cell bodies of the postganglionic neurons Are situated close or within the bladder wall these fibers supply the detrusor muscle and the muscle of the proximal urethra
78
what is the motor supply of parasympathetic of the bladder?
detrusor muscle ( contract to empty the bladder) inhibitory to sphincter vesicae ( Relax to open the sphincter ) also called nerve of emptying or voiding
79
where are the sensation of distention and painful sensation of the bladder and proximal urethra carried?
Sensory parasympathetic fibers ---> Cell bodies ----> Dorsal root ganglia of S2-S4 spinal nerves pelvic splanchnic nerve carry pain WHERE PERITONEUM IS NOT PRESENT ( EVERYWHERE EXCEPT THE SUPERIOR SURFACE WHICH IS COVERED BY PERITONEUM ) ( S2-S4)
80
what is pelvic pain line phenomena ?
pelvic viscera are that are in contact with peritoneum are superior to the pelvic pain line : Pain impulses from viscera superior to the pain line are carried by --> SYMPATHETIC FIBERS ---> ABDOMINOPELVIC SPLANCHNIC NERVES ( T11-L2) ( like the superior surface of the bladder cuz its covered by peritoneum ) Pain impulses from the viscera inferior to the pain line are carried by ---> PARASYMPATHETICS FIBERS ---> PELVIC SPLANCHNIC NERVE ( S2-S4 ) ( like the rest of the bladder cuz it is not covered by the peritoneum )
81
what is cystocele?
herniation of the bladder into vaginal wall Loss of bladder support in females by damage to perineal muscles or pelvic floor so it drops to the vaginal wall
82
what happens in rupture of the bladder?
distended bladder may be injured by injuries to the inferior part of the anterior abdominal wall or by fracture of pelvis Rupture of the superior part of the bladder ---> TEARS THE PERITONEUM AND RESULTS IN INTRAPERITONEAL EXTRAVASATION OF URINE ( urine inside the peritoneum --> greater sac ) Elsewhere ---> rupture will results in EXTRAPERITONEAL EXTRAVASATION ( urine outside peritoneum )
83
what prevents urine reflux from the bladder to the ureters?
1- Oblique direction of the intra-vesical part ureter : the posterior wall of the ureter is firmly anchored to the detrusor muscle of the bladder anterior wall is more flexible , increased intra vesical pressure anterior wall of the ureter will be compressed against the posterior wall like flap valve preventing reflux 2- Peristalsis o the ureteral muscle pass downwards , urine is collected in the bladder by jets and not drops 3- normally the ureteric orifice presents an oblique slit ( IN TUBERCULOSIS OF THE KIDNEY ONE ORIFICE MAYBE CIRCULAR DUE TO SHORTENING OF URETER ---> GOLF HOLE URETER )---> PATHOLOGY, orifice becomes circular instead of oblique

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