Flashcards in Urinary bladder (dave's notes) Deck (22):
Describe the muscle and membrane makeup of the urinary bladder
Smooth muscle arranged in whorls and spirals, lined with loose mucous membrane, surfaced with transitional epithelium
What shape is the bladder?
The distended bladder is globular/ovoid and internally smooth. The undistended bladder is described as XXXX., with internal folds.
What does the apex of the bladder point to? What is attached here?
The sharp apex of the bladder points to the pubic symphasis. It has the remains of urachus attached to it, forming the median umbilical ligament.
Where is the base of the bladder?
The triangular base of the bladder faces backwards (in front of rectum/vagina) and is the posterior surface.
What are the relations of the bladder in the male?
Only the upper part (above the rectovesical pouch) is covered by peritoneum. The ductus deferens medial and the seminal vesicles laterally, attached to this surface. The ureter is at the upper outer corner.
What are the relations of the bladder in the female?
The base is firmly connected with the anterior vaginal wall and uterine cervix, with no peritoneal covering.
Describe the inferolateral surface of the bladder
TWO inferolateral surfaces slope downwards and forwards, cradled by levator ani.The surfaces meet behind the pubic bones, forming the retropubic space
What does the retropubic space contain?
Condensations forming pubovesical (+/-) puboprostatic ligaments
What is the lowest part of the bladder? What does it lie against?
The neck. In the male it lies against the prostate, in the female against pelvis fascia.
Describe the superior surface of the bladder
The superior surfaces is covered by peritoneum which sweeps upwards on the anterior abdominal wall.
What is the trigone?
A triangular shape between the urethral and ureteric orifices (2.5-5cm apart depending on distension)
Give three facts relating to the trigone
It is the least mobile part of the bladder
The ureters enter it obliquely
It may have an indentation from the prostate (uvula vesicle)
Describe the blood supply of the bladder
Principally from the superior and inferior vesicle arteries, plus obturator, inferior gluteal, uterine, and vaginal (IIA)
Describe the venous drainage of the bladder
Veins do not follow attires but instead form a plexus draining backwards across the pelvic floor to the internal iliac vein.
Describe the lymphatic drainage of the bladder
Lymphatics follow the arteries back to the internal iliac and external iliac arteries
What types of nerves supply the bladder?
Sympathetic, parasympathetic, pain, and sensation.
From where is the sympathetic supply of the bladder? What is its function?
From L1,2, via the superior hypogastric plexus. Largely vasomotor but also to trigone and internal sphincter
From where is the parasympathetic supply of the bladder? What is its function?
Fibres from the pelvic splanchnic plexus provide the main motor supply
How do nerves for normal sensation, and nerves for pain reach the bladder?
Normal sensation via parasympathetic via gracile (???), but pain reaches the spinal cord via both tracts.
How do we control the bladder
The bladder fibres produce a ............. appearance. At the male urethral orifice, the muscle fibres form a ....... and is continuous with the ......... .... (not so in the female). This muscle helps to avoid ......... ............. . The mucous membrane is ...... and ..., and lined with .......... ........ . There are no ...... or .......... ........... .
Thick and lax