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90 Cards in this Set
- Front
- Back
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What structures come off of the anterior trunk of the interior iliac artery?
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umbilical, superior vesical, inferior vesical, middle rectal, uterine, and vaginal (all viscera). as well as internal pudendal (perineum supply). also the inferior gluteal, obturator, and umbilical.
just learn where these go in the body, not the order they come off *high variability* |
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What structures come off of the posterior trunk of the interior iliac artery? What do they supply?
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Iliolumbar, lateral sacral, and superior gluteal arteries.
They supply the pelvic walls and gluteal region. |
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Which arteries of the pelvis DO NOT come off of the internal iliac?
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The superior rectal arteries, which is a continuation of the inferior mesenteric artery. As well as the gonadal arteries, which come off of the aorta.
So....notice that the superior rectal is a collateral blood flow to the internal iliac because it joins up with the middle rectal (internal iliac) and inferior rectal (internal pudendal). |
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The deep dorsal vein of the penis or clitoris doesn't follow the branches of the internal pudendal artery. Once it passes in the pelvis, what venous plexus does it join?
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Prostatic venous plexus in men, and vesical venous plexus in women.
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What drains the superficial veins of the penis and clitoral regions?
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superficial external pudendal veins of the great saphenous vein.
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Where do the gonadal veins anastamose?
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The RIGHT gonadal vein goes to the IVC, the LEFT gonadal vein goes to the LEFT RENAL VEIN.
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Where does pelvic lymph collected in the common iliac nodes drain into?
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lateral aortic nodes or lumbar nodes --> lumbar trunks --> thoracic duct at T12.
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Aside from the pelvis, lymph nodes of the TESTES and OVARIES (plus upper part of the uterus) follow a different drainage path, which is...
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directly to the Lateral aortic lymph nodes or directly to the pre-aortic nodes.
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What structures come off of the anterior trunk of the interior iliac artery?
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umbilical, superior vesical, inferior vesical, middle rectal, uterine, and vaginal (all viscera). as well as internal pudendal (perineum supply). also the inferior gluteal, obturator, and umbilical.
just learn where these go in the body, not the order they come off *high variability* |
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What structures come off of the posterior trunk of the interior iliac artery? What do they supply?
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Iliolumbar, lateral sacral, and superior gluteal arteries.
They supply the pelvic walls and gluteal region. |
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Which arteries of the pelvis DO NOT come off of the internal iliac?
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The superior rectal arteries, which is a continuation of the inferior mesenteric artery. As well as the gonadal arteries, which come off of the aorta.
So....notice that the superior rectal is a collateral blood flow to the internal iliac because it joins up with the middle rectal (internal iliac) and inferior rectal (internal pudendal). |
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The deep dorsal vein of the penis or clitoris doesn't follow the branches of the internal pudendal artery. Once it passes in the pelvis, what venous plexus does it join?
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Prostatic venous plexus in men, and vesical venous plexus in women.
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What drains the superficial veins of the penis and clitoral regions?
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superficial external pudendal veins of the great saphenous vein.
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Where do the gonadal veins anastamose?
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The RIGHT gonadal vein goes to the IVC, the LEFT gonadal vein goes to the LEFT RENAL VEIN.
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Where does pelvic lymph collected in the common iliac nodes drain into?
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lateral aortic nodes or lumbar nodes --> lumbar trunks --> thoracic duct at T12.
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Aside from the pelvis, lymph nodes of the TESTES and OVARIES (plus upper part of the uterus) follow a different drainage path, which is...
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directly to the Lateral aortic lymph nodes or directly to the pre-aortic nodes.
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The prostate has multiple lymphatic drainage pathways. Name them all, lest you miss this easy multiple choice question on the exam.
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- mainly internal iliac and sacral nodes
- posterior surface to external iliac nodes - part of anterior surface to internal pudendal |
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Where do lymphatics in the rectum flow to?
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- Follows the drainage of the sigmoid colon, which means towards the inferior mesenteric and lumbar nodes.
- Inferior rectum goes via the middle rectal veins, which drains to the internal iliac nodes. - Anal canal lymphatics go to superficial inguinal nodes |
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Which spinal nerves supply the sacral plexus? Which two are the main nerves and what areas do they supply?
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- lumbosacral trunk (L4-L5) and the ventral rami of S1-S4.
- sciatic (L4-S3): gluteal region and posterior leg - and pudendal: perineum and external genitalia |
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How much about sympathetic innervation do you really know...
The median sacral nerve sends gray rami communicantes to each ventral ramus of the sacral plexus, which carries what type of nerve fibers? |
POSTganglionic SYMPATHETIC nerve fibers.
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What are the extensions of the prevertebral plexuses in the pelvis?
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- superior hypogastric plexus, which separates into the
- right and left hypogastric nerves that enter the pelvic inlet - as well as the inferior hypogastric plexuses (pelvix plexuses) on the lateral pelvic walls - the hypogastric plexuses in turn supply the rectal plexus, the uterovaginal plexus, the prostatic plexus, as well as the vesical plexus. |
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Under sympathetic innervation, which plexus is the hub for all autonomic control? Where does it receive sympathetic input from?
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The Inferior hypogastric plexus. It receives sympathetic input from the hypogastric and sacral splanchnic nerves.
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What are the two pathways that sympathetic neurons reach pelvic viscera?
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1. superior hypogastric plexus ---> inferior hypogastric plexus (hub) ---> subsidiary plexuses.
2. sacral splanchnic nerves from 2nd&3rd sacral sympathetic ganglia carry PRESYNAPTIC sympathetic fibers. |
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Where does the parasympathic nervous system arise from in the pelvis?
Where do they merge in the pelvis? |
Pelvic Splanchnic Nerves S2-S4
They merge at the inferior hypogastric plexus |
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The dilated terminal part of the rectum immediately above and supported by the pelvic diaphragm is called...?
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The ampulla of the rectum
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What is the anorectal flexure?
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A U-shaped sling of the puborectalis muscle around the rectum, which makes an abrupt 80 degree turn in the direction of the gut tube. During evacuation, it becomes a 130 degree shape. It becomes the ANAL CANAL as it perforates the pelvic diaphragm.
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Is the internal anal sphincter voluntary or involuntary?
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Involuntary. It receives parasympathetic innervation from pelvic splanchnic nerves when the rectum is overloaded, and can no longer withhold fluids.
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What is the name of the VOLUNTARY sphincter surrounding the anal canal?
Where do its striated muscles arise from? What are the 3 parts to it, from proximal inside to distal outside? What innervates it? |
The External Anal Sphincter, its perineal body arises from the central tendon of the perineum.
3 parts: deep, superficial, and subcutaneous. The superficial part has a tendinous attachment to the coccyx. The pudendal nerve. |
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What structures are present at the pectinate line?
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Anal valves up to the pectinate line, but below it there is only stratified squamous epithelium.
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How is blood supply different above and below the pectinate line?
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Superior to the line, the blood supply is the same as lymphatic drainage: superior rectal artery and vein (to the internal iliac nodes).
Inferior to the pectinate line: inferior and middle rectal arteries, venous drainage into caval system, lymphatics go into the superficial inguinal lymph nodes. |
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How do innervation above and below the pectinate line differ?
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Superior to: rectal plexus, sympathetic and parasympathetic, from the inferior hypogastric plexus.
Inferior to: inferior rectal nerves off of the pudendal nerve. |
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How does the type of innervation differ above and below the pectinate line?
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Above: only stretch sensation.
Below: somatic voluntary and cutaneous sensory. |
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Internal hemorrhoids are prolapses of rectal mucosa, containing dilated veins of what?
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The internal rectal venous plexus. It is external rectal venous plexus for external hemorrhoids.
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How does the urethra differ between the male and female anatomy?
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The male urethra must pass through the prostate after leaving the bladder, in the female it is short and leaves the pelvic cavity immediately through a hole in the pelvic diaphragm.
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What separate the bladder and the pubic bones?
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the retropubic space
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What happens to the position of the bladder when it fills?
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when filling, the bladder ascends in the extraperitoneal fat of the anterior abdominal wall into the pelvis.
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Where does the base of the bladder rest in males and females?
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In males, it rests on the rectum, in females, it rests on the vagina.
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What is the most fixed region of the bladder and what holds it there?
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The neck region of the bladder, it is held in place by PUBOVESICAL (females), PUBOPROSTATIC (males) ligaments.
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What is the name of the smooth mucous membrane inside of the bladder?
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vesical trigone
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What mark the apices of the triangle in the bladder?
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The ureteric orifices and the internal urethral orifice.
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What type of muscle is the wall of the bladder made of?
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Detrusor
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What is the name of the circular collar of smooth muscle in the neck of the male bladder?
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Involuntary internal sphincter
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In the female, what are the wall muscles in the neck of the bladder continous with?
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The urethra.
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How does blood reach the bladder?
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Superior and Inferior vesical arteries and veins, branches of the internal iliac artery and veins. In addition in the female, you have blood from the obturator and inferior gluteal artery, the uterine as well as the vaginal arteries.
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How is lymph drained in the bladder?
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Superior surface --> external iliac lymph nodes
fundus --> internal iliac lymph nodes |
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How do you slow urine formation/collection?
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Sympathetics from T11-L2 cause vasoconstriction of the renal vessels, they also in the male maintain contraction of the internal sphincter.
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How do you increase urine collection
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Parasympathetic splanchnics S2-S4 travel through the vesical nerve plexus to motor innervate the detrusor muscle, as well as inhibit contraction of the internal sphincter.
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How do sensory nerves travel to the bladder, and what sensation are they concerned with?
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Sensory fibers follow the same path as sympathetics and parasympathetics to detect distension in the bladder.
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What are the proximal and distal points of the male urethra, and what are its 4 divisions?
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Internal urethral orifice and the external meatus at the end of the penis.
divisions: preprostatic, prostatic, membranous/intermediate (in the pelvis), and spongy (in the penis). |
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What is the preprostatic sphincter and what does it do?
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It is a collar of smooth muscle surrounding the bladder neck near the superior prostate. It prevents retrograde flow of ejaculate through the proximal urethra into the bladder. It is often disrupted during prostectomy.
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What do the prostatic sinuses border?
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The urethral crest, and the prostatic ducts open into these.
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What are two structures located at the ejaculatory ducts?
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Collicus Seminalis
Prostatic Utricle |
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Where does the membranous urethra extend from and to? What important structure is continuous with the membranous urethra's CIRCULAR STRIATED MUSCLE?
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Prostate to the bulb of the penis.
External urethral sphincter. |
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What are the limits of the spongy urethra?
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Below the perineal membrane, from the 35 degree flexure of the membranous portion all the way to the pubic symphysis.
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Clinical consideration:
What two significant curves should be considered when inserting a catheter? |
Proximally, the prostatic urethra curves anteriorly through the prostate.
Distally, the membranous urethra runs inferoanteriorly as it passes through the external urethral sphincter. Careful, the urethral wall is very thin and can be ruptured when inserting a catheter. |
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Where do the membranous and spongy parts of the urethra receive their blood supply from?
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The internal pudendal artery
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Where do the preprostatic and prostatic urethral sections receive their blood supply from?
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The inferior vesical and middle rectal arteries
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Where does lymphatics of the 4 divisions of the urethra flow to?
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The internal iliac lymph nodes for the proximal 3. The spongy section goes to the deep inguinal lymph nodes.
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How is the urethra innervated?
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Via the pudendal nerve and the prostatic plexus of the autonomic nervous system (the inferior hypogastric plexus).
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What effect does sympathetic innvervation have on the preprostatic sphincter during ejaculation?
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Sympathetic (shoot) causes CONTRACTION of the preprostatic sphincter so that you don't get reflux of ejaculate into the bladder.
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True or false:
The female urethra is more distensible than the males. |
True.
It is composed of elastic tissue and smooth muscle, and DOES NOT have an internal sphincter, therefore it is more distensible, and the passage of catheters through it is much is of more ease and less pain. |
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What is the only blood supply to the female urethra?
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The internal pudendal and vaginal arteries.
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Where do lymphatics of the female urethra pass to?
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Sacral and internal iliac nodes.
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The ductus deferens is a continuation of what structure?
Where does it join up with the seminal vesicle? |
The epididymis.
It meets up with the seminal vesicle in the inguinal canal, inside of the spermatic cord. Once they meet, they are the ejaculatory duct. |
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What do the vas deferens' respective arteries come off of?
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Branches off the inferior vesical, which anastomose with the testicular arteries.
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Autonomic innvervation to the ductus deferens is mainly sympathetic or parasympathetic?
From which plexus does innervation arise to it? |
Sympathetic
Pelvic Plexus rapid contraction for expulsion of sperm. |
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What is the anatomical location of the seminal vesicles?
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Between the bladder and the rectum, superior to the prostate.
Between the seminal vesicles and the rectum is the RECTOVESICAL POUCH. |
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What supplies blood to the seminal vesicals?
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Inferior vesical artery and middle rectal artery
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What supplies blood to the ejaculatory ducts?
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Deferential arteries which branch off the inferior vesical artery
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What structures hit each of the surfaces of the prostate?
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base (top): bladder
posterior: rectum inferolateral surface: levator ani anterior (muscular): pubic symphysis -with retroperitoneal fat between note!!! the base is at the TOP! and the apex is at the BOTTOM! |
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How does an enlarged bladder obstruct urination?
How could you examine for an enlarged prostate? |
By distorting the PROSTATIC URETHRA or obstructing the INTERNAL URETHRAL ORIFICE.
The prostate sits on the rectum, so you can feel it rectally. |
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How is blood supplied to the prostate?
How about venous drainage of the prostate? |
Inferior vesical artery
internal pudendal artery Middle rectal artery Venous: vertebral venous plexus (this is why prostatic cancer can spread easily to the spine) internal iliac veins |
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What are the five major portions of the uterus, and what is its anatomical location?
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anatomical location: on top of the bladder, with its neck between the bladder and rectum
the body: upper two thirds isthmus: lower third uterine tubes: enter on top fundus: the dome between the uterine tubes. cervix: cynlindrical, narrow inferior part of the uterus protruding into the vagina. |
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What do the extensions of peritoneum off of the uterus become?
What are its divisions? |
The broad ligaments
divisions: mesosalpinx, mesovarium, mesometrium |
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What 3 other ligaments support the uterus?
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1. cardinal or transverse cervical ligament: from broad ligament, lateral pelvic wall to cervix
2. uterosacral ligament: sacrum to cervix 3. pubocervical ligament: pubis to cervix |
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What region of the posterior abdominal wall do the ovaries develop in?
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The superior lumbar region, same as the testes in the male.
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What pathway does the processus vaginalis take?
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through the inguinal canal to the labius majorus
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What is the gubernaculum? What does it become?
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Fibrous cord that connects the obary and primordial uterus
Gubernaculum becomes the ROUND ligament and PROPER OVARIAN ligament |
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What lies in the mesosalpinx of the broad ligament?
What supplies blood to these structures? |
The uterine tubes. Note that salpinx means "2", there are a "pair" of uterine tubes.
Uterine and Ovarian arteries |
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What are the 4 divisions of the uterine tubes?
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1. infundibulum: funnel shaped distal end including fimbriae
2. ampulla: next most proximal section, where fertilization usually happens 3. isthmus: thick-walled portion, lateral to uterus 4. uterine part: passes through uterine wall into uterine cavity AKA the interstitial part of the tube |
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What can infections of the vagina, uterus or uterine tube lead to?
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PERITONITIS, because they are all continuous with the peritoneum.
The vice versa can happen, with infection from the peritoneum spreading to the uterine tube - SALPINGITIS. |
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What is the most common site of ectopic pregnancy?
What happens if they rupture? |
The ampulla of the uterine tube.
Rupture will hemorrhage the pregnancy into the abdominopelvic cavity. |
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What two structures suspend the ovaries?
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The mesovarium and broad ligament
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What does the SUSPENSORY ligament of the ovary connect to?
What does the PROPER ovarian ligament connect the ovaries to? |
The lateral pelvic wall
the uterus |
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What supplies blood to the ovaries?
veinous drainage? |
ovarian arteries (off of the aorta) which anastamose with the uterine artery.
ovarian veins |
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What are the limits of the vagina?
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The uterus and the vestibule (b/w the labia minora)
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Because the vagina extends to the posterior of the cervix, the anterior of the cervix protrudes forward, what is this recess called?
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the vaginal fornix.
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What is the arterial supply to the vagina?
innvervation? |
to superior part: uterine artery
middle and inferior: vaginal artery superior: vaginal plexus and pelvic splanchnic nerves lower: pudendal nerve |
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BONUS FLASHCARD:
where do sacral and pelvic splanchnic nerves come off of, and where do they project to? |
Sacral Splanchnic Nerves come from the Sympathetic Trunk, while Pelvic Splanchnic Nerves come from the S2-4 spinal segments.
BOTH project to the Inferior Hypogastric Plexus. |
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Are pelvic and sacral splanchnic nerves sympathetic or parasympathetic?
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Pelvic Splanchnic Nerves = Parasympathetic
Sacral Splanchnic Nerves = Sympathetic |
