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119 Cards in this Set

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urinary bladder is located _______ in pelvic (abdominal) cavity
retroperitoneally
urinary bladder is covered only on its
superior surface
in males, the peritoneum reflects posteriorly as
rectovesical pouch
in females, the uterus & vagina lie between these two structures
the rectum & the bladder
in females, the peritoneum reflects as
uterovasical pouch & rectouterine pouch
urinary bladder has thick smooth muscular wall known as
detrusor muscle
detrusor muscle is extremely
distensible
urinary bladder, portions of
body, neck, apex, base, fundus
body of urinary bladder is
main portion
neck of bladder lies
inferior
apex of bladder lies
anterior/anterosuperior and is continuous with median umbilical ligament
base of bladder lies
posterior
fundus of bladder, location
dependent upon amount of urine in bladder
trigone
internal triangular area in bladder; contains openings of right & left ureters & urethra
mucosa of urinary bladder adheres to
smooth muscle in the area of the trigone (looks smooth)
urinary bladder, other than trigone, contains
rugae (folds)
urinary bladder lies posterior to
pubic bone
space between urinary bladder & pubic bone known as
retropubic space (of Retzius)
in females, urinary bladder lies anterior to
the vagina (mainly) & the uterus
in females, urinary bladder lies inferior to
the uterus (with ileum)
in males, the urinary bladder lies anterior to
the seminal vesicle and the ductus deferens
in either sex, the pelvic diaphragm lies
lateral to the urinary bladder
in females, pelvic & UG diaphragms lie
inferior to urinary bladder (bladder rests on diaphragm)
in males, the prostate lies
inferior to the urinary bladder
ureters take an oblique course through the
bladder wall
ureters act as a
"sphincter" preventing backflow of urine when bladder contracts
ligaments that hold urinary bladder, in males
puboprostatic
ligaments that hold urinary bladder, in females
pubovesical
urethral sphincter located in
deep perineal space
uritheral sphincter aka
sphincter urethrae muscle
sphincter urethrae mm innervated by
perineal branch of pudendal n. (somatic innervation)
superior vesical a. is a branch of
umbilical a.; provides several branches to anterosuperior aspect
inferior vesical a. is a branch of
the vaginal a. (in females) or the internal iliac a.
portion of fundus of bladder is supplied by
vaginal a. in females & deferential a. in males
veins of pelvis
names correspond to aa and form vesical plexus
in males, vesical plexus drains to
prostatic plexus
prostatic plexus drains to
internal iliac vein, vertebral venous plexus
in females, vesical plexus drains to
uterovaginal plexus
uterovaginal plexus drains to
internal iliac vein, vertebral venous plexus
urinary bladder, lymphatics - superior surface goes to
external iliac nodes
urinary bladder, lymphatics - fundus goes to
internal iliac nodes
urinary bladder, lymphatics - neck to
sacral & common iliac nodes
mictruition reflex, nn responsible for
parasympathetics (S2-4) & their visceral afferent fibers
mictruition reflex, impulses travel
from stretch receptors within bladder to drosal root ganglia S2-4; parasympathetics act on detrusor to expel urine
sympathetic nn cause
contraction of internal sphincter (smooth muscle) of bladder
sympathetic nn have two routes to bladder
superior hypogastric plexus (main route) and sacral splanchnics (fibers that course down chain ganglia to pelvis)
pain from bladder courses with
visceral afferents that travel with sympathetics (T11-L2)
pudendal n, levels
S2-4
pudendal n, type
somatic
deep perineal n. is a branch of
pudendal n.
deep perineal n. innervates
sphincter urethrae m of deep perineal space
muscle within UGD is
voluntary (external) sphincter
rectum means
straight
rectum begins
at SV3 as continuation of sigmoid colon
rectum passses through pelvic diaphragm and becomes
anal canal (renamed)
rectum is located
in pelvis
anal canal is locates
in perineum (ischioanal fossa of anal triangle)
upper 1/3 of rectum is
retroperitoneal
upper 1/3 of rectum is covered on
anterior & lateral sides only
middle 1/3 of rectum is
retroperitoneal
middle 1/3 of recrum is covered on
anterior surface only
lowest 1/3 of rectum is
inferior to perineum
upper 2/3 of rectum has
serosa
lower 2/3 of rectum has
adventitia
major internal feature of rectum
three transverse folds ("valves of Houston")
function of valves of Houston
support fecal mass
composition of valves of Houston
circular smooth muscle, submucosa, & mucosa; causes curvatures
rectal ampulla is
bulge just superior to pelvic diaphragm
these spread out to form anterior & posterior muscle bands on rectum
teniae coli
anal canal has
90 degree angle, directed posterior, from rectal ampulla due to pubocrectalis m.
internal sphincter of anal canal
involuntary, circular smooth m. and innervated by ANS
extrenal sphincter of anal canal
voluntary, skeletal m. and innervated by inferior rectal n. (branch of pudendal n)
portions of anal canal
subcutaneous, superficial, & deep
Hilton's white line aka
intersphincteric line
Hilton's white line is site
where internal & external sphincters meet
Hilton's white line lies inferior to the
(important) pectinate line (divide line)
longitudinal m passes between
sphincters and some fibers form corrugator cutis ani
superficial part of external sphincter attaches to
perinal body & coccyx
anal columns are
vertical folds of mucosa caused by veins
anal sinuses are
depressions between columns
anal valves connect
bases of contiguous columns by bridging across sinuses
anal valves form
pectinate line, which serves as a "divide" line with respect to vasculature & innervation
arterial supply to rectum & anal canal
superior rectal a, middle rectal a, & inferior rectal a.
superior rectal a. is
chief a to rectum
superior rectal a. is terminal branch of
IMA
superior rectal a. unpaired, but divides when
reaching rectum
superior rectal a. supplies submucosa
above pectinate line
middle rectal a. arises from
internal iliac "system," often from the internal iliac itself or from internal pudendal or from another branch
middle rectal a. courses superior to
pelvic diaphragm
middle rectal a. supplies
muscle
inferior rectal a. arises from
internal pudendal
internal rectal a. courses
inferior to pelvic diaphragm
inferior rectal a. supplies submucosa
below pectinate line
middle (median) sacral a. provides minor supply to
rectum & anus
superior & inferior rectal vv drain
submucosa, above & below pectinate line, respectively
veins of rectum & anus are
a major site of porta-caval anastomoses
superior rectal vv drain to portal system via
splenic or SMV, or portal directly
middle & inferior rectal vv. Drain to
IVC via internal iliac
hemorrhoids
suck
pectinate line serves as divide line for
lymphatics
below pectinate line, lymphatics drain
to superficial inguinal nodes (in groin)
above pectinate line, lymphatics drain
to pararectal nodes
pararectal nodes follow blood vessels to
internal iliac nodes for middle & inferior rectal vessels & inferior mesenteric nodes for superior rectal vessels
muscle of rectum is
smooth muscle
muscle of rectum innervated by _____ types of nerves
visceral; sympathetic & parasympathetic
external anal sphincter is
skeletal muscle & receives inferior rectal branch of pudendal n.
parasympathetics act to
increase peristalsis & decrease tone of internal sphincter
sympathetics act to
decrease peristalsis & increase tone of internal sphincter
innervation superior to pectinate line supplied by
visceral afferents that course with the sympathetics (L1 & L2) and with the parasympathetics (S2-4)
inferior to pectinate line supplied by
somatic innervation (pudendal n.)
internal iliac a., posterior division goes to
superior gluteal (exits superior to piriformis), lateral sacral, & iliolumbar
internal iliac a., anterior division goes to
umbilical, obturator, inferior vesical, middle rectal (in females, uterine & vaginal)
terminal branches of internal iliac aa.
internal pudendal & inferior gluteal
sacral plexus formed by
ventral rami L4-S3
anterior division of sacral plexus consists of
tibial, n. obturator internus, n. quadratus femoris
posterior division of sacral plexus consists of
common fibular, superior gluteal, inferior gluteal
peritoneum covers the
uterus
peritoneum reflects onto
rectum & bladder
rectouterine pouch aka
pouch of Douglas