Perineum And Pelvis P. 267-275

Front 1

where does rectum extend?

Back 1

sigmoid colon to anal canal and follows curvature of sacrum and coccyx

Front 2

what's the purpose of the rectum's ampulla? where is it?

Back 2

stores feces
lies immediately above pelvic diaphragm

Front 3

what are the rectum's Houston's valves? what are they formed by? what's their func?

Back 3

houston's valves = 3 permanent transverse folds
formed by circular muscle layer
supports fecal mass

Front 4

what's the arterial blood supply for the rectum?

Back 4

superior, middle, inferior rectal arteries and middle sacral artery
*superior rectal a pierces muscular wall and courses in submucosal layer to anastomose w/ inferior rectal a
*middle rectal a supplies posterior part of rectum

Front 5

describe the venous supply for the rectum:

Back 5

*venous blood returns to portal venous system via superior rectal vein
*returns to caval system via middle and inferior rectal vv
*middle rectal v drains mostly muscular layer of lower part of rectum and upper part of anal canal

Front 6

what innerv the rectum?

Back 6

parasymp nerve fibers by pelvic splanchnic n

Front 7

what's diverticulitis? how does it develop?

Back 7

inflamm of abnormal pouch (diverticulum) in intestinal wall, commonly in colon, esp sigmoid colon
*diverticula develops from high pressure w/i colon

Front 8

what might rectal cancer metastasize to? why?

Back 8

to liver b/c superior rectal vein is tributary to portal v
or to sacral plexus by penetrating posteriorly --> sciatica
or to ureter by lateral invasion
or vagina, uterus, bladder, prostate or seminal vesicles by anterior invasion

Front 9

contrast internal and external anal sphincter: what separates them?

Back 9

int- thickening of circular smooth muscle in lower part of rectum
ext- skel muscle that has 3 parts: subcutaneous, superficial and deep
*sep by Hilton's white line (intermuscular /intersphincteric) groove

Front 10

what's the point of demarcation b/w visceral and somatic parts?

Back 10

pectinate/dentate line

Front 11

descibe diff in epithelium above and below pectinate line?

Back 11

above: cuboidal or columnar
below: stratified squamous

Front 12

describe drainage about pectinate line:

Back 12

above line --> portal venous system by superior rectal v
below --> caval system by middle and inferior rectal vv

Front 13

describe lymphatic drainiage about pectinate line:

Back 13

above: internal iliac nodes
below: superficial inguinal nodes

Front 14

describe sensory about pectinate line:

Back 14

above: pelvic plexus fibers: visceral
below: somatic nerve fibers of pudendal n

Front 15

describe hemorrhoids about pectinate line:

Back 15

above: internal hemorrhoids
below: external hemorrhoids

Front 16

describe diff in innerv of diff types of hemorrhoids:

Back 16

internal: GVA of symp
external: GSA of inferior rectal n

Front 17

compare contrast splanchnic n vs sympathetics:

Back 17

pelvic splanchnic n: inc peristalsis
symp n: decreases peristalsis, maintains tone in internal sphincter, has vasomotor and sensory (pain) fibers

Front 18

what does the iliolumbar a supply?

Back 18

iliac branch: ilacus muscle, ilium
lumbar branch: psoas major and quadratus lumborum

Front 19

what a runs b/w lumbosacral trunk and 1st sacral n?

Back 19

superior gluteal a

Front 20

what does the lateral sacral a supply?

Back 20

spinal meninges and roots of sacral nn
muscles and skin overlying scrotum

Front 21

what does the superior gluteal a supply?

Back 21

buttocks muscle

Front 22

which internal iliac a branch leaves pelvis thru greater sciatic foramen? where?

Back 22

above piriformis: superior gluteal a
below piriformis: inferior gluteal a
b/w piriformis and coccygeus: internal pudendal a and enters perineum thru lesser sciatic foramen

Front 23

what a runs b/w 1st and 2nd or b/w 2nd and 3rd sacral n?

Back 23

inferior gluteal a

Front 24

what a leaves greater sciatic foramen and enters lesser sciatic foramen?

Back 24

internal pudendal a

Front 25

what does umbilical a supply?

Back 25

superior vesical a --> superior part of bladder
artery of ductus deferens--> ductus deferens, seminal vesicles, lower part of ureter, bladder

Front 26

which a has distal part that's obliterated and continues forwards as medial umbilical ligament?

Back 26

umbilical a

Front 27

what a is susceptible to damage during hernia complications? why?

Back 27

obturator a b/c passes close to or across femoral canal to reach obturator foramen

Front 28

what does the obturator a supply?

Back 28

thigh muscles

Front 29

what a corresponds to vaginal a?

Back 29

inferior vesical a

Front 30

what does inferior vesical a supply?

Back 30

bladder fundus
prostate gland
seminal vesicles
ductus deferens
lower part of ureter

Front 31

what does vaginal a come from?

Back 31

uterine a
internal iliac a

Front 32

what does middle rectal a supply?

Back 32

muscular layer of lower part of rectum and upper part of anal canal
supplies prostate gland and seminal vesicles or vagina and ureter

Front 33

what is uterine a homologous to?

Back 33

artery of ductus deferens

Front 34

what a does uterine a come from? how does it end?

Back 34

internal iliac a or in common w/ vaginal or middle rectal a
ends in ovarian a

Front 35

what does uterine a supply?

Back 35

superior branch: uterus body and fundus
vaginal branch: cervix and vagina

Front 36

what is the superior rectal a a direct continuation of?

Back 36

inferior mesenteric a

Front 37

what does median sacral a supply?

Back 37

posterior part of rectum

Front 38

what a does ovarian a come from? how does it reach ovary?

Back 38

abdominal aorta
*reaches ovary via suspensory ligament of ovary

Front 39

what might pelvis cancer cells metastasize to? how?

Back 39

vertebral column, spinal cord, brain via connections of pelvic vv w/ vertebral venous plexus and cranial dural sinus

Front 40

what might prostatic or uterine cancer metastasize to? how?

Back 40

can spread to heart and lungs via internal iliac vv draining prostatic or vesical venous plexus into IVC

Front 41

lymph vessels from the ovary, uterine tube and fundus follow what? drain into what?

Back 41

ovarian artery and drain into para-aortic nodes

Front 42

lymph vessels from uterine body and cervix and bladder drain into what?

Back 42

internal and external iliac nodes

Front 43

lymph vessels from the prostate and rectum (lower part) drain into what?

Back 43

internal iliac nodes

Front 44

what's the sacral plexus formed by? where is it?

Back 44

4th and 5th lumbar ventral rami (lumbosacral trunk) and 1st 4 sacral ventral rami
*lies largely on internal surface of piriformis muscle in pelvis

Front 45

what n leaves the pelvis thru the grtr sciatic foramen above piriformis?

Back 45

superior gluteal n (L4, L5, S1)

Front 46

what n leaves pelvis thru grtr sciatic foramen below piriformis?

Back 46

inferior gluteal n (L5-S2)
sciatic n (L4-S3)
n to obturator internus muscle (L5-S2)
n to quadratus femoris muscle (L5-S1)
posterior femoral cutaneous n (S1-S3)
pudendal n (S2-S4)

Front 47

what does the superior gluteal n innerv?

Back 47

gluteus medius
gluteus minimus
tensor fascia lata muscles

Front 48

what does inferior gluteal n innerv?

Back 48

gluteus max

Front 49

what is the largest n in the body? parts? where does it enter thigh?

Back 49

sciatic
made of peroneal and tibial parts
enters thigh in hollow b/w ischial tuberosity and greater trochanter of femur

Front 50

what does the n to obturator internus muscle innerv?

Back 50

obturator internus
superior gemellus

Front 51

what does n to quadratus femoris muscle innerv?

Back 51

quadratus femoris
inferior gemellus

Front 52

what n lies alongside sciatic n and descends on back of knee? what does it branch into?

Back 52

posterior femoral cutaneous n (S1, S2, S3)
branches into inferior cluneal nn and perineal branches

Front 53

what's the lateral extension of superior hypogastric plexus that lies in extraperitoneal conn tissue lateral to rectum?

Back 53

hypogastric n

Front 54

what type of ganglia does inferior hypogastric plexus have? types of nn plexus has?

Back 54

pelvic ganglia
fibers synapse: pregang and post gang symp, pregang and postgang parasymp
visceral afferent fibers

Front 55

what type of fibers are sacral splanchnic nn?

Back 55

pregang symp that synapse in inferior hypogastric (pelvic) plexus