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46 Cards in this Set
- Front
- Back
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Urinary Bladder (Relations) |
Extraperitoneal immediately posterior to the pubic symphysis Trigone (triangular base) adherent to the pelvic floor Neck anchored by ligaments to the pelvic floor and body of the pubis: Puboprostatic (Male) Pubovesical (Female) |
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Urinary Bladder (Anatomy) |
Trigone: Anterioinferior ends - Urethral opening Posterolateral angle - Ureters enter Walls: Composed of detrusor muscle Urethral opening - internal sphincter (smooth muscle) |
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Urinary Bladder (Innervation) |
Males: Sympathetic supply to the bladder neck to close during ejaculation Micturition - Pelvic Splanchnics S2-4 Preganglionic sympathetic fibres: L1-2 Postganglionic fibres: Hypogastric plexus |
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Urinary Bladder (Blood Supply) |
Internal Iliac artery --> Superior & Inferior vesicular arteries Females - Uterine artery --> Vesicular branches (base of bladder) Vesical plexus (base of bladder) --> Internal Iliac veins Male - Prostatic venous plexus |
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Rectum (Path) |
Starts anterior to S3 Downwards into the sacral concavity Turns forwards at the coccyx as the ampulla (dilated) Bends sharply backwards and passes through: Pelvic diaphragm Puborectal sling Becomes the anal canal |
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Rectum (Blood supply) |
Inferior Mesenteric artery --> Superior Rectal artery Middle rectal artery - Supply to the muscular wall |
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Rectum (Innervation) |
Sympathetic L1-2 Hypogastric Plexus Coeliac Plexus - Along inferior mesenteric and superior rectal arteries Parasympathetic Pelvis Splanchnic nerves (S2-4) |
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Prostate Gland |
Urethra passes through Posterior wall of the urethra pushes forward into the urethral lumen forming the seminal colliculus / verumontanum Prostate gland adds secretions to seminal fluid via ducts - either side of the colliculus Right & Left Puboprostatic ligaments - Connect to posterior Pubis Blood Supply: Inferior Vesical artery Middle Rectal artery |
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Vas Deferens (Path) |
Deep inguinal ring - Enters abdominal cavity Crosses the medial surface of the external iliac vessels and the pelvic brim to enter the pelvic cavity Posterosuperior border of the bladder - Turns medially Posterior to bladder - Dilated to form Ampulla Base of the Prostate Gland - Narrows Unites with seminal vesicle duct to form the ejaculatory duct 2 Ejaculatory ducts pierce the prostate Run obliquely Opens onto the seminal colliculus |
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Vas Deferens and Seminal Vesicle (Blood Supply) |
Vas Deferens Superior Vesical artery --> Artery to the Vas (all the way to the lower pole of the Epididymis) Seminal Vesicles Branches of inferior vesicle artery |
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Vas Deferens (Innervation) |
Intrapelvic - Same as bladder In Spermatic Cord - Same as testis |
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Testis (Anatomy) |
Suspended in the scrotum on the pedicles of the spermatic cords Migrates through the inguinal canal so has a double layer of peritoneum (tunica vaginalis) Residual connection to the peritoneum is obliterated - Processus Vaginalis Covered by Tunica Alburginea - Aids movement of Spermatazoa into the epididymis Epididymis: Head - Upper pole of testis Body - Posterior to the testis Tail - Continuous with the Vas Deferens |
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Testis (Supply) |
Blood Abdominal aorta --> Testicular artery Pampiniform plexus --> Testicular veins --> IVC (right) or Left Renal vein (left) Lymph Para-aortic Nodes Nerve Visceral afferents run with sympathetic efferents of T10 Pain referred to Periumbilical region NO PARASYMPATHETIC SUPPLY |
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Uterus (Anatomy) |
Hollow, antiflexed organ with thick fibromuscular walls that is mobile Fundus - Broad upper end covered by peritoneum Body - Uterine tubes are attached at the cornua Cervix - Projects into the Vagina. Upper end - Internal Os. Lower end - External Os (invaginated into the anterior wall of the vagina at a right-angle) Fornix - Part of the vagina that envelops the cervix. Divided into anterior, posterior and 2 lateral fornices |
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Uterine tubes (Parts) |
Interstitial part - Within the uterine wall Isthmus - Half nearest to the uterus with a narrow lumen Ampulla - Lateral to the isthmus and widens gradually Infundibulum - Widens significantly and opens into the peritoneal cavity Contains fimbriae (partly erectile), one connects to the ovary and grasps it during ovulation |
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Uterus (Supply) |
Blood Supply Uterine artery - Passes medially in the base of the broad ligament Across and above the ureter Abdominal Aorta --> Ovarian Arteries Autonomic supply Sympathtic: T10-L1 (hypogastric plexus) Parasympathetic: Pelvic Splanchnic nerves (S2-4) |
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Uterus (Ligaments) |
Visceral Peritoneum - Anterior, Superior and Posterior surfaces of the uterus and tubes Broad Ligament - Inferior borders of the tubes & Lateral borders of the body. Anterior and Posterior tubes extend and attach to the pelvic floor and lateral pelvic wall Round Ligament - From the junction of the uterus and tubes to the labium majus of the vulva Runs in between layers of the broad ligament Crosses the pelvic rim and goes through the inguinal canal Pubocervical Ligament - Pubis around th bladder to the cervix Cardinal Ligament - Connective tissue bands that run in the broad ligament Lateral pelvic wall to the junction of the cervix and vagina Uterosacral ligament - Uterine isthmus to the sacrum on both sides Lateral to the rectum Raises a visible ridge in the parietal peritoneum |
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Ovary |
Occupies ovarian fossa on the lateral pelvic wall Bulges out form the posterior layer of the broad ligament Mesovarium - attachment to broad ligament Suspentory ligament of the ovary - Raised part of the broad ligament that contains the ovarian vessels Ligament of the ovary - Between the layers of the round ligament to the uterus (level of the uterine tube) Continuous with the round ligament Ovarian artery (direct abdominal aorta branch) Lymphatic drainage is to the para-aortic nodes Sympathetics to T10 - pain reffered to the periumbilical region No parasympathetic supply |
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Ovary (Relations) |
Behind - ureter Lateral - Obturator neurovascular bundle |
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Peritoneal Pouches in Females |
Recto-uterine pouch - Visceral peritoneum on the posterior surface of the uterus continues to the posterior fornix of the vagina and turns backwards into the anterior side of the rectum Vesicouterine pouch - Between the uterus and the bladder |
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Peritoneal pouches in Males |
Rectovesical pouch - Rectum onto the base of the upper part of the bladder In both the male and female pouches abnormal intraperitoneal material may collect in them |
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Internal iliac artery |
Descends to the greater sciatic notch Divides into anterior and posterior trunks that give parietal and visceral branches Visceral branches: Superior and inferior rectal arteries Middle rectal artery Uterine artery Parietal branches: Obturator artery Internal pudendal artery Superior and inferior you real arteries |
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Superior Hypogastric plexus |
Continuation of the aortic plexus with branches from the 3rd and 4th lumbar vertebrae Lies on the sacral promontory between common Iliac arteries Gives branches to the following plexuses: Ureteric Gonadal Common Iliac Divides into the inferior hypogastric plexus |
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Inferior Hypogastric Plexus |
Lies on each side of the rectum Sympathetic (mostly postganglionic) - From Superior Hypogastric Plexus Parasympatheetic (preganglionic) - From Pelvic Splanchnic nerves Collectively known as the pelvic plexuses: Rectal Vesical Prostatic (Male) Uterovaginal (Female) |
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What is the pelvic wall made of? |
2 inominate bones Sacrum Coccyx Piriformis and its fascia Obturator Internus and its fascia |
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What is the pelvic floor made of? |
Levator Ani Coccygeus |
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Levator Ani |
Origin: Pubic bone and Obturator Internus Fascia Insertion: Coccyx Anococcygeal Raphe (between the anorectal junction and the coccyx) Perineal Body (between the Anal Canal and the Prostate/Vagina) Parts: Puborectalis - From the posterior pubis and forms a sling around the anorecatal junction Pubococcygeus - Posterior pubis to Anococcygeal Raphae (compromises the puboprostaticus/pubovaginalis and puboanalis) Iliococygeus - From the arcus tendineus on the obturator fascia and the ischium. Inserts into the anococcygeal raphae |
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Coccygeus |
Origin: Ischial spine Insertion: Lower part of the sacrum and the coccyx Innervation: S3&4 and pudendal nerve Fibres lie parallel to the sacrospinous ligament, but the muscle is anterior to it |
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What is the Perineum? |
Part of the pelvic outlet lying caudal to the pelvic floor Borders: Anterior - Pubic Symphysis Lateral - Ischial tuberosities Posterior - Coccyx |
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What is the Perineum divided by? |
Transverse line between the ischial tuberosities Posterior - Anal triangle Anterior - Urogenital triangle |
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Perineal Membrane |
Fibrous sheet that fills the urogenital triangle Lateral - 2 Ischiopubic rami Posterior - Anchored to the Perineal body (midline) and Colles' fascia (continuation of Scarpas fascia - fibrous layer running throught eh subcutaneous tissue of the abdominal wall) Membrane pieced by: Urethra Vagina Foramina (for nerves and vessels) |
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Perineal Body |
Fibromuscular mass of tissue Midline between urogenital and anal triangles Formed by: Interdigiating fibres of puboprostaticus / pubovaginalis Superficial and deep transverse perineal muscles External Anal sphincter Bulbospongiosus Aka Central tendon of the perineum (important in maintaining the integrity of the pelvic floor and perineum) |
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Deep Perineal Pouch |
Superior to the perineal membrane Bounded by the inferior surface of levator ani Contents: Membranous urethra and external urethral sphincter Cowpers (bulbourethral) glands - male Deep transverse perineal muscle Anterior prolongations of the ischioanal fossa Nerves and Vessels (Penis/Clitoris) |
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Superficial Perineal Pouch |
Between Perineal Membrane and Colles' fascia Contents: External genitalia Isciocavernosus Bulbospongiosus Superficial transverse perineal muscle Greater vestibular / Bartholin's glands - Female |
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Anal Triangle |
Contains Anal canal and ischioanal fossa (with its contents) Borders: Lateral - Sacrotuberous Ligaments (Covered by the lower border of gluteus maximus) Base - Line between the anterior parts of the ischial tuberosities Apex - Tip of the coccyx |
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Anal Canal: Path and Lining |
Start: From the Anorectal junction (at the puborectalis sling of levator ani) Finish: Anocutaneous junction Lining: Upper 2/3 - Mucus, Lower 1/3 - Skin Mucocutaneous junction has a white line shows the embryological division of endoderm vs ectoderm Blood supply - Superior vs Inferior rectal Innervation - Autonomic vs Somatic Lymphatic Drainage - Internal Iliac vs superficial inguinal nodes |
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Anal Canal: Sphincters |
Internal Sphincter: Smooth muscle covering the upper 2/3 of the anal canal Thickening of the circular muscle of the rectum Supplied by parasympathetics External Sphincter: Striated muscle covering the lower 2/3 of the anal canal 3 Parts - Deep (Fused posteriorly with puborectalis) Superficial (Attached anteriorly to the perineal body) Subcutaneous (Deep to the perineal skin) |
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Ischioanal Fossae |
Anal canal is surrounded by fatty tissue (allows it to expand) - Space occupird is the ischioanal fossa Both sides are continuous with each other anterior and posterior to the anal canal Bounded by the ischial tuberosities and the anal canal Anterior Recess - Fat extends forwards between the upper surface of the perineal membrane and lower surface of the pelvic diaphragm on the lateral sides of the external urethral sphincter Contents: Pudendal tunnel - Fascial tunnel in the lateral wall of each fossa. Pudendal vessels and nerves run through this tunnel (They give the inferior rectal vessels and nerves) |
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Vulva |
Female external genitalia is made of: Mons Pubis - fatty protuberance over the pubic symphysis Labia Majora - Hair and extends posteriorly from the Mons Labia Minora - No Hair and Inner folds united posteriorly at the fourchette Vestibule: Space between the labia minora. Urethra opens anteriorly into it, Vagina posteriorly Clitoris: Anterior to urethral opening Ischiocavernosus muscles attach it to the ischiopubic ramus Homologous to penis (2 corpora cavernosa and a small glans) Vestibular Bulb: 2 erectile tissue masses (superficial to the perineal membrane on each side of the vaginal opening) Covered by Bulbospongiosus Posterior - 2 Greater Vestibular (Bartholin's) glands wheich drain anteriorly |
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Penis |
Root: Crura - Attaches to the perineal membrane (ischiopubic rami) Suspentory ligament - Pubic symphysis Body: 2 Lateral Corpora Cavernosa Divide posteriorly to form the crura Covered by Ischiocavernosus muscles Intervening septum Central Corpus Spongiosum Starts at the Perineal membrane (as an enlargement of the bulb) Runs in a groove on the inferior surface of the other 2 muscles Surrounded by bulbospongiosus muscle Glans: Expansion of the corpus spongiosum over the corpora cavernosa External Urethral Meatus - Tip of glans Prepuce - Foreskin attached to the glans by the frenelum Frenelum - Fold of mucous membrane Bucks Fascia - Covers the entire body of the penis Continuous with the septum between the corpora carvenosum and the suspentory ligament |
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Male Urethra |
From internal to external urethral meatus 15 - 20 cm long Prostatic Part: Widest part as it crosses through the prostate Seminal colliculus (verumontanum) - evevation on the posterior wall Ejaculatory duct - Opens onto its summit Prostatic ducts - Opens into grooves on the side Membranous Part: Shortest and most rigid Passes through the deep perineal pouch (surrounded by the external urethral sphincter) Passes through perineal membrane Bulbourethral glands - 2 embedded in the sphincter muscle and secrete a lubricant fluid Spongy Part (Penile urethra): Runs in the corpus spongiosum to the tip of the glans Lumen is transverse (except at the external urethral meatus - transverse lumen to give a spiral stream of urine) External urethral sphincter - Sheet of striated muscle (supplied by the perineal branch of the pudendal nerve). governs urinary continence |
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Scrotum |
Suspended by the spermatic cord Median raphae in the skin Fibrous midline septum seperates the scrotum into 2 cavities Dartos: A layer of smooth muscle that lies in the subcutaneous tissue. Contraction means wrinkling of the scrotum Anterior 1/3: Branch of ilioinguinal nerve Posterior 2/3: Scrotal branch of the pudendal nerve |
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Sacral Plexus |
Formed from the lumbosacral trunk - from the anterior primary ramus of L5 (with a branch from L4), S1-S4 Posterolateral wall of the pelvic cavity Function: Innervate the lower limb and muscles of the pelvis & perineum |
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Coccygeal Plexus |
Formed from: branch from S4 anterior primary rami of S5 coccygeal nerve Posterolateral wall of the pelvic cavityFunction: Innervate the lower limb and muscles of the pelvis & perineum |
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Pudendal Nerve |
Anterior rami of S2-S4 Supplies perineal muscles and skin Leaves through the greater sciatic foramen (below the lower border of piriformis with the internal pudendal vessels) - Medial to the Sciatic Nerve Winds over the sacrospinous ligament to pass through the lesser sciatic foramen to enter the perineum Embedded in Pudendal (Alcock's) canal - fascial tunnel Branches: Inferior Rectal Nerve - Arises in the posterior part of the pudendal canal Passes medially over the roof of the ischioanal fossa Branches to supply the external anal sphincter, perineal skin and levator ani Perineal Nerve: Divides into 3 branches Scrotal (labial) branches - medial branch passes with the artery to supply the scrotum. Lateral branch gives a branch to the anus Muscular branch - Supplies the transverse perineal muscles, ischiocavernosus, bulbospongiosus, external urethral sphincter, external anal sphincter and levator ani Nerve to the bulb: Supplies the bulb of corpus spongiosum Dorsal nerve of the Penis (Clitoris) - Continuation of the pudendal nerve Runs in the ischioanal fossa and pierces the perineal membrane Supplies the skin of the penis / clitoris and the glans |
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Innervation of the Penis / clitoris |
Skin at the root: Anterior scrotal (labial) branch of the ilioinguinal nerve Erectile bodies: Branches of the pelvic plexus |
