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89 Cards in this Set

  • Front
  • Back
a. Begins at S3 as a continuation of sigmoid colon
b. Terminates anterior to the coccyx
c. Retroperitoneal
d. 15 cm long
Rectosigmoid junction (teniae coli at junction)
a. Teniae coli of the sigmoid become a complete outer muscle covering
Upper 1/3 of rectum
a. Peritoneum covers the rectum on its anterior and lateral side
b. Pararectal fossae→ areas lateral to rectum
Middle 1/3 of rectum
a. Peritoneum covers only the anterior surface of the rectum
b. Peritoneum is reflected anteriorly to form the rectovesical pouch in the male
c. Forms rectouterine pouch in the female
Lower 1/3 of rectum
a. Rectal ampulla
b. No peritoneal covering
Rectovesical septum/rectovaginal septum
i. Separates the rectum from the prostate or vagina, respectively
ii. Part of lower 1/3 of rectum
Rectum shape
a. Follows sacral curvature
Transverse rectal folds
a. 3 frontal plane curves
b. Occur at site where internally the rectum has mucosal infoldings
Location of transverse rectal folds
a. Upper and lower valves are on left side
b. Middle on right side
c. Help to support the fecal matter as it accumulates in the rectum
Puborectalis muscle
a. Forms a sling around the rectum at the rectoanal junction
b. Causes 90 degree bend between rectum and anal canal
c. “Perineal flexure”
Anal canal
a. Continuation of the rectum
Anal columns
i. Ridges in upper ½ of anal canal
ii. Separated by anal sinuses
Anal valves
i. Connect lower ends of anal columns
Pectinate line
i. Continuous, scalloped ring of anal valves
i. Transition region just below the pectinate line
ii. Extends inferiorly to level of intersphincteric groove
White line
i. At level of intersphincteric groove
ii. Inferior border of pectin
Anal verge
i. Area below white line
ii. Extends to external opening
Muscular coat of rectum
i. Consists of inner circular layer and outer longitudinal layer
ii. Continues into anal canal
Internal anal sphincter
i. Made of lowermost fibers of inner circular coat
ii. Covers upper 2/3 of anal canal down to intersphincteric groove (white line)
iii. Involuntary
Corrugator cutis
i. Longitudinal muscle fibers that extend to the skin around anus
ii. Cause “puckered” appearance
External anal sphincter
i. Covers entire length of anal canal
ii. Voluntary striated muscle
Subcutaneous part of external anal sphincter
1. Inferior to internal sphincter
2. Encircles the anus
3. No bony attachments
Intersphincteric groove of external anal sphincter
a. White line
b. Formed by junction of subcutaneous part of external sphincter and internal sphincter
Deep part of external anal sphincter
1. Overlaps the internal sphincter
2. Encircles the anal canal
3. Fused to puborectalis
Anorectal ring
a. Portion of deep part of external anal sphincter
b. Palpable above intersphincteric groove
Superior rectal artery
i. Branch of inferior mesenteric artery
ii. Divides into a right and left branch to supply rectum
iii. Main supply to rectum
iv. Anastomose with branches of middle and inferior rectal arteries
Terminal branches of superior rectal artery
1. Form ridges under the mucosa that→ “anal columns”
Middle rectal arteries
i. Branches of internal iliac arteries
ii. Supply only muscle layers
Inferior rectal arteries
i. Branches of the internal pudendal arteries that cross the ischioanal fossa along the obturator internus muscle
ii. Supply the anal canal
Venous drainage
a. To both portal and caval systems
Superior rectal veins
i. Accompany arteries and help form anal columns
ii. Drain into IMV→ portal system
Internal hemorrhoids
1. Variscosities in the superior retal veins deep to anal columns frorm internal hemorrhoids
2. Not painful
Middle rectal veins
i. Drain musculature and empty into internal iliac vein→ caval system
Inferior rectal veins
i. In anal canal
ii. Drain via the internal pudendal vein→ caval
External hemorrhoids
1. Engorgement or thrombosis of inferior rectal veins
2. Painful
Pelvic plexus
i. Both motor and sensory innervation to rectum and anal canal
Pelvic splanchnic nerves
i. Parasympathetic fibers from S2-S4
ii. Join pelvic plexus
iii. Increase peristaltic activity
Automatic emptying of bowel prevention
i. Contraction of voluntary muscle fibers in external anal spincter
ii. Via branches of pudendal nerve
Nerves in charge of reflex control in rectum/anus
i. Sensory fibers arising form S2-S4
ii. Continence and defecation
Upper 1/2 of anal canal innervation
i. Pelvic autonomic fibers
ii. Sensitive to stretching but not cutting
Lower 1/2 of anal canal innervation
i. Branches of inferior rectal nerves from pudendal nerve
ii. Sensitive to pain, temperature, touch, pressure, cutting, and pricking
Peritoneum on superior surface of bladder
i. Covered by visceral peritoneum
ii. Reflected anteriorly over anterior abdominal wall as parietal peritoneum
iii. Female→ posteriorly over uterus
iv. Male→ covers base of bladder before reflecting over anterior surface of rectum
Paravesical fossae
1. Lateral reflections of peritoneum from bladder to lateral pelvic wall
2. Allow bladder to distend laterally
Puboprostatic ligament/pubovesical ligament
1. Male/female
2. Connects neck of bladder to pubic vone
3. Considered visceral pelvic fascia
Base of male bladder
1. Two ductus deferens
2. Seminal vesicles
3. Separated from rectum by rectoprostatic fascia
Base of female bladder
1. Base of bladder abuts anterior wall of vagina
Vesical trigone
1. Triangular area formed by 2 opeinings of ureters and their interconnecting ridge to internal orifice of urethra
Interureteric ridge
a. Runs between opening of each respective ureter
Mucosa over trigone
a. Smooth
b. Elsewhere in has numerous rugae
Ureter entry to bladder
a. Oblique angle
b. Contraction of bladder musculature functions as a physiological sphincter preventing urine reflex
a. Projection on the trigone
b. Created by underlying median lobe of prostate
Detrusor muscle
1. Consists of smooth muscle with fibers coursing longitudinally, transversely, and obliquely
2. Motor innervation by pelvic splanchnic nerves
Superior vesical arteries
1. 2-3 small branches from umbilical arteries
2. Supply superior surface of bladder
Inferior vesical arteries
1. Usually branches of internal iliac artery in male
2. Prostate usually receives branches from inferior vesical artery
3. In female, it is usually an unnamed branch of vaginal artery
Vesical venous plexus in males
a. Continuous with the prostatic venous plexus
b. Drains mainly into internal iliac vein
c. May communicate with internal vertebral venous plexus
Female urethra
i. Short tube
ii. Fused to anterior wall of vagina
Smooth muscle in female urethra
1. Derived from bladder
2. Forms internal sphincter
3. Involuntary
Striated muscle in female urethra
1. In urogenital diaphragm
2. Forms external sphincter
3. Voluntary
Prostatic male urethra
1. First portion
2. Courses through the prostate
3. Urethral crest on posterior surface
Prostatic sinuses
a. Depression bilateral to urethral crest
b. Prostatic ducts open into urethra
Seminal colliculus
a. Enlargement of urethral crest 2/3 of distance down
Prostatic utricle
a. Blind depression about halfway down on colliculus
Ejaculatory ducts
a. Two
b. Open on either side of utricle
Membranous urethra
i. Passes through UG diaphragm and perineal membrane
ii. Shortest, narrowest, least distensible part
iii. Walls are the thinnest of entire urethra
iv. Enters the superior aspect of bulb of the penis
Spongy urethra
i. Extends through the bulb and corpus spongiosum from perineal membrane to external opening
ii. Makes 90 degree turn within the bulb anteriorly
Navicular fossa
1. Dilated part within the glans
2. May have a small mucosal valve proximally
3. Lacuna magna→ mucosal pit in roof (catheter)
4. Meatus→ external orifice
Bulbourethral glands
a. Embedded in deep perineal pouch
b. Lateral to membranous part of urethra
c. Associated ducts pass into the bulb of the penis to dump lubricating pre-ejaculates into spongy urethra
d. Greater vestibular glands in female
Apex of prostate
i. Rests on pelvic diaphragm
Base of prostate
i. Contact with neck of bladder
Periurethral zone of prostate
i. Surrounds prostatic urethra
Central zone in prostate
i. 25% of glandular tissue of prostate
Peripheral zone of prostate
i. 70% of glandular tissue
Benign prostatic hypertrophy
i. Enlargement of glands in posterior median lobe leads to compression of urethra
ii. Micturation becomes difficult
iii. Prostate cancer in glands of posterolateral lobes does not necessarily lead to micturition difficultiy
Blood supply to prostate
i. Branches of internal iliac artery
ii. Especially the inferior vesical
Prostatic plexus
1. Drains mainly into internal iliac vein
2. May drain into internal vertebral venous plexus (no valves)
3. Path for metastatic prostate cancer
Deep dorsal vein of penis
1. Drains into prostatic plexus
2. Provides direct access from outside of body to pelvic cavity
Prostatic plexus of nerves
1. Encircles and embeds within the prostatic fascial sheath
2. Derived from inferior hypogastric plexus
3. Innervation via sympathetic fibers
Parietal pelvic fascia
i. Membranous
ii. Continuation of transversalis fascia
iii. Covers walls and floors of pelvis
iv. Attaches to bones of lateral pelvic wall
v. Forms white line at superior edge of levator ani
Visceral pelvic fascia
i. Reflects onto and fully invests the pelvic viscera
ii. Continuous with parietal fascia
iii. Puboprostatic and pubovesical igaments
Endopelvic fascia
i. Loose areolar, fatty tissue with lymphatics and vessels
ii. Found in gaps between parietal and visceral pelvic fascia and pelvic walls
Cardinal ligaments
a. From cervix and upper vagina to pelvic walls
b. Rectovesical septum in males
Lateral ligaments of rectum
a. From cervix to ala of sacrum
b. Forms pouch of douglas
Lateral ligaments of bladder
a. From cardinal ligament to pubis to sling the bladder
a. Left lower than right
b. Scrotal ligament
i. Remnant of gubernaculum
ii. Attaches testes to scrotum
Tunica albuginea
i. Surrounds testes
ii. Send septa into testis to form lobules
Seminiferous tubules
i. 1-3 coiled tubules in each lobule
Rete testis
i. Opening of tubules
ii. Collecting chamber
Efferent ductules
i. Connect rete testis to epididymis
Testicular descent
i. Retroperitoneal
ii. Processus vaginalis-- testicle comes in behind it