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