110 terms

GA - Pelvic Viscera & Organs of Reproduction

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Obturator artery is a branch of the
anterior division of the internal iliac artery
Ureters are innervated by autonomic sympathetic fibers from what spinal nerves?
T11 - L2
Urters are innervated by what plexuses? (4)
Renal
Aortic
Superior hypogastric
Inferior hypogastric
The urinary bladder is separated from the pubic bones by the
retropubic space
The urinary bladder is attached and supported by the
pubovesical or puboprostatic ligaments
Arteries to the urinary bladder (2)
Superior vesical artery
Inferior vesical artery or vaginal artery
Artery to the anterosuperior portion of the urinary bladder
superior vesical artery
Artery to the fundus and neck of the urinary bladder
inferior vesical artery or vaginal artery
Superior vesical artery is a branch of the
umbilical artery
Angles of the trigone are formed by
the entrance of the two ureters and exit of the urethra
The prostatic venous plexus / vesical venous plexus drain the
fundus of the bladder
prostates
seminal vesicles
ductus deferens
penis
Vesical venous plexus drains to the
internal iliac veins
sacral veins
vertebral venous plexus
Parasympathetic innervation of the bladder comes from what spinal nerves?
S2 - S4
Parasympathetic innervation of the bladder is supplied by
pelvic splanchnic nerves
Parasympathetic stimulation causes emptying of the bladder by contraction of the
detrusor muscle
Parasympathetic stimulation causes emptying of the bladder by relaxation of the
internal urethral sphincter
Internal (preprostatic) part of the male urethra is surrounded by the
internal urethral sphincter
Membranous part of the male urethra in the deep perineal pouch is surrounded by the
external urethral sphincter
Sperm is produced in the
seminiferous tubules
Sperm is stored in the
body of the epididymis
The vas deferens is formed by the tail of the
epididymis
Tunica vaginalis (definition)
Closed peritoneal sac covering the testes
Small amount of fluid between parietal and visceral layers
Tunica albuginea (definition)
Tough outer surface of testes
Cryptorchidism (definition)
undescended testes
Testes normally descend during
3rd - 7th month of pregnancy
Path of testicular descent
Retroperitoneally from posterior abdominal wall
Deep inguinal rings
Through inguinal canal
Gubernaculum testes (definition)
Fibromuscular band that guides the descent of the testes to the future scrotum
Processus vaginalis (definition)
Evagination of peritoneum
Follows testes along their descent
Coverings of testes and accompanying vessels (3)
External spermatic fascia
Cremaster muscle & fascia
Internal spermatic fascia
External spermatic fascia arises from
external oblique aponeurosis
Cremaster muscle & fascia arise from
internal oblique
Internal spermatic fascia arises from
transversalis fascia
Contents of spermatic cord (9)
1. ductus (vas) deferens
2. artery to ductus deferens
3. testicular artery
4. pampiniform plexus of veins
5. lymphatic vessels
6. autonomic nerves
7. remnants of processus vaginalis
8. cremasteric artery
9. genital branch of genitofemoral nerve
Artery to the testes
Testicular artery
Testicular artery arises from
Abdominal aorta
Testicular artery arises from the abdominal aorta at what vertebral level?
L2
Vein of the testes
Pampiniform plexus --> testicular vein
Pampiniform plexus becomes the testicular vein at
the deep inguinal ring
The left testicular vein drains into the
left renal vein
The right testicular vein drains into the
inferior vena cava
Varicocele (definition)
elongation and dilation of pampiniform plexus of veins due to defective valves
"bag of worms"
common in adolescents and young adults
Hydrocele (definition)
Accumulation of fluid within cavity of tunica vaginalis
Hematocele (definition)
Accumulation of blood within cavity of tunica vaginalis
Spermatocele (definition)
Sperm-filled cyst near the head of the epididymis
Lymph of the testes drains to the
Lateral paraaortic nodes
Sympathetic innervation of the testes is from what plexuses?
renal or aortic
Function of the ductus deferens
transmits sperm from the epididymis to the ejaculatory duct
Artery to the ductus deferens arises from the
superior vesical artery (usually)
inferior vesical artery (sometimes)
The ejaculatory duct is formed by the
ductus deferens
seminal vesicle
Seminal vesicle function
Contributes thick, alkaline fluid containing fructose to the seminal fluid
Does not store sperm
The middle lobe and posterior lobe of the prostate are separated by the
ejaculatory duct
Ejaculatory duct opens into the prostatic urethra on the
seminal colliculus
Prostatic fluid empties into the prostatic urethra through
individual duct openings in the prostatic sinuses
Prostate function
Produces a thin, milky fluid containing citric acid and acid phosphatase
Helps to neutralize acidity of vagina
Areas of the prostate
Isthmus / anterior muscular zone / anterior lobe
Right and left lobes / peripheral zones

(??)
Lobule of prostatic lobes
Inferoposterior lobule (posterior lobe)
Inferolateral lobule (lateral lobes)
Superomedial lobule (around ejaculatory duct)
Anteromedial lobule (lateral to urethra)

(??)
Symptoms of benign prostatic hyperplasia
Enlarged prostate
Nocturia
Urgency
Dysuria
Benign prostatic hyperplasia usually occurs in the
middle lobe / central zone
Prostate cancer usually occurs in the
posterior lobe / peripheral zone
Transverse rectal folds, aka
valves of Houston
Transverse rectal folds function
Support fecal matter
The rectum joins the sigmoid colon at what vertebral level?
S3
Peritoneal relationships of the rectum
Upper 1/3 - anterolateral peritoneum
Middle 1/3 - anterior peritoneum
Lower 1/3 - no peritoneum
Superior rectal artery arises from the
inferior mesenteric artery
Middle rectal artery arises from the
anterior division of the internal iliac artery
Inferior rectal artery arises from the
internal pudendal artery
Nerve supply to the external anal sphincter is from
Inferior rectal nerves
Inferior rectal nerves supplied by what spinal nerve?
Mainly S4
Function of the puborectalis portion of the levator ani
Forms a muscular sling around the anorectal junction
Crucial for maintaining fecal continence
Portocaval anastamoses form between
superior rectal vein
middle / inferior rectal veins
Hemorrhoids or rectal varices are enlargements of
portocaval anastamoses
Uterine cavity opens into the cervical canal at the
internal os / ostium
Cervical canal opens into the vagina at the
External os / ostium
Vaginal fornix (definition)
Continuous recess around the vaginal part of the cervix
Normal position of the uterus is
anteverted
anteflexed
Angle of anteflexion is between
body and uterus to cervix
Angle of anteversion is between
axes of cervix and vagina
Passive support of the uterus is provided by
transverse cardinal ligament
uterosacral ligament
relationship with urinary bladder
perineal body
perineal membrane
Dynamic support of the uterus is provided by
the pelvic diaphragm
Pouches found related to the uterus (2)
Vesicouterine
Rectouterine
Rectouterine pouch, aka
cul-de-sac of Douglas
Rectouterine pouch is important because it
is the lowest point in the peritoneal cavity in females and is therefore the sight of accumulation of pathological fluids
Blood supply of the uterus
Mainly from uterine artery
Anastamoses with ovarian and vaginal arteries
Endometriosis (definition)
Normal endometrial tissue found in an abnormal location, often in ovaries
Signs / symptoms of endometriosis
Pelvic / low back pain
pelvic mass
dysmenorrhea
infertility
dyspareunia
pain with defecation or urination
Two samples taken during pap smear
Ectocervical
Endocervical
Function of uterine / fallopian tubes
conduct oocyte from ovary to uterine cavity
Salpingitis (definition)
obstruction of uterine tubes due to inflammation, secondary to STI or abdominal infection
Ectopic pregnancy (definition)
Implantation of embryo outside uterus
Most commonly in uterine / fallopian tube
Ovary suspended from posterior lamina of broad ligament by
mesovarium
Ovary attached to the uterus by the
ligament of the ovary
Ligament of the ovary is a remnant of the
gubernaculum
Ovary connected to the posterior abdominal wall by the
suspensory ligament of the ovary
Suspensory ligament of the ovary contains the
ovarian artery and vein
lymphatic vessels
nerves
Arteries to the ovary (2)
Ovarian artery
Ovarian branch of the uterine artery
Right ovarian vein drains to the
inferior vena cava
Left ovarian vein drains to the
left renal vein
Important relationship of uterine artery
Uterine a. passes superior to the ureter; latter can be nicked/cut during a hysterectomy
Important relationship of peritoneum of ovarian fossa
Immediately in front of ureter
Might be nicked while transecting or suturing suspensory ligament of ovary
Location of the vagina
Posterior to the urethra and urinary bladder
Important relationship of posterior fornix of vagina
Rectouterine pouch - culdocentesis
Ligaments of the uterus (5)
Ovarian ligament, round ligament of the uterus
Broad ligament of the uterus
Transverse cervical ligament, uterosacral ligament
Broad ligament parts
mesosalpinx
mesovarium
mesometrium
Mesosalpinx is found
below the uterine tube
Mesovarium function
suspends the ovary
Mesometrium is found
lateral to the body of the uterus
Pelvic organ prolapse (definition)
Loss of support for pelvic viscera due to weakness of supporting musculature, ligaments, and fascia - esp levator ani and uterosacral, transverse cervical, and pubocervical ligaments
Pelvic organ prolapse symptoms
Pelvic pressure
Protrusion of tissue
Pelvic pain
Low back pain
Bowel / bladder symptoms
Double uterus or bicornuate uterus can be caused by
incomplete fusion of paramesonephric ducts
Congenital anomalies of vagina / uterus (4)
Uterus didelphys (double uterus)
Bicornuate uterus
Vaginal atresia
Cervical atresia
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