Term
| what is the significance of the pectinate line? where is it found? |
|
Definition
| marks the boundary b/w the mucosal lining of the digestive tract and the skin of the anal aperture; runs along underside of anal valves |
|
|
Term
| what transitions take place at the pectinate line? |
|
Definition
SUPERIOR to pectinate line:
-digestive tract (mucosa)
-superior rectal a
-superior rectal v (drains to portal system)
-visceral innervation via inf hypogastric plexus
-lymph drain to inf mesenteric or internal iliac lymph nodes
INFERIOR to pectinate line:
-skin
-inf rectal a.
-middle and inf rectal v (caval system)
-somatic innervation via inf rectal n
-lymph draininage to superficial inguinal lymph nodes |
|
|
Term
| how does the transition in innervation at the pectinate line explain the difference in pain experienced by pts with internal v. external hemorrhoids? |
|
Definition
internal less painful - innervation is visceral via the autonomic inferior hypogastric plexus (no localized pain)
external are very painful due to somatic innervation |
|
|
Term
| what is another name for imperforate anus? what is this condition? |
|
Definition
| anal atresia; congenital obstruction of anal opening that can be corrected by surgery |
|
|
Term
| what are some of the consequences of benign prostatic hypertrophy? what anatomical relationships explain these clinical manifestations? |
|
Definition
-enlargement of the prostate can make urination difficult or impossible
-prostate surrounds the urethra and enlargement can reduce or completely obstruct the outflow of urine |
|
|
Term
| what is one way to access the prostate when performing a prostatectomy (turp)? |
|
Definition
| the prostate can be removed trans-urethrally via the urethral canal of the penis |
|
|
Term
| how does one screen for prostate cancer? anatomically speaking, why is this an effective screening method? |
|
Definition
-screening: PSA testing and annual digital rectal exam
-prostate is immediately anterior to the rectum and can be palpated by a finger in the rectum |
|
|
Term
| what are two routes of entry for a hysterectomy? |
|
Definition
| the uterus can be removed through an incision in the abdominal wall or through the vagina |
|
|
Term
|
Definition
| removal of an ovary or ovaries |
|
|
Term
| where does fertilization usually take place? where does implantation usually take place? what is an ectopic pregnancy? |
|
Definition
-fertilization: uterine tubes
-implantation: uterus
-ectopic pregnancy: implantation outside of uterus, often in uterine tube |
|
|
Term
| what is a hysterosalpingography? |
|
Definition
| radiography of the uterus and uterine tubes after the injection of a contrast medium. |
|
|
Term
what happens in prolapse of the uterus?
what causes prolapse? |
|
Definition
the uterus falls or sinks down; cervix may protrude from the vagina
-weakening of pelvic diaphragm muscles causes prolapse |
|
|
Term
|
Definition
| condition where bladder herniates into the vaginal canal; usually results in stress incontinence |
|
|
Term
|
Definition
| repair of a rupture of the vagina by suturing the edges of the tear. |
|
|
Term
| what is a leiomyoma and what are its associated clinical findings? |
|
Definition
benign uterine tumor, referred to as uterine fibroids
can cause pelvic pain and bleeding |
|
|
Term
|
Definition
| a hernial protrusion of bowel thru a defect in the rectouterine (female) or vesicouterine (male) pouch |
|
|
Term
| how do STDs lead to infertility? which STDs most commonly lead to infertility? |
|
Definition
-chlamydia, gonorrhea - cause scarring (can block uterine tubes, etc.)
-chlamydia, other STDs can cause inflammation (pelvic inflammatory disease) |
|
|
Term
| which muscles control urinary flow? |
|
Definition
-primarily the striated urethrovaginal sphincter (external)
-assisted by pubococcygeal (levator prostate in males) of the levator ani |
|
|
Term
| what is stress incontinence? |
|
Definition
| involuntary loss of control of urination when there is an increase in intra-abdominal pressure (i.e. coughing, lifting objects, etc.). compromised urethral sphincters leak under the pressure |
|
|
Term
| how does one access the peritoneal cavity from the pelvic region (in females only)? |
|
Definition
| the rectouterine pouch, which is part of the peritoneal cavity above the pelvic inlet, is directly behind the posterior fornix of the vagina. Incisions, punctures can open the peritoneal cavity. |
|
|
Term
| what ligaments need to be cut in a hysterectomy? |
|
Definition
-round ligament
-proper ovarian ligament
-anterior leaf and lateral attachments of broad ligament
-an incision below the external os of the cervix and suturing of the 4 corners of the vaginal wall |
|
|
Term
| what is the major blood supply to uterus? what is the relationship between these vessels and the ureter? |
|
Definition
uterine a (branch of internal iliac a) and ovarian a (branch of aorta)
-ureter passes UNDER uterine a. |
|
|
Term
| what structure is ligated in a vasectomy? |
|
Definition
| the ductus deferens (vas deferens) |
|
|
Term
| what is the analogous female structure to the shaft of the penis? |
|
Definition
|
|
Term
| what is the analogous male structure to the labia majora? |
|
Definition
|
|
Term
| what is the analogous female structure to the glans of penis? |
|
Definition
|
|
Term
| what is the analogous male structure to the vestibular bulb? |
|
Definition
| bulb of corpus spongeosum |
|
|
Term
| what is the analogous male structure to the crus of corpus cavernosum clitoris? |
|
Definition
| crus of corpus cavernosum penis |
|
|
Term
| what are the spatial relationships b/w all the structures inserting onto or into the uterus? |
|
Definition
ovarian ligament below uterine tube; round ligament of the uterus - is continuous with ovarian ligament and holds fundus of uterus forward
-uterosacral ligament connects to isthmus of uterus and goes to sacrum |
|
|
Term
| where is the first place that seminal fluid and sperm mix? |
|
Definition
|
|
Term
| trace the path of sperm from beginning to exit from the body |
|
Definition
-formed in seminiferous tubules
-head -> tail of epididymis, thru ductus deferens, into ejaculatory duct, into prostatic urethra, urethra, out penis |
|
|
Term
| where is the uvula found? |
|
Definition
| on the posterior wall of the bladder. The uvula is produced by the middle lobe of the prostate gland and can constrict the internal urethra orifice when the prostate is enlarged |
|
|
Term
where does the aberrant obturator a branch from?
where do "normal" obturator a branch from? |
|
Definition
inferior epigastric artery
anterior internal iliac artery |
|
|
Term
| where is the prepuce found and what tissues contribute to its formation? |
|
Definition
| fold of smooth skins extending over glans clitoris; formed by joining of anterior divisions of labia minora |
|
|
Term
| what is the frenulum of the clitoris and what forms it? |
|
Definition
| small fold posterior to clitoris; formed by joining of deeper, posterior, divisions of labia minora |
|
|
Term
| what is the male counterpart to the labia minora? |
|
Definition
|
|
Term
| what are the 4 major differences b/w male and female pelvises? |
|
Definition
1. subpubic angle and pubic arch greater in females
2. pelvic inlet is rounded in females, heart-shaped in males
3. pelvic outlet larger in females
4. iliac wings are more flared in females |
|
|
Term
| what structure gives rise to the arcus tendineus levator ani and what is its significance? |
|
Definition
-specialization of the obturator m
-serves as origin for levator ani muscles |
|
|
Term
| which major artery in the pelvic region divides into ant and post divisions? |
|
Definition
|
|
Term
| which pelvic viscera receive their blood supply from branches of the posterior internal iliac a? |
|
Definition
| NONE. posterior branch only supplies muscles and body wall |
|
|
Term
| what are the 3 branches of the posterior internal iliac? what does each supply? |
|
Definition
-iliolumbar a: iliacus m, psoas major, quadratus lumborum
-superior gluteal a: gluts and hip joint
-lateral sacral a: sacrum, sacral nerve rootlets, meninges, adjacent muscles |
|
|
Term
| what are the branches of the anterior iliac artery that supply muscles and body wall? |
|
Definition
-inf gluteal a: gluteus maximus and hip joint
-obturator a: medial thigh and hip
-internal pudendal a: perineum (anus, mm of superficial and deep perineal spaces, clitoris or penis, post aspect of labium majus/scrotum) |
|
|
Term
| what are the branches of the anterior iliac artery that supply pelvic viscera? |
|
Definition
middle rectal a - middle portion of rectum
umbilical a - superior bladder via superior vesical a; in males - ductus deferens via artery of the ductus deferens
-inferior vesical a: lower bladder, vagina/prostate; anastomoses with middle rectal a
-uterine a: uterus, uterine tubes, upper vagina
-vaginal a: vagina; anastomoses w/ and sometimes branches from uterine a. |
|
|
Term
| which 2 arteries are the terminal branches of the ant iliac a? |
|
Definition
| internal pudendal a, inferior gluteal a; both innervate structures outside the pelvis |
|
|
Term
| what nerves would be leaving the anterior surface of the sacral sympathetic trunk ganglia to enter the inferior hypogastric plexus? |
|
Definition
|
|
Term
| what nerves would be leaving the lateral surface of the sacral sympathetic trunk ganglia? where are they going? |
|
Definition
| gray rami communicantes; heading toward sacral ventral primary rami |
|
|
Term
| where are the pelvic splanchnics found and where are they heading? |
|
Definition
| branch off ventral rami of S2, S3, S4 and head into inferior hypogastric plexus |
|
|
Term
| which muscles marks the transition from rectum to anus and forms the kink at the anorectal junction? |
|
Definition
|
|
Term
| what is transmitted through the urogenital hiatus? |
|
Definition
| urethra/vagina and anus transmitted thru pelvic diaphragm |
|
|
Term
| is the inferior hypogastric plexus a sympathetic or parasympathetic plexus? |
|
Definition
contains contributions from both:
-sympathetic fibers from hypogastric nerves and sacral splanchnics from sacral sympathetic trunk
-parasympathetics from S2, S3, S4 - pelvic splanchnics |
|
|
Term
| what functions are impaired by damage to the inferior hypogastric plexus? |
|
Definition
-micturition - urinary retention
-erection - erectile impotence
-ejaculation - ejaculatory impotence
-intestinal motility - reduced motility, constipation
-internal anal sphincter control
-uterine contraction/inhibition
-vasoconstriction |
|
|
Term
name the 3 rectal veins
where do they drain? |
|
Definition
-inferior and middle rectal v drain to internal iliac v and IVF (caval system)
-superior rectal v drains to IMV and to portal system |
|
|
Term
| what muscles are strengthened by Kegel exercises? |
|
Definition
|
|
Term
| how would one determine if a patient had sustained a urethral injury? |
|
Definition
| via retrograde urethral cystoscopy using contrast to ascertain if there is a tear in the membranous or spongy regions of the urethra |
|
|
Term
| what nerve comprise the sacral plexus? |
|
Definition
L4-S4 - it includes L4, L5!
It supplies motor innervation to muscles of the pelvic diaphragm, muscles of the urogenital diaphragm, and muscles of the posterior hip, posterior thigh, leg and foot. It supplies sensory innervation to the skin of the perineum, posterior thigh, leg and foot. |
|
|
Term
| the superior vesical arteries usually branch from which artery? |
|
Definition
|
|
Term
| from where is the skin removed in circumcision? |
|
Definition
|
|
Term
| where is the needle inserted when performing a transvaginal pudendal nerve block? |
|
Definition
| just medial to the ischial spine where the pudendal n enters the lesser sciatic foramen |
|
|
Term
| which nerves supplying the perineum will NOT be blocked in a pudendal nerve block? |
|
Definition
-anterior portion of perineum (ilioinguinal nerve,genitofemoral) -perineal branch of the posterior femoral cutaneous nerve
-pain from uterine contractions ascend to the spinal cord via the sympathetic afferent nerves and can still be felt |
|
|
Term
| what is removed in a vasectomy? |
|
Definition
|
|
Term
| what is surgical removal of the testes called? |
|
Definition
|
|
Term
| what is cystoscopy used for? |
|
Definition
| direct visual examination of urinary tract |
|
|
Term
| when performing a urethral catherization in a male, what parts of the urethra will you pass through, in order? |
|
Definition
| spongy, membranous and prostatic urethra |
|
|
Term
what is an episiotomy?
why is it performed? |
|
Definition
| surgical incision into the perineum and vagina to prevent traumatic tearing during delivery |
|
|
Term
| what are common causes of ischioanal abscesses? |
|
Definition
| infections in the anal canal; usually starts as an inflammation of the crypts, which leads to the invasion of normal rectal flora into the ischioanal fossa |
|
|
Term
| where would you inject a needle for spinal anesthesia? what areas would lose sensation? |
|
Definition
-an anesthetic agent is injected directly into the subarachnoid space at the L3/L4 vertebral level
-anesthetizes essentially everything inferior to the waist |
|
|
Term
| what is the difference in injection site b/w spinal and epidural anesthesia? |
|
Definition
spinal - inject into subarachnoid
epidural - inject into epidural space |
|
|
Term
| when is epidural anesthesia used? what areas lose sensation? |
|
Definition
| usually takes 10 to 20 minutes to take effect and has a direct effect on the spinal nerves; often used for operations below the diaphragm and consequently is used in childbirth and cesarean sections |
|
|
Term
| which artery and nerve pierce the perineal membrane (arcuate ligament) right below the pubic symphysis? |
|
Definition
| dorsal a and nerve of the clitoris |
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