Block 4 GARQs #11-20

14d. Describe the internal pudendal artery.

- Courses inferiorly from anterior trunk of internal iliac a. - Leaves pelvis thru greater sciatic foramen (inferior to piriformis) - Passes laterally to ischial spine - Enters perineum thru lesser sciatic foramen - Terminal part of artery accompanies dorsal nerve of penis/clitoris into deep perineal pouch. Supplies deep perineal pouch and erectile tissues

Describe the male urethra

- Intramural/preprostatic urethra is surrounded by internal urethral sphincter - Prostatic urethra is where ejaculatory ducts join the urethra. Ends at external urethral sphincter - Intermediate/membranous urethra passes through deep perineal pouch and penetrates perineal membrane - spongy/penile urethra is located in corpus spongiosum

12. Name and describe the layer of skeletal muscle that forms the floor of the abdominopelvic cavity as well as the "roof" of the perineum. (Consider both the levator ani and the coccygeus muscles.)

- The floor of the pelvic cavity (and roof of perineum) is the musculofascial pelvic diaphragm. It is funnel-shaped, and descends centrally from its attachments on the pelvis. It is composed of the coccyges muscle, levator ani muscle (which is divided into the iliococcygeus, pubococcygeus, and puborectalis muscles).

Describe the female urethra

- Urethra passes antero-inferiorly from bladder, then postero-inferiorly to pubic symphysis, then to external urethral orifice in vestibule of vagina - Runs parallel and anterior to vagina - Passes with vagina thru pelvic diaphragm and perineal membrane into perineum - External urethral orifice is located postero-inferior to glans clitoris and anterior to vaginal orifice

Uterine Tubes

1. Arteries: Ovarian arteries from abdominal aorta; Uterine arteries from anterior branch of internal iliac artery 2. Veins: Ovarian vein; R--> IVC; Left --> left renal vein Tubal veins drain into ovarian and uterine venous plexuses 3. Mesosalpinx

Vagina

1. Arteries: Vaginal branch of internal iliac artery, sometimes branch of uterine artery 2. Veins: Uterovaginal plexus (combination of vaginal and uterine venous plexuses) drains into internal iliac veins through uterine veins 3. No peritoneal coverings

14c. Be sure to discuss the differences between visceral branches in the male and female.

1. superior vesical a. ~MEN & WOMEN: supplies superior bladder and distal ureter ~MEN: gives rise to an artery that supplies the ductus deferens 2. -inferior vesical a. ~MEN ONLY: supplies bladder, ureter, seminal vesicle, prostate 3. -uterine a. ~WOMEN ONLY: arises from anterior trunk instead of inferior vesical artery. Travels in broad ligament to reach cervix. Crosses ureter. The uterine artery is the major supply to the uterus, enlarges in pregnancy. 4. -vaginal a. ~WOMEN ONLY: branches from uterine artery. Descends to vagina. Supplies vagina and adjacent bladder and rectum. 5. -middle rectal a. : same in men and women (Gray's did state explicitly that it was different between men and women, as it did for other arteries). 6. -internal pudendal a. : main artery of perineum. Supplies erectile tissue of penis (MEN) and clitoris (WOMEN)

Include a description of the attachments of this skeletal muscle to the pelvic walls, innervation, and 2 important functions.

Attachments: - Coccygeus: attached to inferior aspect of sacrum and coccyx, and to ischial spine - iliococcygeus: from tendinous arch of obturator internus fascia and ischial spine bilaterally - Pubococcygeus: From tendinous arch and posterior pubic bodies to coccyx via anococcygeal body - Puborectalis: attaches to posterior pubic bodies bilaterally, and fibers loop around posterior wall of rectum Innervation: - Coccygeus: branches of S4-5 - Levator ani: from S2-4 Important functions: 1. SUpport pelvic and abdominal viscera 2. Coccygeus pulls coccyx forward

14a. Describe/diagram the internal iliac artery.

Draw

14d. Describe branches of internal pudendal artery

Early branches: - Inferior rectal arteries: originate from internal pudendal in anal triangle; Crosses ischio-anal fossa and branches to supply muscle and related skin. Anastamoses with middle and inferior rectal arteries. Male branches: - Artery of bulb of penis - Urethral artery - Deep artery of penis - Dorsal artery of penis Female branches: - Arteries of bulb of vestibule - Deep arteries of clitoris - Dorsal arteries of clitoris

What, briefly, are the posterior relationships of the bladder in the male? In female?

Male: Rectum, seminal vesicle Female: Anterior vaginal wall, cervix

13d. uterine tubes (intrauterine portion, isthmus, ampulla, infundibulum, fimbriae).

Uterine tubes (formerly known as oviducts or fallopian): conduct the oocyte from the peri-ovarian peritoneal cavity to the uterine cavity. Serve as usual site of fertilization. Extend laterally from the uterine horns and open into the peritoneal cavity near the ovaries. Divisions from medial to lateral Intrauterine portion: short intramural segment of the tube that passes through the wall of the uterus and opens via the uterine ostium into the uterine cavity at the uterine horn Isthmus: thick-walled part of the tube, enters uterine horn Ampulla: Widest and longest part of the tubule, begins at medial end of infundibulum. Fertilization of oocyte occurs here. Infundibulum: funnel-shaped distal end of the tube that opens into the peritoneal cavity through abdominal ostium Fimbriae: finger-like processes of the fimbriated end of the infundibulum. Spread over the medial surface of ovary. One large ovarian fimbria is attached to superior pole of ovary

What is the urogenital hiatus?

a gap between the medial borders of the levator ani muscles through which pass the urethra and vagina.

14b. Identify the branch, or branches, that: (a) supply the body wall (b) Supply the lower extremity (c) supply pelvic viscera

a. -iliolumbar a. -lateral sacral arteries -umbilical a. (in utero, distal portion not patent in adults) b. -Superior gluteal artery - Inferior gluteal artery - Obturator artery c. -Superior vesical artery - Inferior vesical artery (Men) - Uterine and vaginal arteries (women) - Middle rectal artery - Internal pudendal artery

13C. In addition to a description of each organ, include a description of its arterial supply (including vessel of origin), and its peritoneal coverings. You may wish to include a diagram (diagrams).

a. Uterus: - Arteries: Uterine artery (branch of internal iliac) Some contribution from ovarian (abdominal artery) and vaginal arteries (uterine arteries). - Veins: Uterine venous plexus drain into internal iliac veins - Broad ligament covers body; no covering for cervix

13a. Describe the female internal genital organs -- a. uterus (fundus, body, isthmus), b. cervix (supravaginal and intravaginal portions), c. vaginal fornices,

a. Uterus: thick-walled, pear-shaped, hollow muscular organ in the midline between the bladder anteriorly and the rectum posteriorly. Functions to receive, retain, and nourish the fertilized ovum, embryo and fetus and expel fetus. Divided into two main parts: body and cervix - Body: forms the superior two thirds of the uterus and includes the funds - Fundus: the rounded part that lies superior to the uterine ostia - Isthmus: region between body and cervix b. cervix: cylindrical, relatively narrow inferior 1/3 of uterus ~2.5cm long in non-pregnant women Pierces anterior wall of vagina Cervical canal communicates with cavity of uterine body via internal os and cavity of vagina through external os Supravaginal: between isthmus and vagina Intravaginal: protrudes into superior most anterior vaginal wall and surrounds the external os of the uterus c. vaginal fornix: recess between the margin of the cervix and vaginal wall, divided into anterior, posterior and lateral parts, and surrounded by vaginal fornix Posterior: deepest part and is closely related to the recto-uterine pouch

13b. Describe the typical disposition of the uterus, I,e, define a. anteversion, b. anteflexion, c. retroversion, d. retroflexion.

a. anteversion: tipped anterosuperiorly relative to the axis of the vagina; normally the long axis of the cervix is bent anteriorly on the long axis of the vagina forming a 90 degree angle b. anteflexion: flexed or bent anteriorly relative to the cervix; the long axis of the body of the uterus is bent anteriorly at the level of the internal os forming a 170 degree angle with the cervical canal c. retroversion: inclined posteriorly d. retroflexion: flexed toward sacrum, decreased angle of flexion

What is "the space of Retzius"?

aka prevesical or retropubic space; it is an extraperitoneal space often filled with fat, located between the bladder and pubic symphysis. It acts as a potential space to accommodate bladder expansion

11. Describe the bladder, with special attention to the following: detrusor muscle, trigone, point of entrance of ureters, point of exit of urethra, internal urethral sphincter.

o Bladder is a hollow viscus with strong muscular walls for holding urine • Located in lesser pelvis when empty • "Ascends" into greater pelvis when full o Detrusor muscle: Smooth muscle in bladder wall that contracts for urination o Trigone: smooth muscle triangular area between the two ureter entry sites and the beginning of the urethra o Point of entrance of ureters: aka ureteric orifices; ureters enter bladder obliquely • Ureteric orifices are encircled by detrusor muscle • Located at superior angles of trigone o Point of exit of urethra: aka internal ureteric orifice • Formed by detrusor muscle • Located at inferior angle of trigone o Internal urethral sphincter: Smooth muscle around neck of bladder/beginning of urethra