Pelvic Viscera Anatomy

What connects the superior and inferior hypogastric plexi?

Hypogastric nerves.

Where does the ductus deferens begin?

In the tail of the epididymis at the inferior pole of the testis.

Where does fertilization occur?

In the uterine tube (typically the ampulla).

What are the symptoms of benign prostatic hyperplasia?

Increase in urinary frequency and urgency to void, with a slowing of the flow of urine and incomplete voiding.

The superior portion of the rectum drains to what nodes?

Inferior mesenteric.

The superior rectal artery is a branch of what artery?

Inferior mesenteric.

The superior rectal vein is a tributary of what vein?

Inferior mesenteric.

External hemorrhoids are varicosities of what veins?

Inferior rectal veins.

What branch of the internal iliac artery is present in males, but not in females?

Inferior vesicle artery.

The uterine artery is a branch of what artery?

Internal iliac artery.

The inferior portion of the rectum and the upper anal canal drain to what nodes?

Internal iliac.

The middle rectal artery is a branch of what artery?

Internal iliac.

The middle rectal vein is a tributary of what vein?

Internal iliac.

What are anal columns?

Internal protrusions of the superior rectal veins into the anal mucosa, which are located at the upper end of the anal canal.

The inferior rectal artery is a branch of what artery?

Internal pudendal.

The inferior rectal vein is a tributary of what vein?

Internal pudendal.

What type of hemorrhoids is located above the pectinate line?

Internal.

What type of hemorrhoids is painless?

Internal.

What are anal sinuses?

Intervening spaces between anal columns.

The obliterated portion of the umbilical artery forms what structure?

Medial umbilical ligament.

What three structures support the position of the ovary?

Mesovarium, ligament of the ovary, and suspensory ligament of the ovary.

List the three specializations of the broad ligament.

Mesovarium, mesosalpinx, and mesometrium.

What veins drain the muscles of the rectum and anal canal?

Middle rectal veins.

What is present in the periurethral zone of the prostate gland?

Mucosal/submucosal glands.

Why does the sphincter muscle at the base of the bladder contract during ejaculation?

To prevent reflux of seminal fluid into the bladder.

Where does convergence of the male reproductive and urinary pathways occur?

Within the prostatic urethra.

What is the trigone of the bladder?

A triangle shaped area on the inner wall of the fundus of the bladder demarcated by left and right ureteric orifices and the internal urethral orifice.

The ureter receives vascular supply from what blood vessels?

All of the vessels it passes, including branches of the renal artery, abdominal aorta, superior and inferior vesical arteries, and others.

The anal glands open into what structures?

Anal sinuses.

What forms the pectinate line?

Anal valves and bases of the anal columns.

The bases of anal columns are connected by what structures?

Anal valves.

What is the anatomical relationship between the ductus deferens, the ureter, and the seminal vesicle?

As it approaches the bladder, the ductus deferens passes over the ureter and then medial to the seminal vesicle.

What is culdocentesis?

Aspiration of fluid from the rectouterine pouch via the posterior fornix.

The vesicouterine pouch is formed as the peritoneum passes between what two structures?

Bladder and uterus.

What is a cystocele?

Bladder prolapse.

What innervates the ureter?

Branches of adjacent autonomic nerve plexi (renal, aortic, superior and inferior hypogastric).

What is the double layer of peritoneum that extends from the lateral aspects of the uterus to the lateral walls and floor of the female pelvis?

Broad ligament of the uterus.

List the three regions of the anal canal from superior to inferior.

Columnar zone, anal pecten, and cutaneous zone.

What are the three parts of the external anal sphincter, and which is the principal factor in the muscle's ability to close the anal opening?

Deep, superficial, and subcutaneous. The deep external anal sphincter is the main part.

What are the three layers of the walls of the uterus?

Endometrium, myometrium, and perimetrium.

Fibrous condensations of what structure impart structural support to the pelvic viscera?

Endopelvic fascia.

List the regions of the uterine tube from proximal to distal.

Isthmus, ampulla, infundibulum, and fimbriae.

How can prostate cancer metastasize to the vertebral column?

It can metastasize hematogenously via Batson's veins and the internal vertebral veins.

Based on the innervation of the ureter, ureteric pain can refer to what areas?

It can refer to the groin (L2) and move up to areas just below the umbilicus and the lower back (T11).

Describe the path of the round ligament of the uterus.

It extends anteriorly and laterally from the uterus towards the deep inguinal ring and passes through the inguinal canal to attach to the labium majus.

What is the columnar zone?

It is the region between the anorectal junction and the pectinate line.

What is the purpose of a hysterosalpingogram?

It is used to assess the patency of the uterine tubes. If the tubes are patent, the contrast material will pass from the vagina to the uterus to the uterine tube to the peritoneal cavity.

The cardinal ligament transmits what structures?

It transmits the uterine vessels and the ureter passes through it.

What is a route for paracervical nerve block/anesthesia?

Lateral fornices.

The inferior hypogastric/pelvic plexus carries what type of nerve fibers (sympathetic or parasympathetic)?

Parasympathetic.

What serves as an important point of demarcation/transition within the anal canal?

Pectinate line and anal pecten.

What can result from infection of the anal glands?

Perianal abscesses and fistulae.

Benign prostatic hyperplasia affects what zone of the prostate?

Periurethral zone.

What causes ano-rectal varices?

Portal hypertension can cause ano-rectal varices where the superior rectal veins anastomose with the middle and inferior rectal veins.

What is the function of the loops of detrusor muscle around the ureteric orifices?

Prevent reflux.

Prostate cancer affects what part of the prostate?

Prostatic secretory tissue.

What is the male vestige of the paramesonephric duct (homologue of the vagina)?

Prostatic utricle.

What forms the puborectal sling?

Puborectalis muscle.

What is the most inferior point in the female peritoneal cavity?

Rectouterine pouch of Douglas.

What is the most inferior point in the male peritoneal cavity?

Rectovesical pouch.

What are the two remnants of the gubernaculum in females?

Round ligament and ligament of the ovary.

Which is more anterior, the uterine tube or the round ligament of the uterus?

Round ligament.

What structures travel along the uterosacral ligament?

Sensory fibers from the uterus travel along the uterosacral ligament (severing the uterosacral ligament can reduce pain).

What are prostatic sinuses?

Structure by which the prostate delivers its fluid to the prostatic urethra.

The lower anal canal drains to what nodes?

Superficial inguinal.

What part of the external anal sphincter is important for maintaining the position of the anus?

Superficial.

What three branches of the internal iliac artery pass through the greater sciatic foramen?

Superior gluteal artery, inferior gluteal artery, and internal pudendal artery.

What veins drain the mucosa of the rectum and anal canal?

Superior rectal and inferior rectal.

What is the main blood supply to the rectum and anus?

Superior rectal artery.

Which rectal vein is a portal system tributary?

Superior rectal vein.

Internal hemorrhoids are varicosities in what veins?

Superior rectal.

How can the bladder be accessed without entering the peritoneal cavity?

Suprapubic approach (suprapubic cystotomy).

What contains the ovarian vessels?

Suspensory ligament of the ovary.

The superior hypogastric plexus carries what type of nerve fibers (sympathetic or parasympathetic)?

Sympathetic.

What four structures contribute to components of ejaculate?

Testes, seminal vesicles, prostate, and bulbourethral glands.

What is the anal pecten?

The 1-2 cm region immediately distal to the pectinate line.

Describe the pathway of the ductus deferens from the testes to the ejaculatory duct.

The ductus deferens enters the pelvis through the deep inguinal ring and courses inferomedially toward the region behind the fundus of the bladder, where it joins the duct of the seminal vesicle to form the ejaculatory duct.

What marks the transition from rectum to anal canal?

The perineal flexure (aka the anorectal junction).

What allows expansion of the urinary bladder between the peritoneum and anterior abdominal wall as the bladder fills?

The peritoneum is not firmly bound to the pubic crest.

What is an alternative destination of blood from the prostate besides the internal iliac veins?

The prostatic plexus can drain to the internal vertebral veins via Batson's veins.

Describe the venous drainage of the prostate.

The prostatic venous plexus receives blood from the deep dorsal vein of the penis and typically drains with the vesical plexus to the internal iliac veins.

Why can procedures be performed on the lower end of the rectum/anal canal without danger of invading the peritoneal cavity?

The rectum is only partially covered by peritoneum in the pelvis.

What is the anatomical relationship between the uterine vessels and the ureter?

The ureter passes inferior to the uterine vessels on its approach toward the bladder.

In what orientation does the ureter pass through the urinary bladder wall? Why?

The ureter passes through the urinary bladder wall at an oblique angle, which prevents reflux of urine.

What is the anatomical relationship between the ureters and the iliac vessels and pelvic brim?

The ureters course anterior to the iliac vessels and pelvic brim.

What is the verumontanum?

The verumontanum is another name for the seminal colliculus, into which seminal fluid is delivered in the prostatic urethra.

Describe the path of afferent fibers transmitting pain sensation from the ureter.

They follow sympathetic pathways to T11-L1/L2

What is the function of transverse rectal folds?

They support the weight of fecal matter being stored within the ampulla.

What are the most common sites of renal calculus obstruction of the ureters?

Three constrictions: junction of renal pelvis and ureter, there the ureter crosses the iliac vessels and pelvic brim, and where it traverses the bladder wall.

How can the uterine vessels be accessed surgically?

Through the lateral fornices of the vagina.

How can peritoneal fluid be accessed/aspirated from the rectouterine pouch by needle puncture?

Through the posterior fornix.

What is the treatment for BPH?

Transurethral resection of the prostate.

What artery gives rise to the superior vesicle arteries?

Umbilical artery.

List four structures palpable in the rectal exam of a female.

Upper vagina, cervix, rectouterine pouch, and posterior wall of the uterus.

The lateral fornices are situated close to what structures?

Uterine arteries and the nerves which course alongside them.

The ovarian artery anastomoses with what artery?

Uterine artery.

What branch of the internal iliac artery is present in females, but not in males?

Uterine artery.

What structure can serve as a conduit between the female peritoneal cavity and the exterior?

Uterine tube.

What structures extend posteriorly from the sides of the cervix to attach to the anterior aspect of the sacrum and play a role in maintaining the position of the uterus?

Uterosacral ligaments.

What is pelvic relaxation?

Weakening of the supporting structures for the pelvic viscera, which can cause prolapse of one or more organs through the potential space of the vagina.