Pelvis Morse Anatomy Block II Unit II

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What is the bone the urinary bladder lies behind?: The pubic symphysis.
What lies directly behind the uterus?: The urinary bladder.
What aspect of the bladder does the uterus lie on when the bladder is empty?: The superior aspect.
What marks the end of the sigmoid colon and the start of the rectum?: The body of S3
What reflects on the surface of many structures in the peritoneum?: Parietal peritoneum
Describe the CT that connects the bladder to the pubic symphysis.: Loose areolar CT, allows the bladder to move more freely.
What does endoabdominal fascia become once it enters the pelvis?: Endopelvic fascia.
What are the ligaments that bind the urinary bladder to the pubis? What are they formed from?: Pubovesicle ligaments, formed from endopelvic fascia.
What is the recess called where the peritoneum on the posterior edge of the bladder reflects onto the uterus? (2 names for the same thing): The vesicouterine pouch or the greater sac of the peritoneal cavity
What is the area called where the peritoneum the uterus reflects on the rectum? (4 names): Rectouterine, Retrouterine, Cul-de-sac, Douglas pouch.
Why is the douglas pouch clinically siginficant?: Fluid flows here, it is the lowest part of the peritoneal cavity.
What part of the vaginal wall is very thin and seperates the vagina from the posterior peritoneal cavity?: The posterior vaginal wall.
What can peritonitis be caused by when draining fluid from the douglas pouch?: Dirty needles.
What are the 3 parts the rectum is divided into? Describe where peritoneum covers each part.: Upper, middle, lower.

Upper- peritoneum on 3 sides (anterior and lateral surfaces)
Middle- anterior only
Lower- NO PERITONEUM
How many peritoneal recesses are there in females?: 2
What coats the superior surface of the bladder?: Peritoneum
What surfaces form the apex of the bladder and where is it?: The superior and inferior/lateral surfaces form the apex next to the inferior surface of the pubic symphysis.
What structure may be found at the apex of the urinary bladder?: The Urachus or median umbilical ligament.
What can be found near teh posterior aspect of or base of the urinary bladder in males and females?: Females- upper vagina, part of uterus.
Males- Reproductive glands
Where does the urethra leave the bladder?: Through the neck/floor of the bladder.
What does the neck of the bladder rest on in males and females?: In males- Prostrate gland, in female on pelvic floor.
What sort of things can be found in endopelvic fascia? (Not organs): Nerves, BV (rich venous plexus), autonomics, lots of FAT
What is the rich venous plexus found in the endopelvic fascia? What are the 2 major sources of blood to this?: The vesicle venous plexus, most of the blood comes from the bladder and the deep dorsal vein of the clitoris dumps into the plexus (from inferior to pubic symphysis)
What is the name of the muscle in the wall of the urinary bladder? What kind of muscle is it?: Detrusor muscle, Smooth muscle
What type of epithelium is there in the urinary bladder?: Transitional epithelium.
What forms from the epithelium when the bladder is empty?: Rugae
What are the 3 tubes associated with the urinary bladder? What do they form?: 2 ureters, 1 internal urethral orifice, The form a triangle or Trigone. (Ureters superior to urethra)
Describe the mucusa of the trigone of the bladder.: The mucosa is adherent to the muscular layer, there are NO rugae and it is always smooth.
Where can the external urethral sphincter be found?: Deep pouch.
Where can the internal urethral sphincter be found?: In the neck of the bladder, smooth muscle at the edge of the bladder.
Describe the differences in the internal urethral sphincter between males and females.: In males- definitely exists and acts on the urethra
In females- Maybe? has minimal effect.
Who's urethra is longer, male or female?: Male
What structure does the urethra closely adhere with in females?: The anterior wall of the vagina, you can feel the ridge in an exam.
What are the 2 parts of the uterus?: Body and cervix
What is the part of the body of the uterus superior to the uterine tubes called? WHat is the rest of the body called.: Fundus superior to uterine tubes, body proper is rest
(body proper + fundus = body)
What tube meets the ovaries laterally?: The fallopian or uterine tubes.
On what aspects are the body, cervix and fundus of the uterus covered by peritoneum?: ON the anterior, posterior, and sides of the uterus.
What is the broad ligament and where is it found?: The broad ligament is a double layer of peritoneum found lateral to the sides of the uterus.
What are the 3 parts of the broad ligament?: Mesometrium, Mesoalpinx, mesovarium
What is the largest part of the broad ligament?: The mesometrium
Where is the mesometrium found?: From the body of the cervix to the ligament of the ovary.
Where is the mesalpinx found?: Rest between the ligament o of the ovary and the fallopian tubes.
Where is the mesovarium found?: It is a short stalk that suspends the ovaries.
What are the finger-like processes on the uterine tube called?: These are fibriae.
What do the uterine tubes open into?: THe peritoneal cavity.
The peritoneal cavity open to the exterior?: Yes in males, no in females.
What is the epithelium that covers the ovary called? What does it form?: IT is the germinal epithelium that is a continuation of the epithelium forming the mesothelium and the lining of the uterine tubes.
What space is the egg released into?: The peritoneal cavity.
What do the fimbriae do during ovulation? What pathology can develop if they fail to do their task?: Move during ovulation and massage the surface of the ovaries. If they miss the egg, an ectopic pregnancy can result.
Describe the vagina. What makes up its wall? What larger structure is a part of?: A musculofascial sheath that makes up the lower part of the birth canal.
Describe where the walls of the vagina are not in contact?: In contact everywhere except for where they are separated by the cervix.
What part of the vagina does the cervix pierce?: The anterior wall.
Which is longer, the anterior or posterior wall of the vagina?: The posterior wall of the vagina is longer.
What are the recesses that are made due to the cervix projecting into the vagina?: Fornices.
Describe the sensory layout of the vagina.: 4/5 is sensitive only to stretch and has no pain fibers, the opening is the only part that has pain fibers and can sense temperature, stretch, etc.
What are the 3 fornices and which is deepest? Why?: ANterior, posterior and lateral, the deepest and most pronounced one is the posterior one which is closest to the douglas pouch (rectouterine).
What is the external os?: Part of the cervix or a narrowing that is closest to the vaginal opening.
What are the 3 parts of the cervis? Which is continuous with the body of the uterus?: External os (part of cervix)
Vaginal part
Supravaginal part (continuous w/ body of uterus)
What is the junction of the cervical and uterine cavites? What structure is found there?: The isthmus of the uterus and the internal os.
What is the smooth muscle of the uterine wall called?: Myometrium.
Describe the amount of myometrium in the cervix. What makes it up?: There is very little myometrium in the cervix, it is mostly fibrous CT.
What parts of the uterus loose their epithelial lining during menses?: Only the uterus and fundus, not the cervix.
What is the distal wide/ trumpet shaped part of the fallopian tubes called?: The infundibulum.
What is the longest part of the fallopian tube called? What occurs here?: The longest part is called the ampulla. Fertilization occurs here.
What is the most proximal narrowing of the fallopian tubes? What is just distal to that?: The uterine part. The isthumus of the fallopian tubes is just distal to it.
Give the parts of the fallopian tubes from proximal to distal. (4): Uterine part, isthmus, ampulla, fimbriae.
What does the ligament of the ovary connect?: The side of the uterus and the ovary
What is the part of the ligament of the ovary that heads towards the deep inguingal ring?: THe round ligament.
What are the round ligament and ligament of the ovary both parts of?: The gubernaculum
Describe the appearance of the external os both before and after a vaginal delivery has been performed.: In women without a vaginal delivery the external os is round
It is stellate shepped after vaginal dellivery (Permanent)
In a normal uterus what is the angle between the cervix and the external os? What is this called?: 90 degrees. Anteverted or antevesion
What is the angle of the cervical canal and uterine cavity normally (Internal os angle)? What is this called?: 170 degrees. Anteflexion
What is the opposite of anteversion? WHen can it be said to occur? WHat pathology develops?: If the angle increases beyond 180 degrees the weight of the uterus will push it into the vagina causing a prolapse. This is known as retroversion or retroflexion.
Can you have both antervesion and retroflexion?: YES!
Describe the mobility of the uterus.: The cervix is slightly mobile due to being tightly anchored by endopelvic fascia. The rest of the uterus is highly mobile and rests only on pelvic floor musculature.
What ligament supports the cervix? What makes it up?: The transverse cervical ligament or cardinal ligament supports the cervix. It is made up of thickened endopelvic fascia.
What is a cystocele? What causes it?: Where the urinary bladder impinges on the anterior vaginal wall/cavity. Is weakness in anterior vaginal wall. Due to weak pelvic floor musculature.
What is a rectocele?: Where the rectum impinges on the posterior vaginal wall.

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