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Anatomy of The Abdomen and Pelvis
Anatomy of The Abdomen and Pelvis
wall? 8
10.What is the name of the double membrane surrounding the abdominal contents
that lies deep to the transversalis fascia? 9
1
Abdomen is everything from the diaphragm up to the true pelvis, so bounded inferiorly by the pelvic inlet.
The costal margin above and the V-shape of the pelvis (iliac crest and inguinal ligament) below
It is domed so as to move up into the ribcage meaning upper abdomen is protected by lower ribs
Linea alba is the line down the middle of the abdomen, crossing the umbilicus. The 2 linea semilunaris are
either side of the rectus abdominus muscles.
5
A = mid saggital plane, B = subcostal plane, C = Intertubercular plane, i = right hypocondrium, ii = epigastric
region, iii = left hypochondrium, iv = right flank, v = umbilical region, vi = left flank, vii = right groin, viii = pubic
region, ix = left groin
6
Rectus abdominus
10
Outside in = Campers fascia, Scarpas fascia. There is a negligible amount of deep fascia below the
11
Bound to the fascia lata of the thigh below the inguinal ligament and to structures in the perineum (region
of the external genetalia). Posteriorly to the throacolumbar fascia and the fascia lata of the buttock.
12
Thoraco-epigastric (run through right and left hypochondrium), superficial epigastric (run up to the
umbilicus from the pubic region
13
Flexes the thigh on the trunk or trunk on thigh. Arises from the lumbar transverse processes and lumbar
vertebral bodies, attaches the illiacus muscle (on the iliac fossa) onto the lesser trochanter of the femur.
14
15
Subcostal nerve = T12, Iliohypogastric = L1, Ilioinguinal = collateral branch of iliohypogastric so also L1
16
Enlargement of the psoas major muscle, which runs alongside these nerves. This can happen following
infection of the psoas fascia, or intra-muscular haematomas.
17
Derived from L1 and 2 and emerges from the anterior surface of psoas major and runs down deep to the
psoas fascia to supply the cremaster muscle in the male, via its genital branch.
18
Pull the trunk downwards and forwards to right, left or if contracted together, forwards. Arises from the
lower ribs 5-12, inserts posteriorly to the iliac crest.
19
Internal oblique begins at ribs 9-12 and inserts into the the iliac crest, thoracolumbar fascia posteriorly and
linea alba anteriorly. It functions to stabilise the lumbar spine. The transversus abdominus originates from the
internal surfaces of the bones and cartilages forming the thoracic outlet and iliac crest, as well as the
thoracolumbar fascia. Its primary role is abdominal compression/breathing, and stabilization.
20
Linea alba in the centre, either side are each rectus abdominus muscle, the external oblique passes over
the top of this and the transversus behind. Below the arcuate line, the internal oblique passes infront of the
rectus, above it straddles it on both sides.
21
T7-L1
22
T7-T12
23
24
25
Medial and lateral margins are formed by the split in the aponeurosis (crura/crus), the lateral crus attached
to the pubic tubercle and the medial to the pubic crest. Intercrucal fibres arising from the inguinal ligament
stop the crura from spreading apart.
26
It is the lower free edge of the external oblique aponeurosis. Openings either end are the deep and
superficial inguinal rings. The deep inguinal ring is the beginning of an invagination in the transversalis fascia
which continues into the canal forming its innermost covering. It passes through all 3 layers of abdominal
muscles, obliquely along the inguinal ligament, the internal oblique gives some slips of muscle covering
known as the cremaster muscle.
27
Under the transversus abdominis tendon and internal oblique. Descended testes leave a trail of
surrounding layers called the vas deferens which forms the spermatic cord, derived from 3 layers of
abdominal wall.
28
Begins at the deep inguinal ring, lateral to the inferior epigastric artery, ends at the posterior border of the
testis. Passing through the inguinal canal and emerging at the superficial inguinal ring. As the cord leaves
the inguinal canal, it acquires its 3rd covering, the external spermatic fascia.
29
Internal = fascia transversalis, Middle layer = cremaster layer, Lastly = spermatic fascia derived from the
external oblique. (transversalis abdominis does not contribute to the sheath)
30
31
Medial: The lateral margin of the rectus abdominus muscle (linea semilunaris), Lateral: the inferior
epigastric artery, Inferior: the Inguinal Ligament
32
Supplied by the L1 nerve, loss of this nerve or muscle can lead to direct inguinal hernia
33
A indirect inguinal hernia is where abdominal contents protrude through the deep inguinal ring, direct
inguinal hernias are where the abdominal contents herniate the wall of the inguinal canal without going down
the canal itself.
34
Herniation of stomach up through the hole in the diaphragm through which the oesophagus travels.
35
A double folded membrane which separates the abdominal cavity from the peritoneum. The peritoneal
cavity itself does not contain any organs, rather the gut is trapped within the mesentery in a sandwich.
36
The two sides of the mesentery (either side of the gut organs). The front (ventral) mesentery is shorter
than the dorsal one, so there is continuity beneath it, the mesentery is only a partial septum.
37
The histological term for mesentery, once is has slung around the organs to form the visceral perironeum.
This is a simple squamous columnar epithelium.
4. What is the meaning of the term ligament in context of the peritoneum and what
is the gastro-hepatic ligament? 38
5. Explain the difference between an intra-peritoneal and retro-peritoneal organ39
6. Which organs and structures are retro-peritoneal?40
7. What is the caecal bud? 41
8. What is the vitelline duct?42
9. What is Meckels diverticulum? 43
10.What is the origin of the greater omentum? 44
11.What is the relation of the greater omentum to the greater and lesser sacs? 45
12.What are the functions of the greater omentum?46
13.What is the epiploic foramen?47
14.Name the 4 peritoneal spaces (between the mesenteries)48
38
Ligaments may be formed out of remaining double folds of mesentery, meaning that abdominal organs are
connected to each other in some way. The hepato-gastric ligament is also known as the lesser omentum.
39
As the gut twists and turns in development, some organs lost their mesentery, fusing with the parietal
peritoneum or posterior abdominal wall instead. These are known as retro-peritoneal organs.
40
DUKE CRAPS - Duodenum, Ureters, Kidneys, Espohagus, Colon (ascending and descending), Aorta,
Pancreas, Supraneal Glands
41
Part of the caecum (gut following the stomach) which protrudes into the umbilicus in embreyological
development having been pushed by growth of the liver.During later stages of development, there is anticlockwise rotation of the midgut and the caecum retracts back from the umbilicus, so the caecal bud remains
superior to the gut, then as the gut rotates further, it lies inferiorly on the right.
42
43
44
Expansion of the embryological dorsal mesentery of the stomach. Greater omentum expands downwards
to cover the small intestine.
45
The lesser sac is the area behind the stomach, the greater sac is everywhere else.
46
The greater omentum is a fat filled apron which folds down over the small intestines. Its function is to
localise infection by sticking to any infected region, trapping the infection and preventing it from spreading.
47
aka Omental foramen, passage of communication between the lesser sac (behind stomach) and greater
sac (everywhere else)
48
Left and right paracolic gutters (between the colon and the abdominal wall) and the left and right
paramesenteric gutters (between the colon and the root of the mesentery)
15.How do the peritoneal folds and spaces differ between male and female? 49
Stomach and Spleen
1. What is the approximate position of the stomach in relation to the abdominal
divisions?50
2. What are the main sub-divisions/parts of the stomach, what substances do they
secrete? 51
3. What are the main functions of the stomach?52
4. Name the layers of the gut wall53
5. Name the two parts of the enteric nervous system54
6. Name the 3 muscular coats of the stomach in order 55
7. Name the sphincters of the stomach and oesophagus56
8. What are the right and left crus?57
9. What are rugae58
49
In males, the peritoneum sweeps forward and around the lateral walls and towards the floor of the pelvis
(levator ani muscle), before ascending up the anterior wall of the abdomen. The fossa between the posterior
and anterior folds is known as the rectovesical pouch. Females have an additional fold of peritoneum
dividing this space into the rectouterine pouch (of Douglas) behind and a vesouterine pouch in front.
50
51
Cardia (mucus secretion), fundus (storage/gas), body (mucus, HCl, pepsiongen, intrinsic factor), Pyloris
(mixing, gastrin)
52
53
From lumen outwards: Epithelium, lamina propria, muscularis mucosae (internal ring of smooth muscle),
submucosa, mucularis externa (1 layer circular, 1 layer longlitudinal), serosa.
54
55
Inner oblique layer, middle circular layer, outer longitudinal layer (for peristalsis/churning)
56
Oesophageal sphincter is a layer of muscle but not a true sphincter & pyloric sphincter (exit to duodenum).
Control of gastric reflux is done largely by the muscular fibres of the diaphragm.
57
Tendonous structures which extend from the diaphragm for a short distance down the vertebral column
58
A series of ridges caused by the in-folding of the mucus membrane of the stomach.
Superiorly the liver and left diaphragm, laterally the left kidney, supraneal gland and spleen. Splenic artery,
hepatic portal vein and coealiac trunk. The lesser omentum and lesser sac separate the stomach from
adjacent organs inferiorly.
60
The coeliac artery arises from the aorta. It is split into 3 branches, left gastric, splenic and common
hepatic. The common hepatic artery then splits into the proper hepatic and gastroduodenal artery.
61
62
Coeliac (pre-aortic) nodes and the thoracic duct via the cysterna chyli
63
The right and left vagi (split in the vagus nerve) split anterior and posterior to the stomach.
64
T6-9
65
Immediately beneath ribs 9-10, with ribs 11 and 12 below it. The spleen is highly vascular so a rupture
caused by broken ribs leads to severe haemorrage.
66
Largest lymphoid unit in the body, contains macrophages which destroy old red blood cells, produces
white and red blood cells (in infant), reservoir for 1/3 of platelets, store of blood can be released in response
to adrenaline.
67
The spleen has two surfaces (diaphragmatic and visceral), two borders (one notched and one not). Lower
pole = splenic flexure of the colon, visceral surface = stomach, left kidney and tail of pancreas
68
69
Produces bile (stored in the gallbladder), glucose into glycogen, production of cholesterol, regulation of
fats and amino acids, stores iron, detoxification, immunity, manufacture of plasma proteins.
70
71
Anteriorly: Right lobe and left lobe separated by the falciform ligament. Posteriorly the quadrate lobe and
smaller caudate lobe separated by the coronary ligaments and triangular ligaments
72
Right kidney, hepatic flexure of the colon, oesophagus, stomach and duodenum
73
Portal vein, hepatic artery and the common hepatic duct (into which the bile duct drains from the
gallbladder)
74
The hepatic portal vein is the product of the entire venous drainage of the gut, which includes the superior
and inferior mesenteric veins, the splenic vein, the gastric veins and the cystic vein from the gallbladder.
75
Progressive opening up of pre-existing anastemoses between the systemic and portal venous systems at
one of 4 possible sites: lower oesophagus, anal canal, recanalized umbilical vein to the abdominal wall, or
the posterior abdominal wall.
76
Could result in haemorrhoids, varicose veins on the abdominal wall, diltated superficial veins arising from
the umbilicus (Medusas head).
77
Effectively the reverse of portal hypertension, veins of the anterior abdominal wall enlarge and shunt blood
around the obstruction but in the opposite direction to their normal flow, linking the subclavian/axilliary
system with the iliac/femoral.
78
Reservoir of bile produced by the liver, concentrates the bile and adds mucus, absorbing water out of the
mixture.
79
Right and left hepatic ducts drain from right and left lobes of the liver, these merge to form the common
hepatic duct and then combine with the cystic duct from the gallbladder to form the bile duct which enters the
duodenum.
80
Sphincter at the lower end of the common bile duct where it joins the pancreatic duct, controls biliary
secretion
81
82
83
Exocrine gland secreting digestive enzymes, as an endocrine gland producing and secreting insulin and
glucagon
84
Receives blood from the arteria pancreatica magna (from splenic artery), superior pancreatoduodenal
artery (from gastroduodenal), inferior pancreatoduodenal (from superior mesenteric).
85
Main pancreatic duct (joint with the common bile duct), enters the duodenum through the ampulla of Vater.
The accessory pancreatic duct enters the duodenum superior to the main duct.
86
Foregut: ends after entry of common bile duct into duodenum, Midgut: ends 2/3rds of the way along the
transverse colon, Hindgut: Ends halfway down the anal canal.
87
Lesser omentum
88
Greater omentum
4. What are the right and left spaces superficial to the colon? 89
5. What are the divisions of the intestine? 90
6. Which artery supplies the midgut?91
7. Which artery supplies the hindgut?92
8. What is the suspensory ligament of the duodenum?93
9. What is the most significant difference in the structure of the epithelium between
the small and large intestines?94
10.What are the name of the anatomical folds in the membrane of the duodenum?95
11.Which surface abdominal region does most of the duodenum lie within? 96
12.Which organ does the duodenum encircle on three out of four sides?97
13.What is the name of the opening into the duodenum where pancreatic juice and
bile are secreted from the pancreas and gallbladder?98
14.What is the name of the feature between (13) and the hepatopancreatic ampulla?
99
15.What is the main difference between the epithelium of the ileum and
duodenum 100
89
90
Small Intestine (6m) (3-6 hours): Duodenum (5%), Jejunum (roughly 40%) and Ileum (roughly 60%). Large
Intestine (20 hours): Caecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum.
91
92
93
Ligament of Treitz
94
95
Plicae circularis
96
97
Pancreas
98
99
Sphincter of Oddi
100
16.In which surface abdominal regions are the jejunum and ileum located? 101
17.Which part of the small intestine contains Peyers patches?102
18.What are vasa recta?103
19.What are the three main structural components of the large intestine which are
not found in the small intestine?104
20.What is the difference between appendages and diverticula? 105
21.Which organ does the corner of the ascending and transverse colon turn just
below (at the right colic flexure)?106
22.Which part of the large intestine is the appendix attached to?107
23.Which part of the pelvis does the caecum sit within?108
24.What and where (surface location) is McBurneys point?109
25.Which parts of the the large intestine and small intestine are retroperitoneal and
which are intraperitoneal? 110
26.What are the names for the anastemoses of blood vessels that supply the
ascending and descending colon?111
101
Jejunum mostly located in umbilical region, Ileum located in hypogastric/pubic and right inguinal regions
102
103
Arcades off the mesenteric arteries which run straight to the gut wall
104
Haustra (sac like divisions), Epiploic/Omental appendages (fatty tags on surface), Teniae coli (strips of
longitudinal muscle which contract to produce the haustra)
105
Appendages are normal fatty pouches in the serosa whereas diverticula are pathological pouches of the
whole gut wall and may signify the presence of a blockage or cancer.
106
107
The caecum
108
109
The tip of the appendix, it lies 2/3rds of the way down a line drawn from the umbilicus to the anterior
superior iliac spine. It is the point of maximum pain in appendicitis.
110
Retroperitoneal: Rectum, ascending and descending portions of the colon, duodenum. Intraperitoneal:
transverse colon, sigmoid colon, caecum, jejunum and ileum.
111
wall116
112
Transverse and sigmoid colon are mobile because they have mesenteries and are within the peritoneum
whereas the descending colon is not because it has no mesentery and is retroperitoneal. The transverse
colon has a mesentery however it is retroperitoneal.
113
114
115
A= Ileocaecal artery, B = right colic artery, C=middle colic artery, D=superior mesenteric artery, E= inferior
mesenteric artery, F=left colic artery, G= sigmoid artery, H=superior rectal artery
116
DUKE CRAPS Duodenum, ureters, kidneys, esophagus, colon (asc. & desc.)
117
118
119
120
6. Describe the position of the kidneys in relation to the anterior abdominal wall
and to the ribs121
7. Name the layers of fat and fascia surrounding the kidney?122
8. Which kidney is higher? 123
9. List and describe the locations of the calyxes and pelvis of the kidney124
10.Which vertebral level do the renal arteries arise from?125
11.List the points along the course of the ureter at which it is normally constricted?
126
12.What are the symptoms of renal and ureteric colic and who might be
predisposed to this condition?127
13.Describe the shape and position of each supraneal gland and its main functions128
14.Describe the blood supply and venous drainage of the supraneal gland129
121
Anteriorly, the kidney is related to the spleen, stomach, pancreas, jejunum and descending colon. The
kidneys themselves are in contact with the psoas muscles and fat pads and ribs 11-12 on the posterior
abdominal wall. The centres of each kindey hila lie about 5cm from the medial plane either side of the
transpyloric plane.
122
Surrounded by a thick layer of peri-renal fat and renal fascia, each are contained within a transparent but
tough renal capsule. Outside this is retroperitoneal fat.
123
The left kidney rests on the 11th and 12th ribs, the right just under the 12th
124
The renal pelvis is the flat expansion of the ureter as it passes through the diaphragm. Minor calices are
cup shaped branches of the renal pelvis into individual medullary pyramids. The major calices are formed by
the convergence of several minor calices.
125
126
1/ The junction with the renal pelvis, 2/ where the ureter crosses the pelvic brim, 3/ where the ureter
passes through the bladder wall
127
Ureteric colic is the precipitation of substances in the urine to form kidney stones. Most common in
chronic dehydration, renal infections and prolonged immobilization. Symptoms normally include severe pain
in the renal angle between the back muscles, erector spinae and 12th rib, or anywhere down the course of
the ureter to the groin.
128
Supraneal (adrenal) glands are positioned on top of each kidney, their functions are control of salt and
water balance, regulation of carbohydrate level and secretion of sex hormones.
129
Receives blood from a number of branches from the renal and inferior phrenic arteries and from the aorta,
the venous drainage is by a large vein into the left renal vein.
130
Zona glomerulosa (salt/water balance), Zona fasciculata (regulates carbohydrates), Zona reticularis (sex
hormones)
131
132
1/ Ventral to the gut, 2/ lateral, to the supraneal gland, 3/to the kidneys, 4/ to the gonads (testes or
ovaries), 5/inferior phrenic, 6/inferior phrenic, 7/4th lumbar, 8/median sacral
133
Begins in the body of the 5th lumbar vertebra. It the ascends to the right of the aorta to pierce the central
tendon of the diaphragm
134
Follow the same route as the aortic branches except the anterior ones, whose veins drain into the portal
system
135
The superior epigastric artery a continuation of the internal thoracic artery, it crosses the costal margin.
The inferior epigastric artery is the same artery but further down where the artery anastemoses with an
ascending artery from the internal iliac.
136
137
Unpaired visceral branches: coeliac (T12), superior mesenteric (L1), inferior mesenteric (L3), Paired
visceral branches: suprarenal (L1), renal (L1/L2) and testicular/overian (L2)
138
Foregut (mouth to 1/3 duodenum) = coeliac trunk, Midgut (duodenum to 2/3 transverse colon) = superior
mesenteric artery, Hindgut (2/3 transverse colon to rectum) = inferior mesenteric artery
139
The early thoracic part of the foregut is supplied by the external carotid and oesophageal arteries, the
proctodaeum (lower anal canal) is supplied by the paired inferior rectal arteries.
10.Why do the gut and the beginning and end of the alimentary tract have different
blood supplies?140
11.Which large vessel does venous blood from the proctodaeum end up in? 141
12.Where do the splenic, superior mesenteric and inferior mesenteric veins end up?
142
140
Because embreyologically the ends of the alimentary tract are derived from the ectoderm (outside layer)
and the gut from the endoderm (inside layer)
141
142
All the venous drainage of the gut comes together to form the hepatic portal vein.
143
The hepatic vein drains the liver, the hepatic portal vein is a separate vein which brings nutrient rich blood
to the liver from the gut.
144
The azygos veins which are inferior to the ascending lumbar veins drain into them, the ascending lumbar
veins drain into the inferior vena cava. Superiorly, the azygos veins also drain into the superior vena cava
directly.
145
The tributaries of the vena cava correspond to the abdominal aorta i.e. coeliac T12, superior mesenteric
L1 and inferior mesenteric L3 (all paired) and supraneal L1, the difference is that left renal and gonadal
vessels join the IVC via the left renal vein.
146
The azygos vein drains into the SVC and the ascending lumbar veins connect the azygos vein to the
SVC. Should the IVC become blocked then blood can reach the heart via the SVC
147
A sac like expansion at the inferior end of the thoracic duct, not present in all individuals. Located
between the origin of the abdominal aorta and azygos vein. Right of L1 and L2.
148
lacteals drain into larger lymph nodes around the origin of the gut arteries. Gut lymph is divided into preaortic (coeliac, superior and inferior mesenteric nodes (which correspond to arteries of the same name) or
para-aortic (either side of the aorta) and via the neck, which come from the liver and stomach. So enlarged
lymph nodes in the neck can indicade cancer or infection in the stomach, whereas enlarged para-aortic
nodes can indicate cancer or infection in the gut.
149
The pelvic girdle is the left and right hip bones joined together to (pubic symphysis) and the sacrum
(sacroiliac joint). The pelvic inlet is the ring of bone formed in the centre of the pelvic girdle.
150
The hip bones are formed by the fusion of the ilium, ischium and pubis (which fuse in adulthood into the
innominate bone). The ilium has the superior and anterior iliac spine. The pubis has the pubic tubercle and
superior and inferior rami. The ischium has a spine, tuberosity and a ramus which fuses with the pubis called
the ischiopubic ramus.
151
152
False pelvis is the upper part of the pelvis, in the pelvic region but above the pelvic brim. The true pelvis
is inferior to the pelvic brim and bordered inferiorly by the pelvic diaphragm made up of the levator ani
muscles.
153
Iliac fossae are covered by the iliacus muscles. The true pelvis contains the piriformis and obturator
internus muscle, the foramen between these is closed by the obturator membrane. The pelvic diaphragm
muscle prevents prolapse of the organs from the cavity.
154
The levator ani is a transeverse sheet of skeletal muscle which forms a support for the pelvic viscera
above. It is divided into 3 parts: puboerectalis (inner ring around anus), pubococcygeus (fans out anteriorly),
iliococcygeus (fans out either side of the pubococcygeus).
155
Main muscle of the levator ani and therefore has control over defecation
156
157
Diamond shaped region containing the genitals and anus. Divided into perineal pouches (superficial and
deep) and the ischioanal fossa (a fat filled space at the sides of the anal canal.
158
Fascia surrounding the inferior boundary of the perineum. In females the superficial layer contains fat, in
males it is called the dartos fascia and contains smooth muscle over the scrotum, giving the scrotum the
ability to contract. The deep perineal pouch is membranous and known as the urogenital diaphragm.
159
The deep, membranous layer of the perineum is continuous with Scarpas fascia of the anterior
abdominal wall.
160
161
Derives from S2,3 and 4, branches into dorsal nerve under the urogenital diaphragm (penis/clitoris), over
the urogenital diaphragm, perineal nerve (scrotum/labia) and inferior rectal nerve (anus).
162
163
164
Common iliac nodes (apart from ovaries which drain to the para-aortic nodes)
165
166
Puboerectalis muscle, which is also a pelvic floor muscle and forms part of the anal sphincter
167
Rectal ampulla
168
5. What is the name for the non-keratinising squamous epithelial lining forming 6-7
ridges along the lower anal canal?169
6. What links the lower ends of these columns? 170
7. Describe the structure of the muscularis externa of the rectum?171
4. List the parts of the anal sphincters172
5. What are the blood supplies and venous drainage vessels of the upper and lower
anal canal?173
6. What are the 3 main routes of lymphatic spread from the rectum and anal canal?
174
169
Anal columns
170
Anal valves, together known as the pectinate line. These are above the Anocutaneous white line.
171
Similar to the structure elsewhere in the GI tract (apart from the colon), there is a complete internal layer
of circular muscle coated in a layer of longitudinal muscle
172
The internal anal sphincter is made up of smooth muscle, ends at the white line. The external sphincter is
made up of striated muscle and consists of 3 parts (subcutanous, superficial, deep), going from the outside
in. These are innervated by S2,3 & 4.
173
Upper = superior and middle rectal vessels, Lower = inferior rectal vessels. All are linked to the inferior
mesenteric.
174
Above the pectinate line, lymph drains into the inferior mesenteric pre-aortic nodes and the internal iliac
nodes. Below the pectinate line it drains into the superficial inguinal nodes.
175
The rectum is a distensible contractile chamber which responds to stretch (S2, 3 & 4) as faeces
accumulates inside it from the sigmoid colon. The defecation reflex is controlled by the internal (smooth
muscle/involuntary) sphincter and external (striated muscle/voluntary). The stretch causes inhibition of the
puboerectalis muscle and anal sphincters. Although the external (voluntary) sphincter remains in a state of
tonic contraction until the point of defecation.
176
The external meatus is the narrowest portion of spongy urethra and therefore the hardest part to
catheterize. It is simply the opening of the urethral orifice.
177
1/ The proximal posterior urethra begins at the interface with the bladder, prostate and urethra, 2/
prostatic urethra is entirely contained within the prostate 3/ membranous urethra is located within the
urogenital diaphragm 4/ the anterior/spongy urethra is anything beyond this including the penis
178
The muscular coat is continuous with that of the bladder, it extends the whole length of the tube and
consists of circular fibres. Surrounded by sphincter urethrae between the superior (entrance to the true
pelvis) and inferior urogenital diaphragm.
179
180
Mucous coat continuous with that of the vulva. Mucus glands are called glands of Skene.
181
182
183
184
A raised portion of the prostate that contains several openings into the urethra
185
Spreads through lymphatics to the nodes around the internal and common iliac arteries and aorta.
Venous spread through the internal iliac veins and IVC.
186
187
In females, the course of the ureter crosses the uterine artery, which is absent in males. In males the
ureter passes under the vas deferens (sperm duct).
188
Pyramid shaped - 2 inferolateral surfaces, superior surface and a base. Ureters enter obliquely either side
of the trigone, other point of the trigone is the urethral opening.
189
The remnant of the embryonic urachus (which would have drained the bladder to the umbilical cord)
which runs between the bladder and the umbilicus
190
Trigone is the shape formed by the ureters and urethra entering/exiting the bladder. Detrusor muscle
contracts around the bladder when urinating to squeeze the bladder empty.
191
192
Prominent in males only, on the junction between the bladder and urethra (above the prostate), prevents
reflux of semen and prostate fluid into the bladder.
193
Afferent fibres signal distention through CNS. Parasympathetic efferents from S2-4 inhibit the sphincter
and motor to the detrusor. When holding on, sympathetics from T11-12 and L1-2 cause constriction of
sphincter and inhibit detrusor.
194
When full the bladder becomes an abdominal organ, it can be drained by a suprapubic catheter.
195
In both sexes the pubovesical ligament extends from the pubis to the bladder, in males there is a
puboprostatic (pubis and prostate) ligament, in females there is a pubourethral ligament (pubis and urethra).
196
The urethra above the membranous part can be ruptured by prostatic cancer, in which case the urine will
collect from the membrane upwards. If below it will collect in the superficial pouch. Bulbous (penile) rupture
can be associated with traumatic injury, and in some cases rupture of the membranous urethra can result
from pelvic fracture.