URINARY BLADDER AND URETHRA
• covered with peritoneum and is
URINARY BLADDER
• situated immediately behind the
pubic bones within the pelvis.
• It stores urine and, in the adult, has
a maximum capacity of about 500
mL.
• The bladder has a strong muscular
wall. Its shape and relations vary
according to the amount of urine that
it contains. – if FULL can be
palpated in the hypogastic area
• In the young child, the empty
bladder projects above the pelvic
inlet
• The muscular coat of the bladder is
composed of smooth muscle and is
arranged as three layers of
interlacing bundles known as the
detrusor muscle. At the neck of the
bladder, the circular component of
the muscle coat is thickened to form
the sphincter vesicae.
URINARY BLADDER
APEX
• points anteriorly and lies behind
the upper margin of the
symphysis pubis.
• It is connected to the umbilicus
by the median umbilical ligament
(remains of urachus).
BASE/POSTERIOR SURFACE
• faces posteriorly and is triangular.
The superolateral angles are joined
by the ureters, and the inferior angle
gives rise to the urethra
• The two vasa deferentia lie side by
side on the posterior surface of the
bladder and separate the seminal
vesicles from each other
• The upper part of the posterior
surface of the bladder is covered by
peritoneum, which forms the anterior
wall of the rectovesical pouch.
• The lower part of the posterior
surface is separated from the rectum
by the vasa deferentia, the seminal
vesicles, and the rectovesical fascia
URINARY BLADDER
SUPERIOR SURFACE
related to coils of ileum or sigmoid
colon.
• Along the lateral margins of this
surface, the peritoneum passes
to the lateral pelvic walls.
• As the bladder fills, it becomes
ovoid, and the superior surface
bulges upward into the abdominal
cavity.
INFEROLATERAL SURFACE
• related in front to the retropubic
pad of fat and the pubic bones.
More posteriorly, they lie in
contact with the obturator
internus muscle above and the
levator ani muscle below
URINARY BLADDER
NECK
• lies inferiorly and rests on the
upper surface of the prostate.
Here, the smooth muscle fibers
of the bladder wall are
continuous with those of the
prostate.
• Held in position by:
PUBOPROSTATIC LIGAMENT
male
• PUBOVESICAL LIGAMENT
female
URINARY BLADDER
TRIGONE
• The area of mucous membrane
covering the internal surface of the
base of the bladder
• The superior angles of the trigone
correspond to the openings of the
ureters, and the inferior angle to the
internal urethral orifice
• The trigone is limited above by a
muscular ridge, which runs from the
opening of one ureter to that of the
other and is known as the
interureteric ridge
 • Arteries: The superior and inferior
vesical arteries, branches of the
internal iliac arteries.
• Veins: The veins form the vesical
venous plexus that drains into the
internal iliac vein.
• Lymph Drainage: Internal and
external iliac nodes
• Nerve Supply: The inferior
hypogastric plexuses. The
sympathetic postganglionic fibers
originate in the 1st and 2nd lumbar
ganglia and descend to the bladder
via the hypogastric plexuses.
• The parasympathetic preganglionic
fibers arise as the pelvic splanchnic
nerves from the second, third, and
fourth sacral nerves; they pass
through the inferior hypogastric
plexuses to reach the bladder wall,
where they synapse with
postganglionic neurons
RETROVESICAL POUCH
➢ The peritoneum passes down from
the anterior abdominal wall onto the
upper surface of the urinary bladder.
➢ It then runs down on the posterior
surface of the bladder for a short
distance until it reaches the upper
ends of the seminal vesicles. Here, it
sweeps backward to reach the
anterior aspect of the rectum.
➢ The peritoneum then passes up on
the front of the middle third of the
rectum and the front and lateral
surfaces of the upper third of the
rectum.
➢ It then becomes continuous with the
parietal peritoneum on the posterior
abdominal wall. It is thus seen that
the lowest part of the
abdominopelvic peritoneal cavity
URINARY BLADDER
➢ Because of the absence of the
prostate, the bladder lies at a lower
level than in the male pelvis, and the
neck rests directly on the upper
surface of the urogenital diaphragm
➢ The apex of the bladder lies behind
the symphysis pubis.
➢ The base, or posterior surface, is
separated by the vagina from the
rectum. The superior surface is
related to the uterovesical pouch of
peritoneum and to the body of the
uterus.
➢ The inferolateral surfaces are related
in front to the retropubic pad of fat
and the pubic bones. More
posteriorly, they lie in contact with
the obturator internus muscle above
and the levator ani muscle below.
➢ The neck of the bladder rests on the
upper surface of the urogenital
diaphragm.
URETHRA - MALE
➢ about 8 in. (20 cm) long and extends
from the neck of the bladder to the
external meatus on the glans penis
➢ MEMBRANOUS URETHRA
➢ about 0.5 in. (1.25 cm) long and lies
within the urogenital diaphragm,
surrounded by the sphincter
urethrae muscle. It is the least
dilatable portion of the urethra.
PROSTATIC URETHRA
➢ about 1.25 in. (3 cm) long and
begins at the neck of the
bladder.
➢ It passes through the prostate
from the base to the apex, where
it becomes continuous with the
membranous part of the urethra
➢ is the widest and most dilatable
portion of the entire urethra
➢ urethral crest - longitudinal
ridge on the posterior wall
➢ On each side of this ridge is a
groove called the prostatic
sinus; the prostatic glands open
into these grooves
➢ On the summit of the urethral
crest is a depression, the
prostatic utricle
PENILE URETHRA
➢ about 6 in. (15.75 cm) long and
is enclosed in the bulb and the
corpus spongiosum of the penis
➢ The external meatus is the
narrowest part of the entire
urethra.
➢ The part of the urethra that lies
within the glans penis is dilated
to form the fossa terminalis
(navicular fossa).
➢ The bulbourethral glands open
into the penile urethra below the
urogenital diaphragm
URETHRA - FEMALE
➢ about 1.5 in. (3.8 cm) long.
➢ It extends from the neck of the
bladder to the external meatus,
where it opens into the vestibule
about 1 in. (2.5 cm) below the
clitoris.
➢ traverses the sphincter urethrae
and lies immediately in front of
the vagina.
➢ At the sides of the external
urethral meatus are the small
openings of the ducts of the
paraurethral glands.
PARAURETHRAL GLANDS
➢ open into the vestibule by small
ducts on either side of the
urethral orifice
➢ corresponds to the prostate
URETHRA - FEMALE
➢ GREATER VESTIBULAR GLANDS
➢ pair of small mucus- secreting
glands that lie under cover of the
posterior parts of the bulb of the
vestibule and the labia majora.
➢ Each drains its secretion into the
vestibule by a small duct, which
opens into the groove between the
hymen and the posterior part of the
labium minus.
➢ These glands secrete a lubricating
mucus during sexual intercourse
KIDNEYS AND URETER
KIDNEYS
- reddish brown and lie behind the
peritoneum high up on the
posterior abdominal wall on
either side of the vertebral
column;
- they are largely under cover of
the costal margin
- right kidney lies slightly lower
than the left kidney
KIDNEYS
o HILUM - On the medial concave
border of each kidney is a
vertical slit that is bounded by
thick lips of renal substance
o from the front backward, the
renal vein, two branches of the
renal artery, the ureter, and the
third branch of the renal artery
(V2AUA).
KIDNEYS
o Lymph vessels and sympathetic
fibers also pass through the
hilum
o RENAL CAVITY – a cavity that
the hilum extends into
COVERINGS
Fibrous capsule:
- This surrounds the kidney and is
closely applied to its outer
surface.
Perirenal fat:
- This covers the fibrous capsule.
kidneys
Renal fascia:
- This is a condensation of
connective tissue that lies
outside the perirenal fat and
encloses the kidneys and
suprarenal glands;
- it is continuous laterally with the
fascia transversalis.
Pararenal fat:
- This lies external to the renal
fascia and is often in large
quantity.
- It forms part of the
retroperitoneal fat.

KIDNEYS
➢ Each kidney has a dark brown
outer CORTEX
➢ The cortex extends into the
medulla between adjacent
pyramids as the renal columns.
➢ Extending from the bases of the
renal pyramids into the cortex
are striations known as
medullary rays.
➢ light brown inner MEDULLA
➢ a dozen renal pyramids, each
having its base oriented toward
the cortex and its apex, the renal
papilla, projecting medially
The RENAL SINUS
➢ which is the space within the
hilum
➢ contains the upper expanded
end of the ureter, the renal
pelvis.
➢ This divides into two or three
major calyces, each of which
divides into two or three minor
calyces.
➢ Each minor calyx is indented by
the apex of the renal pyramid,
the renal papilla.
RIGHT kidney
Anteriorly:
- The suprarenal gland, the liver,
the second part of the
duodenum, and the right colic
flexure.
Posteriorly:
- The diaphragm; the
costodiaphragmatic recess of the
pleura; the 12th rib; and the
psoas, quadratus lumborum, and
transversus abdominis muscles.
- The subcostal (T12),
iliohypogastric, and ilioinguinal
nerves (L1) run downward and
laterally.
LEFT KIDNEY
Anteriorly:
- The suprarenal gland, the
spleen, the stomach, the
pancreas, the left colic flexure,
and coils of jejunum
Posteriorly:
- The diaphragm; the
costodiaphragmaticrecess of the
pleura; the 11th (the left kidney
is higher) and 12th ribs; and the
psoas, quadratus lumborum, and
transversus abdominis muscles.
The subcostal (T12),
iliohypogastric, and ilioinguinal
nerves (L1) run downward and
laterally.
Kidney – ARTERIAL SUPPLY
➢ The renal artery arises from the
aorta at the level of the 2nd
lumbar vertebra
➢ Each renal artery usually divides
into five segmental arteries that
enter the hilum of the kidney
➢ Lobar arteries arise from each
segmental artery, one for each
renal pyramid
➢ Each lobar artery gives off two or
three interlobar arteries.
➢ The interlobar arteries run
toward the cortex on each side
of the renal pyramid. At the
junction of the cortex and the
medulla, the interlobar arteries
give off the arcuate arteries,
which arch over the bases of the
pyramids.
➢ The arcuate arteries give off
several interlobular arteries that
ascend in the cortex.
➢ The afferent glomerular
arterioles arise as branches of
the interlobular arteries.
Kidney - VENOUS
Veins
- The renal vein emerges from the
hilum in front of the renal artery
and drains into the inferior vena
cava
Kidney - Lymph Drainage
Lymph Drainage
- Lymph drains to the lateral aortic
lymph nodes around the origin of
the renal artery.
Kidney - Nerve Supply
Nerve Supply
- The nerve supply is the renal
sympathetic plexus.
- The afferent fibers that travel
through the renal plexus enter
the spinal cord in the 10th, 11th,
and 12th thoracic nerves
URETERS
• Each ureter is a muscular tube that
extends from the kidney to the
posterior surface of the bladder
• enters the pelvis by crossing the
bifurcation of the common iliac artery
in front of the sacroiliac joint.
• Each ureter then runs down the
lateral wall of the pelvis in front of
the internal iliac artery to the region
of the ischial spine and turns forward
to enter the lateral angle of the
bladder. Near its termination, it is
crossed by the vas deferens.
• The ureter passes obliquely through
the wall of the bladder for about 0.75
in. (1.9 cm) before opening into the
bladder.
• three constrictions: where the
renal pelvis joins the ureter in the
abdomen, where it is kinked as it
crosses the pelvic brim to enter the
pelvis, and where it pierces the
bladder wall.
PERICARDIUM AND HEART
PERICARDIUM
- is a fibro-serous sac that encloses
the heart and the roots of the great
vessels.
- lies within the middle mediastinum
posterior to the body of the
sternum
- 2nd to the 6th costal cartilages and
anterior to the 5th to the 8th
thoracic vertebrae to restrict
excessive movements of the heart
as a whole and a lubricated
container in which the different
parts of the heart can contract.
FIBROUS PERICARDIUM
- is the strong fibrous part of the sac.
- firmly attached below to the central
tendon of the diaphragm
- fuses with the outer coats of the
great blood vessels passing through
it
- attached in front to the sternum by
the sterno-pericardial ligaments.
- Supplied by the phrenic nerve
SEROUS PERICARDIUM
lines the fibrous pericardium and coats the
heart
PARIETAL PERICARDIUM
lines the fibrous pericardium and is
reflected around the roots of the great
vessels; supplied by phrenic nerve
VISCERAL PERICARDIUM
closely applied to the heart and is often
called the epicardium.
Nerve supply is through branches of the
sympathetic trunks and the vagus nerves
PERICARDIAL CAVITY
The slit like space between the parietal and
visceral layers
 PERICARDIAL SINUSES
OBLIQUE SINUS
A recess form on the posterior surface of
the heart from the reflection of the serous
pericardium around the large veins
TRANSVERSE SINUS
a short passage that lies between the
reflection of serous pericardium around the
aorta and pulmonary trunk and the
reflection around the large veins
>Both sinuses are due to the development of
the heart but has NO CLINICAL SIGNIFICANCE
HEART
➢ a hollow muscular organ that is
somewhat pyramid shaped and lies
within the pericardium in the
mediastinum
➢ It is connected at its base to the
great blood vessels but otherwise
lies free within the pericardium.
➢ Has three surfaces and an apex
SURFACES OF THE HEART
STERNOCOSTAL SURFACE
- formed mainly by the right atrium
and the right ventricle, which are
separated from each other by the
vertical atrioventricular groove
- The right border is formed by the
right atrium; the left border, by the
left ventricle and part of the left
auricle
- The right ventricle is separated
from the left ventricle by the
anterior interventricular groove
SURFACES OF THE HEART
DIAPHRAGMATIC SURFACE
- formed mainly by the right and left
ventricles separated by the
posterior interventricular groove.
- The inferior surface of the right
atrium, into which the inferior vena
cava opens, also forms part of this
surface.
SURFACES OF THE HEART
BASE
- The base of the heart, or the
posterior surface, is formed mainly
by the left atrium, into which open
the four pulmonary veins.
- The base of the heart lies opposite
the apex
SURFACES OF THE HEART
APEX
- formed by the left ventricle, is
directed downward, forward, and
to the left
- It lies at the level of the fifth left
intercostal space, 3.5 in. (9 cm)
from the midline
- In the region of the apex, the apex
beat can usually be seen and
palpated in the living patient
BORDERS OF THE HEART
• Right border is formed by the right
atrium
• Left border, by the left auricle; and
below, by the left ventricle
• Lower border is formed mainly by
the right ventricle but also by the
right atrium
• The apex is formed by the left
ventricle
RIGHT ATRIUM
consists of a main cavity and a small
outpouching, the auricle
SULCUS TERMINALIS
- Found on the outside of the heart
at the junction between the right
atrium and the right auricle and is a
vertical groove
CRISTA TERMINALIS
- A ridge form inside from the sulcus
terminalis
MUSCULI PECTINATI
- trabeculated by bundles of muscle
fibers which run from the crista
terminalis to the auricle
RIGHT ATRIUM - OPENINGS
SUPERIOR VENA CAVA
- opens into the upper part of the
right atrium
- it has no valve
INFERIOR VENA CAVA
- larger than the superior vena cava
opens into the lower part of the
right atrium
- it is guarded by a rudimentary,
nonfunctioning valve
CORONARY SINUS
- which drains most of the blood
from the heart wall opens into the
right atrium between the inferior
vena cava and the atrioventricular
orifice
- It is guarded by a rudimentary,
nonfunctioning valve
RIGHT ATRIOVENTRICULAR ORIFICE
- lies anterior to the inferior vena
cava opening
- is guarded by the tricuspid valve
RIGHT ATRIUM- – FETAL REMNANTS
FOSSA OVALIS
- is a shallow depression, which is the
site of the foramen ovale in the
fetus
- Lie on the atrial septum
- ANULUS forms the upper margin of
the fossa and formed from FOSSA
OVALIS
- Form the lower edge of the septum
secundum
RIGHT VENTRICLE
communicates with the right atrium through
the atrioventricular orifice and with the
pulmonary trunk through the pulmonary orifice
INFUNDIBULUM
- As the cavity approaches the
pulmonary orifice, it becomes
funnel shaped
- The walls are thicker compared to
that of the right atrium
TRABECULAE CARNEAE
- The projecting ridges give the
ventricular wall a sponge-like
appearance
3 TYPES:
• Papillary muscles, which project inward,
being attacked by their bases to the
ventricular wall; their apices are
connected by fibrous chords (the
chordae tendineae) to the cusps of the
tricuspid valve
• The second type is attached at the ends
to the ventricular wall, being free in the
middle
- One of these, the moderator band,
crosses the ventricular cavity from
the septal to the anterior wall
- It conveys the right branch of the
atrioventricular bundle, which is
part of the conducting system of
the heart
• The third type is simply composed of
prominent ridges
VALVES
TRICUSPID VALVE
➢ guards the atrioventricular orifice
and consists of three cusps formed
by a fold of endocardium with some
connective tissue enclosed:
anterior, septal, and inferior
(posterior) cusps
➢ The bases of the cusps are attached
to the fibrous ring of the skeleton of
the heart
➢ the free edges and ventricular
surfaces are attached to the
chordae tendineae which connect
the cusps to the papillary muscles
PULMONARY VALVE
➢ guards the pulmonary orifice and
consists of three semilunar cusps
formed by folds of endocardium
 with some connective tissue
enclosed
➢ The curved lower margins and sides
of each cusp are attached to the
arterial wall.
➢ The open mouths of the cusps are
directed upward into the
pulmonary trunk.
➢ No chordae or papillary muscles are
associated with these valve cusps;
the attachments of the sides of the
cusps to the arterial wall prevent
the cusps from prolapsing into the
ventricle
LEFT ATRIUM
consists of a main cavity and a left auricle.
➢ The left atrium is situated behind
the right atrium and forms the
greater part of the base or the
posterior surface of the heart.
➢ Behind it lies the oblique sinus of
the serous pericardium, and the
fibrous pericardium separates it
from the esophagus.
LEFT ATRIUM-OPENINGS
- The four pulmonary veins, two from
each lung, open through the
posterior wall and have no valves.
- The left atrioventricular orifice is
guarded by the mitral valve.
LEFT VENTRICLE
➢ communicates with the left atrium
through the atrioventricular orifice
and with the aorta through the
aortic orifice.
➢ The walls of the left ventricle are
three times thicker than those of
the right ventricle. (The left
intraventricular blood pressure is
six times higher than that inside the
right ventricle.)
➢ There are well-developed
trabeculae carinae, two large
papillary muscles, but no
moderator band.
AORTIC VESTIBULE
- The part of the ventricle below the
aortic orifice is called the aortic
vestibule
-
LEFT VENTRICLE-VALVES
MITRAL VALVE
➢ guards the atrioventricular orifice
➢ It consists of two cusps, one
anterior and one posterior, which
have a structure like that of the
cusps of the tricuspid valve.
➢ The anterior cusp is the larger and
intervenes between the
atrioventricular and aortic orifices.
➢ The attachment of the chordae
tendineae to the cusps and the
papillary muscles is like that of the
tricuspid valve.
AORTIC VALVE
➢ guards the aortic orifice and is
precisely similar in structure to the
pulmonary valve.
➢ One cusp is situated on the anterior
wall (right cusp) and two are
located on the posterior wall (left
and posterior cusps).
AORTIC SINUS
➢ Behind each cusp and is formed
through the bulging of the aortic
wall.
CONDUCTING SYSTEM OF THE HEART
SINU-ATRIAL NODE
➢ located in the wall of the right
atrium in the upper part of the
sulcus terminalis just to the right of
the opening of the superior vena
cava.
➢ The node spontaneously gives
origin to rhythmic electrical
impulses that spread in all
directions through the cardiac
muscle of the atria and cause the
muscle to contra
ATRIOVENTRICULAR NODE INTERNODAL CONDUCTION PATHWAYS
strategically placed on the lower part of the Anterior Internodal Pathway
atrial septum just above the attachment of the • leaves the anterior end of the sino-
septal cusp of the tricuspid valve. atrial node and passes anterior to
➢ The atrioventricular node is the superior vena caval opening
stimulated by the excitation wave and descends on the atrial septum
as it passes through the atrial and ends in the atrioventricular
myocardium. node
➢ The speed of conduction of the Middle Internodal Pathway
cardiac impulse through the • leaves the posterior end of the sino-
atrioventricular node (about 0.11 atrial node and passes posterior to
seconds) the superior vena caval opening
ATRIOVENTRICULAR BUNDLE and descends on the atrial septum
➢ The cardiac impulse is conducted to to the atrioventricular node
the ventricles by the Posterior Internodal Pathway
atrioventricular bundle. • leaves the posterior part of the
➢ the only pathway of cardiac muscle sino-atrial node and descends
that connects the myocardium of through the crista terminalis and
the atria and the myocardium of the valve of the inferior vena cava
the ventricles to the atrioventricular node.
➢ the only route along which the
cardiac impulse can travel from the
atria to the ventricles
➢ then descends behind the septal MA PASAR RATA!!
cusp of the tricuspid valve to reach
the inferior border of the
membranous part of the ventricular
septum.
➢ At the upper border of the
muscular part of the septum, it
divides into two branches, one for
each ventricle
RIGHT BUNDLE BRUNCH BLOCK
➢ passes down on the right side of the
ventricular septum to reach the
moderator band, where it crosses
to the anterior wall of the right
ventricle.
➢ Here, it becomes continuous with
the fibers of the Purkinje plexus
LEFT BUNDLE BRUNCH BLOCK
➢ pierces the septum and passes down on
its left side beneath the endocardium.
➢ It usually divides into two branches
(anterior and posterior), which
eventually become continuous with the
fibers of the Purkinje plexus of the left
ventricle.