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Anatomy III
Anatomy III
Anatomy III
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This lecture includes the slides that the doctor read and I added the doctors words right in the boxes.
The doctor started by making a correction, which is the additional slides on the website.
UreDers
Muscular Tube Measuring About 25 Cm. Begin
at Renal Pevis, then descend retroperitoneally and
anterior to psoas muscle to posterior surface of
Urinary bladder.
Then cross pelvic inlet into minor (true) pelvis where they are still retroperitoneal
and cross anterior to Common Iliac Bifurcation And Anterior To Sacro-iliac Joint.
Then it follows the course of internal iliac artery (which goes to the pelvis).
Sigmoid colon and mesocolon and left Colic vessels, Testicular/Ovarian artery.
Posteriorly: Left Psoas muscle and bifurcation of common iliac artery.
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***During hysterectomy (surgical removal of the uterus) ureter can be ligated with uterine artery.
(it is posterior to artery near cervix).
Clinical Points
Long = 25 cm, Narrower and 3 constrictions:
Hence susceptible to renal stones lodgment at constriction sites.
Renal Colic:
Severe pain experienced when renal stones are lodged.
Afferent fibers enter spinal cord at T 11-12 and L 1-2 (Skin of Flank loin and
Groin Areas).
Renal stone arrest at Lower Part referred pain felt at Tip of Penis/Testicles
or labia in case of females.
Surfaces.
The 2 ureters enter the urinary bladder at the 2 lateral angels in the superior posterior region. The
area above the entrance of the 2 ureters is called the fundus.
And notice in the picture the internal urethral orifice (which is under the autonomic nervous
system) and the external (which is voluntary).
Now regarding the interior aspect of the urinary bladder, like any organ in the body that is subjected
to distension (the stomach for e.g.). You can see that it's folded to allow it to extend. These folds are
called "Rugae".
- still in the interior aspect we have a triangular area that extend between the 2 upper lateral points
(which represent the opening of the 2 ureters) and the internal urethral orifice. This area is called
the "trigon".
Trigone of the bladder is not folded, it smooth; the significant of this is Because if its folded this will
affect the potency of the tube (ureter), that means the urine will not pass easily from the ureter to
the bladder.
At the neck of urinary bladder we have the prostatic urethra and prostate (regarding males)
while in females related to urogenital diaphragm.
Regarding males as we said we have the prostate gland at the neck of the bladder. And in the
urethra there is an opening for the vas deference which passes within the substance of the prostate
gland carrying semen to the ejaculatory duct; this part of urethra is called prostatic urethra. Then
the urethra pass through the urogenital diaphragm.
- It's supplied by Superior and Inferior Vesical arteries which are branches of Internal Iliac Artery.
- Regarding the venous drainage it's correspond to the arteries and drain into the internal iliac vein.
- Nerve Supply via the Inferior Hypogastric Plexus from Sympathetic fibers of L 1-2
Bladder clinical:
1- In infants the empty bladder lies within the false abdominal cavity. As it mature (in adults) it
shifts and move into the minor pelvis (true pelvis), but when full can rise above pelvic inlet.
2- Prostatic Hypertrophy: Affects Males above 45 yrs. Hence
Pressure over Prostatic Urethra and cause Residual volume
and Urgency to Micturation and Possible Retention.
URETHRA :
Muscular Tube Carries urine from the Bladder to the outside of the body
Internal Sphincter prevents urine from emptying; composed of smooth muscle; involuntary
External Sphincter at the upper portion of the urethra allows you to resist the urge to urinate; composed
of skeletal muscle; voluntary
Female Short and Wide opens to the outside at the urethral meatus, subjected more to UTI
Male longer and narrow, passes through the prostate gland; carries urine and sperm.
Hence Males more prone for Renal Stone arrest But Females more susceptible to Urinary Tract Infection
Males (3 parts)
1. Prostatic post. wall has urethral crest that contains 2 openings of ejaculatory ducts. Prostatic
ducts are lateral to urethral crest.
2. Membranous the narrowest crosses urogenital diaphragm and surrounded by deep
transverse perineal m. and sphincter urethrae m. (external sphincter)
-Both musc. by pudendal n.
- the place where lodgment of renal stone occur
3. Penile (spongy/cavernous) surrounded by corpus spongiosum, enlarges into fossa navicularis,
and ends as external urethral meatus. Openings of bulbourethral glands just below urogenital
diaphragm. (vulnerable to catheter penetration)
Females
-
Courses through urogenital diaphragm and is surrounded by deep transverse perineal m. and
sphincter urethrae m. (later muscles doesnt completely surround urethra and is the reason for
high incidence of stress incontinence in women)
Posterior surface fuses with anterior wall of vagina.
External urethral orifice stratified Squamous epitheliumopens into vestibule of vagina between
labia minora.
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Done by:
Anagreh
Obiedat
Zoubi
Shatnawi
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