Abdomen and Pelvis

Extent, Formation, And Contents Of Anterior Abdominal Wall

Firm and elastic wall

Anterior Abdominal Wall Extent:

• Superiorly from the costal margin and xiphoid process
• Inferiorly up to the iliac crest and pubic symphysis

Read And Learn More: Abdomen And Pelvis

The anterior abdominal wall is made up of 8 layers. They are:

• Superficial To Deep

• Deep fascia is absent in the anterior abdominal wall, which allows the abdomen to distend during pregnancy or after meals.

1. Umbilicus

• Umbilicus is a normal scar in the anterior abdominal wall, representing the site of attachment of root of the umbilical cord
• The position of the umbilicus is variable
• In most cases:
  • Adults: Lies a little below the midpoint of the linea alba
  • New-born: Slightly lower
  • Old age: Lower due to decreased tone of abdominal muscles.

Importance of Umbilicus

• Umbilicus act as an important anatomical and embryological landmark
• Anatomically:
  • Watershed line: Venous and lymphatic flow is directed away from the umbilicus (directed upwards above the umbilicus and directed downwards below the umbilicus)
  • Umbilicus is a site of portocaval anastomosis
  • Skin around the umbilicus comes under the T10 dermatome.
• Embryologically:
  • It is the meeting point of four folds of the embryonic plate:
    • Head
    • Two lateral plates
    • Tail
  • It is the meeting point of three systems in fetal life, they are:
    • Umbilical vessel (vascular system)
    • Vitello intestinal duct (digestive system)
    • Urachus (excretory system).

2. Superficial Fascia

• Made of layers of fat, more at the lower half
• Above the level of the umbilicus, the superficial fascia is made up of a single layer of fat
• Below this level, it is made up of two layers, namely:
  • Camper’s fascia: Superficial fatty layer
  • Scarpas fascia: Deep membranous layer.

Camper’s Fascia

• Superficial fatty layer
• It is continuous with superficial fascia with adjoining parts of the body
• Over the penis: It is devoid of fat
• Over scrotum: It is replaced by dartos muscle.

Scarpas Fascia

• Deep membranous layer
• Made up of elastic type of fibrous tissue
• It is continuous below with another membranous layer of the superficial fascia of the perineum, called the Colle’s fascia

Scarpas Fascia Attachments

• Midline: Linea alba
• Each side: It is separated from external oblique muscles by a layer of loose areolar tissue
• Inferiorly: Attached to fascia lata of thigh (this line of attachment is surface marked by Holden’s line)
• It encloses the penis up to the base of glans
• In the scrotum, it is replaced by dartos muscle.

Muscles of Anterior Abdominal Wall

 

 

Flat Muscles Of Anterior Abdominal Wall

• Anterior Abdominal Wall Muscle
  • External oblique muscle
  • Internal oblique muscles
  • Transversus abdominis muscle
• Anterior Abdominal Wall Nerve supply
  • Lower six thoracic nerves (T7–T12) and fist lumbar (L1) nerve
  • Internal oblique muscles
  • Transversus abdominis muscle
• Anterior Abdominal Wall Blood Supply
  • Blood supply of all felt muscles of anterior abdominal wall is from same source, they are:
  • Lower posterior intercostal arteries
  • Subcostal arteries
  • Superior and inferior epigastric arteries
  • Superfiial and deep circumflx arteries
  • Posterior lumbar artery.

Three important structures are formed by the above-mentioned felt muscles of the anterior abdominal wall, namely:

1. Inguinal ligament
2. Conjoint tendon
3. Cremaster muscle.

Out of which, inguinal ligament and conjoint tendon are explained in detail:

1. Anterior Abdominal Wall Inguinal ligament

• Thick fibrous band, lying beneath the fold of the groin
• Derived from the lower free border of the external oblique aponeurosis
• Extend: Anterior superior iliac spine to pubic tubercle
• The lower border of the inguinal ligament is attached to the fascia lata (deep fascia of thigh)
• Traction by this fascia pulls the inguinal ligament convex downwards.

Extensions of Inguinal ligament

• Lacunar ligament:
  • Triangular in shape
  • Apex attached to pubic tubercle
  • Base directed laterally
  • Lacunar Ligament Attachments
    • Anteriorly: Medial end of inguinal ligament
    • Posteriorly: Pecten pubis.
• Pectineal ligament:
  • It is the extension of posterior part of the lacunar ligament
  • Considered as a thickening in the upper part of the pectineal fascia.
• Reflcted part of inguinal ligament:
  • Formed by superficial fibers from the medial end of the inguinal ligament passing upwards and medially
  • These fiers intermix with those of opposite side at the line alba
  • It lies behind the superficial inguinal ring.
• Ilioinguinal ligament: Fibrous band between the inferior surface of the inguinal ligament to iliopectineal eminence.

2. Conjoint tendon

• Also known as falx inguinalis
• Formation: By the fusion of lower aponeurotic fibers of internal oblique and transversus abdominis muscle
• It has attachments to the pubic crest and medial part of the pecten pubis
• It forms the medial half of the posterior wall of the inguinal canal
• Medially it is continuous with the anterior wall of the rectus sheath
• Laterally it is usually free, but sometimes may be continuous with the interfoveolar ligament.

Conjoint Tendon Applied Anatomy

The portion of the abdominal wall which is weakened due to the presence of superficial inguinal ring is strengthened by the conjoint tendon.

Vertical Muscles of Anterior Abdominal Wall

1. Rectus Abdominis Muscle

• One of the two vertical muscles of anterior abdominal wall, the other being pyramidalis
• Extend: From the costal margin to the pubic symphysis along the linea alba
• It narrows as it descends downwards (wider above and narrow below)

Rectus Abdominis Muscle Origin: From two tendinous heads—lateral and medial

• Lateral head: From the lateral part of pubic crest and pubic tubercle
• Medial head: From the anterior pubic ligament

Rectus Abdominis Muscle Insertion:

• Inserted through 4 flashy slips
• These fleshy slips gets inserted along a horizontal line passing from lateral to medial on the 7th, 6th, 5th costal cartilages and xiphoid process

Rectus Abdominis Muscle Actions: Flexes the trunk, supports the abdominal viscera

Rectus Abdominis Muscle Nerve supply: T7–T12 thoracic nerves

Rectus Abdominis Muscle Blood supply: Superior and Inferior epigastric arteries.

Pyramidalis Muscle

• Triangular muscle
• Base of the triangle forms the origin and the apex forms the insertional part of the muscle
• Lies in front of the lower part of rectus abdominis
• It is covered by rectus sheath

Pyramidalis Muscle Origin: From the front of the pubis and pubic symphysis

Pyramidalis Muscle Insertion:

• Attached medially to the linea alba
• Point of attachment lies midway between the umbilicus and pubic symphysis

Pyramidalis Muscle Actions: Tenses the lower linea alba

Pyramidalis Muscle Nerve supply: Subcostal nerve

Pyramidalis Muscle Blood supply: Inferior epigastric artery, deep circumflex iliac artery.

The abdomen is situated between the thorax and pelvis, encapsulating vital organs such as the stomach, intestines, liver, and kidneys. It is bounded superiorly by the diaphragm and inferiorly by the pelvic inlet. This cavity is not just a passive space; it plays an active role in processes like digestion, respiration, and waste elimination.

The pelvis, forming the lower part of the trunk, supports the weight of the upper body and facilitates movement by transferring that weight to the lower limbs. It encompasses not only bony structures but also a complex arrangement of muscles and connective tissues that protect internal organs and maintain bodily functions. Together, these regions are integral to maintaining homeostasis and facilitating daily activities. This page will guide you through their anatomy, highlighting key features, functions, and clinical significance.

• Anterior Abdominal Wall Important Question And Answers
• Human Male Genital Organs Important Question And Answers
• Abdominal Cavity And Peritoneum Important Question And Answers
• Human Digestive System Important Question And Answers
• Human Small And Large Intestines Important Question And Answers
• Spleen Pancreas And Liver Question And Answers

• Biliary Apparatus Question And Answers
• Blood Vessels Of Abdomen And Pelvis Question And Answers
• Rectum And Anal Canal Question And Answers
• Pelvis And Perineum Anatomy Question And Answers
• Male And Female Reproductive Organs Question And Answers
• Urinary Bladder And Urethra Question And Answers
• Posterior Abdominal Wall Question And Answers
• Kidney Ureter And Suprarenal Gland Question And Answers

Kidney Ureter And Suprarenal Gland Question And Answers

Question 1. Describe the anatomical features of kidney.
Answer:

The Anatomical Features Of Kidney

• Bean-shaped excretory organ
• Situated on either side of the vertebral column in the posterior abdominal wall
• Right kidney is slightly lower than the left
• Vertebral Level: T12–L3
• Length: 11 cm
• Breadth: 6 cm
• Thickness: 3 cm
• Weight
  • Male: 150 g
  • Female: 130 g
• Color: Reddish brown
• Orientation: Directed downwards and laterally

Read And Learn More: Abdomen And Pelvis

External Features Of Kidney: It has

• Two Poles:
  • Broad upper pole
  • Pointed lower pole, which lies 2.5 cm above the iliac crest.
• Two Surfaces:
  • Anterior Surface: Irregular, faces anterolaterally
  • PosteriorSurface: Flat, faces posteromedially.
• Two Borders:
  • Medial Border
    • Concave
    • The middle part of concavity shows a depression, called hilum
  • Lateral Border
    • Convex.

Hilum of Kidney:

• Hilum is present on the central part of the medical border
• Hilum Transmits The Following Structures (From Anterior To Posterior)
  • Renal vein
  • Renal artery
  • Renal pelvis
  • Branch of renal artery
  • Lymphatics and sympathetic nerves.

Kidney Relations

Question 2. What are the relations of kidney?
Answer:

The Relations Of Kidney

Question 3. Write a note on coverings of kidney.
Answer:

Coverings Of Kidney

• The kidney has 4 coverings
• They Are (From Inside To Outside):
  • Fibrous capsule or true capsule
  • Perinephric fat or fatty capsule
  • Fascial capsule/false capsule/renal fascia/fascia of Gerota
  • Perinephric fat.
• True Capsule Of Kidney
  • True Capsule Is Made Up Of:
    • Collagen fibers
    • Elastic fibers
    • Smooth muscle fibers
  • True capsule gives a shining appearance to the kidney
  • Normally true capsule can be easily stripped of
  • But The Capsule Becomes Adherent In Renal Diseases.
  • Fatty Capsule Or Perinephric Fat Of Kidney
    • It is an adipose tissue layer
    • Numerous fibrous strands connecting the true and false capsules pass through the fatty capsule.
• False Capsule Of Kidney
  • False Capsule provides common covering to kidney and suprarenal glands
  • False Capsule Consists Of Two Layers:
    • Anterior layer: Fascia of Toldt
    • Posterior layer: Fascia of Zuckerkandl
  • On Horizontal Tracing Of False Capsule:
    • Two layers fuse along the lateral border of the kidney and become continuous with transversal fascia
    • Medially
      • The anterior layer passes anterior to renal vessels and joins with the anterior layer on the opposite side, in front of the abdominal aorta and inferior vena cava
      • Posterior layer blends with psoas fascia and gets attached to lumbar vertebral bodies
  • On vertical Tracing Of False Capsule:
    • Superiorly: Anterior and posterior layers fuse above the suprarenal gland and become continuous with the diaphragmatic fascia
    • Inferiorly: Two layers run downwards along the ureter and merge with fascia iliaca and are open inferiorly.
• Perinephric Fat Of Kidney
  • Perinephric Fat is a part of retroperitoneal fat
  • Lies outside the fascial capsule
  • Found more on the posterior aspect of the kidney.

Question 4. What is Morrison’s parallelogram? And how is it drawn?
Answer:

Morrison’s Parallelogram

• It is the surface marking of the kidney from the back
• Morris Parallelogram Is Drawn In The Following Way:
  • Two horizontal lines are drawn, one at the level of the spine of T11 and the other at the level of the spine of L3
  • Then two vertical lines are drawn, one 2.5 cm and the other 9 cm lateral to the median plane
  • Hilum lies opposite to the lower border of 1st lumbar spine. Lower on the right side.

Question 5. Describe in detail the blood supply of the kidney. Mention vascular segments of the kidney.
Answer:

The Blood Supply Of Kidney

• Each kidney is supplied by one renal artery (branch of the abdominal aorta)
• In 30% of individuals accessory renal arteries are also seen

Course Of Kidney:

• Renal arteries arise directly from the abdominal aorta (between L1 and L2)
• The right renal artery passes to the right side and the left renal artery to the left side
• A further course is similar for both

Venous Drainage Of Kidney

• Drained by right and left renal vein into inferior vena cava
• Course Of Venous Blood From Renal Substance Is As Follows:

Vascular Segments Of Kidney

• Based on the distribution of five segmental arteries, each kidney is divided into five vascular segments:
  • Apical: It occupies both anterior and posterior surfaces
  • Upper Anterior: It occupies the anterior surface only
  • Middle Anterior: It occupies the anterior surface only
  • Lower: It occupies the entire inferior pole and includes both anterior and inferior surfaces
  • Posterior: It occupies the posterior surface only.

Applied Anatomy Of Kidney: Just like the liver, surgical resection of the kidney is done on the basis of vascular segments—which helps to preserve the healthy parenchyma.

Lymphatic Drainage Of Kidney: Drains into para-aortic lymph nodes.

Nerve Supply Of Kidney

• Supplied by renal plexus of nerves
• Renal plexus consists of sympathetic and parasympathetic nerve fibers
  • Sympathetic supply from T10–L1 spinal segments
  • Parasympathetic supply from vagus nerves.

6. Write a note on the development of the kidney.
Answer:

The Development Of Kidney

• The kidney develops from the intermediate cell mass
• Intermediate cell mass lies between the paraxial mesoderm and lateral plate mesoderm
• Paraxial mesoderm gives rise to somites
• Intermediate cell masses extend craniocaudally on both sides of the primitive dorsal aorta
• In the cervical and upper thoracic region, it shows segmentation called nephrotomes
• The remaining unsegmented portion below gives rise to the nephrogenic cord
• The nephrogenic cord later divides into 3 parts, from above to below pronephros, mesonephros, metanephros
• Excretory tubules of the kidney are formed from metanephros
• The collecting part of the kidney is formed from a diverticulum called the ureteric bud
• The ureteric bud is derived from the lower part of the mesonephric duct
• Horseshoe kidney—the lower pole of two kidneys fuse together to form an isthmus.

Question 7. Describe briefly about the external features of suprarenal glands.
Answer:

The External Features Of Suprarenal Glands

• They are endocrine glands present on the upper pole of the kidney enclosed by renal fascia
• Location: Lies in the epigastric region, anterosuperior to the upper part of the kidney, in front of the crus of the diaphragm

Suprarenal Glands Shape:

• Right Suprarenal Gland: Pyramidal in shape
• Left Suprarenal Gland: Semilunar in shape

Suprarenal Glands Size:

• Length: 5 cm
• Breadth: 3 cm
• Thickness: 1 cm
• Weight: 5 g

Suprarenal Glands External Features

• Right Suprarenal Gland: it has
  • Apex
  • Base
  • Two Surfaces: Anterior and posterior
  • Three Borders: Anterior, medial, and lateral
• Left Suprarenal Gland: it has:
  • Two Ends: Narrow upper end and rounded lower end
  • Two Surfaces: Anterior and posterior
  • Two Borders:
    • Medial Border: Convex
    • Lateral Border: Concave.

Question 8. Write a note on the blood supply of the suprarenal gland. Also, mention its lymphatic drainage and nerve supply.
Answer:

Suprarenal Gland:

Suprarenal Glands Arterial Supply

• Superior Suprarenal Artery: Branch of the inferior phrenic artery
• Middle Suprarenal Srtery: Branch of the abdominal aorta
• Inferior Suprarenal Srtery: Branch of the renal artery.

Suprarenal Glands Venous Drainage

• Drained by right and left suprarenal veins:
  • Right suprarenal vein drains into the inferior vena cava
  • The left suprarenal vein drains into the left renal vein.

Suprarenal Glands Lymphatic Drainage: Drain into lateral aortic nodes.

Suprarenal Glands Nerve Supply: Receive mainly myelinated preganglionic sympathetic fibers derived from splanchnic nerves.

Question 9. Describe in detail the features, division, course, and relations of the ureter.
Answer:

Ureters:

• Ureters are a pair of narrow muscular tubes that transports urine from the kidney to the bladder
• Extent: From the ureteropelvic junction to base of the urinary bladder
• Length: 25 cm, upper half lies in the abdomen and lower half in the pelvis
• So, The Ureter Is Divided Into Three Parts Based On Its Location, Namely:

1. Abdominal Part: Renal pelvis—pelvic brim
2. Pelvic Part: Pelvic brim—base of the urinary bladder
3. Intravesical Part.

Ureter Course:

Suprarenal Glands Relations:

Suprarenal Glands Intravesical Part

• Narrowest part
• This part has an oblique course in the wall of the bladder
• This oblique passage acts as a flap valve and prevents the reflux of urine from the urinary bladder back to the ureter
• Ureteric openings are 5 cm and 2.5 cm apart in distended and empty bladders respectively.

Suprarenal Glands Blood Supply

Suprarenal Glands Arterial Supply:

These branches further divide into ascending and descending branches and they form a plexus in the connective tissue sheath on the surface of ureter and then supply it.

Suprarenal Glands Venous Drainage: Drained by veins corresponding to the arteries

Suprarenal Glands Lymphatic Drainage

• Lateral aortic nodes
• Iliac nodes.

Suprarenal Glands Nerve Supply

• Sympathetic Supply: From T10 to L1 spinal segments through renal, aortic, and hypogastric plexuses
• Parasympathetic Supply: From S2 to S4 through pelvic splanchnic nerves.

Question 10. Name the constrictions of ureter.
Answer:

The Constrictions Of Ureter

The Ureter Presents With 5 Constrictions:

• At the pelvic ureteric junction at the level of the tip of the transverse process of L2 vertebrae
• At the brim of the true pelvis
• At the point of crossing of the ureter by ductus deferens
• Intravesical or intramural: During its passage through the bladder wall
• At the ureteric orifice in the interior of the urinary bladder.

Ureter Applied Anatomy: These constrictions can act as the site of lodgment of kidney stones.

Kidney Ureter And Suprarenal Gland  Multiple Choice Questions And Answers

Question 1. The kidney is related posteriorly to all the structures except:

1. Iliohypogastric nerve
2. Subcostal nerve
3. Small intestine
4. Renal fascia

Answer: 3. Small intestine

Question 2. Renal angle lies between:

1. 11th rib and lateral border of sacrospinalis
2. 12th rib and lateral border of sacrospinalis
3. 10th rib and lateral border of sacrospinalis
4. 12th rib and lateral border of quadratus lumborum

Answer: 2. 12th rib and lateral border of sacrospinalis

Question 3. The structures in the hilum of the kidney are:

1. Renal vein
2. Renal artery
3. Ureter
4. All of the above

Answer: 4. All of the above

Question 4. The suprarenal gland has:

1. 1 artery 3 veins
2. 2 arteries 2 veins
3. 3 arteries 3 veins
4. 3 arteries 1 vein

Answer: 4. 3 arteries 1 vein

Question 5. Regarding the relations of the ureter, which is incorrect?

1. Cross the vas deferens in males
2. Medial to the transverse processes of lumbar spine
3. Cross the genitofemoral nerve
4. Narrowest at the PUJ

Answer: 1. Cross the vas deferens in males

Question 6. Which of the following structures is normally NOT found at the L1 vertebral level?

1. Hilum of kidneys
2. Origin of the celiac trunk
3. Pylorus of stomach
4. 3rd part of duodenum.

Answer: 4. 3rd part of duodenum.

Posterior Abdominal Wall Question And Answers

Question 1. What is thoracolumbar fascia? What are its attachments?
Answer:

Thoracolumbar Fascia

• It is the deep fascia covering the deep muscles on the posterior aspect of the trunk
• It attaches erector spinae to the posterolateral surface of vertebral bodies
• Thoracolumbar Fascia Can Be Divided Into Two Parts:
  1. Lumbar Part
  2. Thoracic Part.

Read And Learn More: Abdomen And Pelvis

1. Thoracolumbar Fascia Lumbar Part

• Made Up Of 3 Strong Layers Of Deep Fascia, Namely:
  • Anterior Layer: The layer
  • Middle And Posterior Layers: Thick and strong layers
• Between the anterior and middle layers lies the quadratus lumborum muscle
• Between the middle and posterior layers lies the erector spinal muscle and transversal spinal muscle
• Laterally the 3 layers fuse to form an aponeurotic sheet
• Internal oblique and transversus abdominis muscles gets there origin from this aponeurotic sheet.

Thoracolumbar Fascia Attachments

• Anterior Layer
  • Superiorly: Forms the lateral arcuate ligament
  • Inferiorly: Iliac crest
  • Medially: Transverse process of lumbar vertebrae
• Middle Layer
  • Superiorly: Lower border of 12th rib
  • Inferiorly: Iliac crest
  • Medially: Tips of the transverse process of lumbar vertebrae, intertransverse ligaments
• Posterior Layer
  • Superiorly: Thracic part of the thoracolumbar fascia
  • Inferiorly: Iliac crest
  • Medially: Spinous process of lumbar vertebrae.

2. Thoracolumbar Fascia Thoracic Part

Thoracolumbar Fascia Attachments

• Superiorly: Continuous with the superficial lamina of investing layer of cervical fascia
• Laterally: Angles of ribs
• Medially: Spinous process of thoracic vertebrae.

Question 2. Write a note on psoas major.
Answer:

Psoas Major

• The Psoas major is one of the important muscles in the posterior abdominal wall
• Other Muscles Are Psoas minor, iliacus, and quadratus lumborum.

Psoas Major Origin

• Psoas arises from 14 fleshy Slips:
  • Five Slips: Each slip arises from bodies and intervertebral discs between two adjacent vertebrae, from T12 – L5
  • Five Slips: Each slip arises from the anterior surface and lower borders of the transverse process of five lumbar vertebrae (L1 – L5)
  • Four Slips: Each slip arises from tendinous arches connecting the constricted parts of the lumbar vertebrae.

Psoas Major Insertion

• Psoas major descends along the pelvic brim
• Passes anterior to the inguinal ligament and anterior to the hip joint
• Enter the thigh
• And ends on the medial side of a tendon (the lateral side of this tendon receives fiers of iliacus)
• This tendon is inserted into the anterior surface of tip of the lesser trochanter
• Since psoas major and iliacus have a common insertion and action they are together called Iliopsoas.

Psoas Major Nerve Supply: Ventral rami of L2, L3, and L4 spinal nerves.

Psoas Major Actions

• Chief flexor of thigh
• Maintain stability at hip
• Lateral flexion of the trunk on same side.

Psoas Major Relations:

• At Abdomen
  • Anterolaterally
    • Kidney
    • Ureter
    • Renal vessels
    • Gonadal vessels
    • Psoas fascia
    • Medial arcuate ligament
    • Psoas minor
  • Medially
    • Lumbar vertebral bodies and vessels
  • Posteriorly
    • Lumbar plexus
    • Transverse process of lumbar vertebrae
• At Thigh
  • Anteriorly
    • Femoral artery
    • Fascia lata
  • Posteriorly
    • Synovial bursa separating capsule of the hip joint from the muscle
  • Medially
    • Femoral vein
    • Pectineus muscle
  • Laterally
    • Iliacus muscle
    • Femoral nerve

Question 3. What is psoas sheath?
Answer:

Psoas Sheath

• Psoas Sheath is a fascial sheath enclosing the psoas major muscle
• Psoas Sheath is derived from psoas fascia.

Question 4. Write a note on cisterna chyli.
Answer:

Cisterna Chyli

• Elongated lymphatic sac
• Length: 5–7 cm
• Breadth: 4 mm
• Vertebral level: L1 – L2
• Location: Between aorta and azygos vein, in front of L1 and L2
• It is overlapped by right crus of the diaphragm
• Formed by union of right and left lumbar lymph trunks
• It continues superiorly as the thoracic duct

Psoas Sheath Tributaries:

• Two lymph vessels from lower intercostal lymph nodes (open superiorly).
• Right and left intestinal lymph trunks (opens in the middle)—arising from preaortic lymph nodes.
• Right and left lumbar lymph trunks (opens inferiorly)—arising from lateral aortic lymph nodes.

Posterior Abdominal Wall Multiple Choice Questions

Question 1. Thoracolumbar fascia:

1. Is also known as lumbar ventral fascia
2. Encloses all the intrinsic muscles of the back
3. Encloses the trapezius, rhomboids, and serratus anterior muscles
4. Terminates at the first rib

Answer: 2. Encloses all the intrinsic muscles of the back

Question 2. Which is not true about the psoas major?

1. It arises from the lower border of T12–L5 vertebrae and intervertebral discs between them
2. It crosses the pelvic brim and passing deep to the inguinal ligament, gets attached to the lesser trochanter of the femur
3. It is supplied by L1, L2, L3
4. It causes flexion and lateral rotation movements at hip joint

Answer: 4. It causes flexion and lateral rotation movements at hip joint

Question 3. The cisterna chyli lies adjacent to the:

1. T12 vertebral body on the right side, posterior to the aorta
2. T12 vertebral body on the left side, anterior to the aorta
3. L1 vertebral body on the left side, anterior to the aorta
4. L1 vertebral body on the right side, posterior to the aorta

Answer: 4. L1 vertebral body on the right side, posterior to the aorta

 

Urinary Bladder And Urethra Question And Answers

Question 1. Explain in detail about the external features and relations of the urinary bladder in males and female.
Answer:

Urinary Bladder

• Hollow muscular organ acting as a temporary reservoir of urine
• It receives urine through the ureter and is passed out via the urethra by micturition

Urinary Bladder In Male And Female Location:

In adults, an empty bladder lies in the front part of the lesser pelvis below the peritoneum and behind the pubic symphysis

• In male, it lies in front of the rectum
• In female, it lies in front of the uterus

Urinary Bladder In Male And Female Shape: Empty bladder is tetrahedral, distended bladder is globular

Read And Learn More: Abdomen And Pelvis

Urinary Bladder In Male And Female Capacity: Normally 120–320 ml of urine is present in the urinary bladder, maximum capacity – 500 ml.

Urinary Bladder In Male And Female External Features

• Empty Bladder Has A Tetrahedral Shape, It Has:
  • Apex
  • Base
  • Neck
  • The surfaces—superior and two inferolateral surfaces
  • Four borders—anterior, posterior, and two lateral.

Urinary Bladder Apex Or Anterior Angle

• Urinary Bladder is the meeting point of the superior and two inferolateral surfaces
• Lies posterior to the upper margin of the pubic symphysis
• It provides attachment to the median umbilical ligament.

Urinary Bladder Base Or Posterior Surface

• Urinary Bladder is almost like an inverted triangle
• Urinary Bladder has broad and narrow ends
• The broad end (posterior border) is directed superiorly
• The narrow end is directed inferiorly.

Urinary Bladder Apex Or Anterior Angle Urinary Bladder Base Or Posterior Surface Relations Of Base

• Male
  • The Upper Part Of Base
    • Rectovesical pouch
    • Coils of intestine
  • Lower Part Of Base
    • Seminal vesicles
    • Termination of vas deferens
• Female
  • Uterine cervix
  • Vagina

Urinary Bladder Neck Or Inferior Angle

• The lowest and most fixed part of the urinary bladder lies about 3–4 cm behind the lower part of the pubic symphysis
• It is the meeting point of inferolateral surfaces and the narrow end of the base
• It is pierced by the internal urethral meatus and continues as the urethra
• Circular fiers of the detrusor muscle get modified at the neck to form an internal urethral sphincter.

Urinary Bladder Neck Or Inferior Angle Relations

• Male
  • Base of prostate
• Female
  • Pelvic fascia
  • Urogenital diaphragm

Urinary Bladder Superior Surface

• Triangular in shape
• Bounded on each side by inferolateral surface
• Base of this triangle is formed by the posterior border which lies between two ureteric orifices.

Urinary Bladder Superior Surface Relations

• Male
  • Peritoneum
  • Coils of intestine
  • Sigmoid colon
• Female
  • Peritoneum
  • Uterine cervix (supravaginal part)

Urinary Bladder Inferolateral Surfaces

• Two in number
• Directed downward, forward, and medially
• They meet each other in the midline and are separated by the anterior border
• Lateral borders separate inferolateral surfaces from superior surfaces
• They are devoid of peritoneum.

Urinary Bladder Inferolateral Surfaces Relations

• Common For Both Males And Females.
  • Anteriorly
    • Retropubic space/Cave of Retzius
    • Puboprostatic ligaments in males and pubovesical ligaments in female
    • Pubis
  • Posteriorly
    • Obturator internus muscle
    • Levator ani muscle

Question 2. Write a note on the ligaments supporting the urinary bladder.
Answer:

The urinary bladder is supported by true and false ligaments:

1. True Ligaments: These are the condensation of pelvic fascia around the base and neck of the bladder and developmental remnants:

• Median Umbilical Ligament
  • Remnant of urachus
  • Extends from apex to umbilicus
• Medial And Lateral Puboprostatic (m)/Vesical Ligaments (f)
  • Formed from the condensation of pelvic fascia and smooth muscle fibers
  • They fit the neck of the bladder and also forms the floor of the Cave of Retzius
  • They Are Closely Related To Vesical Venous Plexus
    • Medial Puboprostatic (m)/Vesical Ligaments (f)
      • Extend from neck of the bladder to pubic symphysis
      • Directed downwards and backward
    • Lateral Puboprostatic (m)/Vesical Ligaments (f)
      • Extend from the neck of the bladder to the tendinous arch of the obturator fascia
      • Directed medially and backward
• Lateral Ligament
  • Condensation of pelvic fascia
  • Extend from inferolateral surface to tendinous arch of pelvic fascia
• Posterior Ligaments
  • Condensation of pelvic fascia
  • Extend from neck and base of the bladder to lateral pelvic wall
  • They contain vesical venous plexus
  • Directed backward and upwards along the vesical venous plexus.

2. False Ligaments: They are raised peritoneal folds that do not form any support to urinary bladder, they are:

• Median umbilical fold formed by median umbilical ligament
• Medial umbilical fold formed by obliterated umbilical arteries
• Lateral false ligament formed by the peritoneum of the paravesical fossa
• Posterior false ligament formed by the peritoneum of urogenital folds.

Question 3. Write a note on the interior of the urinary bladder and what is trigone of the bladder is.
Answer:

Interior Of The Urinary BLadder

• In an empty bladder, the mucus membrane is pale in color
• Most of the mucosa appears as irregular folds or rugae since they are loosely attached to the muscular layer
• But over a triangular area, located in the lower part of the base of the urinary bladder, the mucosa is fully attached to the muscular coat
• This does not show rugae or irregular fold
• This area is known as the trigone of the bladder.

Trigone Of Bladder

• Trigone Of Bladder has the shape of an equilateral triangle
• Trigone Of Bladder Has:
  • Apex/Anterior Angle
    • Directed downward and forward
    • The internal urethral orifice is present at the apex
  • Posterolateral Angles
    • Two in number
    • Ureters open at these angles
    • These openings are 5 cm apart in the distended bladder and 2.5 cm apart in the empty bladder
• The upper margin of the trigone is formed by fibers of the inner longitudinal muscle coat of the ureter
• Two sides of trigone are formed by ureters-ureteral ridges (modification of inner longitudinal muscle coat of ureter)
• In male, there is a slight elevation of trigone, above and behind the internal urethral orifice (which is produced by the projection of the median lobe of the prostate).

Trigone Of Bladder Applied Anatomy

• In BPH, the median lobe enlarges and blocks the internal urethral meatus, leading to urinary retention
• The Mucosa of trigone is more vascular and sensitive than other parts of urinary bladder.

Question 4. Write a short note on blood supply, lymphatic drainage, nerve supply, and development of urinary bladder.
Answer:

Urinary Bladder Arterial Supply

• Male: Branches of superior vesical and inferior vesical arteries
• Female: Branches of superior vesical and vaginal arteries, and minor contribution from uterine arteries.

Venous Drainage of Urinary Bladder

• Veins of the bladder from the vesical venous plexus
• The vesical venous plexus drains into internal iliac veins
• The vesical venous plexus communicates with the prostatic venous plexus.

Lymphatic Drainage of Urinary Bladder: Lymphatics drain into external iliac lymph nodes.

Nerve Supply Of Urinary Bladder

• Sympathetic Nerves: Derived from T11, T12, L1, L2 spinal segments through the vesical venous plexus
• Parasympathetic Nerves: Derived from S2, S3, and S4 spinal segments.

Development of Urinary Bladder

• Cloaca Is Subdivided By Urorectal Septum Into:
  • Anterior primitive urogenital sinus
  • Posterior anorectal canal
• The Cranial and largest part of the urogenital sinus is called the vesicourethral canal
• The vesicourethral canal forms most of the urinary bladder
• Trigone of the bladder is formed by absorption of the mesonephric duct
• The apex of the bladder is derived from the urachus
• Splanchnopleuric mesoderm gives rise to muscular and serous walls of the bladder
• Ectopia vesicae: Congenital anomaly in which the posterior wall of the bladder is exposed to the outside, and the anterior wall of the bladder is missing
• Hourglass bladder: The urinary bladder becomes divided into upper and lower parts by a middle constriction, thus giving the appearance of an hourglass.

Question 5. Describe about male urethra and write briefly about the external urethral orifice.
Answer:

Male Urethra

• It is 18–20 cm long
• Extent: Internal urethral orifice to external urethral orifice
• Shape:
• Erected Penis: J-shaped
• In the Flaccid State Of The Penis: S-shaped
• Division

Based On The Location, The Urethra Is Divided Into 3 Parts, Namely Prostatic Part, Membranous Part, And Penile Part

Urethra Prostatic Part

• Urethra Prostatic is the widest and most dilatable part
• Urethra Prostatic is 3–4 cm long
• This portion passes through the prostate
• Internally The Posterior Wall Of The Prostatic Part Shows The Following Features:
  • Urethral Crest
    • Urethral Crest is a midline ridge, present throughout the posterior wall of the prostatic part of the urethra
    • This ridge projects into the lumen, giving the lumen a crescentic appearance on the transverse section
  • Colliculus Seminalis Or Verumontanum
    • Colliculus Seminalis is an elevation in the middle of the urethral crest
    • Colliculus Seminalis has a slit-like orifice, which is the opening for the prostatic utricle
    • Ejaculatory ducts open on both sides of the opening for prostatic utricle
  • Prostatic Sinuses
    • They are shallow depressions present on both sides of urethral crest
    • Each sinus has 15–20 openings for the prostatic glands.

Urethra Membranous Part

• The Urethra Membranous is the shortest and least dilatable part of the urethra
• Urethra Membranous is about 1.5–2 cm long
• Urethra Membranous passes through the urogenital diaphragm
• Runs downwards and just 2.5 cm above pubic symphysis, it pierces the perineal membrane
• The wall of the membranous urethra has a muscular coat provided by the sphincter urethrae muscle
• Urethra Membranous act as a voluntary external sphincter of the bladder
• The membranous part also contains numerous mucus glands.

Urethra Penile Part

• Also called the spongy part
• It is 15–16 cm long (flaccid penis)
• This portion passes through the corpus spongiosum of the penis
• Extent: Membranous urethra to the external urethral orifice

Urethra Penile Part Course:

• During its course, the penile part shows two dilatations, they are:
• Intrabulbar Fossa: At the bulb of penis
• Navicular Fossa: At the glans penis

Urethra Other Features

• All portions of the penile urethra except that at the terminal navicular fossa contain urethral glands called Littre’s glands
• These glands open into the penile part through small pit-like mucus recesses called urethral lacunae
• But the roof of navicular fossa contains one lacunae called lacuna magna.

External Urethral Orifice

• The narrowest part of the urethra, about 6 mm long
• It is like a sagittal slit
• It is limited on both sides by a small labium.

Epithelial Lining Of Urethra

• Part Of The Urethra
  • Prostatic Part
    • Above seminal colliculus
    • Below seminal colliculus
    • Membranous part
    • Spongy urethra above navicular fossa
    • Stratified columnar epithelium
    • Navicular fossa
  • Epithelial Lining
    • Transitional epithelium
    • Stratified columnar epithelium
    • Stratified columnar epithelium
    • Stratified squamous epithelium

Blood Supply Of Urethra

• Arterial Supply
  • Urethral Artery: Branch of the internal pudendal artery
  • Dorsal penile artery.
• Venous Drainage
  • The penile part of the urethra drains into → Dorsal veins of the penis → Internal pudendal vein → Prostatic venous plexus
  • Prostatic and membranous part of urethra → Prostatic and vesical venous plexus → Internal iliac veins.
• Lymphatic Drainage
  • Prostatic and membranous urethra → Internal iliac nodes
  • Penile part of urethra → Deep inguinal nodes.
• Nerve Supply
  • Sympathetic Supply: From L1 and L2 spinal segments through superior hypogastric plexus
  • Parasympathetic Supply: From S2, S3, S4 segments through pelvic splanchnic nerves
  • The terminal part of the urethra is supplied by somatic nerves derived from the urethral branches of the pudendal nerve.

Question 6. Write a brief about the female urethra.
Answer:

Female Urethra

• Shorter than the male urethra
• The female urethra corresponds to prostatic and membranous parts of the male urethra
• Extent: From the neck of the bladder to the external urethral orifice in the vestibule of the vagina
• Anterior Relations: Anterior wall of the vagina and pubic symphysis
• The urethral wall is made of an inner longitudinally arranged smooth muscle layer and outer circularly arranged sphincter urethrae.

Urinary Bladder And Urethra Multiple Choice Questions

Question 1. Lymphatics from penile part of urethra drain into which of the following lymph nodes?

1. Internal iliac nodes
2. Deep inguinal nodes
3. Sacral nodes
4. Para-aortic lymph nodes

Answer: 2. Deep inguinal nodes

Question 2. The __________ space is located between the body of the urinary bladder and the pubic symphysis:

1. Retropubic space
2. Vesicouterine space
3. Uterosacral space
4. Rectopubic space

Answer: 1. Retropubic space

Question 3. A student while passing a catheter into male urethra suddenly injured it. The rupture is in?

1. Prostate gland
2. Spongy part of urethra
3. Membranous part of urethra
4. Prostatic part of urethra

Answer: 3. Membranous part of urethra

Question 4. Pubovesical ligament holds the ___________________ of the urinary bladder in place:

1. Fundus
2. Body
3. Base
4. Neck

Answer: 4. Neck

Question 5. The urinary bladder is attached to the anterior abdominal wall via the________ligament:

1. Median umbilical
2. Medial umbilical
3. Lateral umbilical
4. Round

Answer: 1. Median umbilical

Male And Female Reproductive Organs Question And Answers

Question 1. Describe about the external and internal features, lobes, and relations of the prostate.
Answer:

Prostate

• Accessory sex gland in the male
• It secretes acid phosphatase, citric acid, fibrinolysin, prostate specific antigens, PGs, amylase, etc.
• These secretions contribute to the bulk of the seminal fluid
• Paraurethral glands of skene are homologous to the prostate in female.

Prostate Location

• In the lesser pelvis between the neck of the urinary bladder above and the urogenital diaphragm below:
• Anteriorly related to the lower part of the pubic symphysis and the upper part of pubic arch
• Posteriorly related to the ampulla of the rectum

Read And Learn More: Abdomen And Pelvis

Relations Of The Prostate:

• Shape: Inverted cone, with broad base—directed upward and pointed apex directed downward
• Weight: 3 g
• Length: 3 cm
• Breadth: 4 cm
• Thickness: 2 cm

Prostate External Features

• The prostate has an apex, four surfaces—anterior, posterior, and two inferolateral surfaces and a base
  • Apex
    • Directed downward
    • It is continuous with the neck of the urinary bladder
    • The junction between the base and neck of the urinary bladder is marked by a circular groove
    • Numerous venules of the prostatic plexus and the urinary bladder are present inside the groove
    • Base is pierced in the median plane by the urethra approximately at the junction of its anterior 1/3rd and posterior 2/3rd.

• • Anterior surface
    • Narrow and convex from side to side
    • Location: 2 cm behind the pubic symphysis
    • This 2 cm gap is filled up by retropubic fat and forms the retropubic space of Retzius.
    • The lower end of the anterior surface (just a little above the apex) is pierced by the urethra.
  • Posterior Surface
    • It is triangular in shape
    • Posteriorly, it is separated from the ampulla of the rectum by the fascia of Denonvilliers
    • The posterior surface is divided into an upper smaller area and a lower larger area by a transverse sulcus passing through it
    • The transverse sulcus is pierced on each side by the ejaculatory duct
    • A lower large area is again divided by a posterior median sulcus into two lateral lobes
    • The upper smaller area is called the median lobe
    • The median lobe is wedge-shaped, its base has an elevation known as uvula vesicae and is composed mainly of glandular tissue.
    • Lobes Of Prostate

The Prostate Is Incompletely Divided Into Five Lobes:

1. Anterior lobe
2. Posterior lobe
3. Median lobe
4. Two lateral lobes

1. Anterior Lobe (isthmus)

• Situated in front of the urethra
• Bridges the two lateral lobes in front of the urethra
• Devoid of glandular tissue, so adenomas never occur here

2. Posterior Lobe

• Situated behind urethra and below the ejaculatory duct
• Connects the two lateral lobes behind the urethra
• Contains glandular tissue and is the main site of carcinoma

3. Median Lobe

• Lies posterior and superior to prostatic utricle and ejaculatory ducts
• Utricle lies within lobe
• Common site for adenoma

4. Two Lateral Lobes (right and left)

• Contains numerous glands
• Also can become a site for carcinoma.

Internal Features Of Prostate

• Prostatic urethra—it passes through the gland
• There are openings for ducts of prostatic follicles into the prostatic sinuses of the prostatic urethra
• Right and left ejaculatory ducts pass through the gland and open into the prostatic urethra
• Prostatic utricle saw inside the prostate.

Question 2. Classify the zones of the prostate.
Answer:

Prostate Gland Has Been Divided Into Different Zones On The Basis Of Its Composition By Mcneal. They Are:

• Peripheral Zone
  • Forms about 70% of the fraction of gland
  • Location: Subcapsular portion of posterior aspect of mprostate gland which surrounds distal urethra
  • Most common site of prostatic carcinomas.
• Central Zone
  • Forms about 25% of the fraction of gland
  • It is the part of the gland surrounding the ejaculatory duct.
• Transitional Zone
  • Approximately 5% of the fraction of gland
  • This is the region of the gland responsible for benign prostatic hypertrophy.
  • Anterior Fibromuscular Zone
  • Area devoid of glandular components
  • Composed of muscle and fibrous tissue.

Question 3. Write briefly on the capsules of the prostate.
Answer:

The Prostate Has A True Capsule And A False Capsule:

True Capsule Of Prostate:

• Formed by condensation of connective tissue stroma of the gland and is continuous with stroma of gland
• True Capsule Of Prostate is devoid of venous plexus
• The true Capsule Of the Prostate is adherent to the prostate.

False Capsule Of Prostate:

• Located outside true capsule
• False Capsule Of Prostate is derived from pelvic fascia
• False Capsule Of Prostate covers the prostate gland and urinary bladder
• False Capsule Of Prostate contains prostatic venous plexus on each side
• Anteriorly it is continuous with puboprostatic ligaments
• And posteriorly with true ligaments of bladder and rectovesical fascia.

Applied Anatomy Of Prostate

• During BPH, the prostate gets an additional pathological capsule
• Adenoma compresses the peripheral part of the gland which acts as the third capsule.

Question 4. What are the supports of the prostate?
Answer:

• Puboprostatic ligaments—on the anterior aspect
• Urogenital diaphragm
• The rectovesical fascia of Denonvilliers—on the posterior aspect.

Question 5. Describe the blood supply, lymphatic drainage, and nerve supply of the prostate. What are the communications of prostatic venous plexus and what is its importance?
Answer:

• Arterial Supply Of Prostate
  • Inferior vesical artery
  • Middle rectal artery
  • Internal pudendal artery
• Venous Drainage Of Prostate
  • Veins of prostate form the prostatic venous plexus
  • They drain into the inferior vena cava through iliac veins
  • They also have valveless communications with internal and external vertebral plexus through which they drain into the intracranial dural venous sinuses.
  • Applied: Carcinoma prostate can metastasise to the heart via internal iliac veins and vertebral column and through internal and external vertebral plexus.
• Lymphatic Drainage Of Prostate
  • Lymphatics Drain:
    • Mainly into internal iliac nodes and sacral group of lymph nodes
    • Partly into external iliac nodes.
• Nerve Supply Of Prostate
  • Sympathetic Supply: From L1, L2 spinal segments through superior hypogastric plexus
  • Parasympathetic Supply: From S2, S3, and S4 spinal segments by pelvic splanchnic nerves.

Question 6. Briefly mention the age changes in the prostate.
Answer:

The Age Changes In The Prostate

• Childhood: Small
• Puberty: Sudden increase in size
• 20–30 Years: Marked proliferation
• 30–45 Years: Size remains constant and involution starts
• 45 Years And Above: May be enlarged (BPH) or reduced (senile atrophy).

Question 7. Write a note on the development of the prostate.
Answer:

Prostate Develops From A Large Number Of Buds Arising From The Prostatic Urethra

• Buds arising from the endodermal part of the prostatic urethra form the glandular part of the prostate
• Buds arising from the mesodermal part of the prostatic urethra form the stroma of the prostate.

Question 8. Write a note on the location, size, and position of the uterus. Describe the different parts of the uterus.
Answer:

Uterus

• Also called hysteria
• Location Of Uterus: In the lesser pelvis between the bladder and rectum
• Shape Of Uterus: Pear­shaped, flattened anteroposteriorly backward
• Size Of Uterus:
  • Length: 7.5 cm
  • Breadth: 5 cm
  • Height/thickness: 2.5 cm
  • Weight: 30–40 g

The Normal Position Of The Uterus: Uterus normally lies in the position of anteversion and anteflexion

• Anteversion—the long axis of the uterus forms an angle of about 90 degrees with the long axis of the vagina. This forward angle is known as the angle of anteversion
• Anteflxion—the long axis of the body of the uterus is bent forward at the level of internal os on the axis of the cervix. They make an angle of 170 degrees with each other. This position is known as anteflexion and the angle is known as the angle of anteflexion.

Parts Of Uterus

• Body: Upper 2/3rd (extends from fundus to isthmus)
• Cervix: Lower 1/3rd

The Junction Between the Body And Cervix Is Called The Isthmus.

• Body It includes:
  • Fundus
  • Two Surfaces:
    • Anterior/vesical
    • Posterior/intestinal
  • Two lateral borders—right and left.
• Fundus
  • Free upper end of the uterus
  • Convex dome­like in appearance
  • It lies above the openings of the uterine tubes
  • It is covered by peritoneum.

Two Surfaces Of Uterus

• Anterior Surface/Vesical Surface
  • Flat surface
  • Directed downward and forward
  • It is covered with the peritoneum up to the isthmus
  • From this point, the peritoneum sets reflected onto the upper surface of the urinary bladder and becomes the ureterovesical pouch.
• Posterior Surface/Intestinal Surface
  • Convex
  • Directed upward and backward
  • It is covered by the peritoneum
  • It also forms the anterior wall of the rectouterine pouch.

Two Lateral Borders Of Uterus:

• Rounded and convex
• The nonperitoneal part, since it provides attachment to the broad ligament of the uterus
• The uterine tube opens in the upper end of the lateral border
• The round ligament of the uterus is attached anteroinferior to the opening of the uterine tube and the ligament of the ovary is attached posteroinferior to the opening of the uterine tube.

Cervix Of Uterus

• Lower cylindrical part
• Length: 2.5 cm
• Wider in the middle
• Its lower part projects into the anterior wall of the vagina, dividing the cervix into two parts:
  • Supravaginal Part—upper part
  • Vaginal Part—lower part
• Vaginal Fornices: Space between the vaginal part of the cervix and the vaginal wall.

External OS Of Uterus : Opening of Cervix into Vagina

• Nulliparous Women: Small and circular
• Multiparous Women: Large and transverse

Internal Os Of Uterus: Opening of the body of the uterus into cervix

• Uterine Cavity Proper/Cavity Of The Body—triangular in shape
• Cervical Canal/Cavity Of The Cervix—spindle­shaped.

Question 9. What are the relations of different parts of the uterus?
Answer:

The Relations Of Different Parts Of The Uterus

Question 10. Classify the ligaments of uterus. Write a note on broad ligament.
Answer:

Ligaments Of Uterus classified Into Two Types:

1. False Ligaments: Peritoneal folds, provide no support to uterus
2. True Ligaments: Fibromuscular bands, provide support to the uterus.

1. False Ligaments Of Uterus

• Broad Ligaments (Right And Left)
  • Folds of peritoneum
  • Have two layers—anterior and posterior
  • Connects the uterus to the lateral pelvic wall.
  • False Ligaments Of Uterus External Features
    • When the bladder is full, it has:
      • Two Surfaces—anterior and posterior
      • Four Borders—upper, lower, medial, lateral.
  • Parts of Broad Ligament
    • Mesosalpinx—the part between the uterine tube and the ligament of ovary
    • Mesometrium—part below the ligament of the ovary
    • Mesovarium—it attaches the posterior layer of the ligament with the ovary
    • Suspensory ligament of ovary
    • Part of the broad ligament extends from the upper pole of the ovary and infundibulum of the uterine tube to the lateral wall of the lesser pelvis.
  • Contents of Broad Ligament
    • Uterine tube
    • Ligaments—round ligament of uterus, ligament of ovary
    • Arteries—uterine artery, ovarian artery
    • Nerves—uterovaginal plexus, ovarian plexus
    • Vesicular appendices
    • Lymphatics
• Anterior Ligaments—ureterovesical fold of peritoneum
• Posterior Ligaments—rectovaginal fold of peritoneum.

2. True Ligaments Of Uterus

• Round ligament of uterus
• Transverse cervical ligaments
• Uterosacral ligaments.

Question 11. Write briefly about the blood supply, lymphatic drainage, and nerve supply of uterus.
Answer:

Arterial Supply Of Uterus

• Two Uterine Arteries:
  • Branch of the anterior division of the internal iliac artery
  • It ascends along the side of the uterus
  • Terminates by anastomosing with the ovarian artery.
• Two Ovarian Arteries
  • Branch of abdominal aorta.

Venous Drainage Of Uterus

• Veins correspond to arteries
• They form venous plexus
• Drains into uterine and vaginal veins and then to internal iliac veins.

Lymphatic Drainage Of Uterus

• Fundus and upper part of the body—pre­ and paraaortic lymph nodes
• The lower part of the body—external iliac nodes
• Cervix:
  • Lateral part—external iliac nodes obturator nodes
  • Posterolaterally—internal iliac nodes
  • Posteriorly—sacral nodes.

Nerve Supply Of Uterus

• Sympathetic Supply: Derived from T12–L2 spinal segments
• Parasympathetic Supply: Derived from S2–S4 spinal segments.

Question 12. What are the supports of the uterus? Write briefly about some of the important supports.
Answer:

• They keep the uterus in position
• And prevent it from sagging down.

Primary Supports Of Uterus

• Muscular
  • Pelvic diaphragm
  • Perineal body
  • Urogenital diaphragm.
• Fibromuscular
  • Pubocervical ligaments
  • Transverse cervical ligaments of Mackenrodt
  • Uterosacral ligaments
  • Round ligament of uterus.
• Visceral
  • Urinary bladder
  • Vagina
  • Uterine axis.

Secondary Supports Of Uterus

• Broad ligaments
• Uterovesical fold of peritoneum/anterior ligament
• The rectovaginal fold of the peritoneum/posterior ligament.
• Pubocervical ligaments Of Uterus
  • Derived from the endopelvic fascia
  • Connects cervix to the posterior surface of the pubis
  • Corresponds to puboprostatic ligaments in males.
• Transverse cervical ligaments Of Uterus
  • Fan­shaped fibromuscular band
  • Derived from the endopelvic fascia
  • Present on both sides
  • Extent: From the lateral aspect of the cervix and upper vaginal wall to the lateral pelvic wall
  • They form a hammock, which supports the uterus.
• Uterosacral ligaments Of Uterus
  • Two In Number
    • Derived from the endopelvic fascia
    • Extent: From cervix to posterior aspect of 5–2 and 5–3 vertebrae
    • They are enclosed within rectouterine folds of the peritoneum
    • The ligaments pull the cervix backward against the forward pull of the round ligament.
• Round Ligament Of The Uterus
  • Length: 10–12 cm
  • Lives between the 2 layers of broad ligaments

Course Of Uterus:

Uterine Axis

• Anteversion position prevents the uterus from sagging down through the vagina
• Because of the anteversion, during an increase in intraabdominal pressure, the uterus gets pushed against urinary bladder and pubic symphysis.

Question 13. Write a note on the development of the uterus.
Answer:

The Development Of The Uterus

• Paramesonephric ducts (Müllerian ducts) get fused to form a uterovaginal canal
• Epithelium of uterus is developed from the uterovaginal canal
• Myometrium is formed from the surrounding mesoderm
• Unfused horizontal parts of two paramesonephric ducts partially get embedded in the substance of myometrium to form ‘fundus of uterus’
• Soon after, the cervix is also recognized as a separate region
• Didelphys uterus: Complete duplication of uterus
• Unicornuate uterus: One­half of uterus absent.

Question 14. Explain in detail about the uterine tubes and mention its development.
Answer:

The Uterine Tubes

• Also known as fallopian tubes
• Length: 10 cm
• Location: Upper free margin of broad ligament of uterus.

Uterine Tubes External Features: It has two ends and four parts

Uterine Tubes External Features Ends

• Medial End: Opens into lateral angle of the uterine cavity
• Lateral End:
  • Also called infundibulum
  • Funnel­shaped
  • It has a number of figer­like projections called fimbriae
  • One fimbriae is longer and is attached to a tubal pole of the ovary. It is called ovarian fimbriae.

Uterine Tubes External Features Parts: From lateral to medial, the fallopian tube is divided into

1. Infundibulum
2. Ampulla
3. Isthmus
4. Intramural

1. Infundibulum

• Funnel­shaped
• Length: 1 cm
• Lateral­: most end

2. Ampulla

• Length: 5 cm
• Lateral 2/3rd of tube
• Widest and longest part
• Thin­walled and tortuous

3. Isthmus

• Narrow and rounded
• Medial 1/3rd of tube

4. Intramural/Uterine Part

• Length: 1 cm
• Lies within the walls of the uterus
• Opens at the superior angle of the uterine cavity.

Blood Supply Of Uterine

• Arterial Supply
  • Medial 2/3rd of tube­uterine artery
  • Lateral 1/3rd of tube­ovarian artery
• Venous Drainage
  • Uterine vein
  • Ovarian vein.
• Lymphatic Drainage
  • Internal iliac lymph nodes
  • Pre­ and para­aortic lymph nodes.
• Nerve Supply
  • Sympathetic Supply
    • Though ovarian and superior hypogastric plexus
    • Derived from T–10 to L–2 spinal segments.
  • Parasympathetic Supply
    • Medial part – derived from S2, S3, S4 spinal segments through pelvic splanchnic nerves
    • Lateral part – derived from vagus nerve.

Development Of Uterine Tube: Derived from unfused parts of paramesonephric ducts.

Male And Female Reproductive Organs Multiple Choice Questions And Answers

Question 1. Anatomically how many lobes are noticed in the prostate gland?

1. 2 lobes
2. 4 lobes
3. 3 lobes
4. 5 lobes

Answer: 4. 5 lobes

Question 2. Which lobe of prostate is more prone to malignancy?

1. Anterior lobe
2. Median lobe
3. Lateral lobe
4. Posterior lobe

Answer: 2. Median lobe

Question 3. Which best describes the prostate gland?

1. Surrounds the base of the bladder and pierces the membranous urethra
2. Is most prone to cancer in the inferior­posterior region and lateral lobes
3. Has a superior lobe that is most readily palpable by digital rectal exam
4. Is supplied mainly by the superior rectal artery

Answer: 2. Is most prone to cancer in the inferior­posterior region and lateral lobes

Question 4. Lymph from the uterine body drains into __________ nodes:

1. Superficial inguinal
2. External iliac
3. Internal iliac
4. Lumbar

Answer: 2. External iliac

Question 5. Which statement most accurately describes the body of the uterus?

1. The thick, convex superior portion
2. Inferior­most portion
3. Contains most of the uterine cavities
4. Has a tapered region leading to the cervix called the uterine cornu

Answer: 3. Contains most of the uterine cavities

Question 6. Which ligament transmits the uterine arteries from the internal iliac to the uterus?

1. Uterosacral ligament
2. Round ligaments of the uterus
3. Suspensory ligament of the ovary
4. Transverse cervical ligament

Answer: 4. Transverse cervical ligament

 

 

Perineum And True Pelvis Question And Answers

Question 1. What is perineum and what are its boundaries?
Answer:

Perineum

Lowest region of the trunk in the erect position, lying below the pelvic diaphragm.

Superficial Boundary Of Perineum

• Anteriorly
• Male: Scrotum
• Female: Mons pubis
• Posteriorly: Buttocks
• Each side: Upper medial aspect of thigh

Deep Boundary Of Perineum

• Anteriorly: Lower margin of the pubic symphysis
• Posteriorly: Tip of the coccyx
• Each side: Sacrotuberous ligament, ischial tuberosity, conjoint ischiopubic rami

Read And Learn More: Abdomen And Pelvis

Question 2. What is the urogenital and anal triangle?
Answer:

Perineum Is Divided Into Two Triangles, Namely:

1. Anteriorly—urogenital triangle
2. Posteriorly—anal triangle

• The apex of both triangles are directed opposite to each other
• The base of both triangles are formed by a horizontal plane passing through the anterior end of ischial tuberosities
• The perineal body is located at the midline of the base of both triangles.

Question 3. Write a note on the boundaries and contents of the superficial perineal pouch.
Answer:

Superficial Perineal Pouch Boundaries: Same for both males and females

• Superiorly: Perineal membrane
• Inferiorly: Membranous layer of the superficial fascia of the perineum (Colles fascia)
• Laterally: Conjoint ischiopubic rami
• Posteriorly: The pouch is closed by the fusion of superior and inferior walls
• Anteriorly: The pouch is open, and is continuous with the anterior abdominal wall through scrotum and penis (in males).

Superficial Perineal Pouch Contents

• Male
  • Root of penis
  • Duct of bulbourethral glands
  • Superficial transverse perineal muscles
  • Urethra
  • Branches of internal pudendal artery and nerve
• Female
  • Root of clitoris
  • Urethra
  • Greater vestibular glands
  • Superficial transverse perineal muscles
  • Branches of internal pudendal artery and nerve

Question 4. Write a note on the boundaries and contents of the deep perineal pouch.
Answer:

Deep Perineal Pouch

Deep Perineal Pouch Boundaries: Same for both males and females

• Superiorly: Superior fascia of urogenital diaphragm
• Inferiorly: Perineal membrane (Inferior fascia of urogenital diaphragm)
• Laterally: Conjoint ischiopubic rami
• Posteriorly: It is limited by the fusion of two fascial layers
• Anteriorly: It is closed due to the fusion of superior and inferior fascial layers.

Deep Perineal Pouch Contents

• Male
  • Membranous urethra
  • Bulbourethral glands on both sides of the urethra
  • Two striated muscles: Sphincter urethrae and deep transverse perineal muscles
  • Dorsal nerve of the penis
  • Branches of internal pudendal artery and nerve
• Female
  • Urethra
  • Vagina
  • Two Striated Muscles:
    • Sphincter urethra and deep transverse perineal muscles
    • The dorsal nerve of the clitoris
    • Internal pudendal artery and its terminal branches

Question 5. What is the urogenital diaphragm?
Answer:

Urogenital Diaphragm

• Urogenital is a muscular sheet consisting of sphincter urethrae muscle and deep transverse muscle
• Urogenital is enclosed between the superior and inferior fascia of the urogenital diaphragm
• Structures Piercing Urogenital Diaphragm:
  • Male: Membranous urethra
  • Female: Urethra and vagina
• It Acts As A Support For:
  • Male: Prostate and neck of the urinary bladder
  • Female: Vagina and neck of the urinary bladder
• It also reinforces the pelvic diaphragm at the urogenital hiatus.

Question 6. Write a note on the perineal membrane.
Answer:

Perineal Membrane

• Inferior fascia of the urogenital diaphragm
• It lies between deep and superficial perineal pouches
• Triangular in shape
• Apex is directed anteriorly
• Base is directed posteriorly

Perineal Membrane Relations

• Superiorly: Deep perineal pouch
• Inferiorly: Superficial perineal pouch

Perineal Membrane Attachments

• Apex: Attached to the arcuate ligament of the pubis as transverse perineal ligament
• Laterally: Ischiopubic rami
• Base: Perineal body
• The posterior border is continuous with the fascia over deep transverse perineal muscles

Perineal Membrane Is Pierced By:

• Male
  • Urethra in the midline
  • Ducts of bulbourethral glands
  • Artery to the bulb of penis
  • Deep artery and dorsal artery of penis
  • Urethral artery
  • Dorsal nerve of penis
  • Two posterior scrotal nerves and vessels on each side of the base
• Female
  • Urethra
  • Vagina
  • Arteries to the bulb of the vestibule on each side of the vagina
  • Deep artery of clitoris
  • Dorsal nerves and vessels of the clitoris
  • Posterior labial nerves and vessels
  • The perineal membrane of the female is very thin because it is pierced by the vagina in addition to other structures.

Question 7. Write briefly on the perineal body.
Answer:

Perineal Body

• Perineal Body is a mass of fibromuscular tissue situated in the midline at the junction of the urogenital triangle and anal triangle
• In males, it lies between the bulb of the penis and the anal canal
• In females, it lies between the anal canal and the lower part of the posterior wall of the vagina
• It Provides Attachment To 10 Muscles Of The Perineum Which Are:
  • Right and left superficial transverse perineal muscles
  • Right and left deep transverse perineal muscles
  • Right and left bulbospongiosus muscles
  • Two levator ani muscles
  • One sphincter ani muscle
  • One longitudinal muscle coat of anal canal.

Perineal Body Applied Anatomy

• In males, the perineal body supports the prostate and anal canal
• In females, the perineal body is an important contributor for the maintenance of pelvic diaphragm
• Sometimes during episiotomy, the perineal body can get a cut which results in prolapse of the uterus, urinary bladder, and rectum.

Question 8. What is the pudendal canal?
Answer:

Pudendal Canal

• Fascial canal within the obturator fascia lining the lateral wall of the ischiorectal fossa
• Also known as Alcock’s canal
• Situated about 1 inch above the ischial tuberosity
• Extent: From lesser sciatic notch to the posterior boundary of perineal pouches
• The canal is bounded by obturator fascia and lunate fascia

Pudendal Canal Contents:

• Pudendal nerve
• Internal pudendal vessels.

Question 9. Write a note on the pelvic diaphragm.
Answer:

Pelvic Diaphragm

• V-shaped flor of true pelvis
• Also called pelvic floor
• It separates the pelvis from the perineum
• Formation: By the right and left levator ani and coccygeus muscles enclosed in the superior and inferior layers of the fascia of the pelvic diaphragm
• Structures Passing Through It:
  • Males: Urethra and anorectal junction
  • Females: Vagina, urethra, and anorectal junction

These Structures Pass Through Two Openings:

Hiatus Urogenital:

• Hiatus Urogenital is a triangle-shaped opening formed between the anterior fibers of levator ani muscles
• The urethra in males and females and the vagina in females pass through it

Hiatus Rentals:

• Hiatus Rentals is a circular opening formed between the anococcygeal raphe and perineal body
• Anorectal Junction Passes Through It
  • The pelvic diaphragm is covered in its superior and inferior aspects by the superior and inferior fascia of the pelvic diaphragm.

1.  The Superior Fascia Of The Pelvic Diaphragm

• Attached anteriorly to the superior ramus of the pubis and to the back of the body of pubis
• Superior Fascia Of The Pelvic Is continuous:
  • Anteriorly: With sacrococcygeal ligament
  • Posteriorly : With fascia on the piriformis
  • Laterally: With obturator fascia

2. Inferior Fascia Of The Pelvic Diaphragm

• Also covers the medial wall of the ischiorectal fossa
• Laterally, it is continuous with the obturator fascia.

Relations Of Pelvic Diaphragm

Question 10. Describe in detail about the functions, boundaries, and contents of the ischiorectal fossa. Name the three recesses in relation to the ischiorectal fossa.
Answer:

The Ischiorectal Fossa

• Now called the ischioanal fossa, since it is located between ischial tuberosity and anal canal, not in the rectum
• It is a wedge-shaped fat-filed space on either side of the anal canal

Ischiorectal Fossa Functions:

• Allows distension of anal canal during defecation
• Allows dilatation of vagina during parturition.

Ischiorectal Fossa Boundaries

• Apex
  • Formed by the junction of fascia covering obturator internus and inferior fascia of pelvic diaphragm
  • Apex directed anteromedially towards the pubic symphysis
• Laterally: Fascia covering obturator internus muscle and ischial tuberosity
• Medially:
  • On The Upper Part: Fascia covering external anal sphincter
  • On The Lower Part: Fascia covering levator ani muscle
• Posteriorly:
  • Lower margin of gluteus maximus muscle
  • Sacrotuberous ligament
• Anteriorly: Posterior margin of perineal pouches
• Base/Floor: Deep transverse perineal fascia.

Ischiorectal Fossa Contents

• Ischiorectal pad of fat
• Pudendal canal and its contents (pudendal nerve, internal pudendal vessels)
• Posterior scrotal vessels and nerves
• Perineal branch of 4th scrotal nerve
• Inferior rectal branches of the pudendal nerve
• Perforating cutaneous nerve
• Lymphatic trunks.

TThere Are 3 Recesses Or Narrow Extensions Of The Ischiorectal Fossa, Namely:

1. Anterior Recess: Extends from the urogenital diaphragm to body of the pubis
2. Posterior Recess: Lies deep to the sacrotuberous ligament
3. Horseshoe Recess:
   • Lies posterior to the anal canal
   • Connects the two ischioanal/rectal fossa.

Question 11. Write a note on celiac ganglion.
Answer:

Celiac Ganglion

• Largest ganglion in the body
• Two in number
  • Location: On each side of the celiac trunk
  • Shape: Irregular
  • Division: Each ganglion is divided into:
    • Large upper part—receives greater splanchnic nerve
    • The smaller lower part or aorticorenal ganglion receives lesser splanchnic nerve.

Question 12. Write a note on the formation and branches of the celiac plexus.
Answer:

The Formation And Branches Of Celiac Plexus

• A dense network of nerve fibers connecting the two celiac ganglia
• It is the largest major autonomic plexus
• Location: In front of the abdominal aorta around the celiac trunk and around the root of the superior mesenteric artery
• Vertebral level: T12 – L1
• Celiac Plexus Is Formed By The Following Incoming Fibers:
  • Preganglionic sympathetic fibers through greater and lesser splanchnic nerves
  • Postganglionic sympathetic fibers from celiac ganglion
  • Preganglionic vagal fibers from the posterior vagal trunk containing fiers from both right and left vagus, with predominant fiers from the right vagus
  • Sensory fibers from the diaphragm reach the plexus along the inferior phrenic artery

Celiac Plexus Branches: The Celiac plexus gives rise to a number of secondary plexus, which surround the branches of the aorta. These are:

• Hepatic plexus
• Phrenic plexus
• Suprarenal plexus
• Left gastric plexus
• Splenic plexus
• Renal plexus
• Testicular plexus
• Ovarian plexus
• Superior mesenteric plexus
• Intermesenteric plexus
• Inferior mesenteric plexus

Question 13. Write a brief on the sacral plexus.
Answer:

Sacral Plexus

• Sacral Plexus is a network of nerve fibers that supplies the skin and muscles of the pelvis and lower limb
• Location: On the surface of the posterior pelvic wall, anterior to the piriformis muscle
• Sacral Plexus is derived from the anterior rami of spinal nerves— L4, L5, S1, S2, S3, and S4
• Sacral Plexus also receives contributions from the lumbar spinal nerves L4 and L5 to form the lumbosacral trunk
• Each anterior rami divides into anterior and posterior branches.

Sacral Plexus Branches:

1. Superior gluteal nerve
2. Inferior gluteal nerve
3. Sciatic nerve
4. Posterior femoral cutaneous nerve
5. Pudendal nerve
6. Other branches: Nerve to piriformis, nerve to obturator internus, nerve to quadratus femoris.
   • Anterior branches supply the flexor muscles of the lower limb
   • Posterior branches supply the extensor and abductor muscles

Perineum And True Pelvis Multiple Choice Question And Answers

Question 1. The contents of the ischiorectal fossa are all except:

1. Pudendal nerve
2. Pudendal artery
3. Perineal branch of the obturator nerve and nerve to obturator internus
4. None

Answer: 3. Perineal branch of the obturator nerve and nerve to obturator internus

Question 2. The contents of the ischiorectal fossa lie in the:

1. Medial wall
2. Lateral wall
3. The floor of the fossa
4. Near the apex

Answer: 2. Lateral wall

Question 3. What structure represents the posterolateral boundary of the perineum?

1. Ischial tuberosity
2. Sacrospinous ligament
3. Gluteus maximus
4. Sacrotuberous ligament

Answer: 4. Sacrotuberous ligament

Question 4. Where is celiac plexus situated?

1. Anteromedially to the sympathetic chain
2. Posteromedially to left sympathetic chain
3. Posteriorly to the abdominal aorta
4. Anteriorly to abdominal aorta
5. Posteriorly to arch of aorta

Answer: 4. Posteriorly to arch of aorta

Question 5. Th membranous layer of superfiial fascia of perineum is called:

1. Fascia lunata
2. Colles’ fascia
3. Scarpa’s fascia
4. Camper’s fascia

Answer: 2. Colles’ fascia

Question 6. The pelvic diaphragm is comprised of which of the following muscles?

1. Piriformis, obturator internus, levator ani, and ischiococcygeus
2. Obturator internus, levator ani, and ischiococcygeus
3. Levator ani and ischiococcygeus
4. Levator ani

Answer: 3. Levator ani and ischiococcygeus

Rectum And Anal Canal Question And Answers

Question 1. Describe in detail the anatomical features and relations of the rectum.
Answer:

Rectum:

• Part of large intestine between sigmoid colon and anal canal
• Lies in the true pelvis
• Location: Posterior part of lesser pelvis, in front of the lower three pieces of sacrum and coccyx
• Length: 12 cm
• Rectum Diameter:
  • Upper Part: 4 cm (same as sigmoid colon)
  • Lower Part: Dilated—rectal ampulla
• Rectum Extent:
  • Upper end—continuous with a sigmoid colon at the level of S3 vertebrae
  • Lower end—lies a little below and in front of the tip of the coccyx

Read And Learn More: Abdomen And Pelvis

Rectum Course:

Rectum Curvatures: There are two anterior-posterior curvatures and three lateral curvatures.

Anteroposterior Curvature

• Sacral Curvature: It follows the concavity of the sacrum and coccyx
• Perineal Curvature: It is the backward bend of the anorectal junction

Lateral Curvature

• Upper Lateral Curvature: It is convex to the right at the S3–S4 junction
• Middle lateral curvature: It is convex to the left at the sacrococcygeal junction and is most prominent
• Lower Lateral Curvature: It is convex to the right at the level of tip of the coccyx

Rectum Mucosal Folds: The mucous membrane of rectum shows a number of longitudinal and transverse folds.

• Transverse Folds/Houston’s Valves:
  • Permanent folds
  • Located against the concavities of lateral curvatures of the rectum

They Are Four In Number:

1. First, Fold: lies near the upper end close to the rectosigmoid junction, projects from the right or left wall of rectum
2. Second Fold
   • Lies 2.5 cm above 3rd fold
   • Projects from the left wall of the rectum
3. Third Fold: largest fold
   • Projects from the anterior and right walls of the rectum
   • Lies at the level of the upper end of the ampulla.
4. Fourth fFold
   • Lies 2.5 cm below the third valve
   • Projects from the left wall of the rectum.

Rectum Longitudinal Folds

• Transitory/temporary folds
• Seen in the lower part of the rectum
• Disappears when rectum distended

Rectum Peritoneal Relations

Rectum Visceral Relations

• Rectum Anterior Relations

• Rectum Posterior Relations
  • Lower part of the sacrum
  • Coccyx
  • Muscles
    • Piriformis muscles (right and left)
    • Coccygeus muscles
    • Levator ani muscles
  • Blood Vessels
    • Median sacral vessels
    • Lateral sacral vessels
    • Superior rectal vessels
• Ganglion impar
• Pelvic splanchnic nerves and sympathetic chains
• Fascia of Waldeyer.

Rectum Arterial Supply

• Superior rectal artery
• Middle rectal arteries
• Inferior rectal arteries
• Median sacral artery

Rectum Venous Drainage: Internal and external venous plexus of rectum and anal canal:

• Superior rectal vein
• Middle rectal vein
• Inferior rectal vein

Rectum Lymphatic Drainage

• The upper half of the rectum—pararectal and sigmoid nodes, inferior mesenteric nodes.
• The lower half of the two rectums—internal iliac nodes.

Rectum Nerve Supply

• Sympathetic supply—derived from L1, L2 spinal segments
• Parasympathetic supply—S2, S3, S4 spinal segments.

Question 2. What are the supports of rectum?
Answer:

The Supports Of Rectum

• Lateral Ligaments Of The Rectum:
  • Present on each side of the rectum
  • Formed by condensation of pelvic fascia
• Puborectalis sling of the pelvic diaphragm
• Fascia of Waldeyer
• Pelvic floor-formed by levator and muscles
• The rectovesical fascia of Denonvilliers
• Pelvirectal and ischiorectal fat—surrounds the rectum
• Pelvic peritoneum and related vascular pedicles
• Perineal body.

Rectum Applied Anatomy

• Prolapse Of Rectum: The pelvic diaphragm is an important support for the rectum
• When the pelvic diaphragm is weakened (for example, damage during parturition), the rectum can prolapse out of anus.

Question 3. Describe in detail the anatomical features and relations of the anal canal.
Answer:

The Anatomical Features

• Terminal part of the large intestine
• Length: 3.8 cm
• Location: In the anal triangle between the ischiorectal fossa
• Extent: Anorectal junction to the anal orifice
• Direction: Downwards and backward
• It is surrounded by inner involuntary and outer voluntary sphincters
• They keep the lumen closed.

Interior Of Anal Canal

• The pectinate line divides the anal canal into upper and lower parts
• The pectinate line, also called the watershed line, is a transverse line, running along the lower limit of anal valves
• It is a dividing line between endodermal and ectodermal parts of anal canal
• The lower part of the anal canal can again be subdivided into upper and lower regions by the Hilton’s line.

Interior Of Anal Canal Upper Part

• Length: 15 mm
• Extent anorectal junction to pectinate line
• Lined by a mucous membrane:
  • Reddish in color

Interior Of Anal Canal Shows The Following Features:

• Anal Columns Of Morgagni
  • There are 6–10 longitudinal folds seen in the mucous membrane
  • They contain terminal radicles of the superior rectal artery and vein.

Anal Columns of Morgagni Applied Anatomy: Radicles are well developed in the right anterior, right posterior, and left lateral positions. As a result, piles are more common at these sites.

Anal Valve of Morgagni: They are transverse folds of the mucous membrane, which connect the lower ends of adjacent anal columns.

Anal Valve of Morgagni Applied Anatomy: Passage of hard stools could injure the anal valve leading to anal fissure formation.

• Anal Sinuses
  • They are vertical recesses above each anal valve and between anal columns
  • Anal glands often into the floor of the anal sinuses.

Interior Of Anal Canal Lower Part

1. Upper Region/Pecten
   • Known as transition zone
   • It is 15 mm long
   • Extent: Pectinate line to Hilton’s line
   • Lined by non­keratinized stratified squamous epithelium
   • Mucosa is less mobile than the upper part
   • Mucosa appears bluish in color due to the presence of rich venous plexus underneath
   • White Line Of Hilton
     • It is whitish in color compared to bluish color of pecten, so known as white line of Hilton
     • It corresponds to inter sphincteric groove in the wall of anal canal.
2. Lower Region
   • Shortest part of anal canal
   • It is 8 mm long
   • Extent: White line of Hilton to anal verge
   • It is lined by true skin with sweat and sebaceous glands

Rectum Relations

• Anteriorly
  • Male
    • Membranous urethra
    • Bulb of penis
  • Female: Lower end of vagina
  • Both: Perianal body
• Posteriorly
  • Anococcygeal ligament
  • Tip of coccyx.
• Laterally: ischiorectal fossa

Rectum Anal Musculature: Anal musculature is divided into four groups, namely

1. Internal sphincter
2. External sphincter
3. Anorectal ring
4. The conjoint longitudinal muscle layer

1. Internal Sphincter

• Involuntary
• Made up of thickened circular smooth muscle coat, surrounding upper 2/3rd of the anal canal
• Extent: From anorectal junction to Hilton’s line
• Above it is continuous with a circular muscle coat of rectum

2. External Sphincter

• Voluntary
• Made up of striated muscle
• Surrounding the entire length of the anal canal

External Sphincter Is Divisible Into Three Parts:

1. Deep
2. Superficial
3. Subcutaneous

1. Deep Part
   • Located outer to the internal sphincter
   • Deep Part has no bony attachment
   • Few fires from deep part are attached to the anorectal raphe
2. Superficial Part
   • The superficial Part lies below the deep part
   • Extends up to inter-sphincteric groove
   • Superficial Part is the only part of the external sphincter with bony attachments
   • Origin from the last piece of coccyx
   • Insertion on either side of perineal body
   • It does not completely encircle the anal canal (does not support the anal canal in the midline posterior)
3. Subcutaneous Part
   • Lies below the internal sphincter in the perianal space
   • Subcutaneous Part encircles the lowest part of anal canal below inter sphincteric groove
   • Subcutaneous Part also has no bony attachment.

3. Anorectal Ring

• Muscular Ring Present At The Anorectal Junction Made Up Of:

1. Puborectalis part of levator ani
2. Fibers of the deep part of the external sphincter
3. Fibers of internal sphincter

• Anorectal ring forms a sling from the pubic bones
• Contraction of the puborectalis pulls the anorectal junction forward, which increases the angulation between the rectum and anal canal (an important factor in the continence mechanism).

4. Conjoint Longitudinal Muscle Layers

• It is the continuation of the longitudinal muscle layer of the rectum which fuses with few fiers of puborectalis (conjoint)
• It separates the internal and external sphincters
• As it goes downwards, this layer becomes ferroelastic and breaks into a number of fibrous septa at the level of the white line of Hilton
• The fibrous septa spread out fanwise and get attached to the skin around the anus
• Most medial septum forms—anal intermuscular septum
• Most lateral septum forms—perianal fascia.

Blood Supply Of Anal Canal

• Arterial Supply
  • Superior Rectal Artery: above the pectinate line
  • Below The Level Of Pectinate Line: inferior rectal artery.
• Venous Drainage
  • Above The Level Of Pectinate Line: superior rectal vein, from there to portal vein
  • Below The Level Pf Pectinate Line: inferior rectal vein.
• Lymphatic Drainage
  • Upper Part: Internal iliac nodes
  • Lower Part: Horizontal group of superficial inguinal nodes.
• Nerve Supply
  • Above The Pectinate Line:
    • Sympathetic (L1 and L2) through inferior hypogastric plexus
    • Parasympathetic (S2, S3, S4) through pelvic splanchnic nerve
  • Below The Pectinate Line: somatic supply through inferior rectal nerve
  • Internal Sphincter:
    • Sympathetic Nerves: contract
    • Parasympathetic Nerves: relax
  • External Sphincter: inferior rectal nerve and perineal branch of S4 nerve.

Question 4. Which are the surgical spaces related to the anal canal?
Answer:

The Surgical Spaces Related To The Anal Canal

• Ischioanal space or ischiorectal space.
• Perianal Space: Lies below the level of Hilton’s line between the perianal fascia and skin. A perianal abscess occurs here.
• Submucous Space: Lies above Hilton’s line between the internal anal sphincter and mucous membrane lodges the internal rectal venous plexus.

Question 5. Write a note on the development of the rectum and anal canal.
Answer:

The Development Of The Rectum And Anal Canal

• The upper part of the rectum develops from the endoderm of hindgut
• The lower part of the rectum and upper part of the anal canal is developed from the anorectal canal
• The lower part of the anal canal developed from the proctodeum.

Rectum And Anal Canal Multiple Choice Questions And Answers

Question 1. Lymph from the superior rectum drains into ______ nodes:

1. Superficial inguinal
2. External iliac
3. Lumbar
4. Sacral

Answer: 3. Lumbar

Question 2. Which lymph nodes drain the lower anal canal?

1. External iliac
2. Deep inguinal
3. Para­aortic
4. Superfiial inguinal

Answer: 4. Superfiial inguinal

Question 3. Which of the following is true about the internal anal sphincter?

1. Is skeletal muscle
2. Has longitudinal fibers
3. Has no bony attachment
4. None of these

Answer: 3. Is skeletal muscle

Question 4. Which of the following pelvic organs is not a content of the spermatic cord?

1. Rectum
2. Pelvic appendix
3. Ovary
4. Urinary bladder

Answer: 1. Rectum

Question 5. Conjoint longitudinal coat of the anal canal is formed by the fusion of?

1. Pubococcygeus with longitudinal muscle coat of rectum
2. Iliococcygeus with longitudinal muscle coat of rectum
3. Internal with external anal sphincter
4. Deep with the superficial part of the external anal

Answer: 1. Pubococcygeus with longitudinal muscle coat of rectum
sphincter

Large Blood Vessels Of The Gut Question And Answers

Question 1. Write in detail about the formation, course, tributaries, and relations of portal vein.
Answer:

Portal vVein

Portal Vein Length: 7.5–8 cm.

Portal Vein Formation

• Site Of Formation: Behind the neck of the pancreas
• Vertebral Level: L2
• By the union of the superior mesenteric vein and splenic vein.
• Inferior mesenteric vein drains into splenic vein

Read And Learn More: Abdomen And Pelvis

Portal Vein Course:

• Right Branch
  • Shorter and wider
  • Portal Vein enters right lobe of liver
  • Also receives the cystic vein.
• Left Branch
  • Longer and narrower
  • Portal Vein enters left lobe of liver
  • Portal Vein gives branches to caudate and quadrate lobes
  • Portal Vein receives paraumbilical veins

Based On Its Course, The Portal Vein Can Be Divided Into Three Parts:

1. Infraduodenal part
2. Retroduodenal part
3. Supraduodenal part

Portal Vein Relations

Portal Vein Tributaries

• Splenic vein
• Superior mesenteric vein
• Left gastric vein
• Right gastric vein
• Superior pancreaticoduodenal vein
• Cystic vein
• Paraumbilical vein.

Question 2. What is portocaval anastomoses or portosystemic anastomoses?
Answer:

Portocaval Anastomoses

• There are many sites in the abdominal cavity, where there is anastomoses between the portal and systemic venous systems
• The communicants act as important routes of collateral circulation in cases of portal obstruction Important sites of portal caudal anastomoses is described below.

Portocaval Anastomoses Or Portosystemic Anastomoses Applied Anatomy: In portal obstruction, veins around the umbilicus get distended, called as caput medusae.

1. Umbilicus
   • The left branch of two portal vein anastomoses with paraumbilical veins (systemic)
   • The paraumbilical vein receives superficial veins of the anterior abdominal wall.
2. Lower End Of Esophagus: Esophageal tributaries of left gastric vein (portal) anastomose with esophageal tributaries of accessory hemiazygos vein (systemic)
3. Anal Canal: Superior rectal vein (portal) anastomoses with middle and inferior rectal veins (systemic)
4. Bare Area Of Liver: Hepatic venules (portal) anastomoses with phrenic and intercostal veins (systemic)
5. Posterior Abdominal Wall: Veins of retroperitoneal organs (portal) anastomoses with retroperitoneal veins of the posterior abdominal wall and renal capsule (systemic).

Retroperitoneal Organs

• Duodenum
• Ascending colon
• Descending colon

Table Showing Site And Vessels Of Portocaval Anastomoses:

Question 3. Write a note on the internal iliac artery.
Answer:

Internal Iliac artery

Smaller terminal branch of common iliac artery

Internal Iliac Artery Course:

Internal Iliac Artery Relations:

• Anteriorly
  • Ureter
  • Uterine tube
  • Ovary
• Posteriorly
  • Sacroiliac joint
  • Lumbosacral trunk
  • Internal iliac vein
• Medially
  • Peritoneum
• Laterally
  • External iliac vein
  • Obturator nerve

Branches Of Anterior Division Internal Iliac Artery And Areas Supplied:

Branches Of Posterior Division Internal Iliac Artery And Areas Supplied:

Question 4. Write a note on the celiac trunk.
Answer:

Celiac Trunk

• Artery of foregut, since it supplies all the derivatives of foregut in the abdomen
• It is a short vessel
• Length: 1.25 cm
• Celiac Trunk Origin: Arises from the front of abdominal aorta just below aortic opening of the diaphragm
• Celiac Trunk Vertebral Level Of Origin: Between T12 and L1
• Course: Runs forwards and a little to the right and ends by dividing into its three terminal branches
• Celiac Trunk Terminal Branches:
  • Left gastric artery
  • Common hepatic artery
  • Splenic artery

Celiac Trunk Relations:

• Anteriorly: Lesser sac and lesser omentum
• Posteriorly: Abdominal aorta
• Inferiorly: Splenic vein and body of pancreas
• Right: Right crus of the diaphragm, caudate process of the liver, and right celiac ganglion
• Left: Left crus of the diaphragm, cardiac end of the stomach, and left celiac ganglion stomach
• Structures Supplied (Foregut derivatives): The lower end of the esophagus, stomach, duodenum up to the level of opening of the common bile duct, liver, greater part of pancreas, and spleen.

Question 5. Write a note on the Superior Mesenteric Artery

or

Write a note on the SMA  Disease

Answer:

Superior Mesenteric Artery

• Artery of the midgut, since it supplies all the derivatives of the midgut
• Origin: In front of the abdominal aorta about 1.25 cm below the origin of the celiac trunk
• Vertebral Level Of Origin: L1

Superior Mesenteric Artery Course:

Superior Mesenteric Artery Relations:

• Anteriorly: Body of pancreas, splenic vein
• Posteriorly: Left renal vein, the uncinate process of the pancreas, the third part of the duodenum, right psoas major, inferior vena cava.

Superior Mesenteric Artery Branches:

• Inferior pancreaticoduodenal artery
• Middle colic artery
• Right colic artery
• Ileocolic artery
• 12–15 Jejunal and ileal branches

Structures Supplied (Midgut Derivatives): Duodenum below the opening of the common bile duct, jejunum, ileum, appendix, cecum, ascending colon. Right 2/3rd of transverse colon, lower half of head of the pancreas.

Question 6. Write a note on the inferior mesenteric artery.
Answer:

Inferior Mesenteric Artery

• Artery of the hindgut, since it supplies all the derivatives of the hindgut in the abdomen and also derivatives of the posterior part of the cloaca
• Inferior Mesenteric Artery Origin: Arises from the front of the abdominal aorta about 3–4 cm above the termination of the aorta
• Inferior Mesenteric Artery Vertebral level Of Origin: L3

Inferior Mesenteric Artery Course:

Inferior Mesenteric Artery Branches:

• Left Colic Artery
• Sigmoid Arteries: 2–4 in number
• Superior Rectal Artery: Terminal branch.

Inferior Mesenteric Foregut Derivatives: Epithelium of the pharynx, esophagus, stomach, duodenum till ampulla of Vater, respiratory system auditory tube and mucous membrane of the tongue, parenchyma of liver, pancreas, thyroid, parathyroid, etc.

Inferior Mesenteric Midgut Derivatives: Epithelium of the duodenum from the ampulla of Vater to junction of right 2/3rd and left 1/3rd of the transverse colon.

Inferior Mesenteric Hindgut DerivativesP: Mucous membrane of the large intestine from left 1/3rd of the transverse colon to mucocutaneous junction of the anal canal, parenchyma of the prostate, epithelium of urinary bladder, urethra, etc.

Large Blood Vessels Of The Gut Multiple Choice Question And Answers

Question 1. The bifurcation of the aorta into the common iliac arteries is located at which vertebral level?

1. L1
2. L2
3. L3
4. L4
5. L5

Answer: 4. L5

Question 2. Which of the following is not a direct branch of celiac trunk?

1. Common hepatic artery
2. Inferior pancreaticoduodenal artery
3. Splenic artery
4. Left gastric artery

Answer: 2. Inferior pancreaticoduodenal artery

Question 3. Which of the following is a branch of the posterior division of the internal iliac artery?

1. Uterine
2. Umbilical
3. Superior gluteal
4. Pudendal

Answer: 3. Superior gluteal

Question 4. Inferior mesenteric vein opens into:

1. Splenic vein
2. Inferior vena cava
3. Superior mesenteric vein
4. Portal vein

Answer: 1. Splenic vein

Question 5. Which of the following ligaments contains the splenic artery?

1. Splenocolic ligament
2. Gastrosplenic ligament
3. Splenorenal ligament
4. Splenophrenic ligament

Answer: 3. Splenorenal ligament

 

Biliary Apparatus Question And Answers

Question 1. Classify biliary apparatus. Mention briefly about hepatic ducts.
Answer:

Biliary Apparatus

Biliary Apparatus Can Be Classified Into:

• Intrahepatic biliary apparatus
• Extrahepatic biliary apparatus

The intrahepatic part drains the bile secreted by hepatocytes to the outside, i.e. into extrahepatic part, which stores the bile in the gallbladder and transports it into 2nd part of the duodenum

Read And Learn More: Abdomen And Pelvis

1. Intrahepatic Part: It consists of

• Bile canaliculi
• Bile ductules
  • Interlobular bile ducts

2. Extrahepatic Part: It consists of:

• Right and left hepatic ducts
• Common hepatic duct
• Gallbladder
• Cystic duct
• Common bile duct

Right And Left Hepatic Ducts:

• They emerge at the porta hepatis after the union of their respective interlobular ducts
• Arrangement of structures at porta hepatis (Posterior to anterior)
  • Mnemonic: VAD (Vein artery duct)
  • Vein
  • Artery
  • Duct (hepatic duct).

Common Hepatic Duct:

• Length: 3.5 cm
• Formation: By the union of right and left hepatic ducts at the right end of porta hepatis
• Course: It runs downward for about 2.5–3 cm and unites with the cystic duct at an acute angle
• And forms the common bile duct
• It also forms the left boundary of Calot’s triangle.

Question 2. Write in detail about the gallbladder.
Answer:

Gallbladder:

• The Gallbladder is an elongated pear-shaped organ
• The Gallbladder is the reservoir of bile

Gallbladder Extent: Right end of porta hepatis to the inferior margin of the right lobe of the liver

Gallbladder Parts: It can be anatomically divided into fundus, body and neck

Gallbladder Fundus

• Most anterior and expanded part of the gallbladder, completely surrounded by peritoneum
• It projects from the inferior border of the liver and lies very near to anterior abdominal wall (fundus corresponds to the tip of 9th costal cartilage)

Gallbladder Fundus Relations

• Anteriorly: Anterior abdominal wall
• Posteriorly: Transverse colon

Gallbladder Body

• Gallbladder is the continuation of fundus
• Gallbladder is directed upwards, backward, and to the left
• The superior surface of a body of the gallbladder is in contact with the inferior surface of the liver at the fossa of the gallbladder, this part is devoid of the peritoneum
• The inferior surface is covered by the peritoneum
• Its upper end is narrow and is continuous with the neck at the right end of the porta hepatis

Gallbladder Body Relations

• Superior Surface: Inferior surface of the liver
• Inferior Surface: Transverse colon, 1st and 2nd parts of duodenum.

Gallbladder Applied Anatomy

Due to the close association of the body of the gallbladder with the transverse colon and duodenum, gallstones can sometimes ulcerate through its wall into the duodenum or transverse colon

Neck Of Gallbladder: The narrowest part of the gallbladder

Gallbladder Course:

• The posteromedial wall of neck shows a projection called Hartman’s pouch
• The Lumen of neck has a spiral wall
• Inferiorly neck is related to fist part of duodenum.

Hartman’s Pouch: A spheroid or conical pouch at the junction of the neck of the gallbladder and the cystic duct Gall-stones commonly get stuck at the Hartman’s pouch

Question 3. Write a note on the cystic duct.
Answer:

Cystic Duct

• Cystic Duct is S-shaped
• Length: 3–4 cm

Cystic Duct Course:

Cystic Duct Provides A Two-Way Passage: Receives bile from the common hepatic duct and sends bile out via the common bile duct.

Question 4. Write a note on the common bile duct. Mention the important anatomical features of the intraduodenal part common bile duct.
Answer:

Common Bile Duct

• Length: 7.5 cm
• Diameter: < 7 mm
• Formation: By the union of the cystic duct with common hepatic duct near the porta hepatis

Common Bile Duct Course:

• The narrowest part of common bile duct
• Has a very oblique course
• The pancreatic duct and common bile duct unite to form, a hepatopancreatic ampulla or ampulla of Vater in the wall of the duodenum, very close to the summit of major duodenal papilla
• Distal end of the ampulla is constricted
• Ampulla is surrounded by the hepatopancreatic sphincter or sphincter of Oddi
• The sphincter is made up of circular muscles.

Cystic Duct Relations

• Supraduodenal Part
  • Anteriorly: Liver
  • Posteriorly: Portal vein and epiploic foramen
  • Left: Hepatic artery
• Infraduodenal Part
  • Anteriorly: A groove in the upper and lateral parts of the posterior surface of the head of the pancreas
  • Posteriorly: Inferior vena cava
  • Right: 2nd part of duodenum
• Retroduodenal part
• Anteriorly :1st part of duodenum
• Posteriorly: Inferior vena cava
• Left: Gastroduodenal artery

Question 5. Briefly describe the blood supply, lymphatic drainage, and nerve supply of the biliary apparatus.
Answer:

The Blood Supply, Lymphatic Drainage, And Nerve Supply Of The Biliary Apparatus

Biliary Apparatus Arterial Supply

• Gallbladder: Cystic artery—right branch of hepatic artery
• Common Bile Duct:
  • The upper part from the descending branches of the cystic artery
  • The lower part from the ascending branches of the superior pancreaticoduodenal artery
  • Also minor contribution by hepatic artery proper.

Biliary Apparatus Venous Drainage

• The superior surface of the gallbladder is drained by veins which directly enter into the liver substance and open in to hepatic ducts
• Rest of the gallbladder drained by one or two cystic veins into the right branch of the portal vein
• Lower part of bile duct drains into portal veins.

Biliary Apparatus Lymphatic Drainage

• Gallbladder, cystic duct, hepatic duct, the upper part of common bile—cystic nodes of Lund, node of the anterior border of the epiploic foramen
• Lower part of common bile duct—lower hepatic nodes, upper pancreaticosplenic nodes.

Biliary Apparatus Nerve Supply

• Sympathetic Supply: T7–T9
• Parasympathetic Supply: Both vagus and right phrenic nerve.

Question 6. Write a short note on Calot’s triangle and its importance.
Answer:

Calot’s Triangle

• Also known as cystohepatic triangle
• An inverted triangle (apex facing downwards)

Calot’s Triangle Boundaries

• Superiorly: Inferior surface of liver
• Right: Cystic duct
• Left: Common hepatic duct

Calot’s Triangle Contents

• Right hepatic artery
• Cystic artery
• Cystic lymph nodes of Lund.
• Applied Anatomy
  • During cholecystitis, the cystic nodes of Lund are found enlarged.

Biliary Apparatus Multiple Choice Questions And Answers

Question 1. The sphincter of Oddi consists of a following number of small sphincters:

1. 2
2. 3
3. 5
4. 6

Answer: 2. 3

Question 2. The Fundus of the gallbladder is related to the tip of:

1. Right 8th costal cartilage
2. Right 9th costal cartilage
3. Left 8th costal cartilage
4. Left 9th costal cartilage

Answer: 2. Right 9th costal cartilage