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Regional Anatomy 3 (Urinary Bladder Retroperitoneal organ, located in…

Regional Anatomy 3 (Urinary Bladder

Retroperitoneal organ, located in the pelvic cavity (Reg 3 interconnection)
During Infancy and childhood empty bladder sits largely above pelvic brim
It is shaped like a 3 sided pyramid
Connected to the umbilicus by the median umbilical ligament
Superior angles receive ureters, inferior angle gives rise to the urethra
- In males it is related to rectum, seminal vesicles and ampullae of deferens ducts
- In females it is related to vagina
Neck is the lowest part of bladder, where 2 inferolateral surfaces and base converge giving rise to urethra
- there are bilateral ureters but only a singular urethra
- Ureteral openings are located just superiorly to the vesicle trigone
Micturiation control
- internal sphincter: smooth muscle controlled by involuntary control; prevents retrograde ejaculation
- External sphincter: skeletal muscle controlled by voluntary or somatic control
Urethra length in female is approx. 4 cm
- urethral opening is much closer to the anus and thus higher susceptibility for UTI

, Male Reproductive Organs
Internal Organs

Ductus (vas) Deferens
- Carries mature sperm from epidydimis to ejaculatory duct
- Ductus deferens joins seminal vesicle and becomes ejaculatory duct
Seminal Glands (vesicles)
Its secretions are discharged into ejaculate by smooth muscle wall contractions.
- Contains fructose which is essential for nourishment of spermatozoa
Prostate
- Fibromuscular and glandular organ that surrounds 2nd part of male urethra
- Ejaculatory ducts run through prostate to open into prostatic urethra
- Divided into 5 lobes: anterior, median (middle), posterior, right and left lobes
Ejaculatory duct
- Arises from union of seminal vesicle and ductus deferens

, Mediastinum

, Pericardium and Heart, Hindgut
Large Intestine

Extends from the iliocecal junction to anus
Function: Absorbtion of water and electrolytes and storage of undigested material until they are excreted as feces
Parts:
Cecum: Blind-ended pouch, portion is intraperitoneal and part is retroperitoneal
- Iliocecal valve: 2 mucosal folds
Vermiform Appendix is attached to the cecum and is intrapeitoneal
- Contains large amount of lymph tissue
- Tip is mobile
- Sensory fibers frmo appendix terminate at T10
  level and refered pain occurs to the periumbilical region
  - Neuromusc connection
  - Dermatonal referral pain from appendix to umbilicus area
  - Anterior hip pain (iliopsoas) and back pain could be referred pain from retrocecal appendix*
    Gastro connection
Ascending colon
- from ileocecal junction to inferior surface of right lobe of live
Transverse colon
Descending Colon
- from left colic flexure to left iliac fossa
- Retroperitoneal
Sigmoid Colon
- Begins at the level of S3
- Intraperitoneal
Rectum
Anal Canal

, Kidneys

Parts
Ant and post surfaces
superior and inferior pole
medial and lateral border
Structures at Hilum
Renal v. and a. and renal pelvis
Lymph vessels and autonomic n.n.
Coverings
Renal fascia, perirenal fat, and pararenal fat help support and keep kidneys in position
Internal Structures
Renal sinus consists of 2 layers:
1) Cortex (outer layer)
2) Medulla (inner layer)
Medullary pyramids bases face the cortex
Collecting ducts perforate renal papillae and drain urine into minor calyces
Minor calyces join to form the major calyces which open into renal pelvis (end of ureter)
Contents of Renal Sinus
Branches of renal a.
tributaries of renal v.
minor and major calyces
renal pelvis
lymph vessels
autonomic vessels
adipose tissue

, Pelvic Walls, Vessels and Nerves
Pelvis

Bony pelvis is divided into 2 parts by the pelvic brim (pelvic inlet)
1) Above pelvic brim = greater/false pelvis
- Forms lower part of abdominal cavity
  2) Below pelvic brim = lesser/true pelvis
- Encloses pelvic cavity and its contents
- has two openings: pelvic inlet and pelvic outlet (pelvic floor)
  Pelvic cavity
Short curved canal whose anterior wall is shorter than the posterior wall
The walls are formed by muscles, bones, ligaments and the pelvic diaphragm
Pelvic floor formed by Coccygeus muscle, piriformis muscle, obturator internus, and Levator ani muscles:
- Puborectalis, Pubococcygeus, Illiococcygeus
  - Nerve supply is from ventral rami of S2-S4 spinal nerves via direct muscular branches and pudendal nerve
    Rectum
Begins anterior to S3, as a continuation of the sigmoid colon (Reg 3 interconnection). It follows curve of coccyx and pierces the pelvic diaphragm.
80 degree anorectal angle (perineal flexure) @ anorectal junction
Puborectalis muscle maintains the angle
Sacral part of sympathetic trunk is important because if there is rectal cancer present you will possibly have pain in the dermatomes to that nerve supply.
In males prostates can be evaluated through the rectum because of the proximity of the prostate to the rectum (Reg 3 interconnection)
In females there is a small separation of tissue between the rectum and the vaginal canal.

, Suprarenal (Adrenal) Glands

Endocrine, retroperitoneal glands located on upper pole of kidneys
R one is pyramidal shaped and related to the liver, IVC, and posteriorly to diaphragm
L one is crescent shaped and related to the pancreas, lesser sac, and stomach as well as posteriorly to the diaphragm
contains two layers
1) cortex: outer layer, originates from mesoderm
2) inner layer, originates from ectoderm
Arterial supply
1) superior suprarenal a.a. branches of inferior phrenic a.
2) middle suprarenal a.a. from paired visceral branch of abdominal aorta
3) inferior suprarenal a. branch from renal a.
Venous drainage
one suprarenal v. on each side
R suprarenal v. drain into the IVC
L suprarenal V drains into the L renal v.

, Neuromuscular connection

Phrenic n. supply to the fibrous pericardium and parietal layer of the heart is responsible for referred pain to the arm during myocardial ischemia

, Reg 3 Interconnection
Peritoneal organs: SAD PUCKER

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