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ANP 300 > Lab 11: The Pelvis > Flashcards

Lab 11: The Pelvis Flashcards

1
Q

pelvis

A
  • 2 os coxae
  • coccyx
  • sacrum
  • iliac crest
  • ischial spine
  • ischial tuberosity
  • ischial tuberosity- sit on it
  • subpubic angle- broad and wide -> female
  • subpubic angle- narrow and tall -> male
  • arcuate line or pelvic brim- divides the true pelvis from the false pelvis
  • false pelvis is above arcuate line
  • true pelvis is below the arcuate line
  • greater sciatic notch is bigger in females
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2
Q

pelvic brim

A
  • posteriorly- sacral plateau
  • anterior- pectin pubis
  • lateral- arcuate line
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3
Q

pelvis ligaments

A
  • anterior sacroiliac joint- stabilized anteriorly and posteriorly -> anterior and posterior sacroiliac ligament
  • inguinal ligament- thickened lower margin of the external oblique muscle
  • running from the anterior iliac spine to the pubic tubercle
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4
Q

pelvis ligaments

A
  • greater and lesser sciatic notch
  • ligaments enclose and form a foramen
  • greater sciatic foramen
  • lesser sciatic foramen -> goes to perineum
  • sacrospinous ligament- from sacrum to ischial spine
  • sacral tuberous ligament- from the sacrum to the ischial tuberosity
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5
Q

pelvic cavity

A
  • continuous with abdominal cavity
  • peritoneum extends into the false pelvis
  • small/large intestine sits in false pelvis and are covered in peritoneum
  • pelvic cavity begins at pelvic brim
  • organs in true pelvis are retroperitoneal
  • bounded inferiorly by pelvic diaphragm -> muscular floor
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6
Q

pelvic diaphragm

A
  • separates the pelvic cavity from the perineum
  • runs from the pubic bone to the coccyx
  • urethra, anal canal pass through the pelvic diaphragm
  • urogenital hiatus- allow passage of the urethra in both sexes -> vagina in females
  • muscular components:
  • levator ani
  • coccygeus
  • innervation- S2-S4 ventral rami
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7
Q

levator ani

A
  • three muscles:
  • pubococcygeus
  • puborectalis
  • iliococcygeus
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8
Q

perineum

A
  • region of the pelvis below the pelvic diaphragm
  • made of 2 triangles:
    1. urogenital triangle (anterior)- perineal membrane divides superior portion and inferior portion
    2. anal triangle (posterior)
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9
Q

muscles of the urogenital triangle

A
  • above the perineal membrane:
  • sphincter urethrae
  • deep transverse perineus
  • inferior to perineal membrane:
  • ischiocavernous- covers the crus of the penis or clitoris (sides of triangle)
  • bulbospongiosus- covers bulb of penis and the bulb of the vestibule (middle of triangle)
  • superficial transverse perineus (base of triangle)
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10
Q

muscles of the anal triangle

A

-external anal sphincter

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11
Q

erectile tissue

A

-found deep to the inferior compartment muscles (bulbospongiosus and ischiocavernosus)

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12
Q

perineal erectile tissues: female

A
  • ischiocavernosus covers crus of clitoris and corpus cavernosum
  • bulbospongiosus covers bulb of vestibule
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13
Q

perineal erectile tissues: males

A
  • ischiocavernosus covers crus of penis and crus of clitoris and corpus cavernosum
  • bulbospongiosus covers bulb of penis and corpus spongiosum
  • two columns of corpus cavernosum and one corpus spongiosum
  • ischiocavernosus covers crus cavernosum and bulbospongiosus covers bulb and sponge tissue
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14
Q

corpus cavernosum

A

-homologous to crus of penis

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15
Q

bulb of the vestibule and penis

A

-corpus spongiosum

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16
Q

innervation of erectile tissues

A
  • erection- parasympathetics to corpus cavernosum

- ejaculation- sympathetics to bulbospongiosus muscle

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17
Q

male perineal tissues

A
  • bulb of penis and corpus spongiosum transmit the urethra
  • paired corpus cavernosum
  • corpus spongiosum and urethra running through it
  • deep artery of the penis supplies the corpus cavernosum
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18
Q

bladder

A
  • receives urine from the ureters
  • detrusor muscle (smooth and thick) -> contracts when we pee
  • orifices of the uteters
  • smooth portions of the bladder- trigone
  • sphincter urethrae- somatic, outside pelvis (perineum)
  • urethra is short for females and long for males
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19
Q

urethra: males

A
  • extends down from prostate- prostatic urethra
  • membranous urethra
  • spongy/penile urethra- through shaft of penis
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20
Q

prostate

A

-contributes to the ejaculatory fluid

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21
Q

bulbourethral glands

A
  • outside pelvis
  • perineum
  • secrete fluid
  • homologous to vestibular gland
  • produce fluid that contributes to ejaculation
  • whole purpose is to neutralize acidity of vagina
  • embedded in the internal sphincter urethrae
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22
Q

greater vestibular gland

A
  • during sexual aurosal- lubrication

- fluid for lubrication is highly acidic

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23
Q

uterus

A
  • fundus
  • body
  • cervix- protrudes into the vaginal cavity -> part of the uterus still though
  • covered in peritoneum
  • 3 layers:
  • endometrium
  • myometrium
  • perimetrium
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24
Q

broad ligament

A
  • double layer peritoneum
  • 3 portions:
  • mesovarium- attached to the ovary and bread ligament of uterus
  • mesosalpinx- portion that attached to fallopian tube
  • mesometrium- everything else
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25
Q

round ligament

A
  • adhere to abdominal wall

- connects ovary and abdominal wall

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26
Q

suspensory ligament of the ovary

A
  • where the gonadal arteries travel

- connects uterus and pelvic wall

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27
Q

fallopian tube

A

-isthmus, infundibulum with fimbriae, and ampulla

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28
Q

ovarian ligament

A
  • leads to ovary

- connects ovary and uterus

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29
Q

ductus defernes

A
  • gets stuck under the peritoneum between the bladder

- ampulla- widen portion

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30
Q

seminal vesicle

A

-adds fluid to ejaculation

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31
Q

path of ejaculation

A

-scrotum -> testis -> epididymis -> ductus defernes -> seminal vesicles -> ejaculatory duct -> prostate gland -> bulbourethral gland -> urethra -> penis `

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32
Q

testes

A
  • covered in tunica albuginea and tunica vaginalis (makes sperm)
  • testicular artery
  • pampiniform plexus of veins (thermoregulation)
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33
Q

deep inguinal ring

A
  • opening in the internal oblique muscle
  • where the testes descend
  • through inguinal canal
  • come out at the external oblique at the superficial inguinal ring
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34
Q

spermatic cord

A
  • lateral abdominal walls
  • fascial layers:
  • external spermatic fascia- from external abdominal oblique aponeurosis
  • cremaster muscle and fascia- from internal abdominal oblique
  • internal spermatic fascia- from transversalis fascia
  • transversus abdominis is not involved!
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35
Q

aorta

A
  • splits into the left and right common iliac arteries

- common iliac arteries split into the internal and external iliac arteries

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36
Q

arterial supply from abdominal aorta

A

-ovarian artery and testicular artery -> gonadal arteries

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37
Q

arterial supply from the inferior mesenteric artery

A

-superior rectal artery -> rectum

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38
Q

arterial supply from the external iliac artery

A

-inferior epigastric artery -> small branch to cremaster muscle (surrounds the testes)

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39
Q

arterial supply from the internal iliac

A
  • branches into anterior division and posterior division
  • anterior division- obturator artery -> exits through obturator foramen
  • inferior gluteal artery -> exits through greater sciatic foramen -> gluteal
  • umbilical artery -> gives off superior vesical artery to bladder, then becomes umbilical ligament
  • middle rectal artery -> rectum
  • internal pudendal artery -> exits through greater sciatic foramen -> into perineum through lesser sciatic foramen, then gives off: perineal artery, inferior rectal artery, and artery of penis/clitoris
  • inferior vesical artery (males only)- prostate, seminal vesicles, ductus deferens OR uterine artery (females only) -> uterus
  • posterior division:
  • lateral sacral artery
  • superior gluteal -> exits through greater sciatic foramen -> gluteal muscles
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40
Q

internal pudendal artery

A

-gives off deep artery, dorsal artery, and bulbo

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41
Q

parasympathetic innervation in the pelvis originates from the

A

-pelvic splanchnic nerves

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42
Q

sperm is produced in the

A

seminiferous tubules

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43
Q

innervation of bulbospongiosus and ischiocavernosus

A

-perineal nerve

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44
Q

Bony Pelvis

A
  • left and right os coxae, sacrum, coccyx
  • os coxae- composed of 3 fused elements: ilium, ischium, pubis
  • pubic bones articulate with one another anteriorly by symphysis (fibrocartilaginous)
  • posteriorly the ilium articulates with the ala of the sacrum at the auricular surface -> forms sacroiliac joint
  • os coxae is waisted below the auricular surface by the greater sciatic notch -> delimited inferiorly by the ischial spine
  • below the spine, ischium is indented by the lesser sciatic notch -> bounded inferiorly by the ischial tuberosity
  • ischial pubic bodies are joined by the superior ramus of the pubis superiorly and the ischiopubic ramus inferiorly
  • these rami are surrounded by obturator foramen
  • upper margin of the superior ramus of the pubis has a sharp crest that continues posteriorly as a ridge -> arcuate line
  • crest and arcuate line constitute the pelvic brim -> separate the false pelvis and pelvic cavity (true pelvis or obstetrical pelvis)
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45
Q

pelvic ligaments

A
  • ilium and sacrum are joined anteriorly along the edge of the auricular surface by the anterior sacroiliac ligament and posteriorly by the posterior sacroiliac ligament
  • ischial spine and sacrum are connected by the sacrospinous ligament -> closes the open end of the greater sciatic notch -> creating greater sciatic foramen
  • ischial tuberosity and sacrum are connected by the sacrotuberous ligament -> with the sacrospinous ligament they close the open end of the lesser sciatic notch -> create the lesser sciatic foramen
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46
Q

sex difference in pelvis

A
  • appear during puberty
  • females- greater distance between sacrum and ischial spines and the distance between the 2 ischial tuberosities
  • subpubic angles: males- formed by the left and right ischiopubic rami below the symphysis is narrow
  • subpubic angles: females- subpubic angle is more obtuse
  • ischiopubic ramus: males- inferior margin of the ischiopubis ramus is straight or even slightly convex
  • ischiopubic ramus: females- slightly concave
  • body of pubis: males- tall and narrow
  • body of pubis: females- short and broad
  • greater sciatic notch: males- narrow, forming an angle of 30
  • greater sciatic notch: females- broader curve, attaining an angle of 60
  • auricular surface: males- large, extending well over the first 3 sacra elements
  • auricular surface: females- joint surface is smaller, usually extending over the first 2 sacral elements
47
Q

muscles of the pelvis

A
  • move the trunk and lower limbs
  • provides attachment to a group of muscles that make up the pelvic diaphragm -> dome shaped and has opening that permit the passage of certain structures
  • dome is convex downward and is composed of more than one muscle
48
Q

pelvic diaphram

A
  • composed of several muscles whose fibers arise along a line that extends around the inside of the pelvis from the body of the pubis, thickened fascia that covers obturator internus, the body of the ischium, and the sacrospinous ligament
  • divides the pelvis into 2 parts: above diaphragm -> pelvic cavity, below diaphragm perineum
  • pelvic diaphragm has 2 components: levator ani and coccygeus
  • levator ani- 3 muscles
  • coccygeus- one muscle
  • all four muscles are innervated by ventral rami of S2-S4
49
Q

levator ani

A
  • fibers run posteriorly and inferiorly to converge in the midline of a linear tendon that beings behind the pubic symphysis and stretched to the tip of coccyx
  • this tendon is pierced by the rectum -> divides it into anterior and posterior
  • anterior- perineal body
  • posterior- anococcygeal raphe
  • gap between the pubic symphysis and the perineal body is -> urogenital hiatus -> permits passage of the urethra in both sexes and the vagina in females
  • 3 muscles of the levator ani:
  • pubococcygeus- most anterior, fibers arise from the body of the pubis and pass around the urogenital hiatus to insert into the perineal body
  • puborectalis- arises from the pubis and the fascia over obturator internus -> inserts into the anococcygeal raphe forming a sling that pulls the rectum forward -> puborectal sling
  • iliococcygeus- arises from the fascia over obturator internus and the ischium and inserts into the anococcygeal raphe
50
Q

levator ani: puboractalis

A
  • arises from the pubis and the fascia over obturator internus
  • inserts into the anococcygeal raphe forming a sling that pulls the rectum forward -> puborectal sling
  • puborectal sling must be relaxes in order for fecal matter to pass from the rectum into the anal canal during defection
51
Q

coccygeus

A
  • aka ischiococcygeus
  • fibers arise from the ischial spine and run along the sacrospinous ligament to the sacrum and coccyx
  • coccygeus is only variably present (much more profound muscle in our primate relatives with tails)
52
Q

muscle of the perineum

A
  • perineum- region of the pelvis below diaphragm
  • diamond shaped outline
  • bounded anteriorly by the pubic symphysis
  • bounded posteriorly by the top of coccyx
  • bounded lateral by the 2 ischial tuberosities
  • roof of the perineum is formed by the pelvic diaphragm
  • floor of perineum is formed by a sheet of fibrous connective tissue (colle’s fascia) that is an extra (deep) layer of the body’s superficial fascia
  • 2 regions: urogenital (anterior) and anal triangle (posterior)
53
Q

urogenital triangle

A
  • divided into superior and inferior compartments by the perineal membrane
  • flat fibrous sheet that stretches between the left and right ischiopubic rami
  • has a free anterior margin with a small gap between it and the back of the pubic symphysis
  • posterior margin is free except in the midline where it is attached to the perineal body
  • perineal membrane has an opening that permits passage of the urethra and vagina -> also traverse the urogenital hiatus above it
  • five muscles occupy the urogenital triangle
  • 2 muscles lie above the perineal membrane and 3 muscles below (within urogenital triangle)
54
Q

anal triangle

A
  • differs from the urogenital triangle because it does not posses a flat membranous sheet that divides it into upper and lower parts
  • traversed by the anal canal -> continuation of the rectum below the pelvic diaphragm and it extend to the anus
  • anal canal is situated behind the perineal body and in front of the anococcygeal raphe
  • on the other side of anal canal it is surrounded by fat that occupies a wedge shaped space -> ischiorectal (ischioanal) fossa
  • these fat-filled fossae permit the anal canal to distend during defecation
  • wall of anal canal is composed of outer longitudinal and inner circular smooth muscle fibers
  • thickening of the circular smooth muscle fibers in the upper half of the canal forms an involuntary internal sphincter
  • there is also a voluntary external sphincter that encircles the canal -> only skeletal muscle of the anal triangle
  • only one muscle in the anal triangle -> external anal sphincter
55
Q

muscles of the urogenital triangle: superior to the perineal membrane

A
  • 2
  • sphincter urethrae
  • deep transverse perineus (more trivial)
56
Q

muscles of the urogenital triangle: sphincter urethrae

A
  • superior to the perineal membrane
  • circular muscle
  • surrounds the urethra in both sexes
  • situated between the pelvis diaphragm and perineal membrane
  • males- paired bulbourethral glands (open into the urethra) are embedded in this muscle
  • females- muscle fibers spin off the sphincter urethrae to encircle the inferior portion of the vagina -> fibers form the sphincter urethrovaginalis
57
Q

muscles of the urogenital triangle: deep transverse perineus

A
  • superior to the perineal membrane
  • more trivial than the sphincter urethrae
  • arises from the ischial tuberosity
  • runs medially
  • insert into the perineal body in both sexes
  • function is unknown
58
Q

muscles of the urogenital triangle: inferior to the perineal membrane

A
  • ischiocavernosus
  • bulbospongiosus
  • superficial transverse perineus
59
Q

muscles of the urogenital triangle: ischiocavernosus

A
  • inferior to the perineal membrane
  • arises from the ischiopubic ramus and covers the crus of either the penis or the clitoris
  • crus is a highly vascular tube of erectile tissue that is attached to the inner surface of the ischiopubic ramus just below the perineal membrane
60
Q

muscles of the urogenital triangle: bulbospongiosus

A
  • inferior to the perineal membrane
  • arises from the perineal membrane medial to ischiocavernosus
  • males- single, midline muscles covers the bulb of the penis and the root of the corpus cavernosum of the penis
  • females- bilateral muscle covers the bulb of the vestibule (homologous to bulb of penis) -> also covers the greater vestibular gland (bartholin’s gland)
  • greater vestibular gland is located at the posterior end of the bulb of the vestibule on either side of the vaginal orifice
61
Q

muscles of the urogenital triangle: superficial transverse perineus

A
  • inferior to the perineal membrane
  • more trivial than ischiocavernosus and bulbospongiosus
  • superficial transverse perineus arises from the edge of the ischial tuberosity
  • passes medially
  • inserts into the perineal body in both sexes
  • function is unknown
62
Q

muscle of the anal triangle: external anal sphincter

A
  • arises from the perineal body and sends fibers around either side of the anal canal
  • inserts into anococcygeal raphe
  • constricts the anal canal -> enabling one to be continent
  • skeletal- voluntary
  • encircles the canal
63
Q

peritoneum of the pelvic cavity

A
  • pelvic cavity is continuous superiorly with the abdominal cavity
  • peritoneum that lines the walls of the abdominal cavity extends into the pelvic cavity
  • peritoneum covers the small and large intestines within the false pelvis
  • organs that reside within the true pelvis -> retroperitoneal
  • males:
  • peritoneum reflects away from the anterior abdominal wall onto the upper surface of the urinary bladder
  • runs across the bladder and then reflects onto the anterior surface of the rectum
  • gap between the bladder and rectum forms a peritoneal recess known as the rectovesical pouch
  • females:
  • peritoneum reflects away from the anterior abdominal wall onto the upper surface of the urinary bladder
  • runs across the bladder and then reflects onto the anterior surface of the uterus
  • gap between the bladder and uterus forms a peritoneal recess known as the -> vesicouterine pouch
  • sheet of peritoneum runs over the uterus, where it jumps off ono the anterior surface of the rectum
  • gap between the uterus and uterus forms a second larger peritoneal recess known as the rectouterine pouch
64
Q

common pelvic viscera

A
  • no difference in: GI and urinary systems, rectum and anal canal, urinary bladder and ureters
  • length and relationships of the urethra differ between the sexes though
65
Q

bladder

A
  • storage receptacle for urine from the kidney
  • urine passes to the bladder from the kidneys through 2 ureters
  • 1-1/2 pints
  • situated directly behind the pubic bones and is composed of 3 layers of tissue
  • sits a little higher in the pelvis in males because of the prostate gland below it
  • innermost layer consists of a highly distendable epithelium that is thrown into fold called rugae when the bladder is empty
  • flattens as bladder fills
  • thick middle layer is composed of smooth muscle -> detrusor muscle
  • outermost layer is adventitia
  • adventitia is perineum and therefore covers only the upper surface of the bladder
66
Q

ureters

A
  • muscular tubes
  • run along the posterior wall of the abdomen on the front of psoas major
  • they enter the pelvic cavity at the sacroiliac joint, crossing the bifurcation of the common iliac artery into the external and internal iliac arteries
  • they then follow the internal iliac artery along the lateral wall of the pelvis to the ischial spine, where they turn medially to enter the posterolateral walls of the bladder
67
Q

ureteric orifice

A
  • ureters enter the bladder obliquely -> ureteric orifice
  • ureteric orifice can be composed by internal pressure
  • prevents a reverse flow of urine as the bladder fills
68
Q

urethral orifice

A
  • urine passes out of the bladder through urethral orifice
  • circular fibers of the detrusor muscle are thickened to form an involuntary sphincter -> internal sphincter urethrae (sphincter vesicae)
69
Q

trigone

A
  • triangular area between the ureteric and urethral orifices -> called trigone
  • mucous membrane lining the trigone is always smooth, even when bladder is empty
70
Q

male genitalia

A
  • produce sperm and deliver to vagina
  • scrotum
  • testis
  • epididymis
  • ductus deferens
  • seminal vesicle
  • ejaculatory duct
  • prostate gland
  • bulbourethral gland
  • urethra
  • penis
71
Q

scrotum

A
  • outpouching of the lower part of the anterior abdominal wall
  • partly divided into two compartments by a fibrous median septum -> expressed external by a midline ridge of skin -> scrotal raphe
  • each compartment contains testis, epididymis, and spermatic cord
  • composed of a # of tissue layers that cover each testis:
  • outermost -> skin
  • beneath the skin is a layer of smooth muscle -> dartos muscle (responsible for the wrinkled appearance of the scrotal skin
  • deep to the dartos muscle there are 3 layers that constitute the spermatic fascia -> derive from the muscle and fascial layers of the anterior abdominal wall (external oblique muscle, internal oblique muscle, transversalis fascia)
  • middle layer of the spermatic fascia is the cremaster muscle -> contraction brings the testis closer to the body when scrotal temperature falls
  • spermatic fascia surrounds the ductus deferens and the lymphatic ducts, autonomic nerves, and blood vessels that supply the testis -> package of ducts, nerves, and blood vessels -> spermatic cord
  • serous membrane -> testis vaginalis -> partially covers the testis in front and on the lateral side
  • deepest layer -> tunica albuginea -> forms a thick fibrous capsule that adheres to the testis
72
Q

inguinal canal

A
  • structures within the spermatic cord reach the testis from the abdominopelvic cavity by way of the inguinal canal
  • inguinal canal runs along inguinal ligament
  • entrance from the abdominopelvic cavity is known as the deep inguinal ring
  • exits into the scrotum at the -> superficial inguinal ring
  • testis descends from the abdominopelvic cavity into the scrotum through the inguinal canal
  • during descent the testis encounters the muscle and facial layers of the anterior abdominal wall and drags these layers with it into the scrotum through the canal
73
Q

testis

A
  • egg shaped
  • responsible for the production of sperm and androgens (testosterone)
  • covered by a fibrous capsule -> tunica albuginea
  • number of fibrous septa that divide the interior of the testis into lobules extend from the tunica albuginea
  • each lobule contains several seminiferous tubules
  • seminiferous tubule are responsible for the production of sperm -> open into a network of channels called the rete testis
  • drain into a series of efferent ducts that pierce the tunica albuginea and open into the epididymis
  • testicular artery and vein enter and leave the testis at the hilum
  • vein forms a dense network known as the pampiniform plexus around the ductus deferens within the spermatic cord
74
Q

epididymis

A
  • highly coiled tube that is responsible for the storage and maturation of sperm until they are ejaculated
  • has a head -> open the efferent ducts from the testis
  • body -> extends down the posterolateral side of the testis at the bottom
  • tail -> begins to straighten out and enlarge to turn upward as the ductus deferens
75
Q

ductus deferens

A
  • vas deferens
  • continuation of the tube that comprises the epididymis
  • about 18 inches
  • ascends through the scrotum covered by the fascial layers of the spermatic cord
  • traverses the inguinal canal and, leaving the cover of the spermatic cord, -> enters the abdominopelvic cavity over the body of the pubic bone
  • upon entering the abdominal cavity -> ductus deferens passes onto the urinary bladder -> runs posteriorly over the bladder crossing the ureter and then turns downward to run along the medial border of an accessory gland -> seminal vesicle (behind bladder)
  • terminal portion of ductus deferens is expanded -> ampulla
  • seminal vesicle open into the ampulla at which point it becomes known as the ejaculatory duct -> it then pierces the prostate gland to open into the lumen of the urethra
76
Q

seminal vesicle

A
  • seminal vesicles are lobulated organs
  • 2 inches
  • lie on the posterior surface of the bladder
  • secrete a fructose rich alkaline fluid that constitutes a good portion of the seminal fluid that is expelled upon ejaculation
  • fluid nourishes the sperm and helps neutralize the natural acidity of the vagina
  • duct that leads from the seminal vesicle open into the distal end of the ampulla of the ductus deferens
77
Q

ejaculatory duct

A
  • the tube that is formed by the union of the ductus deferens and the duct from the seminal vesicle
  • pierces the posterior surface of the prostate gland
  • opens into the urethra
78
Q

prostate gland

A
  • cone shaped mass of glandular tissue
  • surrounds the first part of the urethra known as the prostatic urethra
  • surrounded by a thin fibrous capsule and a layer of smooth muscle
  • glandular secretions are squeezed through tiny opening sin the prostatic urethra by this smooth muscle
  • prostatic secretions are released during ejaculation
  • mix with seminal fluid and sperm to produce semen
79
Q

bulbourethral glands

A
  • immediately below the prostate gland -> sphincter urethrae muscle
  • embedded within the substance of this muscle are 2 pea-sized bulbourethral glands -> cowper’s glands
  • secrete a clear alkaline fluid that serves as a lubricant and to neutralize urethral acidity
  • each gland has a duct that opens into the urethra below the prostate
  • 1/2 inch long portion of the urethra between the prostate and the bottom of the sphincter urethrae is known as the membranous urethra
80
Q

penis

A
  • comprises 3 bodies of erectile tissue surrounded by tubular sheaths of fascia and skin
  • erectile tissue bodies are the midline corpus spongiosum and the left and right corpora cavernosa
  • urethra runs through the corpus
81
Q

penis: corpus spongiosum

A
  • midline corpus spongiosum has a expanded root -> bulb of the penis
  • lies below the perineal membrane and is covered by the bulbospongiosus muscle
  • urethra enters the bulb and continues forward through the substance of the corpus spongiosum -> spongy urethra
  • distal end of the corpus spongiosum is expanded as the gland penis
  • urethra open at the tip of the glans penis by the external urethral orifice
82
Q

penis: corpus cavernosum

A
  • root of each corpus cavernosum is known as the crus of the penis
  • run along the underside of the perineal membrane adjacent to the ischiopubic ramus
  • covered by the ischiocavernosus muscles
  • corpora cavernosa extend distally along the shaft of the penis dorsal to the corpus spongiosum
  • a prominent artery -> deep artery -> runs the length of each corpus cavernosum
  • corpora are surrounded by a layer of deep fascia -> creates a porous midline septum between them
  • their distal ends are covered by the gland penis
  • along the dorsal surface of the fascia sheath covering the corpora cavernosa run the large dorsal vein, the dorsal nerves, and a pair of dorsal arteries of the penis
83
Q

prepuce (foreskine)

A
  • skin that covers the body of the penis is loosely attached and extends over the glans penis as a retraceable sheath called the prepuce (foreskin)
  • attached to the ventral surface of the glans penis by a vertical fold -> frenulum
84
Q

female genitalia

A
  • produce ova and provide an environment for their fertilization and for embryonic and fetal development
  • labia majora
  • labia minora
  • clitoris
  • vagina
  • uterus
  • uterine tube
  • ovary
85
Q

external genitalia: females

A
  • labia minora and majora, clitoris -> vulva
  • perineum below the urogenital triangle
  • mons pubis vestibule and vestibular glands
86
Q

mons pubis

A
  • mound of adipose and areolar tissue that covers the ventral aspect of the pubic bones and symphysis
  • continuous posteriorly with the 2 labia majora
87
Q

labia majora

A
  • form the outer border of the vulva
  • contain adipose and areolar tissue from the mons pubis
  • smooth muscle fibers (homologous to the dartos muscle of the male scrotum) lie deep to the skin
  • posteriorly the labia majora lose some of their adipose tissue where they join at the posterior labial commissure just anterior to the anus
88
Q

labia minora

A
  • thin folds of skin medial to the labia majora
  • contain connective tissue rather than fat
  • anteriorly each labium splits into 2 folds that join with the fold form the opposite side anterior and posterior to the clitoris
  • conjoint anterior fold form the prepuce, and the posterior fold form the frenulum of the clitoris
89
Q

vestibule

A

-space between the labia minora

90
Q

urethral meatus

A

-vestibule contains the urethral meatus

91
Q

vaginal orifice

A

-posterior to the urethral meatus

92
Q

hymen

A
  • around the circumference of the vaginal orifice there is commonly a thin fold of mucous membrane known as the hymen
  • may partially occlude the orifice until it is ruptured
93
Q

clitoris

A
  • situated at the anterior end of the vestibule
  • free distal end is the glans
  • partially shrouded by the prepuce
94
Q

lesser vestibular (skene’s) glands and greater vestibular (bartholin’s) glands

A
  • opening into the vestibule are 2 pairs of mucous secreting glands
  • anterior pair- lesser vestibular glands -> open on either side of the urethral meatus
  • posterior pair- greater vestibular (bartholin’s) glands -> lie at the posterior end of the blub of the vestibule and are covered by the bulbospongiosus muscle
  • their ducts open on either side of the vaginal orifice
  • their secretion aid in vaginal lubrication
95
Q

clitoris

A
  • located at the anterior end of the vestibule
  • homologous to penis
  • composed of bodies of erectile tissue (4 rather than 3) and crus, bulb, glans
  • root of clitoris is made of 4 masses of erectile tissue that lay against the inferior surface of the perineal membrane -> 2 bodies are medial and 2 are lateral
  • left and right bulb of the vestibule constitute the medial masses of erectile tissue
  • left and right crus of clitoris constitute the lateral masses of erectile tissue
96
Q

erectile tissue of clitoris: bulb of vestibule

A
  • left and right bulb of the vestibule constitute the medial masses of erectile tissue
  • lie along either side of the urethral meatus and vaginal orifice
  • covered inferiorly by the bulbospongiosus muscle
  • posterior end partially covers the greater vestibular gland
  • anteriorly the left and right bulbs of the vestibule unit to form a short corpus spongiosum
  • anterior (distal) extremity of the corpus spongiosum is expanded to form the glands clitoris -> partially covered by the prepuce of the labia minora
97
Q

erectile tissue of clitoris: curs of clitoris

A
  • left and right crus of clitoris constitute the lateral masses of erectile tissue
  • lie along the ischiopubic ramus
  • partially covered by the ischiocavernosus muscle
  • their anterior ends form the corpora cavernosa of the clitoris
  • merge with the corpus spongiosum to form the body of the clitoris
  • distal ends of the corpora cavernosa are covered by the glans clitoris
98
Q

vagina

A
  • internal genitalia
  • tube of smooth muscle and elastic tissue that extends upward and posteriorly for about 3 inches from its orifice
  • situated between the urinary bladder and urethra and the rectum
  • traverses the perineal membrane and levator ani
  • lined with mucous membrane that is thrown into fold known as rugae
  • upper end is pierced by the uterine cervix
  • cervix project downward and backward into the vaginal lumen -> forms a recess known as fornix around it
99
Q

uterus

A
  • hollow pear shaped organ with thick muscular walls
  • divisible into 3 parts: fundus, body, and cervix
  • fundus lies superior to the uterine cavity
  • body surrounds the uterine cavity below the entrance of the uterine tubes, and it appears inferiorly to become continuous with the cervix
  • cervix extends into the vagina
  • uterine cavity is triangular in coronal projection but merely a narrow slit in sagittal section
  • extends through the cervix where it is known as the cervical canal and opens into the vagina at the external os
  • composed of 2 layers of tissue and is largely covered by peritoneum
  • most of the uterine wall is composed of a layer of smooth muscle called the myometrium
  • internal to the myometrium is a highly vascular layer called the -> endometrium
  • most of it is shed each month during menstruation if an ovum has not been implanted in it
100
Q

uterine tubes

A
  • two uterine (fallopian) tubes connect the peritoneal cavity adjacent to each ovary with the uterine cavity
  • lateral end is greatly expanded to form -> infundibulum
  • opening of the infundibulum next to the ovary is known as the ostium
  • surrounded by numerous finger-like projections -> fimbriae -> grasp the ovary
  • secondary oocyte (ovum) is released from the ovary -> effectively swept across the small gap to the ostium by the motion of cilia lining the fimbriae
  • uterine tube is composed of smooth muscle lined with ciliated mucous membrane
  • muscular peristalsis and ciliary action carry the secondary oocyte from the ostium into the uterine cavity (3 days)
  • fertilization of the oocyte occurs within the uterine tube
101
Q

ovary

A
  • almond shaped
  • attached to a peritoneal fold that drapes over the uterine tube known as the broad ligament by a mesentery called -> mesovarium
  • ovary is also held in place by fibrous cord known as -> ovarian ligament -> stretches between the ovary and uterus
  • nerves, blood vessels, and lymphatics to the ovary run through the suspensory ligament
  • substance of the ovary is surrounded by a thin fibrous capsule -> tunica albuginea
  • external to it is a single layer of cuboidal cells that constitute -> germinal epithelium
  • substance of the ovary is encapsulated by the tunica albuginea -> Stroma
  • stroma has a medulla and a cortex
  • medulla- highly vascular
  • cortex- contains round epithelial vesicles known as -> follicles
  • each follicle contains a cell known as a primary oocyte that is capable of developing into an egg
102
Q

follicle development

A
  • follicle that hasnt been stimulated by FSH -> primordial follicle
  • upon FSH stimulation -> primary follicle
  • cells of primary follicle are primarily responsible for the secretion of estrogen
  • as primary follicle develops -> forms a fluid filled antrum that partially surrounds the primary occyte
  • with development of antrum and additional protective layers around the oocyte -> primary follicle becomes known as a secondary follicle
  • as fluid filled antrum continues to enlarge the secondary follicle becomes a mature (graadian) follicle
  • mature follicle grows creating a prominent bulge on the surface of the ovary
  • in mature follicle, primary oocyte, which has completed its first meiotic division -> becomes arrested in the second meiotic division -> becomes the secondary oocyte
  • mature follicle ruptures -> releasing secondary oocyte into the ostium of the uterine tube
  • cells of the ruptured mature follicle develop into a corpus luteum after release of the secondary oocyte
  • corpus luteum primarily secretes progesterone
  • if the oocyte that has been released is not fertilized the corpus luteum degenerates into -> corpus albicans in about 2 week time
103
Q

ligaments of the uterus and ovary

A
  • uterus is covered in peritoneal anteriorly, superiorly, and posteriorly, and the uterine tubes become invested with a double layer of peritoneum
  • double layer is called the broad ligament
  • its thickened superior margin is elongated laterally to the pelvic wall as the suspensory ligament
  • suspends the ovary from the lateral wall of the pelvis and is the conduit for the blood vessels and nerves the run to the ovary
  • in the embryo the ovary is located high up on the posterior abdominal wall -> connected to the skin of the anterior abdominal wall (skin that will become labia majora) by a fibrous cord -> gubernaculum -> runs past the uterus below the uterine tube and pulls the ovary into the broad ligament
  • once it is nestled in the broad ligament -> ovary begins to enlarge and pushes out a fold peritoneum from the posterior side of the broad ligament
  • this fold is pushed out so far that it reflects back onto itself, creating a mesentery of the ovary called the mesovarium
  • remnant of the gubernaculum that extends between the ovary and the uterus becomes the ovarian ligament
  • the remnant of the gubernaculum that runs between the uterus and the skin of the anterior abdominal wall become the round ligament of the uterus
  • round ligament traverses the inguinal canal to end in the connective tissue of the labia majora
  • some of the ligaments that support the uterus, uterine tubes, and ovaries are peritoneal reflections, whereas other are remnants of the gubernaculum
104
Q

blood vessels of the pelvis: arteries

A

-pelvis and perineum receive blood from vessels that branch from the abdominal aorta, the inferior mesenteric artery, the external iliac artery, and the internal iliac artery

105
Q

arteries of pelvis: branches from abdominal aorta

A
  • gonadal arteries branch from the front of the abdominal aorta just below the level of the renal arteries
  • ovarian arteries- descends into the pelvic cavity behind the peritoneum -> enters the suspensory ligament and passes through the broad ligament and mesovarium to reach the ovary
  • testicular artery- does not enter the pelvis -> descends along psoas major turns into the inguinal canal and runs with the spermatic cord to reach the testis
106
Q

arteries of pelvis: branch from the inferior mesenteric artery

A
  • superior rectal artery is a terminal branch of the inferior mesenteric artery
  • supplies the upper part of the rectum
107
Q

arteries of pelvis: branch from the external iliac artery

A
  • abdominal aorta bifurcates into 2 common iliac arteries
  • each common iliac artery divides at the level of L5-S1 into an external iliac artery and an internal iliac artery
  • external iliac artery sends off a branch called the inferior epigastric artery -> sends small twig to supply the cremaster muscle
108
Q

arteries of pelvis: branches from the internal iliac artery

A
  • internal iliac artery bifurcates after a short distance into anterior and posterior divisions
  • posterior division has one branch that supplies pelvic viscera
  • anterior division has several branches that supply pelvic viscera and the perineum
  • from the posterior division -> the lateral sacral artery descends along the sacrum providing blood to viscera adjacent to it
  • superior gluteal artery branches from the posterior division and exits the pelvis through the greater sciatic foramen to supply the buttocks
  • anterior division has two branches that exit the pelvis to supply adjacent muscles
  • these are the obturator artery which traverse the obturator foramen and the inferior gluteal artery which leaves via the greater sciatic foramen
  • from the anterior division -> the umbilical artery runs toward the anterior abdominal wall across the top of the bladder and gives off the superior vesical artery to it
  • umbilical artery then loses its lumen to become the medial umbilical ligament
  • middle rectal artery supplies the middle and lower part of the rectum
  • next branch of the anterior division is sex-dependent
  • in males -> known as the inferior vesical artery -> supplies the prostate gland, seminal vesicles, and ductus deferens
  • in females -> it is known as the uterine artery -> runs across the pelvic floor and ascends along the vagina and the uterus between the layers of the broad ligament
  • internal pudendal artery - >exits pelvis through the greater sciatic foramen and then enters the perineum through the lesser sciatic foramen
  • gives off 3 branches here
  • inferior rectal artery supplies the anal canal
  • perineal artery supplies the muscles of the perineum
  • third branch is sex-dependent
  • in females- third branch is artery of the clitoris
  • in males- third branch is artery of the penis
109
Q

veins of the pelvis

A
  • veins that drain the pelvic cavity accompany its arteries

- veins carry the same names as the arteries that they accompany

110
Q

nerves of the pelvis

A
  • skeletal muscles of the pelvis are supplies by spinal nerves
  • pelvic viscera including the reproductive organs and GI tract are supplied by autonomic nerves
  • spinal nerves from L2 to L4 form the lumbar plexus that those form L5 to S3 form the sacral plexus and that the two are connected by the lumbosacral trunk between L4-L5
111
Q

spinal nerves in the pelvis

A
  • lumbar plexus provides nerves to the thigh muscles
  • the femoral nerve is one branch of the lumbar plexus
  • the obturator nerve is another branch of this plexus
  • barely enters the pelvic cavity below the arcuate line and leaves it through the obturator foramen
  • sacral plexus also provides nerves to the muscles of the lower limb
  • largest branch is the sciatic nerve
  • it runs along the backside of the pelvic cavity for a short distance -> exiting it through the greater sciatic foramen
  • ventral rami of S2-S4 provide branches to the muscles of the pelvic diaphragm
  • ventral rami of S2-S4 also combine to form the pudendal nerve -> exits the pelvic cavity through the greater sciatic foramen
  • curves around the sacrospinous ligament and enters the perineum via the lesser sciatic foramen in company with the internal pudendal artery
  • pudendal nerve provides a branch the inferior rectal nerve to the external anal sphincter
  • pudendal nerve divides into 2 terminal branches at the posterior margin of the perineal membrane
  • one branch of the perineal nerve
  • splays out below the membrane to supply bulbospongiosus and ischiocavernosus and the skin of the scrotum or labia majora
  • the other branch is the dorsal nerve of the penis (clitoris)
  • runs across the top of the perineal membrane to supply the sphincter urethrae and it then pierces the membrane to run on to the clitoris or penis
112
Q

sympathetic nerves in the pelvis

A
  • sympathetic fibers to pelvis viscera come from the sympathetic trunks
  • left and right trunks run along the spinal column, cross over the sacrum, and travel medial to the anterior sacral foramina
  • 2 trunks merge in front of the coccyx
  • located along the trunks are a series of paravertebral ganglia
  • sympathetic fibers from the upper lumbar paravertebral ganglia may run to and synapse in a series of preaortic ganglia that lie on the front of the abdominal aorta around the roots of the celiac, superior, and inferior mesenteric arteries
  • axons descend into the pelvis from these preaortic ganglia by hypogastric nerves
  • hypogastric nerves intertwine to form a superior hypogastric plexus where the abdominal aorta divides into the common iliac arteries
  • hypogastric nerves leave these plexuses and run into the pelvis alongside the common iliac arteries
  • in the pelvis the hypogastric nerves form a second plexus -> the inferior hypogastric plexus -> by interweaving with parasympathetic fibers (pelvic splanchnic nerves) that emanate from S2-S4
  • nerves from the inferior hypogastric plexuses thus carry both sympathetic and parasympathetic fibers to the pelvic viscera
113
Q

parasympathetic nerves in the pelvis

A
  • parasympathetic outflow is restricted to the cranial nerves and to spinal cord levels S2-S4
  • bc the vagus nerve does not extend into the pelvis -> All of the pelvic organs receive parasympathetic stimulation from nerves that emanate from S2-S4 -> pelvic splanchnic nerves
  • pelvic splanchnic nerve fibers mingle with sympathetic fibers in the inferior hypogastric plexuses
  • from these the parasympathetic fibers run to various target organs where they synapse in ganglia adjacent to or within the organ wall

ANP 300 (20 decks)

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