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Anatomy > Genitourinary And Renal System > Flashcards

Genitourinary And Renal System Flashcards

1
Q

What is the inguinal canal

A

The inguinal canal is an oblique passageway through the muscles of the anterior abdominal wall and lies superior to the medial half of the inguinal ligament

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2
Q

What does the inguinal canal pass through

A

It passes through each layer of the abdominal wall as it travels medially and inferiorly

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3
Q

Where does the inguinal canal start and finish

A

The inguinal canal starts at the transversalis fascia deep and laterally and finishes with the external oblique aponeurosis superficially and medially

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4
Q

How long is the inguinal canal in an adult

A

5cm long

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5
Q

What makes up the anterior border of the inguinal canal

A

The anterior border of the inguinal canal is
The external oblique aponeurosis
Laterally only: internal oblique aponeurosis

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6
Q

What makes up the posterior border of the inguinal canal

A

The posterior border is made up of
The transversalis fascia
Medially only: medial fibres of the aponeuroses of the internal oblique and transversus abdominis known as the conjoint tendon

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7
Q

What makes up the roof of the inguinal canal

A

The roof of the inguinal canal is made up of
The transversalis fascia
The arching fibres of the internal oblique and transversus abdominis

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8
Q

What makes up floor of the inguinal canal

A

The floor of the inguinal canal is made up of
Inguinal ligament which is rolled up on the lower border of the external oblique aponeurosis

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9
Q

What does the inguinal canal contain in a female

A

Round ligament of the uterus
Llioinguinal nerve
Genital branch of the genitofemoral nerve

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10
Q

What does the inguinal canal contain in the male

A

In males, the content of the inguinal canal are all contained in the spermatic cord except for the ilioinguinal nerve which runs in the canal but outside of the spermatic cord
2 nerves- Genital branch of the genitofemoral nerve and the sympathetic nerve fibres
3 arteries- Testicular artery, cremasteric artery and artery to the vas deferens
3 fascial layers- External spermatic fascia, cremaster muscle and fascia and internal spermatic fascia
4 other structures- Pampinform venous plexus, lymphatics, vas deferens and processus vaginalis

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11
Q

What is the external spermatic fascia derived from

A

The external spermatic fascia is derived from the external oblique aponeurosis

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12
Q

What is the cremaster muscle and fascia derived from

A

The cremaster muscle and fascia is derived from the internal oblique muscle

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13
Q

What is the internal spermatic fascia derived from

A

The internal spermatic fascia is derived from the transversalis fascia

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14
Q

What is the processus vaginails derived from

A

The processus vaginails is derived from the peritoneum

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15
Q

What is a hernia

A

A hernia is an abnormal protrusion of tissues or organs from one religion into another through an opening or defect

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16
Q

What is an inguinal hernia

A

An inguinal hernia is a protrusion of abdominal contents usually part of the greater omentum or loops of small intestines through the anterior abdominal wall and into the inguinal canal

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17
Q

What is an indirect inguinal hernia

A

An indirect inguinal hernia is when intra-abdominal contents are forced through the deep inguinal ring and into the inguinal canal

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18
Q

Where can an indirect inguinal hernia move to from the inguinal canal

A

The hernia may migrate into the scrotum in males or into the labia majora in females

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19
Q

What is the potential risk of an indirect hernia

A

The herniated tissue can strangulate and become ischaemic and a surgical emergency

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20
Q

What a direct inguinal hernia

A

A direct inguinal hernia where intra-abdominal contents are forced through the posterior wall of the inguinal canal and directly through the superficial ring

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21
Q

What are characteristics of the scrotal skin

A

Thin
Wrinkled
Darkly pigmented than other areas

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22
Q

What lies beneath the scrotal skin

A

Below the scrotal skin is a thin layer of superficial fascia and thin involuntary muscles called the dartos

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23
Q

Where does the superficial fascia extend between

A

The superficial fascia extends between the testicles

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24
Q

What does the superficial fascia form

A

The superficial fascia forms a septum dividing the scrotum into the right and left halves

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25
Q

What does each half of the scrotum contain

A

Each half of the scrotum contains a testis, epididymis and lower part of the spermatic cord

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26
Q

What are the testes

A

The testes are the male reproductive organs which produce sperm and secrete testosterone

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27
Q

What covers the testes

A

The testes are covered by the same 3 layers of spermatic fascia that cover the spermatic cord
The external spermatic fascia
The cremaster
The internal spermatic fascia

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28
Q

What is the tunica vaginalis

A

The tunica vaginalis is a sac derived from the peritoneum which partially surrounds the testes

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29
Q

What is the epididymis

A

A coiled tube lying along the posterior border of each testes

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30
Q

What makes up the epididymis

A

Expanded head superiorly, a body, a pointed tail

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31
Q

What is the function of the epididymis

A

Stores spermatozoa formed in the testes

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32
Q

What is the function of the vas deferens

A

The vas deferens carries sperm from the epididymis and travels with the testicular vessels in the spermatic cord

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33
Q

Where do the testicular arteries branch from

A

The testicular arteries are branches of the abdominal aorta

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34
Q

Where does venous blood drain to from the testes and epididymis

A

The venous blood drains from the testes and epididymis enters the pampiniform venous plexus

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35
Q

What does the pampiniform venous plexus form

A

It forms the testicular vein

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36
Q

Where does the right testicular vein drain into

A

The inferior vena cava

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37
Q

Where does the left testicular vein drain into

A

The left testicular vein drains into the left renal vein

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38
Q

What is hydrocoele

A

Painless swelling caused by peritoneal fluid between the layers of the tunica vaginalis around the testes

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39
Q

What is varicocele

A

Abnormal dilation of the pampiniform venous plexus

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40
Q

Which side is varicocele more common and why

A

It is more common on the left side than the right because the left testicular vein drains into the left renal vein before draining into the inferior vena cava

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41
Q

What is epididymo-orchitis

A

Painful inflammation of the epididymis and testis

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42
Q

What causes epididymo-orchitis

A

In younger people epididymo-orchitis is often causes by a sexually transmitted infection such as chlamydia or gonorrhea
In older people epididymo-orchitis is often caused by a urinary tract infection

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43
Q

What is testicular torsion

A

Twisting of the testis on the spermatic cord

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44
Q

What can be caused by testicular torsion and what happens if it is left untreated

A

Ischaemia of the testes and is a surgical emergency. If left untreated it can lead to necrosis and loss of the affected testis

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45
Q

If a lump on the testis is cancerous what is the treatment plan

A

Surgery to remove the testis and a length of cord and then chemotherapy or radiotherapy if needed

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46
Q

Where could testicular cancer metastasize and why

A

If testicular cancer does metastasizes it will likely follow the lymphatic drainage which follows the testicular arteries back to the lymph nodes around the abdominal aorta so the metastases first to the para-aortic or retroperitoneal lymph nodes

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47
Q

What is cryptorchidism

A

Undescended testis

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48
Q

How does cryptorchidism occur

A

During the development of a baby the testes form in the abdomen and they descend through the inguinal canal to reach the scrotum before birth but if this fails to occur the infant will be born with 1 or both testes absent from the scrotum and the affected testis will be stuck somewhere along the path of descent

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49
Q

Why is cryptorchidism an issue

A

Spermatogenesis is optimal just below core body temperature which is reached in the scrotum but in the abdomen the temperature will be too high for sperm production
Undescended testes are also at an increased risk of cancer

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50
Q

What is a vasectomy

A

Male sterilisation or permanent male contraception

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51
Q

How is a vasectomy performed

A

The scrotum is incised and the vasa deferentia are located on either side and seperated before lighting cauterising each end preventing the passage of sperm from the testes

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52
Q

What is the penis

A

The male organ of sexual intercourse

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53
Q

What is the penis primarily made up of

A

It is primarily made up of three cylinders of erectile tissue

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54
Q

What are the 3 cylinders of the erectile tissue

A

2 corpora cavernosa dorsally
1 corpus spongiosum ventrally

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55
Q

What encloses the corpora cavernosa and corpus spongiosum

A

The erectile tissue is enclosed deep within the fascia of the penis

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56
Q

What is the deep fascia of the penis known as

A

Bucks fascia

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57
Q

What is the end of the penis known as

A

It is called the glans

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58
Q

What is the end of the penis an expansion of

A

The glans is an expansion of the corpus spongiosum

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59
Q

Where does the penile urethra located

A

The penile urethra lies within the corpus spongiosum

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60
Q

Where does the urethra open

A

As the urethra approaches the end of the penis and opens up via the external urethra meatus

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61
Q

What is the blood supply of the penis

A

The arterial supply to the penis is via the penile arteries

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62
Q

Where do the penile arteries branch from

A

They branch from the internal pudendal arteries which branch from the internal iliac arteries

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63
Q

What is the nerve supply to the penis

A

The nerve supply via the penis is from S2-S4

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64
Q

what nerves carries general sensation and sympathetic innervation to the penis

A

The dorsal nerve of the penis

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65
Q

What is the dorsal nerve of the penis a branch of

A

The dorsal nerve of the penis is a branch of the pudenal nerve

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66
Q

What causes an erection

A

Parasympathetic fibres in the penis

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67
Q

Where do parasympathetic fibres arise from

A

They arise form the peri-prostatic nerve plexus

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68
Q

What is responsible for the increase in size and rigidity of the penis during an erection

A

The corpora cavernous

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69
Q

How does an erection occur

A

During sexual arousal arterial blood flow into the corpora of the penis increases so it becomes engorged with blood. The corpus spongiosum does become engorged as well but not as much as the corpora cavernous

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70
Q

What is the main role of the corpus spongiosum

A

During erection is to prevent the urethra from been compressed which would prevent ejaculation

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71
Q

What is erectile dysfunction

A

Erectile dysfunction is a term to describe the inability to achieve or maintain an erection during sexual activity

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72
Q

What does achieving and maintaining an erection reply on

A

Achieving and maintaining an erection relies on intact nerve pathways, reflexes, controlled blood flow in and out of the corpora cavernous of the penis and psychological arousal

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73
Q

What medications could be used to treat erectile dysfunction

A

Sildenafil/viagra

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74
Q

What is another word for adrenal

A

Suprarenal

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75
Q

Where are the adrenal glands located

A

Adrenal glands lie closely to the upper pole of each kidney

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76
Q

Where is the right adrenal gland located

A

The right adrenal gland lies behind the liver and inferior vena cava

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77
Q

Where is the left adrenal gland located

A

The left adrenal gland lies behind the stomach and pancreas

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78
Q

What arteries supply the adrenal glands

A

Superior adrenal artery
Middle adrenal artery
Inferior adrenal artery

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79
Q

What is the superior adrenal artery a branch of

A

It is a branch of the inferior phrenic artery

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80
Q

What is the middle adrenal artery a branch of

A

It is a branch of the abdominal aorta

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81
Q

What is the inferior adrenal artery a branch of

A

It is a branch of the renal artery

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82
Q

What drains the adrenal glands

A

They are drained by a single vein on each side the left and right adrenal vein

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83
Q

Where does the right adrenal vein drain to

A

Directly into the inferior vena cava

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84
Q

Where does the left adrenal vein drain into

A

The left adrenal vein drains into the left renal vein which then joins the inferior vena cava

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85
Q

What is the adrenal gland composed of

A

Outer part is the cortex and the inner part is the medulla

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86
Q

What is the function of the cortex

A

The cortex produced steroid hormones

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87
Q

What hormones are produced in the cortex

A

Cortisol
Aldosterone
Testosterone

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88
Q

What does the medulla of the adrenal gland produce

A

Adrenaline

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89
Q

What is a phaeochromocytoma

A

A rare hormone producing tumour of the adrenal medulla which causes excess secretion of hormones

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90
Q

Signs and symptoms of phaeochromocytoma

A

Hypertension
Tachycardia
Excessive sweating

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91
Q

What is the average size for a kidney

A

11cm long
7cm wide
4cm thick

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92
Q

Why are the kidneys described as been extra-peritoneal

A

They are extra/retro-peritoneal as they are located behind the peritoneum not above or below it

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93
Q

Where are the kidneys located

A

They are located either side of the upper lumbar vertebrae

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94
Q

What is each kidneys embedded in

A

Perinephric fat which is covered by renal fascia with another layer of paraphernic fat on the outside of the fascia

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95
Q

What is on the medial border of the kidney

A

The renal hilum

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96
Q

What is in the renal hilum

A

Renal vessels, nerves, lymphatics and ureter are located

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97
Q

What are the right and left renal arteries a branch of

A

The abdominal aorta

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98
Q

Where to the left and right renal veins drain into

A

They drain directly into the inferior vena cava

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99
Q

What is the internal aspect of the kidney made up of

A

The cortex, medulla and the calyces

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100
Q

What are the functional units of the kidney

A

The nephrons

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101
Q

What is the function of the nephrons

A

Filtering blood
Reabsorbing water and solutes
Secreting and excreting waste products as urine

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102
Q

What is present in the cortex of the kidneys

A

The glomeruli
Glomerular capsule
Proximal and distal tubules
Parts of collecting duct

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103
Q

What is found in the renal pyramids in the medulla of the kidney

A

The nephron loops of Henle
Rest of collecting ducts

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104
Q

From the collecting ducts where does urine travel to

A

Down the pyramid to the renal papilla at the apex of the pyramid where it enters a minor calyx

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105
Q

How is a major calyx formed

A

Lots of minor calyx merging forms a major calyx

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106
Q

What forms the renal pelvis

A

Merging of major calyx form the renal pelvis

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107
Q

What is the renal pelvis in continuation with

A

The ureter

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108
Q

What is the function of the ureter

A

Carries urine to the urinary bladder

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109
Q

How is urine transported

A

The urine is transported through narrow tubes by peristalsis

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110
Q

Where do the ureters run

A

They run anterior to the psoas major on the posterior abdominal wall and cross the pelvic brim to enter the pelvis

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111
Q

Where do the ureters enter the bladder

A

They enter the bladder on the inferomedial aspect of the bladder

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112
Q

What are kidney stones usually made of

A

Calcium oxalate

113
Q

What are risk factors of developing kidney stones

A

High urine calcium
Dehydration
Obesity
Certain medications

114
Q

Typical presentation of an obstructing stone

A

Excruciating pulsating pain from from loin to groin

115
Q

Why is pain felt loin to groin with a kidney stone

A

Because the pain fibres supplying the ureters originates in T12-L2 nerves so pain is referred and felt in the T12-L2 dermatomes

116
Q

What happens if the flow of urine is obstructed

A

The kidney will fill with urine and swell which can injury the kidney and could cause infection

117
Q

Where are the 3 regions the ureters narrow where a stone could get stuck

A

The pelvi-ureteric junction
Pelvic brim
Vesicles-ureteric junction

118
Q

What is the most common cause of a urinary tract infection

A

Bacteria usually E.Coli

119
Q

Who is more common to get urinary tract infections and why

A

Females because the urethra is shorter

120
Q

What is an infection of the urinary bladder called

A

Cystitis

121
Q

Symptoms of cystitis

A

Burning sensation when passing urine
Feeling the need to pass urine more frequently

122
Q

What is pyelonephritis

A

When the urinary tract infection spreads proximally to the kidney causing a more serious infection needing intravenous antibiotics

123
Q

What are signs and symptoms of pyelonephritis

A

Fever
Flank pain
Nausea
Vomiting

124
Q

What can cancers of the kidneys be divided into

A

They can be didived into three main types based on there histological origin
Renal cell carcinomas
Transitional cell carcinomas
Wilms tumours

125
Q

Where do renal cell carcinomas originate

A

They originate from the lining of the nephron

126
Q

Where do transitional cell carcinomas originate

A

They originate from the epithelial lining inside the kidney

127
Q

Where do wilms tumours originate

A

They originate from renal stem cells

128
Q

Symptoms of renal cancers

A

Pain in the flank
Palpable mass in abdomen
haematuria

129
Q

Why could the spread of renal cancer be slow

A

The kidneys are encased in a renal capsule, perinephric fat, renal fascia and paranephric fat so must grow very large and penetrate all these structures before it can invade other organs and structures

130
Q

Why does a left sided varicocele need an investigation for a renal cancer

A

A left sided varicocele warrants investigation because the left testicular vein drains into the left renal vein which may be compressed or obstructed by a Renal tumour

131
Q

What is the posterior abdominal wall and where does it run from and to

A

The posterior abdominal wall is the region behind the abdominal cavity
It runs from the attachments of the diaphragm to the pelvic brim

132
Q

What does the posterior abdominal wall consist of and what structures run along it

A

The posterior abdominal wall consists of the lumbar spine with the psoas and quadratus lumborum muscles
Structures which run along it include the inferior vena cava, the aorta with associated with autonomic plexuses and lymph nodes and the sympathetic trunks on either sides of the lumbar spine. More laterally the ureters run along the surface of the psoas muscle towards the pelvis along with the gonadal arteries

133
Q

What forms the lumbar plexus

A

Lumbar spinal nerves from L1-L4 with a contribution from the T12 nerve

134
Q

What does the lumbar plexus give rise to

A

The lumbar plexus gives rise to several branches that innervate skin and muscle of the abdominal wall and thigh

135
Q

Which branches of the lumbar plexus run along the posterior abdominal wall

A

Iliohypogastric and ilioinguinal nerves which supply the anterior abdominal wall and skin of external genitalia
Genitofemoral nerve which supplies the skin of external genitalia
Lateral femoral cutaneous nerve which supplies the skin over the lateral thigh
Femoral nerve which supplies the muscle and skin of the anterior thigh
Obturator nerve which supplies the muscles and skin of the medial thigh

136
Q

Where does the thoracic aorta pierce the diaphragm

A

At the level of T12

137
Q

After piercing the diaphragm where does the aorta go

A

The thoracic aorta becomes the abdominal aorta which descend through the abdomen on the posterior abdominal wall just to the left of the midline and the terminates by bifurcating into the left and right common iliac arteries at the level of L4

138
Q

What are the unpaired arteries given off from the abdominal aorta

A

Coeliac trunk
Superior mesenteric artery
Inferior mesenteric artery

139
Q

What are the paired arteries given off from the abdominal aorta

A

Renal arteries
Adrenal arteries
Gonadal arteries
Lumbar arteries

140
Q

What unites the to form the inferior vena cava

A

The inferior vena cava is formed by the union of the left and right common iliac veins at the level of L5 which then ascends on the posterior abdominal wall just right of the midline

141
Q

What is an AAA

A

Abdominal aortic aneurysm which is is bulging of the abdominal aorta caused by a weak point in the blood vessel wall

142
Q

What are the risk factors for developing an AAA

A

Smoking
Alcohol
Hypertension
Atherosclerosis

143
Q

How are AAA’s diagnosed

A

An AAA is diagnosed if the diameter is bigger than 3cm

144
Q

What happens if an AAA ruptures

A

Significant intra-abdominal bleeding

145
Q

What are the functions of the pelvis

A

Supporting the spine, torso and upper body
Locomotion
Housing and protecting the pelvic viscera

146
Q

How many bones is the pelvis made up of

A

3

147
Q

What are the 3 bones the Levi’s are made up of

A

The sacrum and the left and right hip bones

148
Q

What is the hip bones composed of

A

The hip bones are composed of 3 bones
The ilium
The ischium
The pubis

149
Q

What are the 5 articulations of the pelvis

A

Hip joint- between the head of the femur and the acetabulum of the pelvis
Sacroiliac joint- between the sacrum and the ilium of the hip bone
Pubic symphysis- between the two two pubic bones
Lumbosacral joint- between the 5th lumbar vertebrae and the sacrum
Sacrococcygeal joint- between the sacrum and the coccyx

150
Q

What are bony landmarks in the pelvis that you can palpate

A

Iliac crests
Anterior superior iliac spine
Iliac tubercle
Pubic tubercle
Inguinal ligament
Mid-inguinal point
McBurney’s point

151
Q

What are the differences between a male and female pelvis

A

Females have a wider pelvis with circular pelvic inlet for childbirth but males have a narrower pelvis with heart shaped pelvic inlets in males
Females have an obtuse angle formed by the inferior pubic rami whereas males have an acute angle formed by the inferior pubic rami
Females have wider and shorter sacrum compared to narrower and longer sacrums in males

152
Q

What does the pelvis contain

A

Organs from the gastrointestinal and the genitourinary systems

153
Q

What is the arterial supply of the pelvis

A

Left and right internal iliac arteries

154
Q

What branches of the iliac arteries supply the pelvis viscera

A

Vesical arteries which supply the bladder in both males and females and the prostate and seminal vesicles in males
Uterine and vaginal arteries in females
Middle rectal artery supplying the rectum
Internal pudendal artery which supplies the perineum
Superior and inferior gluteal arteries supplying the gluteal region

155
Q

Where do the pelvic plexuses drain into

A

They drain into the internal iliac vein

156
Q

What is the sacral plexus

A

Found within the pelvis where the sacral spinal nerves join together

157
Q

What are key nerves which arise from the sacral plexus

A

Sciatic nerve
Pudendal nerve
Superior and inferior gluteal nerves
Pelvic splanchnic nerves

158
Q

What is the pelvic floor

A

The pelvic floor is a collective name for several muscles that support the pelvic organs

159
Q

What are the main functions of the pelvic floor

A

Prevent herniation of pelvic organs inferiorly
Control continence of urine and faeces
Aid in increasing intra-abdominal pressure

160
Q

What muscles make up the pelvic floor

A

The pelvic floor is made up of 2 muscles - levator ani and coccygeus
Levator ani is made up of 3 smaller muscles - puborectalis, pubococcygeus and iliococcygeus

161
Q

What does the puborectalis attach to and what is its function

A

The puborectalis is a u-shaped muscles which attaches to the pubic bones anteriorly and forms a sling around the rectum, it can pull on the rectum so that the sharp angle is formed between the rectum and anal canal preventing defecation. When it relaxes the path from the rectum to the anal canal straightens to allow faeces to pass

162
Q

What does the pubococcygeus attach to

A

The pubococcygeus lies posterior and lateral to puborectalis. It attaches to the pubic bone anteriorly and the coccyx and sacrum posteriorly

163
Q

What does the iliococcygeus attach to

A

The iliococcygeus lies posterior to the pubococcygeus. It attaches to the spines of the ischium and the coccyx

164
Q

What is levator ani innervated by

A

Levator ani is innervated by a branch of the S4 nerve and some branches of the pudendal nerve

165
Q

What can cause pelvic floor weakness

A

Pelvic floor weakness is caused by the pelvic floor muscles been stretched, damaged and weakened by childbirth, ageing, straining or obesity

166
Q

What can pelvic floor weakness lead to

A

Incontinence of urine and faeces
Pelvic organ prolapse

167
Q

What is found immediately superior and inferior to the pelvic floor

A

The perineum

168
Q

What are the 2 regions the perineum can be separated into

A

The anal triangle
The urogenital triangle

169
Q

What are the layers of the urogenital triangle

A

Skin
Perineal fascia
Superficial perineal pouch
Perineal membrane
Deep perineal pouch

170
Q

Where is the perineal body located

A

Between the two triangles of the perineum

171
Q

What is the perineal body and what is its function

A

Dense mass of fibrous tissue and muscle which sits in the Center of the perineum and acts as an attachment for almost all the perineal and pelvic floor muscles

172
Q

What attaches to the perineal body

A

Levator ani
External anal spinchter
External urethral spinchter
Superficial and transverse perineal muscles
Bulbospongiosus

173
Q

What is the superior perineal pouch a part of

A

The urogenital triangle

174
Q

What does the superior perineal pouch contain

A

It contains most of the erectile tissue which unites to form the clitoris or penis and the muscles overlying them

175
Q

Where do the corpora cavernosa run

A

The corpora cavernosa runs symmetrically along the ischial rami bilaterally to converge in the midline

176
Q

What is the part of the corpora cavernosa called which is attached to the ischial rami called

A

The crura

177
Q

Where is the corpus spongiosum located

A

The midline

178
Q

What is the difference between the corpus spongiosum in males and females

A

In males the corpus spongiosum has an expanded part proximally which rests on the perineal membrane, which is known as the bulb of the penis
In females the corpus spongiosum splits into two parts that flank the vaginal opening, which are known as the bulb of vestibule or bulb of the clitoris

179
Q

What is the corpora cavernosa covered by

A

The corpora cavernosa is covered by ischiocavernosus muscles

180
Q

What are the corpus spongiosum covered by

A

The corpus spongiosum is covered by bulbospongiosus muscles

181
Q

What is the function of the ischicavernosus muscles

A

They help stabilise the erect penis or clitoris

182
Q

What in the function of the bulbosponigiosus in males and females

A

In males the bulbospongiosus assists by maintaining erection by compressing veins that drain the erectile tissue and it contracts to squeeze any remaining urine or semen from the urethra
In females the bulbospongiosus helps maintain clitoral erection and constricts around the vaginal orifice which helps expression of fluid from the greater vestibular glands

183
Q

What is the arterial supply to the perineum

A

Via the internal pudendal artery which is a branch of the internal iliac artery

184
Q

What is the main nerve of innervation to the perineum

A

Innervation to the perineum is via the pudendal nerve

185
Q

What is an episiotomy

A

A pre-emotive incision

186
Q

When would an episiotomy be needed and why

A

An episiotomy could be needed during childbirth as the perineal body could be damaged due to stretching or tearing of the perineal tissue which can lead to incontinence and pelvic floor weakness which can lead to prolapse

187
Q

What are the male organ of reproduction

A

Paired testes
Epididymides
Vasa deferentia
Seminal vesicles
Ejaculatory ducts
Bulbo-urethral glands
Prostate
Penis

188
Q

What is the vas deferens

A

The tube that Carries sperm from the epididymis up the spermatic cord and through the inguinal canal into the pelvis

189
Q

Where does the vas deferens terminate

A

It terminates by joining the duct of the seminal vesicle to form the ejaculatory duct

190
Q

What are seminal vesicles

A

They are a lobulated sac about 4cm long which lies lateral to the ampulla of the vas deferens

191
Q

What are the functions of the seminal vesicles

A

They secrete a thick alkaline fluid which forms the bulk of seminal fluid known as semen

192
Q

Where does the ejaculatory duct lead to

A

The ejaculatory duct pierces the back of the prostate gland and enters the prostatic urethra

193
Q

What is the prostate

A

The prostate gland is a spherical fibromuscular gland about the size of a walnut which lies against the neck of the bladder

194
Q

What are the vas defererns, seminal vesicles and prostate gland all supplied by

A

They are all supplied by branches of the internal iliac artery

195
Q

What is benign prostatic hyperplasia

A

The prostate gland completely encircles the urethra and with progressing age the prostate can become enlarged which can lead to compression of the urethra and inability to pass urine which would require catheterisation to drain the urine

196
Q

Why does prostate cancer commonly metastasises to the vertebrae

A

Venous blood from the prostate passes into a plexus of veins which lies anterior or the sacrum and communicate with the azygos vein, these veins communicate with veins in the vertebrae bodies and so this is how the cancer can spread to the vertebrae

197
Q

How is a prostate examined

A

The prostate can be examined during a rectal exam which involves pushing a finger into the rectum via the anus and flexing it anteriorly to palpate the prostate, you can feel the size contours and firmness

198
Q

What does the female pelvis contain

A

Uterus
Cervix
Vagina
Uterine tubes
Ovaries

199
Q

What is the uterus

A

A pear shaped hollow muscular organ about 8cm long which communicates laterally with the uterine tubes and inferiorly with the vagina

200
Q

What is the uterus composed of

A

A fundus which sits above the uterine tubes
A body which is typically angles anteriorly and lies on the superior surface of the bladder
Cervix

201
Q

What happens if conception occurs

A

If conception occurs the developing blastocysts will implant into the uterine lining, the endometrium, in the body of the uterus
The middle muscular layer of the uterus, the myometrium, becomes distended as pregnancy continues

202
Q

What is the space behind the uterus but anterior to the rectum called

A

The rectouterine pouch also known as the pouch of douglas

203
Q

What is the pouch of Douglas

A

The deepest part of the peritoneal cavity

204
Q

What are the cervix

A

The cervix is composed of a narrow lumen and the cervical canal

205
Q

What does the cervical canal communicate with

A

The cervical canal communicates with the uterine cavity via the internal os and with the vagina via the external os

206
Q

What is the vaginal fornices

A

The vaginal fornices is formed by the recess created by the lower part of the cervix lying inside the vagina

207
Q

What stabilises the position of the cervix

A

The position of the cervix is stabilised by the levator ani

208
Q

What are the uterine tubes

A

Also known as the Fallopian tubes
They carry the ova from the ovary towards the uterus
They are around 10cm long and around found running along the upper boarder of the broad ligament

209
Q

What is the infundibulum of the uterine tubes

A

The infundibulum is a dilated ampulla at the lateral end of the uterine tubes, the free edge is broken up into finger like projections known as fimbriae which are draped over the ovaries

210
Q

What are the ovaries

A

They are almond shaped organs which are about 4cm long and 2cm wide, they are attached to the posterior aspect of the broad ligament by a small mesentery known as the mesovarium

211
Q

Where are the ovaries located

A

The location is not fixed but they usually lie in the ovarian fossa which is formed by the angle between the internal and external iliac arteries

212
Q

Apart from the ovaries what else lies in close relation to the ovarian fossa

A

The ureter and obturator nerve

213
Q

What is the vagina

A

The vagina is the female organ for sexual intercourse and the excretory duct of the uterus, which is about 10cm long

214
Q

Where is the vagina located

A

The upper 2/3 of the vagina lie in the pelvic floor and the lower 1/3 in the perineum

215
Q

What is the vagina closely related to

A

The vagina is closely related to the bladder anteriorly and the urethra is often embedded in the anterior wall of the lower 1/3 vagina

216
Q

What is the arterial supply to the uterus, cervix, uterine tubes and vagina

A

All these structures are supplied by branches of the internal iliac artery

217
Q

What supplies blood to the ovaries

A

The ovaries are supplied by the ovarian artery

218
Q

What is the ovarian artery a branch of

A

The abdominal aorta

219
Q

What is the vulva

A

Collective term for all parts of the female external genitalia

220
Q

What is the blood supply to the vulva

A

The vulva is supplied mainly by the pudendal arteries which are branches of the internal iliac arteries

221
Q

What nerves innervate the vulva

A

The innervation to the vulva is by 4 nerves
The ilioinguinal nerve
The genital branch of the genitofemoral nerve
The pudendal nerve
The posterior cutaneous nerve of the thigh

222
Q

What are the parts of the vulva

A

The mons pubis
Labia majora
Labia minora
Clitoris
Vestibule
Vaginal opening
Hymen
Urinary meatus
Vestibular gland

223
Q

What is the mons pubic

A

The mound of fatty tissue infront of the pubic symphysis which Causes an elevation of hair bearing skin

224
Q

What is the labia majora

A

Prominent hair bearing folds of skin that meet at the mons pubis anteriorly

225
Q

What is the labia minora

A

Smaller hairless folds of skin medial to the labia majora
The labia minora fuse anteriorly to form the hood of the clitoris
They form the boundaries of the vestibule

226
Q

What is the clitoris

A

A pea-sized mound of tissue which is is highly sensitive comprised of the erectile corpora cavernosa and the corpus spongiosum which can become engorged during sexual arousal

227
Q

What is the vestibule

A

It is the area between the labia minora which contains the vaginal opening, urinary meatus and vestibular glands

228
Q

What is the vaginal opening

A

The opening to the vagina known as the vaginal introitus

229
Q

What is the hymen

A

The hymen is a thin membrane that partially covers the vaginal opening

230
Q

When could the hymen rupture

A

The hymen could rupture during the first act of sexual intercourse but can also rupture during exercise, using tampons or can just be absent altogether

231
Q

What is the urinary meatus

A

The opening of the urethra which lies posterior to the clitoris but anterior to the vaginal opening

232
Q

What are the two vestibular glands

A

The greater vestibular gland
The lesser vestibular gland

233
Q

What is the greater vestibular gland and where is it located
What is its function

A

The greater vestibular gland is also known of the Bartholins gland which lies posterior to the vaginal opening
It’s function is to secrete a lubricant into the vagina during sexual arousal

234
Q

What is the lesser vestibular gland, where is it located and what is its function

A

The lesser vestibular gland also known as the skenes gland, they lie near the urethral opening
There function is debated but believed to secrete fluid which may lubricated the vaginal opening/urethra and may have an anti-microbial affect

235
Q

What is an ectopic pregnancy

A

An ectopic pregnancy is when a blastocyst implants outside of the uterus usually in the uterine tubes

236
Q

Why is an ectopic pregnancy an emergency

A

The uterine tube is not accommodated to stretch to accommodate a growing embryo and so may rupture which could cause internal bleeding and can be life-threatening and so surgery would be required to remove the pregnancy from the tube

237
Q

What is endometriosis

A

It is a condition where endometrial tissue which lines the inside of the uterus is found outside of the uterus, usually around the ovaries, uterine tubes, uterine ligament and the rectouterine pouch

238
Q

Signs and symptoms of endometriosis

A

Chronic pain
Cyclical pain related to menstruation
Pain during intercourse

239
Q

How is endometriosis diagnosed

A

Using biopsy samples taken during surgical exploration

240
Q

Signs and symptoms of gynaecological cancers

A

Pelvic pain
Abnormal vaginal discharge
Abnormal vaginal bleeding
Abdominal swelling
Urinary disturbances
Fatigue
Weight loss

241
Q

What is the urinary bladder and where is it located

A

A hollow muscular organ located in the pelvis below the peritoneum and is an infra-peritoneal organ which is located posterior to the pubic symphysis and anterior to the vagina and rectum

242
Q

What is the urinary bladder supplied by

A

It is supplied by the vesical arteries which are branches of the internal iliac arteries

243
Q

Where do vesical veins drain into

A

They drain into the internal iliac vein

244
Q

What is the function of the urinary bladder

A

It stories urine and helps to squeeze the urine out during micturition

245
Q

What happens to the bladder when it is completely empty

A

It may squash down completely

246
Q

How does the bladder fill with urine

A

The bladder fills with urine through the ureters which drain into the posterior aspect of the bladder near the base, known as the trigon, which is made up of a smooth wall. The ureters enter here on an angle which forms a rudimentary valve which prevents reflux of urine back into the ureters

247
Q

Why is the internal wall of the bladder corrugated

A

It allows the bladder to stretch without tearing when it fills with urine

248
Q

What muscle does the bladder wall contain

A

The smooth muscle called the detrusor muscle

249
Q

What is the function of the detrusor muscle

A

Contracts to forcibly expel urine

250
Q

How is the release of urine controlled

A

The release of urine is controlled by 2 sphincters
The internal urethral sphincter
The external urethral sphincter

251
Q

Where is the internal urethral sphincter located and what is it composed of

A

It is located at the base of the bladder where it opens into the urethra
It is composed of smooth muscle which is under involuntary control

252
Q

Where is the external urethral sphincter located and what is it composed of

A

The external urethral sphincter is located just after the prostate in males and in the perineal pouch in females
It is composed of skeletal muscle and is under voluntary control

253
Q

What is the urinary bladder innervated by

A

The urinary bladder is innervated by somatic, sympathetic and parasympathetic nerves
The somatic nerve fibres come via the branches of the pudendal nerve which allows conscious control of the external urethral sphincter
The sympathetic nerve fibres come from branches of the hypogastric nerve which causes relaxation of the detrusor and contraction of the internal urethral sphincter allowing storage of urine
The parasympathetic nerve fibres come from the pelvic splanchnic nerves which causes contraction of the detrusor and relaxation of the internal urethral sphincter allowing for initiation of micturition

254
Q

What is the urethra

A

The urethra Carries urine from the internal urethral orifice of the bladder to the external urethral orifice

255
Q

How is urination controlled

A

Urination is controlled by Centers in the cerebral cortex, brainstem and sacral spinal cord through the sacral micturition Centers
As the bladder fills the stench of the bladder wall is detected and is relayed to the sacral spinal cord via visceral afferent fibres, when they reach the sacral spinal cord they synapse onto motor neurons, this stimulate the contraction of the bladder.

This is known as an arc reflex

256
Q

Why can older children and adults consciously control urination where infants can’t

A

In older children and adults the reflex arc is inhibited by inputs from the cerebral cortex so they can detect bladder filling and so can consciously control when they urinate. It is achieved in infants through potty training where they learn to recognise bladder filling and develop descending pathways that inhibit the reflex when it is not convenient to urinate

257
Q

What happens to bladder dysfunction if a patient suffers an injury to the spinal cord above the sacral level

A

2 pathways will be interrupted
Ascending pathways conveying sensation to the bladder filling to the brain so the patient would be no longer aware of bladder filling
Descending pathways that expert voluntary, inhibitory control over the external urethral sphincter so it will be permanently relaxed

But the reflex arc will still function but the patient doesn’t have any inhibitory control over it so the patient will not realise they need to pass urine and the bladder will automatically empty as it fills and so will be urine incontinent

258
Q

What happens to bladder dysfunction if the patient suffers an injury to the spinal cord or cauda equina below the sacral level

A

The reflex arc will be disrupted and the bladder will fill without emptying because the stretch cannot be detected in the sacral micturition Centers
The internal urethral sphincters will be permanently contracted they bladder will continue to fill and so the pressure will eventually exceeds the strength of the internal urethral sphincter so urination will occur but if the pressure never exceeds the maximum a patient will develop urinary retention
Eventually urine will back up in the ureters to the kidneys

259
Q

What is the rectum

A

The rectum is the terminal part of the large intestine which is about 12cm long

260
Q

How many flexures does the rectum have

A

The rectum has 2 flexures
The curve anteriorly known as the sacral flexure
The curve posteriorly known as the anorectal flexure

261
Q

What is the function of the rectum

A

Storage of faeces prior to defecation

262
Q

What is the anal canal

A

The most distal part of the gastrointestinal tract which is about 4cm long which extends from the distal rectum to the anus and lies in the anal triangle

263
Q

what controls defecation

A

2 anal sphincters the internal and external anal sphincters

264
Q

What is the internal anal sphincter composed of

A

Smooth muscle and is involuntary

265
Q

What is the external anal sphincter composed of

A

Skeletal muscle and in voluntary controlled

266
Q

What is the pectinate line

A

Also known as the denate line
It divides the superior part of the anal canal from the inferior part

267
Q

What is the superior part of the anal canal derived from embryologically

A

The superior part of the anal canal is derived from the endoderm

268
Q

What is the inferior part of the anal canal derived from embryologically

A

The inferior part of the anal canal is derived from the ectoderm

269
Q

What is the superior part of the anal canal supplied by

A

The superior part of the anal canal is part of the hindgut and so is supplied by the inferior mesenteric artery via the superior rectal artery

270
Q

What is the venous drainage of the superior part of the anal canal

A

Venous drainage is via the portal venous system towards the liver

271
Q

What is the superior part of the anal canal encircled by

A

The internal anal sphincter

272
Q

What is the internal anal sphincter innervated by

A

Sympathetic fibres from the sympathetic trunk
Parasympathetic fibres from the pelvic splanchnic nerves

273
Q

What is the inferior part of the anal canal supplied by

A

The inferior anal canal is supplied by the middle and inferior rectal arteries which are branches of the internal iliac arteries

274
Q

What is the venous drainage of the inferior part of the anal canal

A

The venous blood from the inferior part of the anal canal enter the systemic venous drainage

275
Q

What is the inferior part of the anal canal encircled by

A

The external anal sphincter

276
Q

What is the external anal sphincter innervated by

A

The external anal sphincter is innervated by The pudendal nerve

277
Q

What are haemorrhoids

A

The wall of the anal canal are lined by an abundance of veins that form cushions which aid faecal continence
The cushions are known as haemorrhoids or piles

278
Q

Where would haemorrhoids be located if they were painless

A

Above the pectinate line

279
Q

Where would haemorrhoids be located if they become painful

A

Below the pectinate line

Anatomy (5 decks)

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