3. Urinary system, Genital organs, Pelvic cavity, Perineum Flashcards
(76 cards)
1
Q
Kidney - Topography
A
- retroperitoneal organ, from T12 to L3 vertebrae
- right kidney lower than left (bc.: right lobe of liver)
- medial side: hilum w/ ureter, vessels + nerves
- Relationships:
- superior:
- diaphragm
- inferior:
- psoas major m. (medial)
- quadratus lumborum m. (anterior)
- transverse abdominis m. (lateral)
- superior:
- Layers:
- Fibrous capsule (outermost)
- Adipose capsule
- Renal fascia (innermost)
2
Q
Kidney - Anatomy
A
- bean shaped organ, consisting of:
- Renal capsule
-
Cortex
- outer part of kidney
- highly vascular
-
Medulla
- inner part of kidney
- 8-12 renal pyramids w/ straight- + collecting tubules
- apex of pyramids: Papilla
- 10 to 25 collecting tubules open into minor- + major calxy → renal pelvis → ureter
3
Q
Kidney - Blood supply
A
Arteries
- Renal artery (2x, from abdominal aorta)
- right one is longer (abdominal aorta is slightly left!)
Veins
- Renal veins (2x, from IVC)
- left one passes inferir to superior mesenteric artery
4
Q
Kidney - Histology
A
functional unit of kidney: Nephron
-
Renal corpuscle
- Bowman’s capsule
- Parietal: simple squamous epithelium
- Visceral: podocytes
- Glomerulus
- highly vascular
- covered with glycocalyx
- Bowman’s capsule
- Renal tubules
- Proximal tubule
- simple cuboidal epithelium
- narrow lumen, rich in mitochondria
- Intermediate tubule
- simple squamous epithelium
- narrow lumen
- Distal tubule
- simple cuboidal epithelium
- round lumen
- Reunient tubule
- simple cuboidal epithelium
- Collecting tubule
- simple cuboidal epithelium
- Chief cells w/ vasopressin
- Intercalated cells
- Proximal tubule
5
Q
Kidney - Microcirculation
A
- before entering hilum: renal artery divides into 5 segmental arteries
- 5 segmental art.
- interlobar art.
- 2 arcuate art.
- interlobular art. (→ nephrons)
- afferent arterioles
- glomerular capillaries
- efferent arterioles
- → veins
- interlobular art. (→ nephrons)
- 2 arcuate art.
- interlobar art.
6
Q
Ureter - Anatomy
A
- retroperitoneal, 25 cm muscular tube
- from: renal pelvis → urinary bladder
- runs down abdominal wall anterior to psoas major m.
- Crosses at 3 sites:
- Gonodal vessels (posterior to them)
- Common iliac vessels (anterior to them)
- Deferent duct/Uterine artery (posterior to them)
7
Q
Ureter - Blood supply
A
Arteries
- Aorta
- Renal art.
- Gonodal art.
- Common + internal iliac art.
- Umbilical art.
- sup. + inf. vesical art.
- middle rectal art.
8
Q
Ureter - Histology
A
-
Tunica mucosa
- Mucous epithelium lamina
- urothelium
- Proper lamina
- thick, loose CT, blood vessels, nerves
- star shaped lumen
- Mucous epithelium lamina
-
Tunica muscularis
- inner layer: longitudinal m. layer
- outer layer: circular m. layer
-
Tunica adventitia
- CT, blood- and lymph vessels, nerves
9
Q
Urinary bladder - Anatomy
A
- infraperitoneal, lemon shaped organ
- walls: detrusor muscle (thick)
- sits in lesser pelvis (when empty)
- consists of:
-
Apex
- connected to median umbilical lig.
-
Base
- inverted triangle shape
- upper corners:
- 2 ureters enter
- lateral umbilical lig. attach
- lower corner:
- neck with int. urethral sphincter
- between corners: trigone (smooth area on inside of the bladder)
-
Apex
10
Q
Urinary bladder - Supporting structures
A
- supported by paracysticum:
- males: puboprostatic lig.
- females: pubovesical lig.
- superior:
- peritoneum
- median umbilical lig.
- inferior: levator ani muscle
11
Q
Urinary bladder - Blood supply
A
Arteries
- sup. + inf. vesical art (from internal iliac art.)
Veins
- vesical venous plexus (to internal iliac vein)
12
Q
Urinary Bladder - Innervation
A
Sympathetic
- Lumbar paravertebral splanchnic nerve
Parasymphathetic
- Sacral plexus
13
Q
Urinary bladder - Histology
A
-
Tunica mucosa
- Mucous epithelium lamina
- urothelium
- Proper lamina
- thin CT
- star shaped lumen
- Mucous epithelium lamina
- Tunica muscularis
- inner layer: longitudinal m. layer
- outer layer: circular m. layer
-
Tunica adventitia
- CT, elastic fibres, blood- and lymph vessels, nerves
14
Q
Scrotum - Anatomy
A
- sac consisting of layers
- “some damn englishman called it testes”:
- S: skin (middle: raphe)
- D: dartos fascia and muscle
- E: external spermatic fascia
- C: cremasteric fascia
- I: internal spermatic fascia
- T: tunica vaginalis
- T: tunica albuginea
- contains:
- external spermatic fascia
- testes
- epididymis
- deferens duct
15
Q
Scrotum - Blood supply
A
Arteries
- ant. + post. scrotal art. (from pudendal art.)
Veins
- testicular vein (to IVC)
16
Q
Scrotum - Innervation
A
- Genitofemoral nerve
- ant. + post. scrotal nerves
17
Q
Spermatic cord
A
- begins at deep inguinal ring, exits at superficial inguinal ring
- enclosed 3 layers
- internal spermatic fascia
- cremasteric fascia
- external spermatic fascia
- contents:
- deferens duct
- deferens duct artery (from inf. vesical artery)
- testicular artery (from abdominal aorta)
- pampiniform plexus of veins (to testicular veins)
- cremasteric art. + vein
- genital branch of genitofemoral nerve
- lymph vessels
18
Q
Inguinal canal
A
→ slit-like passage above and parallel to the lower half of the inguinal ligament
- begins at deep inguinal ring
- opening of tubular evagination of tranversal fascia which hosts:
- men: the spermatic cord
- women: round ligament of uterus
- opening of tubular evagination of tranversal fascia which hosts:
- ends at superficial inguinal ring
- superior to pubic tubercle
- in aponeurosis of external oblique m.
19
Q
Testes - Anatomy
A
- plum-shaped retroperitoneal organ
- develops in abdominal cavity, passes through inguinal canal
- covered by tunica vaginalis (derived from peritoneum)
- Parts:
- Capsule
- Lobules divided by septa
- inside: seminiferous tubules, draining through efferent ducts into epididymis
20
Q
Testes - Blood supply
A
Arteries
- testicular art. (from abdominal aorta)
Veins
- pampiniform plexus (to testicular vein)
- right testicular vein → IVC
- left testicular vein → left renal vein (!)
21
Q
Testes - Histology
A
- Covered by tunica albuginea (type 1 collagen fibres)
- Convoluted + straight seminiferous tubule
- Germinal epithelium (simple cuboidal epithelium)
- contains sertoli cells
- Deferens duct
- simple cuboidal non-ciliated epithelium
- simple columnar epithelium
- star shaped lumen
- Epididymis duct
- pseudostratified columnar epithelium with stereocilia
- contains fluid from sertoli cells
Layers:
- Epithelium
- Sertolli cells
- Limiting membrane
- carries spermatogenic cells
- Connective tissue
- Leydig cells: synthesize and secrete testosterone
22
Q
Epididymis - Anatomy
A
- on posterior surface of testes
- covered by tunica albuginea (NOT t. vaginalis!)
- Parts
- Head
- efferent ducts form testes enter here
- Body
- Tail
- → deferens duct
- Head
23
Q
Epididymis - Blood supply
A
Arteries
- Head: testicular art. (from abdominal aorta)
- Body + Tail: deferential art. (from internal iliac art.)
Veins
- Pampiniform plexus (to testicular vein)
24
Q
Epididymis - Histology
A
- ciliated tall columnar cells
- basal cells
- clear cells
- intraepithelial lymphocytes
Has muscular coat for sperm movement!
25
Spermatogenesis
→ production of spermatids (non-mature sperm cells)
* Sertolli cells are essential
* provide support for developing sperm cells
1. **Spermatogonia**
* at periphery of seminiferous tubules
* divide by Mitosis: only one daughter cells becomes a primary spermatocyte
2. **Primary spermatocyte**
* ****divide in Meiosis I : forms haploid secondary spermatocytes
3. **Secondary spermatocyte**
* ****divide in Meiosis II : forms spermatids
4. **Sperm cells**
* ****spermatids differentiate into sperm cells
26
Deferent duct - Anatomy
* contination of tail of epididymis
* transports spermatozoa from testes to prostatic urethra
* "ampulla" unites with duct of seminal vesicle
* → forms: ejaculatory duct
* Parts: E F I P A
1. Epididymic part
2. Funicular part
3. Inguinal part
4. Pelvic part
5. Ampullaric part
27
Deferent duct - Blood supply
**Arteries**
* Deferential art. (*from inf. vesical art.*)
28
Deferens duct - Histology
3 layers:
1. **Tunica mucosa**
1. Lamina epithelium
* pseudostratified columnar epithelium with stereocilia
2. Lamina propria
2. **Tunica submucosa**
* connective tissue
3. **Tunica muscularis**
* ****inner: longitudinal
* middle: circular
* outer: longitudinal
29
Seminal vesicle
* paired gland, produces alkaline part of seminal fluid
* lower ends from duct, which joins the ampullae of the deferens ducts
Blood supply:
**Arteries**
* inferior vesicle art.
**Veins**
* inferior vesicle vein
30
Seminal vesicle - Histology
**3 layers:**
1. Epithelium
* simple columnar epithelium (glandular)
* secretes fructose (energy source for sperm)
* mucosal folds
2. Lamina propria
* CT
* inner: circular layer
* outer: longitudinal layer
3. Lamina adventitia
* Fibroelastic CT
31
Prostate - Anatomy
* inferior to urinary bladder
* surrounds urethra
* basic secretion neutralizes acidic pH in vagina
* consists of muscles
* internal urethral sphincter (smooth muscle)
* external urethral sphincter (skeletal muscle)
* 3 lobes: right, left + middle
32
Prostate - Blood supply
**Arteries**
* inf. vesical art.
* internal pudendal art.
* inferior rectal art.
**Veins**
* prostatic venous plexus (*to internal iliac veins*)
33
Prostate - Histology
**2 layers:**
1. Proximal
* urothelium
2. Distal
* stratified columnar epithelium
**2 types of tissues**
1. Fibromuscular tissue - 30%
* CT + smooth muscle
2. Glandular tissue - 70%
* opens into prostatic sinus
**3 types of glands**
1. Mucosal glands
2. Submucosal glands
3. Main prostatic glands
34
Male urethra - Anatomy
* 3 major portions:
1. **Prostatic portion**
* widest part of urethra
* Urethral crest
* opening of submucosal ducts and prostatic glands
* Seminal colliculus
* opening of ejaculatory ducts (2x)
2. **Membranous portion**
* ****passage through urogenital diaphragm
* controlled by ext. urethral sphincter
3. **Spongy portion**
* ****longest of the 2 portions
* in spongy body of penis
* opens at penile head, forms navicular fossa
35
Male urethra - Blood supply
**Arteries**
* inferior vesical art.
* middle rectal art.
36
Male urethra - Histology
1. **Prostatic part**
* ****Urothelium
2. **Membranous part**
* Stratified columnar epithelium
3. **Spongy part**
* Stratified columnar epithelium
4. **Navicular fossa**
* Stratified squamous non-keratinized epithelium
37
Penis - Anatomy
* can be divided into 5 major parts:
1. Head
2. Body
3. Root
4. Corpus cavernosum
* fills with blood to cause erection
5. Corpus spongiosum
* contains urethra and bulb of penis
38
Penis - Blood supply
**Artery**
* Dorsal penis artery (*from internal pudendal art.*)
**Vein**
* Dorsal penis vein
39
Penis - Innervation
* Pudendal nerve
40
Penis - Histology
1. **Corpus cavernosum**
* surrounded by tunica albuginea
* CT + smooth muscle
2. **Corpus spongiosum**
* surrounded by tunica albuginea
* Urethra (stratified columnar epithelium)
* more CT, less smooth muscle
41
Erection mechanism
* Deep art. of penis → helicine art. (has special smooth muscle valves called "Ebner's cushions")
* During sexual excitement, cushions open, allowing blood to flow
* Blood flow inhibits venous drainage → erection
42
Ovaries - Anatomy
* almond shaped organ, 2.5-5cm long
* behind to broad ligament, attached to it posteriorly by the mesovarium
* expells ovum/oocyte into peritoneal cavity and then into uterine tube
43
Ovaries - Ligaments
* Mesovarium
* suspensory lig.
* contains ovarian art.
* utero-ovarian lig.
44
Ovaries - Blood supply
**Arteries**
* ovarian art. (*from abdominal aorta*)
* uterine art. (*from internal iliac art.*)
* vaginal art. (*from ovarian branch)*
**Veins**
* right ovarian vein (*to IVC*)
* left ovarian vein (*to left renal vein)*
45
Ovaries - Histology
2 layers:
1. Covering epithelium
* germinal epithelium = simple cuboidal epithelium
2. Tunica albuginea
* dense CT
* divided into cortex and medulla
**Medulla**
* large vessels, nerves and CT
**Cortex**
1. **Primordial follice**
2. **Primary follicle**
3. **Secondary follicle******
4. **Premature follicle**
46
Oogenesis
→ makes ovum from oogonium
1. **Oogonia (Mitosis)**
* produces more oogonia and primary oocytes
2. **Primary oocytes (Meiosis I)**
* forms large secondary oocyte + polar body
3. **Secondary oocytes (until Meiosis II metaphase)**
4. **Ovum**
* ****completion of Meiosis II converts secondary oocyte into a zygote and a second polar body
47
Ovarian folliculli - Histology
1. **Primordial follice**
* oocyte w/ granulosa cells
2. **Primary follicle**
* oocyte w/ granulosa cells
* zona pelucida starts to form
3. **Secondary follicle**
* oocyte covered by zona pelucida w/ granulosa cells
* covered theca cells****
4. **Tertiary follicle**
* ****cytoplasm filled with granulosa cells
* contains antrum
48
Uterus - Anatomy
* 4 main parts
1. Fundus - superior and anterior
2. Body
3. Isthmus - constricted part between body +
4. Cervix - narrow part, continues to vagina
* anteverted and anteflexed (90° vagina vs. longitudinal axis of uterine body)
* lies between urinary bladder and rectum
* vesico•uterine pouch
* recto•uterine pouch (Douglas p.)
* enclosed by peritoneum = broad lig.
49
Uterus - Ligaments
* infraperitoneal; enclosed by broad lig.
* suspended by:
* pubo•vesical lig
* cardinal lig.
* recto•uterine lig.
* round lig.
* supported by:
* pelvic diaphragm
* urogenital diaphragm
50
Uterus - Blood supply
**Arteries**
* uterine art. (*from internal illiac art*)
**Veins**
* uterovaginal venous plexus (between 2 layers of broad lig.)
* cervical plexus of uterus
51
Uterus - Histology
**Layers:**
1. **Endometrium**
* simple columnar epithelium
1. Stratum functionale
* simple tubular glands
2. Stratum basale
* ends of tubular glands
* straight arteries
2. **Myometrium**
3. **Perimetrium**
* tunica subserosa + - serosa
52
Cervix - Histology
Layers:
1. **Endometrium**
* Mucous epithelium
* simple columnar epithelium
* Lamina propria mucosa
* branched tubular glands
2. **Myometrium**
* few smooth muscle fibres
* many CT fibres
3. **Perimetrium**
1. ****Nabothian cysts
* mucous filled pouches
2. Papanicolau smear
* detection of cervial cancer
53
Uterine tube
* from uterus towards ovaries
* connect uterine- with peritoneal cavity
* 4 main parts
1. uterine part
2. isthmus
3. ampulla
4. infundibulum
* place of fertilization by spermatozoa (transported by smooth muscle action!)
54
Uterine tube - Blood supply
**Arteries**
* uterine art.
**Veins**
* uterovaginal venous plexus (*to uterine veins*)
55
Uterine tube - Histology
Layers:
1. **Tunica mucosa**
1. Epithelium mucosae
* simple columnar epithelium
* ciliated cells, secretory cells
2. Lamina propria
2. **Tunica muscularis**
* inner: circular muscle
* outer: longitudinal muscle
3. **Tunica subserosa**
4. **Tunica serosa**
56
Structures of female and male lesser pelvis
**Male**, anterior to posterior:
* pubic symphysis
* testes + epididymis + spermatic cord
* urinary bladder
* prostate gland
* seminal vesicle
* rectum
**Female**
* pubic symphysis
* urinary bladder
* vesico•uterine pouch
* vagina + uterus + uterine tubes
* recto•uterine pouch
* rectum
57
Lesser Pelvis - Pelvic spaces
1. **Subperitoneal cavity**
* bordered by _Pelvic diaphragm:_
* Levator ani m.
* Sup. + inf. pelvic diaphragmatic fascia
2. **Ischiorectal fossa**
* ****bordered by _Urogenital diaphragm_:
* deep transverse perineal m.
* perineal membrane
58
Lesser Pelvis - Perineal spaces
1. **Deep perineal space**
* men: bulbourethral glands
* women: major vestibular glands
2. **Superficial perineal space**
* men: Bulbus penis
* women: Bulbus vestibuli
3. **Subcutaneous perineal space**
59
Female genitalia - Anatomy
* consists of:
* mons pubis
* labia majora + minora
* clitoris
* vestibule
* Bartholin's gland
* mucus secretion
* vaginal orifice
* urethral orifice
60
Female genitalia - Blood supply
**Arteries**
* vaginal art. (*from internal illiac art.)*
**Veins**
* vaginal veinous plexus
61
Female genitalia - Innervation
**Sympathetic**
* lumbar splanchnic plexus
**Parasympathetic**
* pelvic splanchnic plexus
62
Female genitalia - Histology
Layers:
1. **Tunica mucosa**
1. Epithelium mucosae
* non-keratinized stratified squamous epithelium
2. Lamina propria mucosa
* loose CT
2. **Tunica muscularis**
* inner: circular muscle
* Outer: longitudinal muscle
3. **Tunica externa**
* dense CT
63
Internal iliac artery - Branches
Parietal:
* iliolumbar art.
* lateral sacral art.
* obturator art.
* superior + inferior gluteal art.
* internal pudendal art.
Visceral:
* umbilical art.
* superior + inferior vesical art.
* deferential-/uterine art.
* vaginal art.
* middle rectal art.
64
Pelvic organs - Lymphatic drainage
1. **Superficial inguinal lymph nodes**
* approximately 10
* receive lymph from:
* gluteal region
* perineum
* lower abdominal wall
* drain into external iliac nodes
2. **Deep inguinal lymph nodes**
* up to 3, medial to femoral vein
* receive lymph from
* glans penis
* clitoris
* connect with superficial nodes
* pass through "lacuna lymphatica" (Rosenmüller's lymph nodes)
65
Pelvic organs - Veins
→ drainage happens through internal iliac vein!
visceral tributaries:
* lateral sacral veins
* middle hemorrhoidal vein
* vesical vein
* uterine vein
* vaginal veins
66
Pelvis - Autonomic NS
check drawing
67
Sacral plexus branches
* arise from sacral spinal nerves S2 - S4 to provide parasympathetic innervation
* in front of piriformis muscle
* leave through the greater sciatic foramen
**Pudendal nerve (mainly)**
* innervates levator ani m. + coccygeus m.
* anal sphincter
* urogenital mm. (internal + external)
68
Pelvis - Sphincters
1. Internal anal sphincter
* pelvic splanchnic n.
2. External anal sphincter
* pudendal n.
3. Internal urethral sphincter
* lumbar splanchnic n.
* inferior hypogastric plexus
4. external urethral sphincter
* deep branch of perineal n.
69
Levator ani muscle - Anatomy
* broad, thin muscle running from sides of pelvis towards the inner side of the coccyx
* forms pelvic floor/diaphragm
* consist of:
* pubo•rectalis m.
* pubo•coccygeus m.
* ilio•coccygeal m.
70
Levator ani muscle - Blood supply
**Artery**
* inferior gluteal art. (*from internal iliac art.*)
71
Levator ani muscle - Innervation
* pudendal nerve
* perineal nerve
* inferior rectal nerve
72
Perineum
* diamond - shaped region, with corners:
* pubic symphesis
* ischial tuberosity
* coccyx
* → "pelvic floor"
1. Pelvic diaphragm
2. Urogenital diaphragm
3. Sphincter and erectile musculature
* external urethral + anal sphincter
* bulbospongiosus, ischiocavernosus
73
Male Perineum - Muscles
from "top to bottom":
* bulbospongiosus m.
* ischiocavernosus m.
* deep transverse perineal m.
* external anal sphincter m
* adductor magnus m.
* gluteus maximus m.
74
Female perineum - Muscles
* vaginal orifice m.
* external anal sphincter m.
* (ano•coccygeal lig.)
* gluteus maximus m.
* levator ani m.
* superficial transverse perineal m.
* adductor magnus m.
* (central tendon of perineum)
* ischiocavernosus m.
75
Abdominal aorta - Paired vs. unpaired branches
1. **Visceral**
1. _paired_
* __middle suprarenal art.
* renal art.
* gonadal art.
2. _unpaired_
1. __sup. + inf. mesenteric art
2. celiac trunk
2. **Parietal**
1. _paired_
* __inf. phrenic art.
* lumbar art. (4 pairs)
2. _unpaired_
* __median sacral art.
76
Lumbar plexus
* subcostal n.
* iliohypogastric n.
* ilioinguinal n.
* lat. cutaneous n.
* femoral n.
* genitofemoral n.
* obturator.
