alimentary system Flashcards
(348 cards)
1
Q
parts of the esophagus
A
cervical, thoracic, abdominal parts.
2
Q
innervation of the esophagus
A
Recurrent laryngeal - vagus nerve
3
Q
physiological constrictions of the esophagus
A
- cricopharyngeal constrictor (upper esophageal sphincter
- aortic constriction
- bronchial constriction
- diaphragmatic constriction
4
Q
parts of the stomach
A
- cardia
- fundus
- body
- pylorus (antrum + canal)
- pyloric sphincter muscle
- greater+lesser curvature
- cardiac notch (of His)
- angular insicure
- angle of stomach
- rugae (mucusal folds)
5
Q
what is the traube space?
A
an area which is covered partially by the liver, the ribs and the stomach from below. allowes to investigate the spleen.
6
Q
what is the triangle of LABBE?
A
an area with free space on the stomach, without ribs or liver.
7
Q
what is the continuation of the stomach?
A
the small intestine - the Duodenum.
8
Q
which arteries supply the stomach?
A
lesser curvature = r+l gastric arteries
greater curvature= r+l gastroepiploic
fundus=short gastric
9
Q
which artery supply the upper part of the esophagus?
A
inferior thyroid artery (a branch of subclavian a.)
10
Q
what is the first part of the stomach?
A
cardia
11
Q
what is the uppermost part of the stomach?
A
fundus
12
Q
what is the biggest part of the stomach?
A
body
13
Q
what is the last part of the stomach?
A
pylorus:
a. pyloric antrum
b. pyloric canal
14
Q
what is the junction between the stomach and the small intestine?
A
the pyloric sphincter muscle (circular smooth muscle)
15
Q
what is the uppermost unpaired vessle of the abdomen?
A
ciliac trunk
16
Q
branches of the celiac trunk?
A
- left gastric artery
- splenic artery (passes behind the stomach to the spleen, it is the biggest)
- common hepatic artery
17
Q
blood supply of the stomach
A
- Distal part of greater curvature:
Common hepatic –>Gastro-duodenal a. –>Right gastroepiploic (Gastro-omental) a. - rest of greater curvature:
Splenic artery –> Left gastroepiploic (Gastro-omental) a. - lesser curvature:
by the Left gastric a.
*There are also branches of the Splenic artery called Short gastric a.
18
Q
venous drainage of the stomach?
A
from coronary vein of stomach to portal vein.
19
Q
parts of Duodenum
A
- ampulla
- superior horizontal part
- superior flexure
- descending part
- inferior flexure
- inferior horizontal part
- ascending part
- duodeno-jejunal flexure
20
Q
intra-peritoneal structures of duodenum?
A
Ampulla + superior Horizontal part,
duodeno-jejunal flexure
(other parts are retro-peritoneal)
21
Q
parts of the small intestine?
A
- duodenum
- jejunum
- ileum
22
Q
parts of large intestine?
A
- cecum
- ascending colon
- transverse colon
- descending colon
- sigmoid colon
**rectum is not a part of a colon.
23
Q
flexures of the colon?
A
- Hepatic (right) colic flexure
- -> between Ascending colon and Transverse colon
- Splenic (left) colic flexure
- -> between Transverse colon and Descending colon
24
Q
The 3 unpaired visceral branches of the Aorta?
A
- celiac trunk (at T12) supplies the fore-gut
- Superior Mesenteric Artery (L1) supply the mid-gut
- Inferior mesenteric artery (L3) supply the hind-gut
25
Junction between mid-gut and fore-gut?
Middle part of descending duodenum - lesser arch of Riolin.
26
junction between the mid-gut and hind-gut
near the left colic flexure - greater arch of Riolin
27
where is the lesser omentum?
between the liver and the lesser curvature of stomach
28
where is the greater omentum?
arises from the greater curvature, to the colon
29
how many layers of peritoneum there is in the greater omentum?
4 layers (2 duplications)
30
which planes do we have in the abdomen? and what are their names?
L1 , L3
L1 - transpyloric plane
L3 - subcostal plane
31
where does the aorta biforcates?
L4
32
what is the junction between the small and the large intestines?
The illio-cecal valve
33
blood supply of Duodenum?
Anterior superior+Posterior superior pancreaticoduodenal arteries.
(they arise from the Gastroduodenal artery, a branch of the Common hepatic artery.)
-->these two join together at the Inferior pancreaticoduodenal artery, a branch of the Superior mesenteric artery.
34
venous drainage of the Duodenum?
The Splenic vein + Superior mesenteric vein ,
| into the Hepatic portal vein.
35
Blood supply of the jejunum and ileum?
Branches of the superior mesenteric artery.
-->jejunal and ileal branches interconnects to form arterial arcades.
+ileo-colic artery
36
venous drainage of the jejunum and ileum?
veins accompanying the arteries drain to the Superior mesenteric vein to the Hepatic portal vein.
37
how many layers of peritoneum there are in the right coronary ligament?
only 1 layer.
38
what is the name of the thickened bands of the outer longitudinal layer of the large intestine?
Teniae coli
39
where are the semilunar folds?
in the colon, projecting into the intestinal lumen.
40
what are the Haustre of the colon?
The bulges outwards in the colon, formed from the semilunar constrictions, (נקניקיה)
41
where are the Omental (epiploic) appendices?
outer surface, sub-serosal fatty tags
42
what is the initial segment of the large intestine?
the Cecum, located in the right iliac fossa
43
which 2 lips form the ileocecal valve at the ileal orifice?
1. ileo-cecal lip (inferiorly)
| 2. ileo-colic lip (superiorly)
44
what is the ileal papilla?
it is the bulge of the 2 lips towards the cecum.
45
what is the frenulum of the ileal orifice?
when the 2 lips of the ileo-cecal valve unite at their outer ends.
46
which artery supply the cecum and appendix?
ileocolic artery (it is a branch of the superior mesenteric artery.)
47
venous drainage of the cecum and appendix?
same name as the arteries, drain into superior mesenteric vein which drains the the hepatic portal vein.
48
what can i find in the Hepatogastric ligament?
left and right gastric a. and v. + coronary vein of the stomach
49
what can i find in the Gastrocolic ligament?
the anastamosis between the left and right Gastroepiploic arteries.
50
what can i find in the Gastrosplenic ligament?
the short gastric arteries and the beggining of the left Gastroepiploic a.
51
which 2 veins form the portal vein?
Superior mesenteric vein + splenic vein
52
what is the innervation of the stomach?
parasympathetis- Vagus nerve
| sympathetic- greater splanchnic nerves via celiac plexus.
53
what is the name of the ligament in the duodenojejnal junction?
Treitzs ligament. (suspensory ligament.)
54
what is the name of the peritoneal fold which leaves the posterior abd. wall and fixes the transverse colon to post. abdominal wall?
transverse mesocolon.
| meso = peritoneal fold
55
peritoneal fold which leaves the post. abd. wall and connected to the jejunum\ileum?
mesentery.
56
what is the root of mesentery?
a structure that fixes the mesentery to the post. abd. wall.
57
deepest part of the peritoneal cavity of female?
recto-uterine pouch (douglas) for women.
58
where can i find the lesser arch of Riolan and what it connects?
in the descending part of duodenum.
it sonnect the sup. and inf. pancreatico-duodenal arteries.
(SMA + CELIAC TRUNK )
59
what are the branches of SMA?
```
inf. pancreaticoduadenal
jejunal a.
ilial a.
iliocolic a.
right colic a.
middle colic a.
```
60
what is the important branch of the iliocolic a?
appendix branch
61
which recesses can we find in the omental bursa?
1. splenic recess.
2. superior recess
3. inferior recess
62
walls of the superior recess?
anterior wall: caudate lobe
posterior border: parietal peritoneum
roof: hepato-renal ligament.
63
where does the inf. rectal a. come from?
from the internal pudendal a., which is a visceral branch of the internal iliac a.
64
what is the upper part of the greater omentum?
gastro-colic ligament.
65
deepest part of the peritoneal cavity of male?
recto-vesicle pouch.
66
what is the connection between greater and lesser sac?
epiploic (omental) foramen (of WINSLOW)
67
where can we find the highest number of neurons?
in the wall of the large and small intestine. (because of the peristaltic movement)
68
what is the biggest branch of the celiac trunk?
splenic artery
69
in which ligament is the splenic artery and what are his parts?
upper part between diaphragm and spleen - phrenico splenic lig.
middle part between the tail of pancreas and spleen - pancreatico-splenic lig.
lower part between spleen and left kidney - spleno renal lig.
**high yield (splenic artery is intraperitoneal and not passes through gastro splenic lig !!)**
70
where does the portal vein come from?
the connection of the splenic vein and the sup. masentric vein
71
what does the gastrosplenic lig. contains?
short gastric artery (for fundus of stomach), +begging of the left gastro-epiploic a.
*branch of splenic artery.
72
contents of hepatogastric lig?
R+L gastric arteries.
| followed by coronary vein of stomach.
73
contents of falciform lig.
in fetal life : umbilical vein
in adult: round ligament of liver
+para-umbilical vein
74
what is the name of the ligament that fixes the proximal part of the duodenum to the liver?
hepato-duodenal ligament.
75
which opening do we have behind the hepatoduodenal ligament?
epiploic foramen (WINSLOW)
76
which ligament suspend the distal part of the duodenum?
suspensory ligament of duodenum (of TREITZ)
77
to where does the ligament of treitz connects?
medial crura of diaphragm \ root of celiac trunk.
78
which ligament is between the diaphragm and left colic (splenic) flexure supports the spleen from below?
sustentacular lig. (phrenico-colic ligament)
79
walls of the epiploic (winslow) foramen
anterior wall: hepato-duodenal ligament (portal triad)
posterior wall: hepato-renal ligament(+IVC)
roof: caudate lobe of liver
floor: duodeno-renal ligament (+sup. horizontal part of duodenum).
80
walls of omental bursa?
anterior wall: lesser omentum+ posterior wall of stomach
posterior wall: parietal peritoneum
floor: transverse mesocolon
roof: left lobe of liver+diaphragm
left wall: wall of splenic recess (hilum+gastrosplenic+pancreaticosplenic ligaments)
81
what is the name of bigger left part of lesser omentum/
hepato-gastric lig.
82
what is the name of the smaller, right part of lesser omentum?
hepato-duodenal ligament.
83
contents of hepato-duodenal ligament?
portal triade (common bile duct, proper hepatic artery, portal vein)
84
what is the name of the upper part of the greater omentum between the transverse colon and stomach?
gastro-colic ligament (made of 6 peritoneal layers)
85
how many layers of peritoneum are there on top of the transverse colon?
greater omentum formed from 4 peritoneal layers.
86
what is the division of the ventral mesentery?
falciform ligament ,
| lesser omentum
87
what is the division of the dorsal mesentery?
gastrosplenic lig.
| phrenicosplenic lig.
88
at which plane can we find the celiac trunk?
L1
89
what can we find in the gastro-pancreatic fold?
| and what is its significance?
left gastric artery.
it divides the vestibule from the cavity proper of the omental bursa
90
where does the veins of the whole G.I tract drains to?
portal vein (NOT IVC) !
91
what drains to the major duodenal papilla?
common bile duct, major pancreatic duct
| VATER's papilla
92
what drains to the minor duodenal papilla?
accessory pancreatic duct (of santorini)
93
what is the blood supply of the duodenum?
* sup. ant. pancreaticoduodenal art.
* sup. post. pancreaticoduodenal art.
(branches of the gastroduodenal artery - from the common hepatic)
* inf. pancreaticoduodenal (from superior mesenteric artery.)
94
which peritoneal structures enclose the bare area of the liver?
right coronary ligament+hepatorenal ligament.
95
which 2 veins label the epiploic foramen of winslow?
IVC +Portal vein
96
branches of inferior mesenteric artery?
left colic a.
sigmoidal a.
superior rectal a.
97
where can i find the greater arch of Riolan and what are the related arteries?
middle colic a. (from SMA)
+
Left colic (from IMA)
They are found in the left (splenic) colic flexure
98
what is the McBurney point?
the point here we can find the appendix, located in the middle between the right ASIS and the umbilicus.
99
what are the 3 flexures of the rectum?
1. rectoroman flexure (where the sigmoid changes to rectum)
2. sacral flexure (follows the shape of the sacrum)
3. perineal flexure
100
what is the blood supply of the rectum?
superior rectal a. (from IMA)
middle rectal a. (from internal iliac a.)
inferior rectal artery (internal pudendal artery.)
total 5!
101
what is Sudeck point?
anastamoses between sigmoidal artery and superior rectal artery.
102
what is the cannon - bohm's point?
it is the last point where the fibers of the vagus nerves extent to. (around the greater arch of riolan)
103
what is the Calot's trigone?
bordered by the cystic duct, common hepatic duct, and lower margin of the liver.
contains the cystic artery.
104
what is the blood supply of the pancreas?
superior+inferior pancreatico-duodenal , + pancreatic branches of splenic artery.
105
which vessels are found in the mesentery?
ileal a. + jejunal a. (arcades)
106
which major structures are crossed by the root of mesentry?
aorta, ivc, right psoas major m.
107
what seperates the two functional lobes of the liver?
Cantlie's line (contain the middle hepatic vein)
108
what covers the liver?
Glisson's capsule.
109
which 2 flexures does the rectum have in the sagittal flexure?
1. sacral flexure
| 2. perineal flexure (by the pubo-rectal m.)
110
to which muscle does the pubo-rectal m. belongs?
lavator ani muscle. (main muscle of the pelvic diaphragm)
111
which continence organs does the rectum have?
pubo-rectal m.
external anal sphincter (striated)
internal anal sphincter (smooth)
(they prevent incontinency)
112
what curve does the rectum have in the frontal plane?
curvature to the right side.
113
which 2 main parts does the rectum have?
ampulla , anal canal
114
what is the boundary between the ampulla and the anal canal?
Ano-rectal line.
| together-anorectum
115
which 3 zones does the anal canal have?
1. columnar zone
2. hemorrhoidal zone (anal pecten)
3. cutaneous zone (distal zone)
116
what structures do we have in the columnar zone?
```
anal glands and sinuses,
anal folds (of MORGANI) - longitudonal mucosal folds.
```
117
what can we find between the columnar and hemorrhoidal zone?
mucosal valves, pectinate line (endodermal-ectodermal epithelium)
118
what is the border between the hemorrhoidal and cutaneous zones?
Ano-cutaneous line (intersphincteric groove, hilton's line)
119
which ligaments make the greater omentum?
1. gastrophrenic lig.
2. gastrocolic lig.
3. gastrosplenic lig.
120
blood supply of the rectum by regions?
1. superior rectal artery - the columnar zone.
2. inferior rectal artery- the anal canal below the pectinate line
3. middle rectal artery - only superficial layer of rectum (not mucosa)
there is anastamoses in the mucose - between the sup. and inf. rectal arteries.
121
which hemorrhoidal plexuses can we find and where?
inner hemorrhoidal plexus - in the mucosa of columnar zone.
outer hemorrhoidal plexus - in the mucosa of the hemorrhoidal zone.
122
which transverse rectal folds do we have, and which is the most important?
superior, middle, inferior transverse rectal folds.
| the most important = middle (Kohlrausch)
123
what can we palpate at the level of the Kohlrausch fold?
female:
Post. vaginal fornix
Douglas pouch.
male:
seminal vesicles
prostate
124
venous drainage of the rectum?
lower portion of anal canal: (distal2\3)
inf. rectal vein-->internal pudendal vein--> internal iliac vein -->common iliac vein--> IVC
upper 1\3- proximal to pectinate line:
superior rectal vein-->inf. mesenteric vein -->splenic vein-->portal vein --> liver.
125
what are porto-caval anastamoses?
connections between the IVC and the portal vein.
126
where can we find portocaval anastamoses?
1. at the coronary vein of stomach and azygous\hemiazygous veins. (bleeding esophagus, varicis)
```
2. around the umbilicus:
periumbilical veins (carries blood to superior epigastric vein --> internal thoracic vein--> brachiocephalic vein-->SVC.
lower paraumbilical veins --> inferior epigastric vein -->external iliac v-->common iliac --> IVC
```
paraumbilical veins drain to portal vein. (CAPUT MEDUZA)
3. around the rectum:
supeior rectal vein --> inf. mesentery vein --> splenic vein --> portal vein.
blood moves back to rectum and dilates the hemorrhoid plexus and causes hemorrhoids.
4. retroperitoneal portocaval anastamoses:
splenic vein (intraperitoneal) + pancreatic vein (retroperitoneal) or renal vein (retroperitoneal)
*bleeding in the retroperitoneum.
127
what are the peritoneal relations of the rectum?
upper part = semi \ intraperitoneal
middle part = retroperitoneal
lower part = infraperitoneal.
128
what are the 3 major compartment of the Peritoneom? (two names for each)
1. sup. transverse mesocolic - also called Epigasrium.
2. inf. transverse mesocolic (can be divided to right and left by the root of mesentry) - Mesogastrium
3, lesser pelvic - hypogastrium
129
what abdominal recesses can we find?
1. at the duodenum - superior, retro, inferior duodenal recesses. also Paraduodenal recess.
2. below the sigmoid colon - intersigmoid recess.
3. at the ileocecal junction - sup.+inf. ileocecal recess
( only superior is vascular - ileocolic a. branches.)
4. paracolic gutter (recess) left+right.
130
what are the branches of the ileocolic artery?
cecal, ileac, appendicular branches.
131
what are the peritoneal recesses that can cause to an internal hernia?
* sup. and inf. duodenal recesses
* sup. and inf. ileo-cecal recesses
* intersigmoideal recess
132
what is the deepest part of the abdominal cavity in supine position?
right sub-hepatic space (recess)
[MORRISON'S pouch, hepatorenal pouch]
between right lobe of liver and rt kidney
133
what is the connection between the retro-splenic space and left iliac fossa?
left paracolic gutter (recess)
134
what are the levels of the kidneys?
left - T11\12 --> L2\3
| right - T12/L1 --> L3
135
which impressions can we find on the anterior surface of the right kidney?
1. hepatic impression
2. duodenal impression
3. colic impression
136
which impressions can we find on the anterior surface of the left kidney?
1. gastric impression
2. pancreatic impression (tail)
3. splenic impression
4. colic impression
5. jejunal impression
137
which structure + muscles are attached to the kidneys posteriorly?
the diaphragm on top.
1. psoas major m. (medially)
2. quadratus lumburum m. (middle)
3. transversus abdominis m. (lateraly)
138
which renal artery is longer and why?
right renal artery is longer (passes behind IVC)
| because the aorta is closer to the left, so the right renal artery is longer.
139
which paired branch of the aorta supplies the diaphragm from below?
inf. phrenic artery.
140
which arteries supply the adrenal gland?
* superior supra-renal artery (branch of the inf. phrenic artery.)
* middle suprarenal a. (branch of the aorta)
* inferior suprarenal a. ( branch of renal artery)
141
venous drainage of the adrenal gland?
Lt - to left renal vein
| Rt- to IVC
142
order of structures at the hilum of the kidney, anterior-posteriorly?
vein, artery, ureter.
| * ureter leaves the kidney through the lower part of the hilum.
143
where does the gonadal veins drain to?
Rt - directly to IVC
Lt - to left renal vein.
*gonadal arteries leaves the aorta directly
144
crossings of the ureter?
1. gonadal vessles: are in front of the ureter
2. common or internal iliac artery: behind the ureter
3. uterine artery: in front of the ureter
4. vas deferenc: in front of the ureter.
145
what can we find in the Calot's triangle?
the cystic a.
146
what are the 3 layers that cover the kidneys?
1. fibrous capsule
2. adipose capsule (mainly brown adipose)
3. renal fascia( ant. Gerota's - pos. Zuckerdandl)
147
what are the two part of the ureter ?
abdominal and pelvic
148
what is the name of the opening of the lesser pelvis?
linea terminalis (pelvic inlet)
149
what are the paired branches of the abdominal aorta?
1. middle suprarenal a.
2. renal a.
3. gonadal a.
150
from where is the inf. suprarenal a. come?
from the renal a.
151
from where is the superior suprarenal a. come?
it come from the parietal a. of the abdominal aorta. (from the inf. phrenic a. )
152
what level is the gonadal a. emerge from?
around L2/L3
153
what is the blood supply of the ureter?
1. renal a.
2. gonadal a.
3. common and internal iliac a.
4. uterine a. / defferential a.
154
what is the Gonadal a.?
in male - testicle a.
| in female- ovarian a.
155
what is the principle a. for the pelvic organs?
Visceral branches of internal iliac a.
156
what is the urinary trigone?
between the two ureters and the urethra.
157
at what level is the renal a. emerge?
at L2 (with the SMA)
158
what is the polar renal a.?
direct branches from the aorta to the pole of the kidney.
159
which two main parts can I find in the kidney?
cortex and medulla
160
what are two parts of the cortex?
renal column and below the capsule.
161
what is the other name of the medulla?
the pyramid
162
the papilla will drain to ?
minor calyx which will drain into major calyx which will go to the renal pelvis
163
what is the other name of the internal iliac a.?
hypogastric a
164
which structures can we find in the McBurney point? and where is it?
1. base of Vermiform appendix
2. iliocecal junction.
3. bifurcation of common iliac a.
4. ovary
5. ureter
6. obturatur nerve
it is located on the lateral 1/3 of the line connected the umbilicus and the right SAIS.
165
which structures can we find in the Lanz point? and where is it?
the apex of the Vermiform appendix.
| it is located between the right and middle 1/3 on the line connected the two SAIS.
166
what are the 3 major organ found in the Epigastrium?
stomach, liver and spleen.
167
what is the name of the continuation of the aorta? the unpaired parietal branch?
median sacral a (unpaired parietal a. )
168
what are the paired parietal a?
1. inferior phrenic a.
| 2. lumber a.
169
what are the paired visceral a.?
1. middle suprarenal a.
2. renal a.
3. gonadal a.
170
what is the Sudeck's point?
the point of anastomosis between the sigmoidal a. and the sup. rectal a.
171
which structure fit in the loop of Duodenum?
the head of the pancreas.
172
what can we find behind the head of the pancreas?
the fusion of splenic vein and the SMV --- to portal vein.
173
the common bile is the fusion of which structures?
the cystic duct and the common hepatic duct.
174
where is the cystic a. come from?
it come from the right hepatic a. (sometimes from the proper hepatic a.)
175
what is the length of the mesentry? (in relation to the root of mesentry).
10 times the length of the root of the mesentry.
176
what is the continuation of the post. + ant. renal fascia?
Transversalis fascia.
177
at what levels are the hilums of the kidneys?
L2-L3
178
which impressions can i find on the anterior surface of right kidney?
1. hepatic,
2. duodenal,
3. colic impressions
179
which impressions can i find on the anterior surface of left kidney?
1. gastric impression
2. pancreatic impression
3. splenic impression
4. colic impression
5. jejunal impression.
180
which impressions can i find on the posterior surface of right and left kidneys?
medial to lateral:
1. psoas major
2. quadratus lumborum
3. transversus abdominis
181
what is the connection between the morrison's pouch and left sub-hepatic space?
epiploic foramen (of winslow)
182
what planes divide the abdomen horizontally?
1. subcostal plane (L2)
| 2. interspinous plane (sometimes called inter-crestal plane)
183
which vertical lines do we have in the abdomen?
Mid-inguinal lines.
184
which 9 regions do we find in the abdominal cavity?
1. right hypochondrium
2. epigastrium
3. left hypochondrium
4. right lumbar region
5. umbilical region (mesogastrium)
6. left lumbar region
7. right inguinal region
8. hypogastrium\pubic region
9. left inguinal region
185
which structures are located in the trans-pyloric plane?
1. pylorus
2. fundus of gallbladder
3. superior mesenteric artery
4. proxymal parts of duodenum
5. hilum of spleen + tail of pancreas.
186
at what level is the head of pancreas?
L2
187
what is the boundary between supracolic and infracolic spaces?
transverse colon.
188
which small spaces do we have at the supracolic space?
1. R+L sub-hepatic space. (omental bursa and morrison's pouch)
2. supra-hepatic (sub-phrenic) space
3. retrosplenic space (left side)
189
where is the root of mesentery attached?
left side of L2 --->to right sacro-iliac joint.
*it divides the infracolic space to right and left infra-colic spaces, which communicate at the duodenojejunal flexure.
190
what is the space between the lateral abdominal wall and ascending colon?
right paracolic gutter (recess)
191
which small spaces do we have at the infracolic space?
R+L paracolic gutter
| R+L iliac fossa
192
what is theconnection between the morrison's pouch and the right iliac fossa?
right paracolic gutter (recess)
193
what is the shallow gap between the body of the testis and epididymis, from lateral side?
sinus of epididymis
*can be vied only from lateral aspect
194
what is the first coat of the testis, right outside the fibrous capsule?
tunica vaginalis propria testis.
* visceral = epiorchium
* parietal= periorchium
195
what is the junction between epiorchium and periorchium?
mesorchium.
196
which rudimentaries are related to the wolffian duct?
1. appendix of epididymis
2. epididymis
3. ductus defferens
4. ejaculatory duct
5. seminal vesicles
(M)
197
what are the coats of the testis, and where do they derive from?
1. fibrous capsule (tunica albuginea)
2. tunica vaginalis propria testis
- ->from parietal peritoneum of vaginal process
3. internal spermatic fascia (t.v. communis testis)
- ->from transverse fascia of the abdominal wall
4. cremaster m.
- -> from descending muscle fibers of internal oblique m. + transversus abdominis m.
5. cremasteric fascia
- -> from fascia of internal oblique m.
6. external spermatic fascia
- ->aponeurosis of external oblique
7. tunica dartos
- ->skin of perineum
8. scrotal skin
- ->epidermis+superficial part of perineal dermis.
198
what is the uncinate process of the pancreas, and what can i find there?
it is a continuation of the head of the pancreas,
| between which i can find the SMA.
199
what are the splenic branches that supply the pancreas?
1. dorsal pancreatic a.
2. great pancreatic a.
3. artery of pancreatic tail
200
what forms the coats of the spermatic cord?
1. internal spermatic fascia
2. cremasteric muscle
3. external spermatic fscia.
201
what are the contents of the spermatic cord?
1. rudiment of vaginal process
2. vas defferens
3. testicular artery
4. pampiniform plexus
5. genital branch of genitofemoral n. (cremaster m. + ant. skin of scrotum)
6. defferential artery (for vas defferens) + vein
7. lymphatic vessels
202
what is the vaginal process?
its a ventral diverticulum, protrusion of the parietal peritoneum to the scrotal sac.
later, the proximal parts of it will fuse and close, forming the tunica vaginalis propria testis.
203
what is the ligament which is responsible to the descent of the testis, and is connected to the inferior pole of the testis and epididymis?
Gubernaculum testis.
(guides the testis from the posterior abdominal wall to the scrotal sac. it will regress with time, getting shorter and shorter.)
204
what is the other name of the hilum of the kidney?
sinus renal
205
what is the function of the ilioinguinal nerve?
it is outside of the spermatic cord,
motor branches= broad abdominal muscles (transversus abdominis, internal + external oblique)
sensory branches = enter the inguinal canal and innervates the anterior skin of scrotal sac ( together with genital branch of genitofemoral n.)
206
what innervates the posterior skin of scrotal sac?
pudendo-hemorrhoidal nerve plexus:
1- posterior scrotal branches of perineal n. (from pudendal n.)
2- perineal branches of posterior femoral cutanous n.
207
what is the blood supply for the scrotum?
internal pudendal a. --> posterior scrotal a. (drains to internal iliac vein)
external pudendal a. --> anterior scrotal a. (drains to femoral vein)
208
which vein drains the pampiniform plexus?
testicular vein?
which drains to:
* renal vein (if left) [they meet at 90 degrees, high pressure]
* IVC (if right, lower pressure than renal vein)
*thats why the vericocele more frequent of left side.
209
what are te ligaments of the urinary bladder?
1. median umbilical ligament (the appex of the bladder is connected to umbilicus, remnant of urachus)
2. connection to the symphesis:
female- pubo-vesicle ligament
male- pubo-prostatic ligament
210
what is the blood supply of the urinary bladder?
visceral branches of the internal iliac artery.
superior vesical a. --> from umbilical a.
inferior vesical a. --> directly.
211
what is the uvula of the bladder?
its an elevation of the urinary bladder in male, produced by the prostate.
212
at what level does the testicular a. arise?
L2
213
what kind of muscle we can find in the tunica dartus?
Smooth muscle
214
what is the function of the pampiniform plexus?
he is responsible for the thermal regulation from the hot blood that come from the aorta.
215
where do the pampiniform plexus drain to?
Testicular vein.
| the right one will drain directly to IVC , while the left will drain to the left renal vein.
216
what is the homologus a. of the deffernt a. in female?
the uterine a.
217
what are the branches of the hypogastric a. (internal iliac a. )?
parietal brances:
1. Sup. gluteal a.
2. inf. gluteal a.
3. obturator a. (give the a. for head of femor.)
visceral branches:
1. umbilicus a. (give the sup. vesical a.)!!!
2. inferior vesicles
3. uterine / deferential a.
4. middle rectal a.
5. internal pudendal a. (give the inferior rectal a.)
218
what are the parts of the male urethra?
1. intramural part
2. prostatic part
3. membranous part
4. spongiosum part
219
what is the last part of the male urethra?
navicular fossa
220
where can we find the sphincter muscles of the male urethra?
1. internal urethral sphincter- found in the intramural part (smooth - not voluntary).
2. external urethral sphincter- found in the membranous part (striated - voluntary.)
221
what is the function of the internal urethral sphincter?
prevents ejaculation during urination and vice versa.
| smooth muscle, symathetic fibers
222
where is the external urathral sphincter?
in the urogenital diaphragm, in the membranous part of the urethra.
223
what are the part of the penis?
1. root of penis (hidden)
- -> contains the bulb of penis (spongy)
- ->crura of penis (cavernous)
2. body of penis
- --neck---
3. glans of penis
- -> foreskin, prepuse (TYSSON's glands)
224
where is the suspensory ligament of the penis?
between the pubic symphisys and cavernous bodies.
225
what is the septum between of the cavernous bodies?
pectiniform septum
| incomplete septum
226
what is the connective tissue that encircles the corpus cavernosum?
tunica albuginea,
| rich in collagen fibers, poor in elastic fibers.
227
what is the reason for the elasticity of the spongy body, compared to the rigid cavernous body?
it is elastic so it won't compress the urethra during erection, so the ejaculation can leave the urethra.
228
what cover the corpus cavernosum + corpus spongiosum?
the facia of the penis.
| both are covered by tunica albuginea.
229
what is the glans of the penis?
it is an expansion of the corpus spongiosum.
230
what fix the bulb of the penis and to where it is connected?
the bulb of the penis is connected to the urogenital diaphragm and covered by the bulbospongiosus muscle.
231
what fixes the root of penis and to where?
it is fixed to the pubic symphesis by the two crura, which covered by the ischiocavernosus m.
232
which vein drains the blood from the corpus cavernosum?
| and what other vessles are there?
the deep dorsal vein.
it is accompanied by 2 dorsal arteries.
(also dorsal nerves somatic, pudendal)
more superficially, there is the superficial dorsal vein.
233
which space is behind the pubic bone and infront of the bladder?
retropubic space [RETZIUS], with vesico-prostatic plexus.
234
what is the difference between erection and ejaculation in terms of innervation?
erection is by parasympathetic fibers
| ejaculation is sympathetic.
235
what happens during emission?
contraction of smooth muscle cells of ductus defferens, pushing the semen to urethra, with the help of bulbus-spongiosus muscle.
236
what is the uvula of bladder?
it is a bulge in the lower part of the trigone, formed by the median lobe of the prostate.
it continues as the urethral crest.
237
what is the seminal collicle?
```
a structure in the prostatic urethra which contains the:
openings of ejaculatory ducts
prostatic utricle (male vagina)
```
next to the seminal collicle are the 2 prostatic sinuses with the openings of prosthatic ducts.
238
what is the blood supply of the prostate?
prostatic a. -->internal pudendal a. --> anterior division of internal iliac a.
*inferior vesical a.?
239
what are the functions of the bulbo-urethral glands?
1. helps in lubrication of distal urethra
| 2. neutralizes acidic urine which remains in the urethra.
240
what is the perineum composed of?
symphysis
tip of coccyx
2X ischial tuberosity.
it devides the region to:
urogenital trigone and anal trigone
241
what can be found in the urogenital trigone?
it is the region where the penis is fixed with muscles.
242
which muscle fix the bulb of penis?
2. bulbo-spongiosus m.
243
what makes up the pelvic floor?
the urogenital diaphragm (anteriorly) + pelvic diaphragm (posteriorly).
244
what are the branches of the internal pudendal a. ?
1. dorsal penile a.
2. deep penile a.
3. artery of the bulb of penis
4. perineal a. (posterior scrotal or labia a. )
5. inferior rectal a.
245
what make up the ejaculatory duct and where is it happen ?
the execratory duct of seminal gland + vas deferns.
| they meet inside the prostate.
246
what is the lowest abdominal point in male?
the rectoviscal pouch.
247
what is the longest part of the urethra?
the spongy part.
248
what are the 3 ligaments related to the ovary?
1. proper ovarian ligament
2. round ligament of uterus.
* they correspond to the male gubernaculum testis, which guides the ovaries to the lesser pelvis.
3. suspensory ligament of ovary.
249
what is the angle between the frontal plane and the longitudinal axis of the vagina, and what is the benefit?
30 degrees, it brings the vagina more forward, allowing more face to face sexual intercourse.
250
what is the angle between the longitudinal angle of cervix of uterus and longitudinal axis of vagina?
70-80 degrees, it is *uterine version*.
the cervix of the uterus is tilted forward, placing it in anteversion position.
251
what are the parts of the uterus?
```
fundus
body
isthmus
cervix
--> supravaginal portion
--> vaginal portion
```
252
what are the parts inside the uterus?
1. uterine cavity
2. cervical canal
3. internal os (in the isthmus)
4. external os.
*cervical canal is between external os and internal os.
253
what are the branches related to the uterine artery?
it originates from the internal iliac a., gives the:
vaginal artery
vaginal branches
**than it ascends lateral to the uterus, to give:
helicin branches
tubal branch (terminal)
ovarian branch (terminal)
254
what are the branches of the ovarian artey, and where is it?
it is inside the suspensory ligament.
its branches are:
ovarian branch
tubal branch.
they anastamose with the corresponding branches of the uterine artery.
255
what is the mullerian duct?
| what are his derivatives in female and male?
also called paramesonephric duct (lateral to the mesonephros- temporary kidneys.)
derivatives in female:
1. appendix vesiculosa
2. uterine tube (fallopian)
3. uterus
4. vaginal fornix
derivatives in male:
1. appendix of testis
2. prostatic utricle.
256
what is the wolffian duct?
| what are his derivatives in female and male?
it is the mesonephric duct. next to the paramesonephric duct.
derivatives in male:
1. appendix of epididymis
2. epididymis
3. vas defferenc
4. ejaculatory duct
5. seminal vesicle
derivatives in female:
1. hydatid of Morgagni
2. epo-ophoron
3. Gartner's cyst
257
what is the broad ligament of the uterus?
peritoneal fold of each side, made of the mullerian duct.
Mesovarium, mesosalpynx, mesometrium.
258
what are the 3 parts of the broad ligament?
1. meso-salpynx (uppermost part, peritoneal fold of uterine tube)
2. mesovarium (connected to ovary)
3. mesometrium (longest, connected to uterus)
259
what is the connective tissue located between the two mesomtrium parts?
parametrium.
260
what is the most important supporting structure of the uterus?
urogenital diaphragm. (support through the wall of the vagina.
261
contents of the parametrium?
1. uterine artery
2. uterovaginal venous plexus.
3. round ligament of uterus
4. ureter.
all these structures pass through the parametrium.
262
contents of the mesosalpynx?
1. tubal branch of ovarian a.
2. tubal branch of uterine artery
+veins
263
contents of mesovarium?
1. ovarian branch of uterine a.
2. ovarian a.
3. epoophoron
264
what are the layers of the uterus?
1. perimetrium (outermost)
2. myometrium
3. endometrium
265
what is the connection between the uterine end of ovary and fundus of uterus?
proper ovarian ligament.
266
parts of the fallopian tube?
1. uterine part
2. isthmus
3. ampulla
4. infundibulum + fimbriae (fingerlike projections)
- -> one of the fimbriae is connected to the ovary.
267
what can we find on the seminal colliculus?
two opening of the ejaculatory ducts + prostatic utricle.
268
what is the biggest pelvic floor muscle?
lavator ani m., main muscle of pelvic diaphragm.
269
what comprises the pelvic diaphragm?
lavator ani m. + its superior and inferior fascia.
270
what are the pelvic floor muscles?
1. lavator ani muscle
2. coccygeus m.
3. piriformis m.
4. upper part of obturator internus m.
- ->(its lower part belongs to perineum.)
271
parts of the lavator ani m.?
1. pubo-perineal part.
- -> from sup. pubic ramus to perineal body, central tendon of perineum.
2. pubo-analis part.
- ->radiates to lateral wall of anus. לא ככ חשוב
3. Pubo-rectal part.
- ->makes a sling around the rectum, continence organ.
4. Ilio-coccygeal m. (the biggest part.)
5. pubo-cocgeus m.
6. Ischiococygeus.
**there is the less important pubo-vaginalis m/pubo-prostatic m.
272
what is the opening infront of the central tendon, between the 2 pubo-perineal parts?
urogenital hiatus.
(one of the openings of pelvic diaphragm)
below it -->anal hiatus
273
what is the tendinous line between the coccyx and the anus?
ano-coccygeal line.
274
what is the tendinous thickening of the obturator internus fascia?
tendinous arch of lavator ani muscle,
| which gives the ilio-coccygeus m.
275
which muscle leaves the ischial spine?
coccygeus m. /ischiococcygeal m.
276
what is the space between the piriformis and the coccygeus muscle?
infra-piriform hiatus.
277
innervation of lavator ani m.?
pudendal n.,
| muscular branches of sacral plexus.
278
blood supply of the pelvic floor?
1. muscular branches of internal pudendal a. (from internal iliac a.)
2. middle rectal artery.
3. inferior vesical artery.
->venous drainage towards the internal iliac v.
279
in female, which 2 organs pass through the urogenital hiatus?
vagina, urethra.
*in man- only urethra.
280
what is the main muscle of the urogenital diaphragm,
| and what structures can i find there?
deep transverse perineal m.
also there are the external urethral sphincter m., major vestibular gland (Bartholinian)->in female
*the urogenital diaphragm belongs to the deep perineum, and its muscles are deep perineal muscles..
281
in female, what is the erectile tissue that pass infront of the urethra?
Bulb of vestibule, made of corpus spongiosum. (?)
282
what is the tissue comprising the clitoris?
cavernous bodies X2
283
what are the superficial perineal muscles?
1. ischio-cavernosus m. (covers crus of clitoris,erection.)
2. Bulbo-spongiosus (bulb of vestibule+Bartolinians)
3. superficial transverse perineal m.
4. external anal sphincter m. (continence)
** only 2,3,4 are connected to perineal body.
all are striated.
284
contents of Ichio-Rectal fossa?
fatty connective tissue
| pudendal [alckok's] canal.
285
what is the opening between the 2 labia minora?
vaginal vestibule
286
what is the space between the 2 labia majora?
pudendal space.
287
what comprises the deep perineal space?
2 options:
a. urogenital diaphragm + ischio-rectal space
b. space of urogenital diaphragm. (superior and inferior fascia.)
288
what includes the superficial perineal space?
1. crura of clitoris + ischio-cavernosus m.
2. bulb of vestibule+ bulbo-spongiosus m.
3. vagina+urethra
the space is between the superficial perineal fascia and the deep perineal fascia.
289
what are the minor vestibular glands?
1. para-urethral glands (minor) [SKENE glands]
-->lubricate the mucose of vagina.
290
what is the name of the muscle which is on the lateral wall of the pelvic floor?
obturator internus m.
uppper part points at the pelvic cavity,
lower part points at the perineum.
291
pudendal nerve belongs to which nerve plexus?
pudendo-hemorrhoidal nerve plexus.
292
which muscles insert in the Ano-coccygeal ligament?
1. ilio-coccygeal m.
2. pubo-rectal m.
3. pubo-coccygeal m.
293
what is the main muscle of the urogenital diaphragm?
deep transverse perineal m.
294
what is the insertion of the bulbo-spongiosus m. ?
perineal body\central tendon.
*like most of the superficial perineal m., except ischiocavernosus.
295
what is the floor of the posterior part of the ischiorectal fossa?
skin of the perineum.
296
what is the floor of the anterior part of the ischiorectal fossa?
urogenital diaphragm.
297
what is the lateral wall of the anterior part of ischio-rectal fossa?
lower part of obturator internus m.
298
what is the roof of the ischio-rectal fossa?
```
lavator ani (pelvic diaphragm)
it also forms the medial wall.
```
299
which canal passes through the ischio-rectal fossa,
| and on which wall?
pudendal [alckok's] canal
on the lateral wall.
300
structures of the pudendal canal?
internal pudendal a+v.
| pudendal n.
301
where is the opening of the bulbo-urethral [cowper's] gland?
in the penile part of the male urethra. [spongy]
302
what comprises the spaces of the lesser pelvis?
- loose connective tissue spaces
| - dense connective tissue spaces
303
what are the loose connective tissue spaces?
| + contents.
1. retropubic/prevesical [RETZIUS]
- -> vesical plexuses [f] OR vesicoprostatic plexus [m]
2. para-rectal space
- -> autonomic plexus (of inferior hypogastric)
304
what are the dense connective tissue spaces?
1. paracolpium (vagina)
2. paracysticum (bladder)
3. parametrium (uterus)
4. paraproctium (lower rectum)
305
what are the 2 main divisions of the internal iliac a. ?
visceral branches {for organs of lesser pelvis}
| parietal branches {pelvic floor}
306
what are the Visceral branches of the internal iliac a. ?
1. umbilical artery a.
2. inferior vesical branches (in man-also prostate)
3. [f]=uterine artery>(vaginal,helicin,ovarian+tubal,ureteric)
[m] = defferential [m]
4. middle rectal a.
5.internal pudendal a.
307
what are the side branches of the internal pudendal artery
1. inferior rectal a.
2. perineal.
3. posterior labial \ posterior scrotal
4. artery of bulb of vestibule \ bulb of penis.-->urethral a.
5. deep artery of clitoris \ deep a. of penis
6. dorsal a. of clitoris \ penis.
308
what are the parietal branches of the internal iliac a. ?
1. ilio-lumbar a.
- ->dorsal branches
- ->spinal branches
- ->iliac branches
* *iliacus m.
2. lateral sacral artery.
- ->spinal branches
3. superior gluteal a.
- >superficial branches for gluteus maximus m.
- >deep branches for gluteu med+min, tensor f. lata
4. obturator a.
- >pubic branch**
- >acetabular branch
5. inferior gluteal artery.
309
what are the branches of the external iliac artery?
1. deep circumflex iliac a.
2. inferior epigastric a.
- >obturator branch**
- >pubic branch
3. a. of round ligament of uterus \ cremasteric a.
310
what is the corona mortis?
it is anastamoses between obturator br. of inferior epigastric AND pubic br. of obturator a.
behind inguinal canal.
311
where does the tendon of obturator internus m. exits from?
lesser sciatic foramen.
312
what exits through the greater sciatic foramen?
piriformis m.
313
which muscle arises from the obturator fascia?
ilio-coccygeus.
314
describe the course of the round ligament of uterus.
starts from the uterus
enters the deep inguinal ring
travels through the inguinal canal
leaves through the superficial inguinal ring
reaches the labia majora. (homologus to scrotum)
315
the superior vesicle artery is a branch of which artery?
umbilical a.
316
the obliterated portion of the umbilical a. is found on which fold?
medial umbilical fold.
317
what is the difference between the male and the female related to the bladder and the urogenital diaphragm?
in females the bladder sit directly on the diaphragam, while in the male there is the prostate between them.
318
what is buldging into the vagina?
posterior vaginal fonix (where the cervix of uterus is fitting).
319
what is the shape of the cervical canal?
spindle shape.
320
what can we find in the junction between the body and the cervix of the uterus?
the isthmus.
321
at what level is the uterine a. arrive to the uterus?
at the level of the isthmus
| .
322
what can we see on the lateral sides of the uterus?
| in the mesosalpynx?
anastomosis between the ascending branch (tubal branches) of the uterine a. + tubal branches of the ovarian a.
323
what is the inferior margin of the broad ligament?
the cardinal lig. (also called the transverse lig. )
324
which ligaments hold the ovaries?
1. suspensory lig.
| 2. proper ovarian lig.
325
in which ligament we can find the uterine vessels?
in the cardinal lig. (also called the transverse lig. )
326
which ligaments make up the broad lig.?
the mesosalpynx + the mesometrium.
327
what is the Farre's line?
the transition between the mesovary and the cuboidal epithelial lining of the ovary (white line)
328
what is the continuation of the proper ovary lig.?
round ligament of the uterus.
329
what is the homologues of the scrutom?
the labia majoria.
330
what is the pararmetrium?
the loose connective tissue space between the two layers of the mesometrium.
331
what covers the obturator muscle?
obturator fascia.
332
which muscles make up the pelvic diaphragm?
* lavetor ani:
1. puborectalis m
2. pubococcygeous m.
3. iliococcygeous m.
*ischiococcygeaous m.
333
which openings can we find in the pelvic diaphragm?
1. urogenital hiatus
| 2. anal hiatus
334
which diaphragm is more superficial?
the urogenital diaphragm.
335
what makes up the perineum?
urogenital trigone + anal trigone.
336
which muscles make up the urogenital diaphragm?
1. deep transverse perineal m.
2. superficial transverse perineal m.
3. bulbospongiousum m.
4. ischiocavarnosus m.
337
which openings can we find in the urogenital diaphragm?
in male- only one for urethra, while in female- two opening for urethra and vagina
338
what are the borders of the ischiorectal fossa?
medial- levator ani m. !
lateral - obturator internus
inferior- deep transverse perineal m.
339
where does the round ligament of the uterus terminates?
in the labia majora.
340
what can be found anterior and posterior to the anal region?
anterior- the perineal body.
| posterior- anococcygeal lig.
341
what is the perineal membrane? and what is its significance?
the inferior fascia of the urogenital diaphragm.
| It isolate the superficial perineal space and the deep perineal space.
342
what is the gubernaculum in female?
round ligament of uterus
| proper ovarian lig.
343
what is the bulb of vestibule?
this is the beginning of the corpus spongiosum of the clitoris.
344
what is homologus to the bulbourethral gland (Cowper) in female?
Greater vestibular glands of Bartolin.
345
what is innervated by the puodendal nerve?
all the pelvic floor.
346
what divide the two subphrenic spaces?
the falciform ligament.
347
which are "secondary intraperitoneal" organs?
testicles + epididimis.
348
which is the only organ that found in the intra peritoneal space?
the ovary
