anatomy Flashcards
(136 cards)
1
Q
gonadal - venous drainage
A
Left ovary/testis –> left gonadal vein –> left renal vein
–> IVC
Right ovary/testes –> right gonadal vein –> IVC
2
Q
left vs right gonadal vein
A
Left –> left renal –> IVC
right –> IVC
3
Q
gonadal vein - female vs male
A
female –> ovarian vein
male –> testicular vein (or spermatic vein)
4
Q
clinical significance of speramatic vein
A
Because left spermatic vein enters the left renal vein at 90 degrees, flow flow is less laminar on left than right
–> more pressure on left vein –> varicocelle more common in left
5
Q
varicocelle is more common in left or right side
A
left
6
Q
Cervical, hilar, Mediastinal, Axillary lymph node cluster drains … (area)
A
cervical –> head and neck
hilar –> lungs
mediastinal –> Trachea and esophagus
axiallary –> Upper limb, breast, skin above umbilicus
7
Q
Celiac lymph node cluster drains … (area)
A
liver, stomach, spleen, pancreas, upper duodenum
8
Q
Superior mesenteric lymph node cluster drains … (area)
A
lower duodenum, jejunum, ilieum, colon to splenic fructure
9
Q
Inferior mesenteric lymph node cluster drains … (area)
A
colon from splenic flexure to upper rectum
10
Q
Para-aortic lymph node cluster drains … (area)
A
- Testes
- ovaries
- kidneys
- uterus
11
Q
internal iliac nodes drain
A
- lower rectum to anal canal (above the line)
- cervix
- corpus carvenosum
- vagina (middle third)
- prostate
12
Q
superficial inguinal drain
A
- anal canal (below the line)
- skin below umbilicus (except popliteal area)
- scrotum
- vulva
- vagina (lower third)
13
Q
deep inguinal nodes
A
glans penis
14
Q
external iliac nodes
A
- body of uterus
- cervix (and upper third of vagina)
- superior bladder
15
Q
cervix lymph drainage
A
external and internal iliac nodes
16
Q
uterus lymph drainage
A
Para-aortic external iliac (body)
17
Q
lymph drainage - uterus, cervix, vagina
A
para-aortic uterus –> uterus
external iliac –> body of uterus, cervix, upper third vagina
internal iliac –> cervix, middle third vagina
superficial inguinal –> lower third vagina
18
Q
Lymphatic drainage of the vagina is generally to the
A
external iliac nodes (upper third of the vagina), internal iliac nodes (middle third), and the superficial inguinal nodes (lower third).
19
Q
Fenale reproductive system - ligaments
A
- infundibulopelvic ligament (suspensory ligament of the ovary)
- Cardinal ligament
- Round ligament of uterus
- Broad ligament
- Ovarian ligament
- uterosacral
20
Q
Fenale reproductive system - ligaments an what they connect
A
- infundibulopelvic (suspensory ligament of the ovary) –> ovaries to lateral pelvic
- Cardinal –> cervix to side wall of pelvis
- Round ligament of uterus –> uterine fundus to labia major
- Broad –> uterus, fallopianm tuves and ovaries to pelvic side wall
- Ovarian –> madian pole of ovary to lateral uterus
- uterosacral –> uterus to the anterior aspect of the sacrum
21
Q
infundibulopelvic ligament is AKA
A
suspensory ligament of the ovary
22
Q
infundibulopelvic (suspensory ligament of the ovary) connects
A
ovaries to lateral pelvic
23
Q
infundibulopelvic (suspensory ligament of the ovary) contains
A
ovarian vessels
24
Q
cardinal ligament connects
A
cervix to side wall of pelvis
25
cardinal ligament contains
uterine vessels
26
Round ligament of the uterus connects
uterine fundus to labia majora
27
Round ligament of the uterus contains
nothing
28
Broad ligament connects
uterine, fallopian tubes and ovaries to pelvic side wall
29
Broad ligament contains
ovaries, fallopian tuves, round ligaments of uterus
30
uterosacral ligament connects
uterus to the anterior aspect of the sacrum
31
ovarian ligament connects
medial pole of ovary to lateral uterus
32
ovarian ligament contains
nothing
33
Derivatives of gubernaculum in females
1. ovarian ligament
| 2. round ligament of the uterus
34
course of round ligmament of the uterus
travels along inguinal canal, in the broad ligament, above the artery of Sampson
35
Sampson artery
- runs under the round ligament of uterus.
| - is anastomosis of the uterine artery and ovarian artery
36
Broad ligament - structure
Fold of peritoneum that comprises the
1. mesosalpinx
2. mesometrium
3. mesovarium (suspends the ovaries)
37
ureter course in females
retroperotoneally, close to gonadal vessels (risk at injury during ligation of ovarian vessels) and under uterine artery)
(risk at injury during ligation of ovarian or uterine vessels)
38
an operation with uterine vessels ligation
hysterectomy
39
clinical correlation of infundibulopelvic ligament
1. very close to ureter --> risk of injury during ligation
| 2. ligate vessels during oophorectomy to avoid bleeding
40
vagina histology
stratified squamous epithelium, nonkeratinized
41
ectocervix histology
stratified squamous epithelium, nonkeratinized
42
transformation zone (female reproductive) histology
Squamocolumnar junction (ectocervic-endocervix)
43
endocervix histology
simple columnar epithelium
44
uterus histology
simple columnar epithelium with long tubular glands in proliferative phase
coiled glands in secretory phase
45
fallopian tube histology
simple columnar epithelium, ciliated
46
ovary, outer surface histology
simple cuboidal epithelium (germinal epithelium covering surface of ovary
47
uterus walls
inside --> endometrium
middle --> myometrium
outside --> Perimetrium
48
perimetrium?
Serous layer of visceral peritonium. It covers the outer surface of the uterus
49
ovarian artery arises from
abdominal aorta (above L2)
50
uterine artery arises from
anterior division of the internal iliac artery
51
ovarian and uterine anastomosis
Sampson artery
52
portions of cervix
1. endocervix
2. transitional zone
3. ectocervix
53
cervical os?
1. external os: the external opening into the vagina
| 2. internal os: theinternal opening into the endometrial cavity
54
Vaginal fornix (fornices of the vagina)
superior portions of the vagina, extending into the recesses created by the vaginal portion of cervix
1. posterior - behind the cervix (largest)
2. anterior
3. twο lateral
55
infundibulopelic - course according to Fallopian tube
it goes under
56
regions of Fallopian tube (from inner to outer)
uterine --> isthmus --> ampula --> infundibulum --> Fimbriae (ostium)
57
parts of male urethra (and direction)
(AFTER bladder and bladder neck) preprostatic urethra --> prostatic --> membranous urethra (through pelvic floor) --> spongy (penile) within the bulb and corpus sponsgiosum
58
spongy (penile urethra) is sometimes further divided to
bulbar and penile urethra
59
suspect urethreal injury in males if
blood seen at urethral meatus
60
male urethral injury - division according to location
posterior urethra - membranous
| anterior urethra - bulbar and penile urethra
61
posterior urethra (membranous) trauma
prone to injury from pelvic fracture --> injury can cause urine to leak into retropubic space
62
Retropubic space is the
extraperitoneal space between the pubic symphysis and urinary bladder
63
anterior urethra bulbar and penile trauma
at risk of damage due to perineal straddle injury --> urine leak beneath deep fascia of Buck --> if fascia is torn, urine escapes into superficial perineal space
64
straddle injury
perineal trauma
65
Buck's fascia?
or fascia of the penis --> is a layer of deep fascia covering the three erectile bodies of the penis
66
Pathway of sperm during ejaculation
mnemonic: SEVEN UP
Seminiferous tubules --> Epidedidymis --> Vas deferens
--> Ejaculation ducts --> urethra --> penis
67
histology of testis and epdidemis
seminiferous tubules (Leyding cells between them, separated by septa) and covered by tunica albuginea --> concentrate in Rete testis --> head of epididymis (efferent ductule) --> tale of epididymis --> vas deferens
68
Prepuce?
- Clitoral hood, skin surrounding and protecting the head of the clitoris
- Foreskin, skin surrounding and protecting the head of the penis in humans
69
Corpus cavernosum vs corpus spongiosum
| according to anatomy
corpus spongiosum --> mass of spongy tissue surrounding the male urethra within the penis (ventral)
Corpus cavernosum --> 2 sponge like regions on erectile tissue of penis (dorsal)
70
erection is control by
parasympathetic nervous system (pelvic nerve)
71
erection mechanism
NO --> increased cGMP --> SMCs relaxation --> vasodilation -> proerectile
72
norepinephrine in erection
norepinephrine increases Ca2+ concentration in in SMCs --> vasoconstriction --> antierectile
73
emission definition/controled by
phase when sperm moves from testes upto prostatic urethra. It is controlled by sympathetic nervous systme (hypogastric nerve)
74
ejaculation definition/controled by
phase when sperm moves from prostatic urethra to the outside. It is controlled by visceral and somatic nerves (The pudendal nerve)
75
emission vs ejaculation according to definition
emission --> phase when sperm moves from testes upto prostatic urethra
ejaculation --> phase when sperm moves from prostatic urethra to the outside
76
Seminiferous tubules - cells
1. spermatogonia (germ cells)
2. sertoli cells (non germ cells)
3. Leyding cells (endocrine cells)
77
Seminiferous tubules - cells/location
1. spermatogonia (germ cells) --> line seminiferous tubules
2. sertoli cells (non germ cells) --> line seminiferous tubules
3. Leyding cells (endocrine cells) --> intersitium (outside the tubule)
78
spermatogonia (germ cells) - function
maintain germ pool and produce primary spermatocytes
79
spermatogonia to sprmatozoon (only the cells)
spermatogonium --> sprmatocytes (1ry and 2ry) --> speramtides --> spermatozoon (spermatozoon in the lumen of seminiferous tubule) (SPERMATOGENESIS)
80
sertoli cells (non-germ cells) - location
line of seminiferous tubules
81
sertoli cells (non-germ cells) - action
1. secrete inhibin B (inhibits FSH)
2. secrete androgen-binding protein (maintain local levels of testosterone --> stimulate spermatogenesis)
3. produce MIF (suppress development of paramesonephric ducts)
4. form the blood-testis barrier --> isolate gametes from autoimmune attack
5. sapport and nourish developing spermatozoa
6. Regulate spermatogenesis
7. convert testosterone and androstenedione to estrogens via aromatase
82
sertoli cells (non-germ cells) are sensitive to
temperature
83
sertoli cells (non-germ cells) are sensitive to ... (explain)
temperature:
| increased Q --> low sperm production and low inhibin B
84
situations that increases temperature in seminiferous tubules
1. Varicocele
| 2. crytorchidism
85
Blood-testis barrier - structure and function
structure: tight junction between Sertoli cells
function: a. isolates gametes from autoimmune attack
b. prevent cytotoxic agents
86
sertoli cells - homolog of female
granulosa cells
87
Leyding cells (endocrine cells) - function
secrete testosterone in the presence of LH
88
Leyding cells (endocrine cells) vs temperature
testosterone production unaffected by temperature
89
Leyding cells - area
interstitium of Seminiferous tubules
90
Leyding cells - homolg of female
theca interna cells
91
which ligaments of the female reproductive system contain nothing
the derivatives of gubernaculum
1. Round ligaments of the uterus
2. ovarian ligament
92
which ligaments of the female reproductive system contain tha major vessels of the area
1. infundibulopelvic ligament --> ovarian vesses
| 2. cardinal vessels --> uterine vessels
93
Female reproductive epithelial histology - MC area of cervical cancer
transformation zone
94
breast - suspensory ligaments - aka and course
aka: Cooper
course: separate the the lobes + attach the skin
95
breast - arterial supply
branches of:
1. internal thoracic (sublavian)
2. lateral thoracic (axillary)
3. anterior + posterior intercoastal
96
breast - lymph nodes
1. most: axillary
| 2. part of medial quadrants: parasternal
97
radial mastectomy?
breast is removed along with pectoralis major and minor, axillary nodes and vessels, and tributaries of axillary vein
98
SA node location
in the sinus venarum of the RA near the entrance of the SVC
99
AV node location
interatrial septum - RA near TV and the orifice of coronary sinus
100
inf epigastric artery - course
branch of ext iliac immediately proximal to inguinal ligament --> supply to lower anterior abdominal wall as it rans superiorlu + and medially up to abdomen
101
superior gluteal artery - course
the continuation of internal iliac artery --> post/inf to supply gluterus and a portion of hip
102
obturator artery - course
branch of internal iliac --> inf to supply pelvic organs
103
ext iliac artery branches
1. inf epigastric
| 2. deep circumflex iliac
104
great saphenous course
medial side of food --> anterior to medial malleolus --> medial aspect of leg + tight --> drains into demoral in the femoral tirangle (inferolateral to pupitubercle)
105
small saphenous vein course
lateral foot --> posteriorly --> into popliteal vein
106
perineal body?
central tendon of the perineum --> lies in the midline between urogenital + anal triangle
the following structures are anchored to it:
1. bulbospongiosus muscle
2. external anal sphincter
3. superficial + deep transverse perinal muscle
4. fibers from external urethral sphincter, levator ani + muscular coat of rectum
107
hip bone is consists by
3 bones: ilium, ischium, pubis
108
pelvis diaphragm weakness -->
prolapse of uteros, bladder or rectum into vagina
109
vesicouterine vs rectovesical pouch
females --> peritoneum onto anterior aspect of uterus (between uterus + bladder) --> vesicouterine pouch
males --> peritoneum onto anterior aspect of the rectum (between rectum + uterus --> rectovesical pouch
110
position of uterus
50% --> anterverted
25% retroverted
25% midverted
due to uterosacral ligament --> loss of the ligament --> prolapse into vagina
111
fructose rich compoment of sperm, and area
| area of Bulbourethral gland of Cowper
```
seminal vesicle (posteriolateral of bladder)
seminal vesicle in ductus deferans (behind bladder) --> ejaculation duct
cowper: junction between membranous + boublous urethra
```
112
The recto-uterine pouch( pouch of Douglas)?
extension of the peritoneal cavity between the rectum and the posterior wall of the uterus in the female human body
113
epistomy - definition + types
it is an incision of the posterior wall of the vagina during labor:
1. medline: extend posteriorly in the midline throught perineal body (vertical)
2. mediolateral: extend througth the bulbospongiosus + transcerus perineus muscle (less risk of damage fibers of external anal sphincter)
114
urogenital dipahragm is transverse by / contains
urethra in both sexes + by vagina
| contains deep transversus perineus muscles + sphincter urethrae (external sphincter)
115
branches of internal iliac artery
1. pelvic visceral branches: umbilical ar, uterine ar, ductus deferens, vaginal art, inferior vesical ar, middle rectal ar
2. perineal branches: internal pubendal --> inf rectal, perineal branch, artery to bulb, deep ar of penis, dorsal ar of penis
3. pelvic wall branches --> iliolumbar, lateral sacral
4. lower limb branches --> superior glut, inf glut, oburator ar
116
pudendal nerve - branches
3 main branches --> inf rectal, perineal nerve, dorsal nerve of penis + clitoris
117
unresponsive to medical management postpartum hemorrhage -->
bilateral ligation of the internal iliax artery (aka as hypogasric artery)
the uterus has collateral blood flow (from ovarian art) --> sufficient to maintain uterine function
118
internal pupendal artery course
branch of anterior trunck of internal iliac --> runs througth the schiatic foramina --> supply the perineum
119
main risk of ovarian torsion
large ovarian mass
120
pampiform plexus
receive venous blood from testis, epididymis, ductus deferans --> drains into testicular veins
121
pelvic innervation
1. pudendal (S2-4) --> sensory: perineum, motor: urethral+anal sphincter
2. Lateral femoral cutaneous (L2-3) --> sensroy: anter + lateral tight (injury during hyperflexion of the thighs for pelvic surgery or vaginal delivery
3. inferior gluteal
4. Genitofemoral (L1-2) --> sensory: scrotum/labia majora, medial thigh (anterior to psoas, injury during laparotomy), motor to parts of genitalia (eg. cremasteric reflex)
5. Obturator
6. Iliohypogastric (T12-L1) --> sensory hypogastric (injury due to Pfnannestiel skin incisions, like cesarean, appendidectomy), motor to anterolateral abdom walls
7. ilioinguinal (L1) --> sensory from skin of the upper + medial thigh, the root of penis + upper scrotal, labia major
122
pupendal nerve - landamark
ischial spine + sacrospinous ligament
| (other important structures: internal pupendal ar + inf gluteal ar - run medial to nerve
123
prostatic plexus - lies ... / origin /
- lies within the fascia of prostate
- origin: inferior hypogastric plexus
- gives rise to lesser + greater carvenous nerves
risk for injury in prostatectomy --> erectile dysfunctin
124
fibrinoids of uterus may located
1. serosal surface (subserosal) --> IRREGULAR ENLARGED UTERUS --> bulk symptoms (eg. constipation)
2. within uteral wall (intramural) --> reproductive difficulties
3. below endometrium (SUBMUCOSAL) --> reproductive difficulties, bleeding
125
imperforate hymen
by incomplete degeneration of the central portion of fibrous tissue band connecting the wall vagina --> priamary amenorrhea, normal secondary sexal, cyclic pelvic pain due to accumulation of blood in vagina + uterus (hematocopos), palbable mass anterior to rectum, difficulties in defecation
126
endometriosis in pouch of douglas
painful defecation, dyspareunia, plpable nodularity on rectpvaginal examination
127
main target of kegel exercise
levator ani:
1. iliococcygeus
2. pubococcygeus
3. puborectalis
128
levator ani injury -->
1. urethral hypermobility
| 2. pelvic organ prolapse
129
gonadal arteries course
right travels in front of IVC + behind ileum + left ar behind left colic + sigmoid art + iliac colon --> cross anteror the ureter --> paraller the external iliac vessels --> inguinal canal --> testes
130
prostate location
| types of obstruction in BPH
between pubic symphisis + + anal canal
1. static obstriction (androgen-mediated)
2. dynamic obstriction (α adrenoreceptor mediated)
131
penile venous outflow anomalies
eg. leakflow of vein --> erectile dysfunction
132
vasectomy?
remove of ductures deferens (vas deferens) --> birth control
133
lymphatic system of lower extremities
1. superficial lymphatic vessels (follow venous system)
2. deep lymphatic vessels (follow arterial system)
the superficial lymphatic system is also divided to medial + lateral
medial bypass the popliteal nodes (like saphenus) --> inguinal area
lateral do not bypass --> popliteal AND inguinal area
134
bladder lymph drainage
superior: external iliac
inferior: internal iliac
135
arcuate line?
horizontal line below the umbilicus that demarcates the lower limit of the posterior rectus sheath. Above that, the rectus abdominis is sourounded by anterior + posterior sheath. Below only by anterior sheath
136
inscision in cesarea delivery
1. midline vertical sepration of the rectus abdominis muscle
2. when additionally space necessary --> horizontal transection of the rectus abdominis --> risk for inferior epigastric arteries
