Anatomy Exam 3 Flashcards
(117 cards)
1
Q
kidneys
A
- retroperitoneally on posterior abd wall at T12-L3 lvl
- regulate blood volume and osmolarity
- produce hormones (renin, erythropoietin, calcitriol)
2
Q
suprarenal/adrenal glands
A
- superomedial on kidneys
- part of endocrine system = secrete corticosteroids & androgens; make epinephrine & norepinephrine
3
Q
structure of outside of kidneys
A
- R lower than L due to liver placement
- lateral margins (convex)
- medial margins (concave) = renal sinus, renal pelvis and renal hilum
- — anterior - renal vein, renal artery, renal pelvis - posterior
4
Q
flow of urine thru the body
A
renal papilla → minor calyx → major calyx → renal pelvis → ureter → bladder
5
Q
ureters
A
- retroperitoneal muscular tubes with narrow lumina
- route = run inferiorly from kidneys → passes over pelvic brim at bifurcation of common iliac arteries → run postero-inferiorly on lateral walls of pelvis → curve anteromedially, superior to levator ani, to enter bladder
- urine transported down by peristaltic contractions
- in males, only structure that passes between ureter & peritoneum is ductus deferens
- in females, ureter passes medial to origin of uterine artery & continues to lvl of ischial spine
6
Q
sites of ureters constriction (kidney stones)
A
- junction of ureters & renal pelvis
- where ureters cross brim of pelvic inlet
- passage thru wall of urinary bladder
7
Q
bladder
A
- hollow sac with strong detrusor muscule walls on pelvic cavity floor
- parts of it = apex, body, fundus & neck
- when empty → in lesser pelvis & has tetrahedral shape
- as it fills → ascends superiorly into intraperitoneal fatty tissue of anteiror abd wall & into greater pelvis
- trigone = triangle area on bladder floor formed by opening of two ureters & urethra
- neck of male bladder = continuous w/ fibromuscular tissue of prostate; form involuntary internal urethral sphincter which contracts during ejaculation to prevent retrograde ejaculation of semen into bladder
- neck of female bladder = continuous with wall of urethra
ureteric orifices & internal urethral orifice are wrapped with detrustor muscle to tighten when bladder contracts to avoid urine reflux into ureters
8
Q
urethra
A
- conveys urine from bladder to outside
- female urethra (3-4cm) «< male urethra (~18cm) so females are at greater risk of UTIs
9
Q
male urethra regions
A
- prostatic urethra (closes off if prostate enlarged - difficulty voiding)
- membranous urethra
- penile urethra
10
Q
diuretics
A
- increase urine volume
- treat hypertension & CHF b/c reduces overall fluid volume
- increase GF (caffeine) or decrease tubular absorption (alcohol - suppress release of ADH)
11
Q
kidney blood supply
A
- renal artery (IVD L1 & L2) divides into 5 segmental arteries & distributes to kidney segments
- renal veins (anterior to renal arteries) drain into IVC
12
Q
ureters blood supply
A
- abd part arteries = renal, testicular/ovarian & abd aorta arteries
- pelvic part arteries = branches of common & internal iliac arteries
- – females → uterine artery branches
- – males → inferior vesical arteries
- veins drain into renal & testicular/ovarian veins for abd part
13
Q
suprarenal/adrenal blood supply
A
arteries
- superior suprarenal arteries (from inferior phrenic artery)
- middle suprarenal arteries (from abd aorta)
- inferior suprarenal arteries (from renal artery)
veins
- R suprarenal vein → IVC
- L suprarenal vein + inferior phrenic vein → L renal vein
14
Q
renal lymph drainage
A
renal lymphatic vessels follow renal veins and drain into lumbar lymph nodes
- superior part → + vessels from kidneys or pass directly to lumbar nodes
- middle part → common iliac lymph nodes
- inferior part → common, external or internal iliac lymph nodes
15
Q
kidney nerve innervation
A
- renal nerve plexus (fibers of abd splanchnic nerves)
- — sympathetic & visceral afferent (pain sensations) fibers
16
Q
ureters nerve innervation
A
- renal nerve plexus + abd aortic & superior hypogastric plexuses (for abd part of ureters)
17
Q
suprarenal/adrenal glands nerve innervation
A
- celiac plexus & abdominopelvic (greater, lesser & least) splanchnic nerves
18
Q
pelvic cavity
A
continuation of abd cavity into pelvis through pelvic inlet
19
Q
perineum
A
shallow compartment, deep to perineal region and inferior to pelvic diaphragm
20
Q
peritoneum
A
lining of abd cavity that continues into pelvic cavity
21
Q
perineal region
A
area of trunk between thighs and buttocks, from pubis to coccyx
22
Q
pelvic inlet
A
- bounded by linea terminalis of pelvis
- formed by;
- – arcuate line of ilium
- – anterior border of ala of sacrum
- – sacral promontory
23
Q
pelvic outlet
A
- bounded by:
- – anteriorly = inferior margin of pubic symphysis
- – anterolaterally = inferior rami of pubis & ischial tuberosities
- – posterolateral = sacrotuberous ligaments
- – posteriorly = tip of coccyx
24
Q
pelvic girdle
A
- bones surrounding pelvic cavity that connect vertebral column to femurs
- – R & L hip bones (fusion of ilium, ischium & pubis)
- – sacrum (fusion of 5 sacral vertebrae)
- function = transfer weight from axial to lower appendicular skeleton; withstand compression and forces; hold & protect pelvic viscera
25
greater/false pelvis
- broader
- superior to pelvic inlet
- bounded by abd wall anteriorly, ala of ilum laterally and L5 & S1 vertebrae posteriorly
- location of some abd viscera (sigmoid colon & ileum)
26
lesser/true pelvis
- narrower
- b/w pelvic inlet & outlet
- location of pelvic viscera (bladder & repro organs)
- bounded by pelvic surfaces of hip bones, sacrum & coccyx
- limited inferiorly by musculomembranous pelvic diaphragm (levator ani)
27
sacro-iliac (SI) joints
- strong, weight-bearing synovial joint (but limited mobility) b/w sacrum & ilium
- anterior SI ligaments = fibrous capsule
- interosseous SI ligaments = transfer weight to ilia and then femur and ischial tuberosities
- posterior SI ligaments = posterior external continuation of interossesous ones
- sacrospinous & sacrotuberous ligaments = limited upward movement of inferior sacrum
28
pubic symphysis
- interpubic/fibrocartilaginous disc b/w 2 pubic bones
| - superior pubic ligament & inferior pubic ligament = connect 2 pubic bones to each other
29
lumbosacral joints
- IV joints
- Z joints
- iliolumbar ligaments = connect transverse processes of L5 to ilia
30
sacrococcygeal joints
- anterior & posterior sacrococcygeal ligaments = reinforce joint
31
antero-inferior pelvic wall
- formed by bodies & rami of pubic bones & pubic symphysis
| - helps bear weight of urinary bladder
32
2 lateral pelvic wall
- formed by hip bones, including obturator foramen
- covered & padded by obturator internus muscles
- contain obturator nerves & vessels & other branches of internal iliac vessels
33
posterior pelvic wall
- wall & roof in midline (sacrum & coccyx) and musculoligamentous posterolateral walls (SI joints & ligaments and piriformis muscles)
- -- each piriformis muscle leaves lesser pelvis thru greater sciatic foramen (sacrospinous & sacrotuberous ligaments) to attach to femur
- site of nerves forming sacral plexus
34
pelvic diaphragm
- bowl- or funnel-shaped
- within lesser pelvis
- consists of coccygeus & levator ani muscles + fascias covering these muscles
- separates pelvic cavity from perineum for which it forms the roof
35
coccygeaus
- small part of pelvic diaphragm
| - supports pelvic & flexes coccyx
36
levator ani
- forms most of pelvic diaphragm
- helps support pelvic viscera & resists increases in intra-abd pressure
- consists of iliococcygeus, pubococcygeus & puborectalis muscles
- tonically contracted most of time to support abdominopelvic viscera
- actively contracted during activities such as forced expiration, coughing, sneezing, vomiting, and when lifting heavy objects to increase support of the viscera during increased intra-abd pressure & to contribute to the increased pressure (to aid expulsion)
37
puborectalis
- assists in urinary & fecal continence
- penetrated centrally by anal canal of which puborectalis forms a sling for defecation control
- active contraction of the (voluntary) puborectalis portion is important in maintaining fecal continence immediately after rectal filling or during peristalsis when the rectum is full and the involuntary sphincter muscle is inhibited (relaxed)
38
pelvic fascia
connective tissue between membranous peritoneum and muscular pelvic walls & floor not occupied by pelvic organs
- parietal pelvic fascia = membranous layer that lines the internal part of muscles forming walls & floor of pelvis
- visceral pelvic fascia = membranous fascia directly covering pelvic organs
- both become continuous where organs penetrate the pelvic floor
- endopelvic fascia = connective tissue between & continuous with parietal and visceral membranous layers
39
pelvic floor injury during childbirth
- perineum, levator ani and pelvic fascia may be injured
- most commonly torn muscles = pubococcygeus (second is puborectalis)
- weakening or tearing of levator ani → incontinence issues or visceral prolapse
40
episiotomies
a surgical incision of perineum and inferoposterior vaginal wall to enlarge the vaginal orifice
- done to avoid damage to levator ani muscles
- mediolateral incisions >>> median incision
41
median incision
- scar produced would be similar to fibrous tissue surrounding it & tearing would be minimal
- if tearing occurred, it would extend toward anus → fistulas or sphincter damage would result
42
mediolateral incision
- circumvents perineal body & directs tearing away from anus
43
autonomic nerves enter pelvic cavity via:
1) sacral sympathetics = sympathetic innervation to lower limbs
2) periarterial plexuses (sympathetic) = postsynaptic, sympathetic, vasomotor fibers to superior rectal, ovarian & internal iliac arteries
3) hypogastric plexuses (mixed) = VI route that sympathetic fibers are conveyed to pelvic viscera
4) pelvic splanchnics (parasympathetic) = parasympathetic innervation of pelvic viscera, descending and sigmoid colon
44
sciatic nerve
- largest nerve in body
- origin = anterior rami of spinal nerves L4-S3
- passes thru greater sciatic foramen inferior to piriformis to enter gluteal region
- supplies = hip joint (via articular branches) and flexors of knee (hamstrings) and all muscles in leg & foot (via muscular branches)
- composed of tibial and common fibular nerves
45
pudendal nerve
- supplies = skin, organs and muscles of perineum
| - micturition, defecation, erection, ejaculation and parurition
46
sacral plexus branches
- sciatic nerve (L4-S3) = tibial (L4-S3) & common fibular (L4-S2)
- superior gluteal (L4-S1) - gluteus medius and minimus and tensor fasciae latae
- inferior gluteal (L5-S2) - gluteus maximus
- posterior femoral cutanoues (S1-S3) - skin of butt, posterior thigh, calf and heel
- pudendal - skin and muscles of perineum
47
main arteries coming off abd aorta
abd aorta → R & L common iliac arteries → at lvl of IVD b/w L5 & S1 vertebrae, external & internal iliac arteries (ureter crosses common iliac artery near this bifurcation)
48
internal iliac arteries
- supplies = pelvic viscera and some musculoskeletal part of plevis; gluteal region, medial thigh regions & perineum
- anterior (mostly visceral) = obturator, umbilical artery, uterine artery, internal pudendal artery, middle rectal artery, inferior gluteal artery, vaginal/inferior vesical artery
- posterior (distributed outside lesser pelvis) = iliolumbar artery, lateral sacral artery, superior gluteal artery
- -- iliolumbar artery = structures in iliac fossa (greater pelvis)
49
branches unique to males only
- inferior vesical artery (= vaginal artery)
| - prostatic branch of inferior vesical artery
50
branches unique to females only
- uterine artery
| - vaginal artery
51
umbilical artery
- before birth, continuation of internal iliac artery (passing along lateral pelvic wall & then ascending anterior abd wall to & thru umbilical ring into umbilical cord)
- prenatally, conduct O2 & nutrient-deficient blood to placenta for replenishment
- when cut, distal parts no longer function & become occluded distal to branches that pass to bladder
52
obturator artery
- origin is variable but usually arise close to origin of umbilical artery where it is crossed by ureter
- passes b/w obturator nerve & vein
- common variation (20%) - an aberrant or accessory obturator artery (OA1) arises from inferior epigastric artery (IEA) & descends into pelvis along usual route of pubic branch
- --- surgeons performing hernia repairs must keep this common variation in mind
53
rectal arteries
- origin = internal iliac artery or in common with inferior vesical artery or internal pudendal artery
- direct continuation of inferior mesenteric artery (IMA) = crosses L common iliac vessels & descends in sigmoid mesocolon to lesser pelvis
- at lvl S3 vertebrae, superior rectal artery (from IMA) divides into two branches which descend on each side of rectum & supply it as far inferiorly as internal anal sphincter
- middle rectal artery
- inferior rectal artery arises from internal pudendal artery as it passes above ischial tuberosity
54
gluteal artery
- inferior gluteal artery - larger terminal branch of anterior division of internal iliac artery
- -- passes posteriorly b/w sacral nerves (S2-S3) & leaves pelvis thru inferior part of greater sciatic foramen inferior to piriformis muscle
- superior gluteal artery - largest branch of posterior division of internal iliac artery; supplies gluteal muscles in butt
55
uterine artery
- branch of internal iliac artery in females (may also arise from umbilical artery)
- homologous to artery to ductus deferens in males
- descends on lateral wall of pelvis, anterior to internal iliac artery and passes medially to reach junction of uterus and vagina, where cervix of uterus protrudes into superior vagina
- blood flow thru uterine circulation increases during pregnancy (if persists → increased risk for pre-eclampsia)
- ascending branch supplies lateral margin of uterus
56
uterine artery and ureter relationship
- water under the bridge
- uterine artery passes directly superior to ureter
- ureter is in danger of being inadvertently clamped (crushed), ligated or transected during a hysterectomy (excision of uterus) when uterine artery is ligated and severed to remove uterus
57
vaginal artery
- homologous to inferior vesical artery in males
- origin = initial part of uterine artery
- supplies = cervix and uterus
58
ovarian branches
- from ovarian and ascending uterine arteries
| - supply = ovaries
59
tubal branches
- from ovarian and ascending uterine arteries
| - supply = uterine tubes
60
inferior vesical artery
- only in males (=vaginal artery)
- passes fundus of bladder
- supplies = seminal glands, prostate, fundus of bladder & inferior part of ureter
- also sends branches to ductus deferens (could also be from superior vesical artery)
61
ovarian/testicular artery
- origin = abd aorta inferior to renal artery but superior to inferior mescenteric artery
- adheres to parietal peritoneum & runs anterior to ureter on posterior abd wall (supplying it)
- as it enters lesser pelvis, it crosses origin of external iliac vessels
- then runs medially to branch into ovarian and tubal branches which anastomose with branches of uterine artery
62
internal pudendal artery
- larger in males
- passes infero-laterally, anteriro to piriformis muscle & sacral plexus
- leaves pelvis b/w piriformis & cocygeus muscles thru inferior part of greater sciatic foramen → posterior of ischial spine → ischioanal fossa thru lesser sciatic foramen → + internal pudendal veins & nerves, thru canal in lateral wall of ischioanal fossa → exits pudendal canal (Alcock's) medial to ischial tuberosity & divides into perineal artery & dorsal arteries of penis or clitoris
63
pelvis drained by what veins?
- internal iliac veins
- superior rectal veins
- median sacral vein
- ovarian veins (females)
- internal vertebral venous plexus
- pelvic venous plexuses formed by interjoining of veins in pelvis
- various plexuses (rectal, vesical, prostatic, uterine & vaginal) unite & drain mainly into internal iliac vein
64
lymph drainage in plevis
- inguinal lymph nodes + lymph from pelvic viscera → external iliac lymph nodes
- drainage from inferior pelvic viscera, deep perineum & gluteal region → internal iliac lymph nodes → common iliac nodes
- lymph from postero-inferior pelvic viscera → sacral lymph nodes → either to internal or common iliac nodes
- external iliac lymph nodes + internal iliac lymph nodes + sacral lymph nodes → common iliac lymph nodes
65
bladder blood supply
- arteries = branches of internal iliac arteries
- -- anterosuperior = superior vesical arteries
- -- fundus & neck = inferior vesical arteries in males and vaginal arteries in females
- -- small branches = obturator and inferior gluteal arteries
- veins
- -- males = vesical venous plexus is continuous with prostatic venous plexus (covers fundus of bladder & prostate, seminal glands, ductus deferens & inferior ends of ureters)
- -- females = vesical venous plexus envelops pelvic part of urethra (neck receives from doral vein of clitoris & works with vaginal or uterovaginal venous plexus)
66
bladder nerve innervation
- sympathetic = from T11-L2/L3 lvls to vesical/pelvic plexuses via hypogastric/pelvic plexuses & nerves
- parasympathetic = pelvic splanhnic nerves and inferior hypogastric plexuses
- -- motor to detrusor muscles in bladder & inhibitory to internal sphincter of males
- -- in males,
- > stretching stimulates visceral afferent fibers causing detrusor to contract & internal sphincter, allowing urine to flow into urethra
- > sympathetic innervation that stimulates ejaculation simultaneously causes contraction of internal urethral sphincter, preventing reflux of semen into bladder
67
pelvic peritoneum
abd peritoneum extends inferiorly covering pelvic viscera & creating a series of folds or fossae
- intraperitoneal = ovaries & uterine tubes
- subperitoneal = everything else + inferior 1/3rd of rectum
- peritoneum covering bladder is not fixed to allow room for bladder filling, creating a variable supravesical fossa (depends on bladder fullness)
68
female urethra
- para-urethral glands (= prostate)
- blood supply = internal pudendal & vaginal arteries
- lymphatic vessels pass to sacral & internal iliac lymph nodes (& inguinal lymph nodes)
- innervation = vesical plexus and pudendal nerve
- visceral afferents from most of the urethra run in the pelvic splanchnic nerves, but the termination receives somatic afferents from the pudendal nerve.
69
male urethra
- blood supply
- --- intramural & prostatic parts = prostatic branches of inferior vesical & middle rectal arteries
- --- intermediate & spony parts = internal pudendal artery
- lymph drains into internal iliac lymph nodes
- nerve innervation = prostatic nerve plexus
70
intramural (preprostatic) part of male urethra
- surrounded by internal urethral sphincter
- extends vertically thru neck of bladder
- sympathetically innervated smooth muscle
- prevents semen from entering bladder during ejaculation
71
prostatic part of male urethra
- descends thru anteiror prostate in concave curve
- bound anteriorly by external urethral sphincter
- widest portion
- has seminal colliculus where urinary & reproductive tracts merge
72
intermediate (membranous) part of male urethra
- passes thru deep perineal pouch surrounded by external urethral sphincter
- most narrow
73
spongy part of male urethra
- courses thru corpus spongiosum
- initial widening in bulb of penis, widens again distally as navicular fossa
- longest & most mobile
- bulbourethral glands drain here
74
parts of the penis
- root = attached part made of perineal muscles & erectile tissue
- body = free pendulous part suspended form pubic symphysis with very little muscles
- glans (head) = sensitive bulbous structure at distal ends of penis
- corona = rounded projected boarder at circumference of base of glans
75
scrotum
a cutaneous fibromuscular sac for testes & associated structures located posteroinferior to penis & inferior to pubic symphysis
- scrotal raphe = bilateral embryonic formation of scrotum at its midline; septum of scrotum
- two layers - heavily pigmented skin and the closely related dartos fascia (fat-free-fascial layer including smooth muscle fibers/dartos muscle responsible for rugose (wrinkled) appreance)
- contraction of dartos muscle causes scrotum to wrinkle when cold, thickening integumentary layer while reducing scrotal surface area & assisting cremaster muscles in holding testes closer to body (to reduce heat loss)
76
testes (testicles)
- male gonads - paired ovoid reproductive glands that produce sperm (spermatozoa) & male hormones, primarily testosterone
- suspended in scrotum by spermatic cord with left testis usually suspended (hanging) more inferiorly than right testis
- tunica albuginea = tough fibrous outer surface that thickens into a ridge on its internal posterior aspect as mediastinum of testis
- from this internal ridge, fibrous septa extend inward between lobules of minutely coiled seminiferous tubules
- seminiferous tubules = in which sperms are produced
- seminiferous tubules are joined by straight tubules to rete testis,
- rete testis = network of canals in mediastinum of testis
77
epididymis
an elongated structure on posterior surface of testis formed by minute convolutions of duct of peididymis
- head = superior expanded part composed of lobules formed by coiled ends of 12-14 efferent ductules
- body = consists of convoluted duct of epididymis
- tail = continuous with ductus deferens
- --- duct that transports sperms from epididymis to ejaculatory duct for expulsion during ejaculation
- sperm entering caput epididymis are incomplete - lack ability to swim forward (motility) & to fertilize an egg
- during transit in epididymis, sperm undergo maturation processes necessary for them to acquire these functions
- final maturation occurs in female reproductive tract
78
ductus deferens (vas deferens)
continuation of duct of epididymis
- relatively thick muscular walls & small lumen, giving it a cord-like firmness
- penetrate anterior abd wall via inguinal canal
- crosses over external iliac vessels & enters pelvis
- passes on lateral wall of pelvis, external to parietal peritoneum
- ends by joining duct of seminal glands to form ejaculatory duct
- primary component of spermatic cord
79
seminal vesicles
- b/w fundus of bladder & rectum & placed obliquely superior to prostate
- do not store sperm
- secrete thick alkaline fluid with fructose (energy source for sperm) and a coagulating agent that mixes with sperms as they pass into ejaculatory ducts & urethra
- duct of the seminal gland joins the ductus deferens to form the ejaculatory duct
80
flow of sperm
seminiferous tubule → straight tubule → rete testis in mediastinum of testis → efferent ductules → epididymis → ductus deferens
81
zones of prostate
1) peripheral = largest zone; area that presses against rectum
2) transition = small; wraps around urethra
3) central = b/w peripheral & transition zones in which ejaculatory duct runs thru
- problems in the transition zone can pinch the urethra & make it difficult to pass urine
82
lobes of prostate
1) anterior = anterior to urethra; mostly muscular; superior continuation of urethral sphincter
2) posterior = posterior to urethra & inderior to ejaculatory ducts; palpable by digital rectal exam
3) lateral = on both sides of urethra; form major part of prostate
4) middle (median) = b/w urethra & ejaculatory ducts; closely related to neck of bladder; most commonly involved in benign prostatic hyperplasia (BPH)
- - enlargement of middle lobe is believed to be partially responsible for formation of uvula that may project into internal urethral orifice
83
circumcision
- separating glans from foreskin
- protecting glans
- crushing or cutting a ring of skin from penis
- many techniques = plastibell, gomco clamp, mogen clamp, dorsal slit
84
root of penis
- cura = attach to inferior surface of ischiopubic rami
- bulb = enlarged posterior part that is penetrated by urethra
- perineal muschles = ischiocavernous & bulbospongious muscles; contain erectile tissue
- located in superficial perineal pouch - b/w perineal membrane & deep perineal fascia
85
corpora cavernosa
- paired and lateral
- outer covering is a dense fibrous CT → tunic albuginea
- incompletely separated by a fenestrated septum that allows blood to flow from one side to other so erection is a bilateral event
- surrounded by fibers of ischiocavernosus muscles which contract during erection
- diverges at pubic symphysis to form cura
86
corpus spongiosum
- medial & inferior to corpora cavernosa
- surrounds penile portion of urethra
- does not become as engorged as corpora thus allowing urethra to maintain some patency for passage of ejaculate
- proximal end - bulbous (bulb of penis)
- distal end - expanded into glans penis
- superficial to perineal membrane & attached to it
- covered by bulbospongious muscles joined at mid-line raphe
- expel any urine or semen remaining in urethra after micturition or ejaculation
87
fascial layers of penis
- skin
- superficial dartos fascia of penis
- deep fascia or buck's fascia
- tunica albuginea
- each cavernous body has tunica albuginea (an outer fibrous covering or capsule)
- superficial to the outer covering is deep fascia of penis, the continuation of deep perineal fascia that forms a strong membranous covering for corpora cavernosa and corpu spongiosum, binding them together
88
erections
- parasympathetic response from cavernous nerves
- dilate deep artery of the penis which fills corpora cavernosa
- since deep fascia (buck's) is unyielding, expansion of corpora cavernosa compresses the deep doral vein preventing blood loss and maintenance of an erection
89
uterus (womb)
- thick-walled, pear-shaped, holow muscular organ that sits in anteverted position (and anteflexed)
- two parts:
1) body = superior 2/3rds & includes fundus of uterus; lies b/w layers of broad ligament & freely movable; two surfaces - vesical (bladder related) & intestinal; demarcated from cervix by isthmus
2) cervix = cylindrical & relatively narrow inferior 1/3; uterus opens into vagina at external os
- blood supply = unterine arteries (and some from ovarian arteries)
- unterine veins run in broad ligament, draining uterine venous plexus formed on each side uterus & vagina → drain into internal iliac veins
90
walls of body of uterus
- perimetrium = outer serous coat; consists of peritoneum supported by a thin layer of connective tissue
- myometrium = middle muscular coat or smooth muscle; becomes greatly distended during pregnancy; main blood supply and nerves of uterus located here
- endometrium = inner mucous coat; firmly adhers to myometrium; actively involved in menstrual cycle
- - if conception occurs, blastocyst impants in this layer
- - if no conception, inner surface of the coat is shed during menstruation
91
rectouterine pouch (of Douglas)
- space in which instruments incorrectly inserted into vagina can end up
- b/w uterus & rectum
92
broad ligament of uterus
- a double peritoneal fold that extends b/w uterus & lateral pelvic wall on each side, forming a partition that separates paravesical fossae & pararectal fossae of each side
- assists in keeping uterus in positon
- mesosalpinx - anterosuperior free border
- mesovarian - by ovaries
- mesometrium - largest part; mesentery for uterus
93
uterine tubes (oviducts or fallopian tubes)
- conduct oocyte, discharged monthly from an ovary during child-bearing years
- provide site of fertilization (ampulla)
- extend laterally from uterine horns and opens into peritoneal cavity near ovaries
- lie in mesosalpinx
- four parts (from lateral → medial):
1) infundibulum = funnel-shaped distal end of tube that opens into peritoneal cavity thru abd ostium; has finger like processes (fimbriae)
2) ampulla = widest & longest part of tube; where fertilization of oocyte usually occurs
3) isthmus = thick-walled part of tube; enters the uterine horn
4) uterine part = short intramural segment of tube that passes thru wall of uterine & opens via uterine ostium → uterine cavity at uterine horn
94
ovaries
- almond-shaped and -sized female gonads in which ooxyte (female gamets or germ cells) develop
- also endocrine glands that produce reproductive hormones
- ligament of ovary - attaches uterus postero-inferior to uterotubal junction
- round ligament of uterus - attaches antero-inferiorly to uterotubal junction
- suspensory ligament of ovary
95
ovarian arteries and veins
- ovarian arteries (from abd aorta) → via mesovarium to ovary and via mesosalpinx to uterine tube
- ovarian veins drain from pampiniform plexus of veins in board ligament near ovary & uterine tube
- - veins of plexu merge to form an ovarian vein
- R overian vein → IVC
- L ovarian vein → L renal vein
- tubal veins → ovarian veins and uterine venous plexus
96
vagina
- distensible musculomembranous tube
- serves as a canal for menstrual fluid
- forms inferior part of birth canal
- receives penis and ejaculate during sex
- communicates superiorly with cervical canal and inferiorly with vestibule of vagina
97
abnormal disposition of uterus
- normal = anteverted & anteflexed
- excessive anteflexion, anteflexion with retroversion & retroflexion with retroversion
- retroverted uterus will not necessarily prolapse but is more likely to do so; exacerbated in presence of disrupted perineal body or atropic pelvic floor ligaments & muscles
98
uterine support systems
- passive/anatomical position = anteverted & anteflexed uterus rests on top of bladder; when intra-abd pressure is increased, uterus is pressed against bladder
- dynamic/pelvic diaphragm = tone of muscles of pelvic diaphragm during sitting & standing & active contraction during periods of intra-abd pressure is transmitted thru surrounding pelvic organs & endopelvic fascia in which they are embedded
99
rectum
- rectosigmoid junction at lvl S3 vertebrae
- dilated terminal part/ampulla of rectum = supports & retains fecal mass before it is expelled during defecation
- anorectal flexure = mechanism for fecal continence; maintained during resting state by tonus of puborectalis muscle and by its active contraction during peristalic contractions if defecations is not to occur; relaxation of puborectalis during defecation results in straightening of anorectal junction
- males - rectum anterior to bladder fundus, terminal parts of ureters, ductus deferens, seminal glands and prostate
- females - rectum posterior to vagina & separated by recto-uterine pouch
100
rectum blood supply
- superior rectal artery (from IMA) = proximal part of rectum
- R & L middle rectal arteries (from inferior vesicle/uterine) = middle and inferior parts of rectum
- inferior rectal arteries (from internal pudendal) = anorectal junction and anal canal
- blood drains via superior, middle and inferior rectal veins
101
rectum nerve innervation
- sympathetic = lumbar spinal cord & via periarterial plexuses on branches of IMA & superior rectal arteries
- parasympathetic = S2-S4 spinal cord lvl
102
perineum superficial boundaries
- anteriorly = mons pubis
- laterally = medial surface (adductor compartment) of thighs
- posteriorly = butt, gluteal folds & superior end of intergluteal or natal cleft
103
male superficial pouch contents
- root (bulb and cura) of penis & associated muscles (ischiocavernous & bulbospongiosus)
- proximal (bulbous) part of the spongy urethra
- superficial transverse perineal muscles
- deep perineal branches of the internal pudendal vessels and pudendal nerves
104
female superficial pouch contents
- clitoris & associated muscles (ischiocavernosus)
- bulbs of the vestibule & surrounding muscle
- greater vestibular glands
- superficial transverse perineal muscles
- deep perineal branches of the internal pudendal vessels and pudendal nerves
105
ischiocavernosus muscles
- paired muscles that are attached to ischiopubic rami and perineal membrane
- maintain erect state by forcing blood into cavernous spaces in cura; increase the turgidity of penis during erection
- upon contraction, they compress venous outflow of penis
106
bulbospongiosus muscle
- paired muscles covering bulb of penis or bulb of vestibule
- in males - joined by median raphe; forms a constrictor that compresses bulb of penis to dispel ejaculate or urine from bulb
- in females - forms a weak sphincter around vagina
- in both - anteiror most fibers assist in erection by increasing pressure on cavernous tissue
107
superficial transverse perineal muscles
- paired muscles that form a cross beam to stabilize perineal region
- when they simultaneously contract, they provide a firmer base for penis during erection
108
The perineal body is the site of convergence and interlacing of fibers of several muscles, including the:
- bulbospongiosus
- external anal sphincter
- superficial and deep transverse perineal muscles
- smooth and voluntary slips of muscle from the external urethral sphincter, levator ani, and muscular coats of the rectum
109
greater vestibular glands
- secrete mucus for vaginal lubrication
| - generally not palpable unless its duct becomes occluded - bartholin cyst
110
perineal membrane
- closes off urogential (UG) triangle & fills UG hiatus
- provides attachment for erectile bodies
- -- males = penis & scrotum
- -- females = vulva or pudendum
- separates superficial perineal pouch from deep perineal pouch
111
deep perineal pouch in female
- proximal part of the urethra
- mass of smooth muscle in the place of deep transverse perineal muscles on the posterior edge of the perineal membrane
- dorsal neurovascular structures of the clitoris
112
deep perineal pouch of male
- intermediate part of the urethra & urethral sphincter
- bulbourethral glands
- deep transverse perineal muscles
- dorsal neurovascular structures of the penis
113
bulbourethral glands
during secual arousal, each gland produces a clear, salty, viscous secretion (pre-cum)
- this fluid helps to lubricate urethra for spermatozoa to pass thru, neutralizing traces of acidic urine in urethra
114
male urethral sphincters
- internal urethral sphincter → autonomic control
- external urethral sphincter → somatic control
- inferior portion forms a circular investment for the intermediate part of the urethra
- this is a true sphincter.
- it continues superiorly as a trough-like extension running vertically across the anterior aspect of the prostate to reach the neck of the bladder.
115
female external urethral sphincter
- urovaginal sphincter
- fiber encircle upper portion of urethra & continue superiorly to neck of bladder
- lowermost, band-like portion surrounds both urethra & inferior-most vagina as an urethrovaginal sphincter
116
external urethral sphincter
- only the inferior part of the external urethral sphincter muscle forms an encircling investment (a true sphincter) for the intermediate part of the urethra inferior to the prostate in the deep perineal space
117
urethral rupture
- rupture in intermediate urethra deep perineal pouch urogenital hiatus outside peritoneum
- rupture in spongy urethra superficial perineal pouch scrotum or penis superficial to Scarpa’s fascia
CANNOT go to thighs
CANNOT go to anal triangle
