APE 9: The genitourinary system Flashcards
(147 cards)
1
Q
The female reproductive tract is __________ in origin
A
mesodermal
2
Q
What 3 things does th lower female reproductive tract consist of?
A
The vulva, the vagina and the cervix
3
Q
What 6 structures make up the vulva?
A
Mons pubis, the labia majora, labia minora, the vestibule, Bartholin’s glands and the clitoris
4
Q
What’s mons pubis?
A
A subcutaneous fat pad located anterior to the pubic symphysis
5
Q
What’s the name of the fold of skin formed by the posterior merging of the labia minora?
A
The fourchette
6
Q
What’s the vestibule?
A
The area enclosed by the labia minora, containing the openings of the vagina and urethra
7
Q
What’s the location and function of Bartholin’s glands?
A
Bartholin’s glands are either side of he vaginal orifice. They secrete lubricating mucus from small ducts during sexual arousal
8
Q
What’s the clitoris formed of?
A
Erectile corpus cavernosa sittue
9
Q
Where does arterial supply to the vulva come from?
A
Blood supply is from the paired internal and external pudendal arteries which branch off the internal iliac artery
10
Q
How’s venous drainage of the vulva achieved?
A
The pudendal veins provide venous drainage, and the labial veins contribute as tributaries
11
Q
Describe the sensory innervation of the vulva
A
Anterior sensory innervation comes from the ilioinguinal nerve and the genital branch of the genitofemoral nerve. Posterior sensory innervation comes from the pudendal nerve and the posterior cutaneous nerve of the thigh
12
Q
Via what nerves do the clitoris and vestibule receive parasympathetic innervation?
A
The cavernous nerves, derived from the uterovaginal plexus
13
Q
Describe the vagina anatomically
A
The vagina is a muscular distensible tube which extends posterosuperiorly from the external orifice to the cervix
14
Q
What is found anterior to the vagina?
A
Anterior to the vagina is the bladder and urethra
15
Q
What’s found posterior to the vagina?
A
Posterior to the vagina is the rectouterine pouch, the rectum and the anal canal
16
Q
What is found lateral to the vagina?
A
Lateral to the vagina are the ureters and the levator ani muscle
17
Q
Describe the meeting of the vagina and cervix anatomically
A
At the upper ending of the vagina, it surrounds the cervix, creating 2 domes (fornices)- an interior fornix and a posterior fornix
18
Q
What’s the function of the posterior fornix?
A
The posterior fornix acts as a natural reservoir for semen after intravaginal ejaculation
19
Q
What are the 4 histological layers of the vagina?
A
Stratified squamous epithelium
Elastic lamina propia
Fibromuscular layer
Adventitia
20
Q
Describe the stratified squamous layer of the vagina
A
This layer provides protection and is lubricated by cervical mucus
21
Q
Describe the elastic lamina propia layer of the vagina
A
This layer is a dense connective tissue layer which projects papillae into the overlying epithelium. The larger veins are located here
22
Q
Describe the fibromuscular layer of the vagina
A
This comprises of 2 layers of smooth muscle: an inner circular later and an outer longitudinal layer
23
Q
Describe the adventitia layer of the vagina
A
The adventitia is a fibrous layer which provides additional strength to the vagina whilst also binding it to the surrounding structures
24
Q
What’s the arterial supply to the vagina?
A
The arterial supply comes via the uterine and vaginal arteries, both of which are branches of the internal iliac artery.
25
Via what veins is venous drainage of the vagina achieved?
The vaginal venous plexus drains into the internal iliac veins via the uterine vein
26
Innervation of the vagina is predominantly from the autonomic nervous system. Which 1/3rd of the vagina receives somatic innervation?
The inferior 1/3rd
27
What are the 2 regions of the cervix?
The ectocervix and the endocervical canal
28
What's the ectocervix?
The ectocervix is the part of the cervix which projects into the vagina. It's lined by stratified squamous non-keratinised epithelium.
29
What's the name of the opening of the cervix?
The external os
30
What's the endocervical canal?
The endocervical canal is the more proximal and inner part of the cervix. It is lined by a mucus-secreting simple columnar epithelium. The endocervical canal ends where the uterine cavity begins.
31
What's the name of the proximal opening of the cervix?
The internal os
32
What 3 things maintain the sterile environment of the cervix?
The shedding of the endometrium, the thick cervical mucus and the narrow external os
33
What supplies blood to the cervix?
Cervical blood supply comes from the uterine artery
34
How is venous drainage of the cervix achieved?
A plexus in the broad ligament that drains into the uterine veins.
35
What 4 nodes are responsible for lymphatic drainage of the cervix?
The iliac, sacral, aortic and inguinal lymph nodes
36
What's cervicitis?
Cervitcitis is chronic inflammation and infection of the cervix, most commonly caused by chlamydia trachomatis or neisseria gonorrhoeae. It's usually asymptomatic, but can cause pelvic pain, vaginal drainage, postcoital bleeding and dyspareunia
37
What are 2 common types of cervical cancer?
Squamous cell carcinomas are cancers of the endothelial lining of the ectocervix. Adenocarcinomas are cancers of the glands found within the lining of the cervix
38
What's the most common cause of cervical cancer?
Infection of the cervix by human papilloma virus (HPV) causes most cervical cancers
39
Describe the uterus' development and function
The uterus is a secondary sex organ which matures during puberty under the influence of sex hormones produced from primary sex organs. The uterus is responsible for the maintenance and transportation of gametes
40
Describe the uterus anatomically
The uterus is part of the upper female reproductive tract. It is a thick-walled muscular organ capable of expansion to accommodate a growing foetus. It's connected distally to the vagina and laterally to the uterine tubes
41
What are the 3 parts of the uterus?
The fundus
The body
The cervix
42
What's the fundus?
The fundus is the top part of the uterus, above the entry point of the uterine tubes
43
In which part of the uterus does the blastocyst usually implant?
The body of the uterus
44
What's the normal anatomical position of the uterus?
Anteverted and anteflexed
45
What does anteverted mean?
An anteverted uterus is rotated forwards towards the anterior surface of the body from the point where the cervix meets the vagina
46
What does anteflexed mean?
Flexed towards the anterior surface of the body, so, in a way, curved caudally
47
When anteverted and anteflexed, where does the uterus lie in relation to the bladder and rectum?
The uterus lies posterosuperior to the bladder and anterior to the rectum
48
What are the 3 most common dispositions of the uterus?
Excessively anteflexed
Anteflexed and retroverted
Retroflexed and retroverted
49
Histologically, the fundus and body of the uterus are composed of 3 tissue layers. What are they?
Peritoneum, myometrium and endometrium
50
What's the peritoneum of the uterus?
The peritoneum is a double-layered membrane, continuous with the abdominal peritoneum
51
What's the myometrium?
A thick, smooth muscle layer. During pregnancy, the cells of the myometrium undergo hyperplasia and hypertrophy in preparation to expel the foetus
52
What's the endometrium?
The endometrium is the inner mucous membrane lining of the uterus that can be divided into 2 parts
53
What are the 2 parts of the endometrium?
The deep stratum basalis and the superficial stratum functionalis
54
What layer is shed in menstruation?
The superficial stratum functionalis of the endometrium
55
What provides the primary support for the uterus?
The tone of the pelvic floor
56
What's the broad ligament?
The broad ligament is a double layer of peritoneum that attaches the sides of the uterus to the pelvis. It acts as a mesentery for the uterus and contributes to maintaining it in position
57
What's the round ligament?
A remnant of the gubernaculum, extending from the uterine horns to the labia majora via the inguinal canal. It functions to maintain the anteverted position of the uterus
58
What's the ovarian ligament?
The ovarian ligament joins the ovaries to the uterus
59
What's the cardinal ligament?
The cardinal ligament is located at the base of the broad ligament and extends from the cervix to the lateral pelvic walls. Contains the uterine artery and vein in addition to providing support to the uterus
60
What's the uterosacral ligament?
The uterosacral ligament extends from the cervix to the sacrum and provides support to the uterus
61
Where does blood supply to the uterus come from?
The uterine artery
62
Where does venous drainage of the uterus come from?
A plexus in the broad ligament that drains into the uterine veins
63
What's a hysterectomy?
The surgical removal of the uterus, usually as a result of cervical or uterine cancer.
64
What are the Fallopian tubes?
The Fallopian tubes are muscular 'J-shaped' tubes found in the female reproductive tract
65
Where are the Fallopian tubes found?
They lie in the upper border of the broad ligament, extending laterally from the uterus, opening into the abdominal cavity, near the ovaries
66
What's the main function of the uterine tubes?
The main function is to assist in the transfer and transport of the ovum from the ovary to the uterus
67
What's the inner mucosa of the Fallopian tubes lined with?
Ciliated columnar epithelial cells and peg cells (non-ciliated secretory cells)
68
What's the point of the ciliated columnar epithelial cells of the oviducts?
To waft and sweep the ovum towards the uterus and supply it with nutrients
69
What are the 4 parts of the Fallopian tubes (lateral to medial)?
The fimbriae, the infundibulum, the ampulla and the isthmus
70
What are the fimbriae of the Fallopian tubes?
Finger-like, ciliated projections which capture the ovum from the surface of the ovary
71
What's the infundibulum of the Fallopian tubes?
A funnel-shaped opening near the ovary to which the fimbriae are attached
72
What's the ampulla of the oviducts?
The widest section of the uterine tubes, where fertilisation usually occurs
73
What's the isthmus of the oviducts?
A narrow section of the uterine tubes connecting the ampulla to the uterine cavity
74
Via what arteries is blood supplied to the oviducts?
The uterine and ovarian arteries.
75
Via what veins is venous drainage of the oviducts achieved?
The uterine and ovarian veins
76
The uterine tubes receive sympathetic and parasympathetic innervation via nerve fibres from the _______ and _______ plexuses
uterine
| ovarian
77
What is salpingitis?
Inflammation of the uterine tubes, usually caused by bacterial infection. It can cause adhesions of the mucosa, which may partially or completely block the lumen of the uterine tubes. This can potentially result in infertility or an ectopic pregnancy
78
What is an ectopic pregnancy?
An ectopic pregnancy is that where the fertilised egg implants in the uterine tubes rather than the endometrium, due to partial or complete occlusion of the lumen of the uterine tube. This is a medical emergency, as the implanted blastocyst can cause rupture and haemorrhage of the affected tube
79
Describe the ovaries
The ovaries are the female gonads and develop within the mesonephric ridge and descend through the abdomen. They stop descending once they reach the pelvis, unlike the male gonads
80
Describe the ovaries anatomically
The ovaries are paired, oval organs attached to the posterior surface of the broad ligament of the uterus by the mesovarium (a fold of peritoneum, continuous with the outer surface of the ovaries). Neurovascular structures enter the hilum of the ovary via the mesovarium
81
What are the main 2 functions of the ovaries?
To produce oocytes in preparation for fertilisation
| To produce the sex steroid hormones oestrogen and progesterone in response to pituitary gonadotrophins (LH and FSH)
82
What are the 3 components of the ovary?
The surface
The cortex
The medulla
83
What's the surface of the ovary made of?
Germinal epithelium
84
What's the cortex of the ovary made of?
The cortex is largely comprised of a connective tissue stroma that supports thousands of follicles. Each primordial follicle contains an oocyte surrounded by a single layer of follicular cells
85
What's the medulla of the ovary made of?
The medulla is composed of a supporting stroma that contains a rich neurovascular network
86
What are the 3 parts of the penis?
The root
The body
The glans
87
What's the root of the penis?
The root of the penis is the most proximal, fixed part of the penis located in the superficial perineal pouch of the pelvic floor, and not visible externally.
88
What erectile tissue and muscle tissue does the root of the penis contain?
The root contains 3 erectile tissues (2 crura and bulb tissue) and 2 muscles (ischiocavernosus and bulbospongiosus)
89
What's the body of the penis?
The body is the free part of the penis, located between the root and glans. It is suspended from the pubic symphysis and composed of 3 cylinders of erectile tissue- 2 corpora cavernous and the corpus spongiosum
90
What's the glans of the penis?
The glans is the most distal part of the penis. It's conical in shape and is formed by the distal expansion of the corpus spongiosum. This contains the opening of the urethra, termed the external urethral orifice
91
What's the purpose of the 2 bulbospongiosus muscles in the root of the penis?
The bulbospongiosus muscles contract to empty the spongy urethra of any residual semen and urine. The anterior fibres also aid in maintaining erection by increasing the pressure in the bulb of the penis
92
What is the purpose of the 2 ischiocavernosus muscles?
The ischiocavernosus muscles surround the left and right crura and contract to force blood from the cavernous spaces in the crura into the corpus cavernosa, helping to maintain erection
93
What are the names of the 2 outer fascial layers of each mass of erectile tissue?
The most superficial layer is the external fascia of Colles. The other is called the deep fascia of the penis, or Buck's fascia.
94
What's the name of the strong fascia deep to Buck's fascia in the penis?
The tunica albuginea, which forms an individual capsule around each cavernous body and fused in the midline
95
What are the 2 ligaments that support the root of the penis?
The suspensory ligament and the fundiform ligament
96
What's the suspensory ligament?
A ligament made of a condensation of deep fascia that connects the erectile bodies of the penis to the pubic symphysis
97
What is the fundiform ligament?
A condensation of abdominal subcutaneous tissue. It runs down from the linea alba, surrounding the penis like a sling and attaching to the pubic symphysis
98
What is the scientific name for foreskin?
Prepuce
99
What connects the prepuce to the glans?
A median fold of skin on the ventral surface of the penis called the frenulum
100
From what 3 sources does the penis receive blood supply?
Dorsal arteries of the penis
Deep arteries of the penis
Bulbourethral arteries of the penis
101
What do these arteries all branch from?
The internal pudendal artery, a vessel that arises from the anterior division of the internal iliac artery
102
What veins are the cavernous spaces of the penis drained by?
The deep dorsal vein of the penis, which empties into the prostatic venous plexus
103
What veins drain the superficial structures of the penis?
The superficial dorsal veins
104
Which spinal cord segments and spinal ganglia supply the penis
S2-S4
105
Sensory and sympathetic innervation to the skin and glans penis is supplied by what nerve?
The dorsal nerve, a branch of the pudendal nerve
106
How's parasympathetic innervation supplied to the penis?
Via the cavernous nerves from the peri-prostatic nerve plexus
107
What's the importance of parasympathetic innervation in the penis?
Parasympathetic innervation is responsible for the vascular changes that cause erection
108
What are some possible causes of erectile dysfunction?
Vascular aetiology, or psychological reasons such as depression and anxiety
109
What's priapism?
A serious condition where erection persists beyond or without sexual stimulation. It's almost always painful and results from blood becoming trapped in the erectile bodies with no arterial flow. Priapism that persists beyond 4 hours is a medical emergency and can lead to corporal scarring or permanent ED.
110
Describe the testes anatomically
The testes are located outside the body within the scrotum, with the epididymis situated on the posterolateral aspect of the testicle. The testes are suspended from the abdomen by the spermatic cord- a collection of vessels, nerves and ducts that supply the testes
111
Describe the structure of the testicles themselves
The testes consist of a series of lobules, each containing seminiferous tubules supported by interstitial tissue. The seminiferous tubules are lined by Sertoli cells that aid the maturation process of the spermatozoa. In the interstitial tissue lie the Leydig cells that are responsible for testosterone production
112
Where are sperm cells produced and developed?
Sperm cells are produced in the seminiferous tubules. The developing sperm travel through the tubules, collecting in the retes testes. Ducts called efferent tubules transport the sperm from the retes testes to the epididymis for storage and maturation
113
What's the name of the closed sac of parietal peritoneal origin that almost entirely covers the testes?
The tunica vaginalis inside the scrotum
114
Why does the tunica vaginalis contain a small amount of viscous fluid?
The fluid is to allow for friction-free movement of the testicles
115
What protects the testicular parenchyma?
The tunica albuginea, a fibrous capsule that encloses the testes and penetrates into the parenchyma of each testicle with diaphragms, dividing them into lobules
116
Vascular supply to the testes
Testicular arteries, branches of the cremasteric artery and the artery of the vas deferens
117
Venous drainage of the testes
The paired testicular veins.
| The left testicular vein drains into the left renal vein, while the right testicular vein drains directly into the IVC
118
Lymphatic drainage of the testes
The lumbar and para-aortic nodes along the lumbar vertebrae
119
Describe the scrotum anatomically
The scrotum is a fibromuscular sac located between the penis and anus. It's dual-chambered, forming an expansion of the perineum
120
What 3 major paired structures does the scrotum contain?
The testes, the epididymis and the spermatic cord
121
What's the dartos muscle?
A sheet of smooth muscle in the scrotum, situated immediately underneath the skin. It acts to help regulate the temperature of the scrotum, by wrinkling the skin, which decreases surface area and reduces heat loss
122
Arterial supply to the scrotum
Anterior and posterior scrotal arteries
123
Venous drainage of the scrotum
The scrotal veins follow the major arteries, draining into the external pudendal veins
124
Lymphatic drainage of the scrotum
Superficial inguinal nodes
125
Describe the spermatic cord anatomically
The spermatic cord is a collection of vessels, nerves and ducts that run to and from the testes, surrounded by fascia. The course of the cord is relatively short, beginning in the inferior abdomen and ending in the scrotum
126
Where is the spermatic cord formed?
At the opening of the inguinal canal, known as the deep inguinal ring, located laterally to the inferior epigastric vessels
127
What are the 3 fascial layers that bind the contents of the spermatic cord together
The external spermatic fascia
The cremaster muscle and fascia
The internal spermatic fascia
128
What's the cremasteric reflex and how can it be triggered?
The cremasteric reflex is triggered by stroking the superior, medial part of the thigh. This causes an immediate contraction of the cremaster muscle, elevating the testes on the side that's been stimulated
129
What's the relationship between the pampiniform plexus and the testicular artery?
The pampiniform plexus is a network of veins that drains the testes. It wraps around the testicular artery and acts as a heat exchanger, cooling the arterial blood before it reaches the testes
130
What's the vas deferens?
A straight, thick muscular tube that conveys sperm from the epididymis to the ampulla, and eventually to the ejaculatory duct. From the ejaculatory duct, sperm can pass through to the prostatic urethra
131
What can testicular torsion lead to, which makes it a medical emergency?
Strangulation of the testicular artery and necrosis of the testis
132
What's the function of the prostate gland?
The prostate secretes proteolytic enzymes into the semen, which act to break down clotting factors in the ejaculate, allowing semen to remain in a fluid state, moving throughout the female reproductive tract for potential fertilisation
133
Where is the prostate?
Theprostate is positioned inferiorly to the neck of the bladder and superiorly to the external urethral sphincter, with the levator ani muscle lying inferomedially to the gland. Most importantly, the prostate lies anterior to the ampulla of the rectum, so the gland can be examined in a DRE
134
What's benign prostatic hyperplasia?
Non-malignant increase in size of the prostate
135
What are the 3 histological zones of the prostate?
The central zone
The transitional zone
The peripheral zone
136
What does the central zone of the prostate surround?
The ejaculatory ducts
137
What does the transitional zone of the prostate surround?
The urethra
138
What part of the prostate gland is the peripheral zone?
The posterior part
139
Arterial supply to the prostate
The prostatic arteries
140
Venous drainage of the prostate
The prostatic venous plexus
141
From what zone do malignant cells commonly originate in prostatic carcinomas?
The peripheral zone
142
What are the bulbourethral or Cowper's glands?
A pair of pea-shaped exocrine glands located posterolateral to the membranous urethra in the deep perineal pouch. They contribute to the final volume of semen by producing a lubricating mucus secretion
143
Describe Cowper's glands histologically
The glands are compound tubule-alveolar glands lined by columnar epithelium
144
What are the seminal vesicles?
A pair of glands found in the male pelvis which function to produce many of the constituents of semen, and ultimately provide 20% of the total semen volume
145
Describe the seminal vesicles anatomically
The seminal vesicles are 5cm long, tubular glands, located between the bladder fundus and the rectum. Their most important relation is with the vas deferens, which combines with the duct of the seminal vesicle to form the ejaculatory duct
146
Describe the seminal vesicles histologically
The gland has a honeycombed, lobulated internal structure with a mucose lined by psudostratified columnar epithelium. These columnar cells are highly influenced by testosterone, growing taller with higher levels
147
What 4 structures make up the SEED acronym for being derived from the mesonephric ducts?
Seminal glands
Ejaculatory ducts
Epididymis
Ductus deferens
