B8.005 Male Reproductive Tract Flashcards
(170 cards)
1
Q
how are pelvic features used forensically for aging
A
Y shaped growth plate that separates 3 bones, the triradiate cartilage, starts fusing at ages 10-16
fusion ends around age 20
2
Q
male vs female pelvis
A
sexual dimorphism occurs after puberty
subpublic angle is 90 deg in females and 70 deg in males
3
Q
characterize pelvic fractures
A
automobile accident: displacement of the pubic symphsis posteriorly, breaking the superior and/or inferior rami
jumping: may lead to displacement of the head of the femur through the acetabulum
pelvis rarely fractures in a single place (it is a ring)
4
Q
what is the pelvic diaphragm
A
muscular funnel that surrounds the anal canal and is formed by:
1) levator ani muscle
2) coccygeus muscle
5
Q
where is the pelvic diaphragm located
A
stretches from the pubic symphysis anteriorly, to the coccyx posteriorly, and is laterally attached to the medial surface of the obturator internus muscle
6
Q
portions of levator ani
A
3 parts innervated by S4, some S3 & S5 1. pubococcygeus 2. puborectalis 3. iliococcygeus
7
Q
pubococcygeus
A
largest part of levator anu
attached from the body of the pubis to the coccyx
8
Q
puborectalis
A
attached from the medial body of the pubis to form a U-shaped muscular sling around the anorectal junction
9
Q
iliococcygeus
A
attached from a tendinous arch of fascia on top of the obturator internus muscles and the ischial spine to the coccyx
10
Q
coccygeus muscles
A
attaches from ischial spine to the distal sacrum and coccyx
innervated by S4 (some S3, S5)
11
Q
function of pelvic diaphragm
A
maintains the proper positioning of the pelvic organs and is essential for maintaining abdominal, and thus thoracic pressure, during micturation, defecation, parturition, and lifting heavy weights
12
Q
what passes through the pelvic diaphragm
A
males: urethra and anus
females: urethra, vagina, and anus
13
Q
relaxation of puborectalis
A
essential during defacation
14
Q
what are kegels
A
isometric contraction of the pubococcygeus muscle and the pelvic diaphragm and pelvic diaphragm
15
Q
function of kegels
A
help prevent urinary stress incontinence and fecal incontinence during and after pregnancy
prevent injuries during parturition and help prevent uterine prolapse after vaginal deliveries
16
Q
perineal membrane
A
connective tissue membrane attaching laterally to the ischial tuberosities, and the ischiopubic rami
tough, connective tissue sheet which serves as a base for the external genitalia structures
17
Q
spaces created by the perineal membrane
A
- superficial perineal space
2. deep perineal space
18
Q
superficial perineal space
A
contains erectile tissues and muscles of the external genitalia in both male and female
19
Q
deep perineal space
A
contains striated muscles of the urethra (sphincter and compressor) and a deep transverse perineal muscle that support the free edge of the perineal membrane
also contains nerves and arteries
20
Q
superficial membranous fascia
A
superficial surface of the superficial perineal space
made of 3 differently named, but continuous membranes:
1. scarpas (anterior abdominal wall)
2. dartos (shaft of penis and scrotum)
3. colles (posterior to scrotum)
21
Q
bleeding patterns of straddle injuries
A
bleed into superficial perineal space
blood is then limited in its diffusion by the superficial perineal membrane (scarpas, dartos, colles) and where it attaches to deep fascial planes
22
Q
where does the superficial perineal membrane attach to deep fascia (outline of blood in straddle injuries)
A
superiorly: fascia surrounding anterior abdominal wall muscles
laterally: inguinal ligament and fascia lata of the thigh
posteriorly: posterior edge of perineal membrane
23
Q
components of external anal sphincter
A
3 parts:
- deep external sphincter
- superficial external sphincter
- subcutaneous external sphincter
24
Q
innervation of external anal sphincter
A
skeletal muscle under voluntary control
innervated by S4 through the inferior rectal/anal nerve (branch off the internal pudendal nerve)
25
internal anal sphincter
smooth muscle
more superior to external sphincter and directly under the mucosa
innervated by sym and parasym fibers from the pelvic splanchnic nerves
normally, tonically contracted, but relaxes to release gas and fecal material
26
importance of the pectinate line
separates visceral and parietal portions of anal canal
27
above pectinate line
nerves: visceral motor and sensory innervation
arteries: IMA
veins: to portal venous system
lymphatics: to internal iliac lymph nodes
28
below pectinate line
nerves: somatic motor and sensory innervation
arteries: internal iliac
veins: to caval venous system
lymphatics: to superficial inguinal lymph nodes
29
internal hemorrhoids
start superior to the pectinate line
| generally painless, often grow quite large before being notices
30
external hemorrhoids
start inferior to pectinate line
| generally quite painful and itch
31
hemorrhoids
swollen (redundant) veins within the anal canal that are thought to be due to increased venous pressure caused by: portal HTN, excessive straining (constipation), excessive weight gain
32
prevalence of hemorrhoids
4% of US pop
| 1 mil new cases per year
33
degrees of internal hemorrhoids
1st: bulges into anal canal during BMs
2nd: bulges from the anus during BM, then goes back in
3rd: bulges from anus during BMs and must be pushed back in with a finger
4th: protrudes from anus all the time
34
treatment for internal hemorrhoids
rubber band ligation, takes 7-10 day for necrotic hemorrhoid to fall off
infrared coagulation for small and medium internal hemorrhoids
35
anal fissues
most common cause of BRBPR at any age
breaks or tears in the skin of the anal canal
generally self healing, but can become chronic
36
epidemiology of anal fissures
1 in 350
most often ages 15-40
90% located in the midline, posterior to the anus, anterior to the coccyx
37
chronic anal fissures
can lead to spasm of the internal anal sphincter, which impairs blood flow to the region, slowing healing
38
treatments for anal fissures
dietary fiber
careful anal hygiene after defecation
placing a cotton ball at anus to keep tissue dry
nitroglycerin or Ca2+ channel blockers, injection of botox
39
scrotum
sac containing testicles and epididymises
| keeps cooler than abdominal temperature
40
testis
produce sperm and androgens
41
epididymis
1. sperm maturation
2. sperm storage
3. sperm disposal
4. absorption of fluid
5. secretion of proteins
42
vas deferens
connects epididymis to urethra
thick walled
peristaltic contractions of the smooth muscle wall move sperm along the vas
43
penis
common outlet for both urine and semen
44
scrotal components of the male after the seminiferous tubules
1. tubulus rectus
2. rete testis
3. ductuli efferentes
4. epididymis
5. vas deferens
45
tubulus rectus
link seminiferous tubule to rete testis
46
rete testis
network of spaces contained within the connective tissue of the mediastinum
47
ductuli efferentes
12 spiral winding tubes arising from the rete testis
| become confluent with a single epididymal duct coiled into a compact structure
48
seminiferous tubules
continuous loops with a lumenal fluid/sperm filled space; about a meter long
49
seminiferous epithelium cell types
1. spermatogenic cells
| 2. sertoli cells (support cells)
50
structure of seminiferous epithelium
from outside to inside:
- peritubular (myoid) cells outside of BM
- basal lamina
- spermatogonium (stem cells) with interspersed sertoli cells
- spermatocytes
- early spermatid
- late spermatid
51
sertoli cell overview
nonproliferating cells which support spermatogenic cells
| contact 3-5 other sertoli and 30-50 spermatogenic cells
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receptors on sertoli cells
FSH and androgen receptors
| both FSH and androgens are required to maintain highly differentiated nature of the cells
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proteins secreted by sertoli cells
```
MIS/AMH
transferrin
ceruloplasmin
androgen binding protein (ABP)
kit ligand/ steel factor
inhibin B
```
54
AMH/MIS
inhibits mullerian duct development into female repro organs
55
transferrin
transports iron into spermatogenic cells
56
ceruloplasmis
transports copper into spermatogenic cells
57
androgen binding protein (ABP)
high affinity for T and DHT
| essential for proper epididymal function
58
kit ligand/ steel factor
required for spermatogenic cell survival (membrane bound)
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inhibin B
inhibits pituitary FSH release
| marker of sertoli cell function
60
blood testis barrier
formed at puberty
tight junctional complex between adjacent sertoli cells
creates a compartment hidden from the immune system
61
function of meiosis
produces 4 unique haploid cells
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stages of spermatogenesis
1. spermatogonia stage
2. primary spermatocyte stage
3. secondary spermatocyte stage
4. spermatid development
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spermatogonia stage
2 weeks
| mitotically dividing stem cells
64
primary spermatocyte stage
```
4 weeks
meiotically dividing cells
1. preleptotene
2. leptotene
3. zygotene
4. pachytene
5. diplotene
```
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secondary spermatocyte stage
8 hours
| quick division
66
spermatid development stage
3 weeks
haploids cells undergoing dramatic shape change from round cell to a sperm
**spermiogenesis***
67
total time for spermatogenesis
74 days (2.5 months)
68
sperm structures
```
acrosome (secretory granule)
head
connecting piece
middle piece of tail
principal piece of tail
end piece of sperm tail
```
69
why are sperm immunologically foreign
1. genetic recombination during meiosis creates new combination of maternal and paternal genes
2. haploid gene expression includes numerous genes products that are unique to spermatogenesis
3. initiates long after immunological self has been determined (aka during puberty, long after birth)
70
Leydig cell overview
interstitial cells
| have LH receptors and produce androgens
71
function of T produced by leydig cells
stimulate spermatogenesis
| inhibit HP axis at hypothalamus and anterior pituitary
72
receptors on spermatogenic cells
dont have any!!!
| controlled by nearby sertoli cells via direct cell cell interactions
73
regulation of heat in testes
normally 2 deg cooler than abdominal temps
result of scrotal location and the counter current heat exchanger from the cooler blood within the pampiniform plexus to the testicular artery
74
result of increased heat in testes
seminiferous tube atrophy
| leydig production of T decreased over the long term
75
what is klinefelters
XXY hypogonadism
| extra X chromosome caused testicular failure of both spermatogenesis and androgen production
76
symptoms of klinefelters
```
decreased T levels
small penis
generally azoospermic
33-50% have breast development
high FSH and LH (trying to increase T)
trouble w language skills
```
77
diagnosis of klinefelters
1 per 600 male births
generally not detected until puberty, unless genetically tested at birth
most common chromosomal abnormality in humans
78
epidemiology of testicular cancer
1-2% of male cancers
second most frequent cancer of 20-29 year old males
germ cell tumors most common
treatable
79
structure of the epididymis
highly tortuous duct, 6 meters long
| takes sperm 3-8 days to travel its length
80
sperm maturation in epididymis
nonmotile sperm obtain the ability to swim
| takes place in head and body
81
sperm storage in epididymis
100 million in each
70% of sperm stored here
a portion released with ejaculation
82
sperm disposal in epididymis
after abstinence, a higher percentage of infertile sperm are released
sperm do "age" within the male repro tract
motility and morphology of sperm depressed after 7 days of abstinence
83
absorption of fluid in epididymis
most of the fluid produced by sertoli cells is absorbed in the caput
84
secretion in the epididymis
secretes a number of proteins which alter the sperm surface
85
epithelium of epididymis
columnar epithelium with variable height (star shaped lumen): 1. principal cells and 2. basal cells
height rises and then falls toward the vas deferens
amount of smooth muscle cells surrounding the epithelium increased caudally toward the vas deferens
86
portions of the epididymis length
1. head/caput
2. body/corpus
3. tail/cauda
- continuous with vas deferens
87
principal cells of epididymal epithelium
long microvilli on apical surface
88
structure of vas deferens
35 cm long, 3 mm in diameter
pseudostratified columnar epithelium with short microvilli
surrounded by 3 layers of smooth muscle (inner and outer longitudinal, middle circular)
89
ampulla
lies just superior to the seminal vesicles, before the ejaculatory ducts
stores sperm
90
congenital absence of vas deferens
CF gene
91
vasectomy
ligation and/or removal of a segment of the vas deferens
spermatogenesis continues at normal or slightly reduced rates
FSH, LH, T unchanged
96% of sperm broken down within epididymis
92
sperm granuloma
can develop post vasectomy at site of sperm leakage
macrophages and other WBCs attack the sperm as foreign bodies
very painful in 4% of men who have gotten vasectomies
93
procedure of vasectomy
simple, outpatient, performed by many family practice physicians
< 60 min
no sutures required
94
vasovasectomy
reversal of vasectomy; reanastomosis & opening of cut and sealed vasal ends
pregnancy rates are lower than expected, probably due to antisperm Abs which develop after vasectomy
95
what is cryptorchidism
undescended testicle
| congenital malposition resulting in retention of the testes anywhere along the route of descent
96
prevalence of cryptorchidism
2-5% of boys under 1
15-20% in premature boys
10% bilateral
97
treatment of cryptorchidism
HCG treatment (stimulates Leydig cells to produce androgens) may stimulate descent
otherwise, early surgery (before 6 mo)
reduction in fertility if not treated
98
pampiniform plexus
veins that wrap around the tortuous testicular artery
| cools the coiled testicular arterial blood with countercurrent heat exchange
99
varicocele
insufficient or congenital absence of valves within the spermatic/ pampiniform plexus veins, causing blood reflux within the pampiniform plexus
occur in 10% of men
100
where does varicocele commonly occur
L side
due to return of the left testicular vein to the L renal vein (higher pressure vein) than the R testicular vein which drains into the IVC
101
consequences of varicocele
```
reduced fertility (count)
treatment often increases sperm production
```
102
grading of varicocele
bag of worms
0. seen only on US
1. smallest, not visible, but felt w valsalva
2. not visible, but felt
3. visible
103
congenital hydrocele
congenital, processes vaginalis remains open to peritoneal cavity
most resolve spontaneously during first year of life without intervention
104
appearance of hydroceles
scrotum rapidly fills with fluid when straining or sitting up
6% of term males
105
acquired hydrocele
abnormal accumulation of serous fluid in the sac of the tunica vaginalis; most often noncommunicating with peritoneal cavity
can also be result of plugged inguinal lymphatic system from repeated, chronic infection
106
testicular torsion
sudden twisting of spermatic cord resulting in strangulation of the blood vessels serving the testis and epididymis
normally prevented by gubernaculum remnant
painful, EMERGENCY, must be treated in 4 hours
107
parts of the male urethra
```
prostatic
membranous (intermediate)
penile
```
108
penis
common outlet for both urine and semen
| erect in anatomical position
109
structure of penis
3 cylinders of erectile tissue
- 2 corpora cavernosa on the dorsal surface formed of erectile tissue
- single corpus spongiosum contains the urethra
- tunica albuginea connective tissue layer surrounds each cylinder
110
penile ligaments
1. fundiform
| 2. suspensory
111
fundiform ligament
attaches from the deep fascia of the penis to the linea alba superiorly
sling-like structure
more superficial than suspensory
112
suspensory ligament
attached from the deep fascia of the penis to the pubic symphysis
deep to fundiform
113
circumcision
release and/or removal of a portion of the foreskin and is performed for both hygiene and religious regions
114
purpose of circumcision
religious (jewish, islamic)
| prevents smegma accumulation (cheesy accumulation of dead skin and sebaceous gland secretions)
115
muscles of the root of the penis
bulbospongiosus
ischiocavernosus
contract to help restrict venous blood flow out from the penis and can cause transient increase in internal penile pressure above arteriolar pressure
116
function of bulbospongiosus
expels both semen and urine from the base of the penile urethra
117
dorsal penile arteries
deep to Buck's fascia outside the corpora cavernosa
118
deep penile (cavernous) arteries
center of each corpora cavernosa
| main source of blood to erectile tissue
119
artery of the bulb of the penis
to bulb of penis and to bulburethral glands
120
somatic innervation to the penis
pudendal nerve
S2-4
becomes dorsal nerve of the penis
121
autonomic innervation of the penis
cavernous nerves
- from inferior hypogastric plexus
- run next to central cavernous artery within corpora of the penis
- has sym and para
122
what is required for successful erection and ejaculation
```
vascular system
smooth and skeletal muscles
urethral sphincters
para and sym ANS
bulbospongiosus muscle
```
123
erection
```
parasympathetic stimulation (S2-4) through pelvic splanchnic, inferior hypogastric, and prostatic nerve plexuses and the cavernous nerves
results in vasodilation of the helical arteries allowing more blood flow (5-10x) and enlargement and erection
```
124
emission
delivery of sperm via vas deferens, prostatic secretions, and seminal secretions into the prostatic urethra
requires sym innervation (L1-2) to smooth muscle in walls of vas deferens, prostate, and seminal vesicle
125
ejaculation
forceful removal of semen from the urethra
internal urethral sphincter (smooth muscle, sym) must remain CLOSED
external urethral sphincter (skeletal) must OPEN
bulbospongiosus muscles contract (pudendal S2-4) forcing semen from the penis base
126
detumescence
loss of an erection
follows sym discharge required for emission
causes constriction of helical arteries, reducing blood flow into the cavernous tissue
127
retrograde ejaculation
semen redirected towards the urinary bladder
| internal smooth muscle sphincter does not function properly
128
causes of retrograde ejaculation
trans-urethral resection of the prostate
| diabetes (neuropathy)
129
WBCs in ejaculate
<1 million is a normal component
| if infected with HIV, prostatic secretions appear to aid the transmission/ spread of HIV from contact with semen
130
black light glow of semen
PSA from prostate
| semenogelins from seminal vesicle
131
WHO sperm guidelines
1.5-6 mL volume
15-200 million per mL
4-44% normal morphology
55% motility (mean)
7.4 pH
coagulates in seconds due to semenogelins from seminal vesicle
liquefaction occurs 10-60 min later caused by prostatic enzymes
132
normozoospermia
normal ejaculate
133
oligozoospermia
<15 mil per mL
134
asthenozoospermia
reduced sperm with forward progression
| <32% progressive motility
135
teratozoospermia
sperm with abnormal morphology
| <4% normal
136
azoospermia
no sperm in ejaculate
137
aspermia
no ejaculate
138
congenital bilateral absence of vas deferens
blockade of the transport of the spermatozoa from the testis or the epididymis to the distal genital tract
oligozoospermia
present in many males with CF
139
how to identify absence of vas deferens
fructose analysis of the semen
| fructose is made in seminal vesicle, so CBAVD men are fructose negative
140
seminal vesicles
secrete 2 ml of viscous, slightly yellow fluid which is present in highest concentration in the last half of the ejaculate
helps wash sperm out of urethra
141
seminal vesicle epithelium
psuedostratified or simple low columnar
142
secretions from seminal vesicle
1. fructose
2. prostaglandins
3. proteins responsible for semen coagulation: semenogelins
4. slightly alkaline pH
143
fructose
energy source for sperm
144
prostaglandins
stimulate smooth muscle contraction in female repro tract, aiding in sperm dispersal
145
semenogleins
coagulate semen seconds after ejaculation
146
alkaline pH of seminal vesicle secretions
help neutralize acidity of vagina
147
function of prostate gland
secretes 0.5 mL of thin, opalescent fluid present in the first portion of ejaculate
148
zones of prostate
periurethral zone transitional zone
central zone
peripheral zone
anterior fibrous zone
149
periurethral zone
smallest region
immediately around urethra
resistant to inflammation and carcinoma
site of SPH
150
peripheral zone
70% of prostate
| site of prostatic cancer
151
components of prostatic secretions
1. prostatic acid phosphatase (PAP)
2. prostate specific antigen (PSA)
3. spermine
4. fibrolysin
152
PAP
may enhance infectivity of HIV in semen
153
PSA
serine protease responsible for liquefaction of semen upon standing and liquefaction of cervical mucus
154
spermine
polyamine
antibacterial properties
musk odor of semen
155
fibrinolysin
liquefaction of semen
156
prostatic concretions
lumenal concretions which are thought to begin as protein and nucleic acid, but may calcify
occur in 20-30% of men over 50
may block ducts or appear in ejaculate
157
what is BPH
benign prostatic hyperplasia
obstructs the passage of urine, leading to increased retention and infections
increased difficulty urinating
158
BPH epidemiology
seldom seen before age 50
| found in 75-80% of non asian men over 80
159
function of stromal cells of the prostate
have 5-alpha-reductase enzyme to convert T to DHT
| diffuses from these cells into epithelial cells
160
function of DHT in the prostate
stimulates production of mitogenic growth factors to stimulate proliferation of both stromal and epithelial cells
161
treatment for BPH
```
a1 inhibitors (doxazosin)
5-alpha reductase type 2 inhibitors (finasteride)
```
162
a1 receptor inhibitors in BPH
relax contraction of smooth muscle in the stroma
| increases urine flow
163
5-alpha reductase type 2 inhibitors in BPH
shrink size of the prostate by reducing androgen concentrations
164
difference in feel of BPH and prostate carcinoma
prostate cancer: lumps or bumps
| BPH: general enlargement
165
prostate adenocarcinoma
3rd most frequent cause of cancer death in US males
PSA is used for monitoring
rectal exam used for screening
166
bulbourethral glands
compound tubuloalveolar glands that secrete clear mucus upon erotic stimuli
167
mechanism of penile erection
1. nerves produce NO which diffuses into smooth muscle cells
2. NO activates guanylate cyclase which converts GTP into cGMP
3. cGMP triggers storage of Ca2+ within the cell (induces relaxation)
4. relaxed smooth muscle presses against the small veins draining blood from the penis
168
erectile dysfunction
repeated inability to achieve and/or maintain penile erection and thus engage in intercourse
169
epidemiology of ED
more frequent in diabetic men
30 mil men in US
incidence increases with age
170
sildenafil mechanism
inhibits PDE5, an enzyme that promotes degradation of cGMP, which regulates blood flow in the penis
by inhibiting breakdown of cGMP, blood flow to the penis is increased, allowing maintenance of erection sufficient for intercourse
