Genitourinary Anatomy Flashcards
(194 cards)
1
Q
The kidney lie infront of which ribs?
A
11th and 12th ribs
2
Q
which kidney is slightly lower
A
right kidney slightly lower
3
Q
the right adrenal gland lies behind which structures?
A
liver and IVC
4
Q
the left adrenal gland lies behind which structures?
A
stomach and pancreas
5
Q
which three arteries supply to the adrenal glands?
A
Superior adrenal artery (from inferior phrenic)
Middle adrenal artery (from abdominal aorta)
INferior adrenal artery (from renal artery)
6
Q
venous drainage of adrenal glands?
A
right adrenal vein –> IVC
left adrenal vein –>left renal —> IVC
7
Q
what does the cortect of the adrenal gland produce?
A
cortisol, aldosterone, testosterone
8
Q
what does the medulla of the adrenal glands produce?
A
adrenaline
9
Q
are the kidneys intraperitoneal?
A
no - retroperitoneal
10
Q
what is each kidney embedded in?
A
perinephric fat and renal fascia and paranephric fat
11
Q
the renal arteries are branches from?
the renal veins drain into?
A
aorta
IVC
12
Q
A
13
Q
what are the functional unit of the kidneys? what are they responsible for?
A
nephrons.
- filter blood, reabsorbing water and solutes, secreting and excreting waste products as urine
14
Q
what structures are found withing the cortex of the kidney?
A
glomerulo, Bowman’s capsule, proximal and distal tubules, part of collecting ducts
15
Q
what are found in the renal pyramids?
A
nephron loop of Henle
rest of collecting ducts
16
Q
From the collecting ducts, urine travels down the pyramid towards the [a] (the apex of the pyramid) where it enters a [b]. [b]s merge with other [b]s to
form a [c]. [c] merge to form the [d] which is continuous with the [e].
A
From the collecting ducts, urine travels down the pyramid towards the renal papilla (the apex of
the pyramid) where it enters a minor calyx. Minor calyces merge with other minor calyces to
form a major calyx. Major calyces merge to form the renal pelvis which is continuous with the
ureter.
17
Q
the ureters run anterior to which muscle on the posterior abdominal wall.
what do they cross to to enter the pelvis?
A
run anterior to psoas major.
cross the pelvic brim to enter pelvis
18
Q
where is the bladder located?
A
below the peritoneum ∴ infra-peritoneal organ
posterior to pubic symphasis
anterior to vagina and rectum
19
Q
what is the smooth muscle in the bladder wall called?
A
detusor - contracts to forcibly expel urine
20
Q
the ureters join the bladder at which part of the bladder
A
the trigone - smooth internal wall.
21
Q
how is reflux of urine prevented when the bladder is full?
A
the ureters enter the trigone of the bladder at an angle, forming a rudimentary valve.
22
Q
name of the folds inside the bladder? function?
A
ruggae.
allow the bladder to stretch without tearing when it fills.
23
Q
how much urine can the the bladder hold in an adult?
A
400-600ml
24
Q
blood supply to bladder?
A
vesical arteries - from internal ileac artery.
vesical veins - to the internal iliac vein
25
the release of bladder in controlled by?
internal sphincter - smooth muscle (involuntary)
external sphincter - skeletal muscle (voluntary)
26
where is the internal sphincter located?
base of bladder where it opens into the urethra
27
where is the external sphincter found?
inferior to prostate in males.
deep perineal pouch in females
28
somatic control of urinary bladder and sphincters:
pudendal nerve S2-S4
- concsious control of external sphincter
29
sypmathetic innervation of the Urinary Bladder and Urethral Sphincters
* Via branches of the hypogastric nerve (sympathetic chain, T12-L2)
* Causes relaxation of the detrusor and contraction of the internal urethral sphincter, allowing storage of urine.
30
Parasympathetc Innervation of the Urinary Bladder and Urethral Sphincters
* Via the pelvic splanchnic nerves (S2-S4)
* Causes contraction of the detrusor and relaxation of the internal urethral sphincter, allowing initiation of micturition.
31
how long is the female urethra?
3-4cm
32
the posterior abdominal wall extends from where to where
from the attachments of the diaphram
to the
pelvic brim inferiorly
33
which nerves supply the anterior abdominal wall muscles
and skin of the external genitalia.
iliohypogastric and ilioinguinal
34
which nerve supplies the skin of the external genitalia.
genitofemoral
35
which nerve supplies the skin over the lateral thigh.
Lateral femoral cutaneous nerve - also known as the ‘lateral cutaneous nerve of the thigh’
36
which nerve supplies the muscles and skin of the anterior thigh
Femoral nerve - often target for nerve blocks for pain releif in lower limb fractures. easy to locate with ultrasound
37
which supplies the muscles and skin of the medial thigh.
obturator nerve
38
39
the thoracic abdomen pierces abdomen at which level?
t12 ---abdominal aorta
40
where does the abdominal aorta bifurcate?
bi**four**cates at L4
into the left and right common iliac arteries
41
what are the paired branches of the abdominal aorta?
renal, adrenal, gonadal, lumbar
42
what are the unpaired branches of the abdominal aorta?
coeliac trunk, SMA, IMA
43
where is the IVC formed, from what?
L5 - from union of left and right common iliac veins.
44
the IVC is to the left/right of midline in abdoman?
IVC to the right
Aorta to the left
45
where does the left gonadal vein typically drain into?
left renal
46
at what level does the IVC pass through the diaphram?
T8
47
what is it called when a UTI spreads to the kidney?
pyelonephritis
| requires IV antibiotics
48
where do:
- Renal cell carninomas
- transitional cell carcinomas
- wilms tumours
orginate from?
Renal cell carninomas - lining og nephron
transitional cell carcinomas - epithelial lining in kidney
wilms tumours - renal stem cells
49
triad of renal cancer symptoms?
pain in the flank
palpable mass in the abdomen
haematuria
## Footnote
As the kidneys are encased in a renal capsule, perinephric fat, renal fascia and paranephric fat, a renal cancer must grow very large and penetrate these layers before it is able to invade adjacent organs and structures.
50
risk factors for AAA?
smoking, alcohol,
hypertension, and atherosclerosis.
51
AAAs are diagnoses if?
dfiameter of aorta wider than 3cm
52
risk factors for kidney stones?
high urine-calcium levels, dehydration, obesity, and certain medications
53
typical kidney stone presentation?
The typical presentation of an obstructing stone in the ureter is
excruciating, pulsatile pain felt from ‘loin to groin’.
This is because the pain fibres supplying
the ureters originate from the T12 to L2 nerves, so pain is referred and felt in the T12 - L2
dermatomes
54
where are kidney stones most likey to get stuck?
3 places where the ureter narrows:
1. Pelvi-ureteric junction (PUJ) – between the renal pelvis and ureter.
2. Pelvic brim - where the ureter runs over the pelvic brim, anterior to the iliac artery.
3. Vesico-ureteric junction (VUJ) - where the ureter joins the bladder.
55
what is a phaeochromocytoma?
This is a rare hormone-producing tumour of the adrenal medulla.
Secretion of excess adrenaline causes symptoms and signs related to hyperactivity of the sympathetic nervous
system which are typically hypertension, tachycardia, and excessive sweating.
56
where is the sacral micturition centre found?
sacral spinal chord:
57
what is the reflect arc involved in urination?
As the bladder fills, stretch of the bladder wall is detected and this is relayed to the sacral spinal cord via visceral afferent fibres.
In the sacral spinal cord these fibres synapse directly onto motor neurons.
= reflex arc = inhibited by inputs from cerebral cortex in adults who have developed descening inhibitory pathways that inhibit reflex = potty training
58
what is the pattern of bladder dysfunction in someone with injury to spinal chord above the sacral level.
1. X ascending pathways conveying the sensation of bladder filling to the brain (so the patient is no longer aware of bladder filling).
2. X descending pathways that exert voluntary, inhibitory control over the external urethral sphincter (so the external sphincter is permanently relaxed).
## Footnote
The reflex arc still functions below the injury, but the patient does not have any inhibitory control over it. The patient does not realise they need to pass urine and the bladder automatically empties as it fills, so the patient is incontinent of urine.
59
what happends to urination in a person with spinal injury at or below sacral micturation centre?
- overflow incontinence: reflex arc disrupted, bladder fills without emptying, internal sphincter permanently contracted until pressure in bladder exceeds sphincter strength.
- urinary retention - if pressure does not exceed sphincter strength, back up of urine to ureters and kidneys.
60
what bones make up the hip bone?
ilium, ischium, pubis --> fuse at the acetabulum of pelvis
61
what are the five articulations of the bony pelvis?
1. hip joint
2. Sacroiliac joint
3. pubic symphasis
4. lumbosacral joint
5. sacrococcygeal joint
62
three differences beetween male and femal bony pelves?
* Wider, circular pelvic **inlet** in females (for childbirth) and narrower, heart-shaped pelvic
inlet in males.
* Obtuse (>90˚) angle formed by the inferior **pubic rami** in females, acute angle (<90˚) in
males.
* Wider and shorter **sacrum** in females; a narrower, longer sacrum in males.
63
64
landmark for eipdural and lumbar puncture?
iliac crest - L4/L5 disc space
65
where can the femoral artery be palpated?
mid-inguinal point
66
three functions of the pelvic floor muscles?
1. Prevent **herniation** of the pelvic organs inferiorly, out of the pelvis.
2. Control **continence** of urine and faeces by providing a sphincter action on the urethra
and rectum respectively.
3. Aid in increasing intra-abdominal **pressure**.
67
what TWO mucles is the pelvic floor made up from?
levator ani and coccygeus
68
what THREE muscles make up the levator ani?
1. puborectalis (sling)
2. Pubococcygeus
3. Iliococcygeus (ischium and coccyx)
69
innervation of levator ani?
branch of S4 and branches of pudenal (S2-S4)
70
71
which artery supplies the bladder in both sexes, and the prostate and seminal vesicles
in males?
vesical
72
label these key branches of the internal iliac artery
## Footnote
* Vesical arteries - supply the bladder in both sexes, and the prostate and seminal vesicles
in males.
* Uterine and vaginal arteries in females.
* Middle rectal artery - supplies the rectum.
* Internal pudendal artery - exits the pelvis to supply the perineum.
* Superior and inferior gluteal arteries - exit the pelvis to supply the gluteal region.
* Obturator artery – exits the pelvis to supply the lower limb.
73
what is the major nerve of the perineum?
Pudendal nerve - S2-S4, somatic
74
which nerves exit the pelvis and innervate the
gluteal region.
superior and inferior gluteal nerves
75
nerves carry parasympathetic fibres from the S2 - S4
spinal cord segments to the pelvic viscera.
pelvic splanchnic
76
Sympathetic fibres that innervate the pelvic viscera are derived from the?
lumbar splanchnic nerve.
77
what are the two flextures of the rectum?
the sacral flexure anteriorly and the anorectal flexure posteriorly.
78
blood supply to the rectum?
superior rectal - from IMA
middle rectal - from internal iliac
inferior rectal - internal pudendal
79
venous blood from the rectum enters which veins?
superior, middle and inferior rectal veins.
branches of these anastomose to form a venous plexus around the rectum and anus = site of portosystemic anastomoses.
80
the perineum is the region between?
between the pubic symphasis and the coccyx.
between the medial surfaces of the thighs.
81
what are the four layers of the urogentital triange?
* skin
* perineal fascia
* superficial perineal pouch
* perineal membran
82
what can be found within each of the layers of the urogenital triangle?
83
how long is the anal canal?
4cm
84
what are the two anal sphincters that control defecation?
internal anal sphnicter - smooth muscle, involuntary
external anal sphinter - skeletal muscle, voluntary
85
what divides the anal canal into superior and inferior parts?
pectinate(/dentate) line
86
The superior part of the anal canal, above the pectinate line, is part of the [a] and derived
from [b]. [c] epithelium (i.e. intestinal mucosa) lines the lumen. It is supplied by
the [d] via the [e]. Venous drainage is via the [f] towards the liver. It is encircled by the [?] anal sphincter which is
innervated by sympathetic fibres (originating from the [g]) and
parasympathetic fibres (via the [h]).
The superior part of the anal canal, above the pectinate line, is part of the **hindgut** and derived
from **endoderm**. **Columnar** epithelium (i.e. intestinal mucosa) lines the lumen. It is supplied by
the **inferior mesenteric artery** via the **superior rectal artery**. Venous drainage is via the **portal
venous system** towards the liver. It is encircled by the **internal** anal sphincter which is
innervated by sympathetic fibres (originating from the **sympathetic trunk**) and
parasympathetic fibres (via the **pelvic splanchnic nerves**).
87
The inferior part of the anal canal, below the pectinate line, is derived from [a].
[b] epithelium lines the lumen. It is supplied by the [c] which originate from the [d]. Venous blood enters the
[e] system and does not pass through the portal system. The inferior anal canal is
encircled by the [f] anal sphincter which is innervated by the [g] nerve (a somatic nerve).
The inferior part of the anal canal, below the pectinate line, is derived from **ectoderm**.
**Stratified squamous epithelium** lines the lumen. It is supplied by the **middle and inferior
rectal arteries** which originate from the** internal iliac arteries**. Venous blood enters the
**systemic** venous system and does not pass through the portal system. The inferior anal canal is
encircled by the **external (voluntary)** anal sphincter which is innervated by the **pudendal nerve**
(a somatic nerve).
88
what/ where is the perineal body?
bewteen the two triangle of the perineum.
This dense mass of fibrous tissue and muscle sits in the centre of the perineum and acts as an attachment for almost all the
perineal and pelvic floor muscles, including levator ani, the external anal sphincter, the external urethral sphincter, and muscles associated with the erectile tissues of the perineum.
89
What can weaken pelvic floor muscles?
childbirth, ageing, straining, obesity
## Footnote
can lead to incontinence of organ prolapse (uterus or rectum)
90
91
What makes up the borders of the inguinal canal?
Anterior -
Posterior
Roof -
Floor -
Anterior
- External oblique aponeurosis
- Laterally only - internal oblique aponeurosis
Posterior
- Transversalis Fascia
- Medially only - medial fibres of the aponeurosis of internal oblique and transversus abdominis (conjoint tendon)
Roof
- Transversalis fascia
- arching fibres of internal oblique and transversus abdominis
Floor
- inguinal ligament
92
what are the three structures founf in thr inguinal canal in females?
1. round ligament of the uterus
2. ilioinguinal nerve
3. genital branch of the genitofemoral nerve
93
how long is the inguinal canal in adults?
aprox 5cm
94
In males, the contents of the inguinal canal are all contained withing which structures, except for?
except for the ilioinguinal nerve (in canal, but outside the spermatic chord)
95
In the spermatic chord there are:
two [?]
three [?]
three [?]
four [?]
two nerves
three arteries
three fascial layers
four "others"
96
what are the two nerves found in the spermatic chord?
* genital branch of the genitofemoral nerve
* sypathetic nerve fibres
97
what are the three arteries found within the spermatic chord?
testicular artery
cremasteric artey
artery to vas deferens
98
what are the four "other" structures found within the spermatic chord?
1. pampiniform venous plexus
2. lymphatics
3. vas deferens
4. tunica vaginalis (from peritoneum)
99
what are the three fascia layers found in the spermatic chord?
1. external spermatic fascia (from external oblique aponeurosis)
2. cremaster muscle and fascia (from internal oblique muscle)
3. internal spermatic fascia (from transversalis fascia)
100
101
beneath the skin of the scrotum is a thin layer of superficuaal fascia, involuntary muscle called?
the dartos
102
The superficial fascia extends between the testes to form
a [?] dividing the scrotum into right and left halves.
septum
103
the testes produce?
and secrete?
produce sperm
secrete testosterone
104
the testes are covered by the same three layers of fascia that cover the spermatic chord, plus are partially surrounded by?
the tunica vaginalis - a sac derived from the peritoneum
105
spermatazoa are formed in the testes and are stored in the..?
epidymis
106
what carries sperm from the epidymis?
vas deferens carries sperm from the epidymis and stravels with the testicular vessels in the spermatic chord.
107
testicular arteries are direct branches of?
abdominal aorta
108
venous blood from the testis and epidymis enter the [a]
the [a] forms the [b]
the right [b] drains into the [c]
the left [b] drains into the [d]
[a] pampiniform venous plexus
[b] testicular vein
[c] IVC
[d] left renal vein
109
what are the three cylinders of erectile tissue that compose the penis?
2 x corpora cavernosa dorsally (top)
1 x corpus spongiosum ventrally (bottom)
110
The corpora cavernosa and corpus spongiosum are enclosed within?
the deep fascia of the penis = Buck's fascia
111
The end of the penis is called the [a] and is an expansion of the [b]. The circular base of the glans is called the [c].
[a] glans
[b] corpus spongiosum
[c] corona
112
The skin of the shaft of the penis extends over the glans and is called the ?.
foreskin
113
114
115
what are the crura of the penis?
symetricsl parts of the corpora cavernosa that are attached to the left and right ischial rami
116
what is the bulb of the penis?
the part of the corpus spongiosum that, proximally, rests on the perineal membrane.
117
as the urethra approaches the end of the penis, it opens via the?
external urethral meatus
118
119
the corpa cavernosa are covered by which muscles?
the corpus spongiosum is covered by which muscles?
corpa cavernosa = ischiocavernous muscles
corpus spongiosum - blubospongious muscle
120
the ischiocavernous muscles force blood where?
into the body of the penis from the crura
121
the bulbiospongiosus mucles forces blood where?
into the glans penis
122
how does the bublospongiosus muscles help maintain and erection?
by compressing the veins that drain erectile tissues and contracting to squeeze and remaining uring or semen from the urethra
123
124
blood supply to the penis?
internal pudendal arteries (from internal iliac)
internal pudendal → deep artery of penis, and artery of bulb of penis
125
126
127
general and sypathetic nerve supply to the penis?
from S2 -S4 - pudendal nerve
- general sensation and sympathetic = dorsal nerve (from pudenal nerve)
127
which nerve is repsponsible for causing an erection?
Peri-prostatic nerve plexus - parasympathetic (dialte the arteries of corpora)
128
ischiocavernosis and bulbospongiosus muscles innervated by?
pudenal nerve (S2-S4)
129
which erectil tissue is primarily responsible for increasing the size and rigidity of the penis during an erection?
the corpora cavernosa
- during sexual arousal, arterial blood flow into the corpora cavernosa of the penis increased so the corpra becomes engorged with blood.
130
what is the role of the corposa spongiosum in penile erections?
also become engorged with blood, but not to the same extent as the corpora cavernosa.
main role is to preven the urethra from being compressed which would prevent ejaculation.
131
132
what is the route of the vas deferens?
include what the ampulla is.
tube that carries sperm from the epidymis up the spermatic chord through the inguinal canal into the pelvis.
from the deep inguinal ring it passes across the side wall of the pelvis and tuns medially into the back of the bladder. Here it has a dilated portion, the ampulla, which lies medially to the seminal vesivle. It terminated by joining the duct of the seminal vesicle to form the ejactulatory duct.
133
what does the seminal vesicle secrete?
a thick alkaline fluid which forms the bulk of semen.
134
the [sv] and [vd] join to become the [] which pireces the back of the [] to enter the []
The duct of the seminal vesicle joins the vas deferens to become the ejaculatory duct which pierces the back of the prostate gland to enter the prostatic urethra.
135
where is the prostate?
the prostate gland is a roughly spherical fibromuscular gland about the size of a
walnut. It lies against the neck of the bladder and is pierced by the urethra and ejaculatory
ducts. Secretions of the prostate are added to the seminal fluid during ejaculation.
136
blood supply to the vas deferens, seminal vesicle and prostate?
internal iliac artery
137
what is a hydrocele?
painless scrotal selling caused by an accumulation of peritoneal fluid between the tinuca vaginalis around the testis.
light can pass thorugh - transillumination
138
what is a variocele?
abnormal dialtion of the paminiform venous plexus which cauyses scrotal swelling.
'bag of worms' on palpation
139
which side is a variocele more likely to be found?
the left - because the left testicular veing drains into the renal before IVC.
left sided variocele might be caused by left renal vein obstruction
140
what is and epidididymo-orchitis?
what are its likely causes?
painful inflammation of epididymis and testes.
-often caused by STI such as ghlamydia or gonorrhoes
or UTI
141
what is a testicular torsion?
twisting of testis on the spermatic chord
can lead to ischaemis = sugrical emergency.
142
what is cryptorchidism? why is it usually treated surgiucally?
an undescended testis
- During foetal development, the testes form in the abdomen and descend through the inguinal canal to reach the scrotum before birth. If this fails to occur, the infant is born with one or both testes absent from the scrotum, and the affected testis will be stuck somewhere along the path of descent.
- spermatogenesis optimal below core body temp, tesis will only function if in scrotum.
- increased risk of testicular cancer
143
where does testicular cancer first metastasises?
will likely follow the lymphatic drainage which follows testicular arteries back to the lymph nodes around the aorta.
therefore likely metastasises first to the para-arotic or retroperitoneal lymph nodes.
144
what are ligated during a vasectony?
scrotum incised and vasa deferens ligated, cauterised and clamped to p[revent passage of sperm
145
how does sildenafil treat ED?
increase blood flow to corpora of penis
146
what is a BPH or BPE. what can it cause?
benign prostatic hyperplasia/enlargement
common with age.
prostate completely encircles the urethra, so enlargement can lead to urinary retention = requires catherterisation.
147
why does prostate cancer commonly metastasise to the vertebrae?
venous blood from the prostate passes intoa plexus which lie anterior to the sacrum ad communicate with the veins which run to the azygous vein in the chest. these veins communicate with the veins in the ventral bodies.
148
what is a clinician feeling for in a DRE?
size, contour and frimness.
hard and craggy = concerning.
149
the vulva is the collective term for?
femal external genitalia
150
what is the mons pubis?
mound of fatty tissue in front of the pubic symphasis
151
what is the labia majora?
prominant hair-bearing fold of the skin that meet at the mons pubis anteriorly
152
what is the labia minora?
smaller, hairless fold of skin located medial to the labia majora.
fuse together anteriorly to form the hood of the clitoris.
form the boundaries of the vestibule.
153
what is the clitoris formed of?
erectile corpora cavernosa and corpus spongiosum
becomes engorged during sexual arousal
154
what is the vestibule?
aria between labia minora.
contains vaginal opening, urinary meatus and vestibular glands.
155
what is the hymen?
thin membrane that partially covers the vaginal opening
156
where is the urinary meatus located
posterior to clitoris, anterior to vaginal opening
157
what are the two vestibular glands
* greater vestibular glands (Bartholin's) located posterior to the vaginal opeingn and secrete lubricant
* lesser vestibular glands (skene's) near urethral opening. function of secretions debated...antimicrobial?
158
159
the crura of the clitoris refers to?
the parts of the corpora cavernosa that are attached to the ischial rami
160
in females, the corpus spongiosum lies in the midline on the perineal membrane (as in males) but it [?].
this makes the [a] of the vestibule
the anterior part of the [a] from the [?]
but is split into ttwo parts that flank that vaginal opening.
this makes the bluble of the vestibule/bulb of the clitoris
the anterior part of the bulb form the glans clitoris
161
as in males, the corpora cavernosa are covered by [?] and the corpus spongiosum is covered by [?] in female genitalia.
corpora cavernosa covered by ischiocavenous muscle
corpus spongiosum covered by bulbospongiosus muscle
162
in femal genitalia, the ischiocavernous fouces blood [?]
the bulbospongiosus forced blood into [a]
Ischiocavernosus forces blood from the crura to the body of the clitoris.
Bulbospongiosus forces blood into the glans clitoris. It
helps to maintain clitoral erection and constricts around the vaginal orifice which can help expression of fluid from the greater vestibular glands.
163
164
blood supply to the clitoris?
internal iliac → internal pudendal arteries → deep arteries of clitoris and arteries of the bulb of vestibule
165
erectil tissues of the cliltoris are innervated by?
parasympathetic nerves
166
ischiocavernosus and bulbospongiosus innervated by?
pudendal nerve (S2-S4)
167
which nerves inverate the vulva?
1. ilioinguinal
2. genital branch of genitofemoral
3. pudendal
4. posterior cutaneous nerve of the thigh
168
the ovaries are attched to the posterior aspect of the [a] by the [b]
[a] broad ligament
[b] mesovarium
169
where are the ovaries usually found?
the ovarian fossa, formed by an angle between the internal and external iliac arteries.
ureter and obturator nerve and vessesl close relations of ovarian fossa
170
how large are the ovaries?
4cm long, 2cm wide
171
how long is the uterus?
8cm long
172
the urterus communicates laterally with the [a] and inferiorly with the [b]
[a] uterine tubes
[b] vagina
173
the body of the uterus is typically angled [a] and rests on the superior surface of the [b].
the junction between the body and the cervix may be tilted [c]
[a] anteriorly / ante-flexed
[b] bladder
[c] anteriorly or posteriorly
174
the uterus is covered in a fold of [a] which adheres to itself to form the [b]
[a] peritoneum
[b] broad ligament
175
the space behind the urterus, anterior to rectum is called the [a] and is lined with [b]. it is the [c] point in the peritoneal cavity so is a common site for the accumulation of [d]
[a] rectouterine pouch / pouch of Douglas
[b] peritoneum
[c] deepest]
[d] intraperitoneal fluid or pus
176
how long are fallopian tubes?
10cm
177
the fallopian tubes run in the [a] border of the broad ligament.
near the uterus, the tubes have a narrow [b].
laterally the tubes have a dilated [c] leading to a funnel shaped [d]. the free edge of the [d] are broken up into finger like projections called [e] which are draped over the ovary.
[a] upper
[b] isthmus
[c] ampulla
[d] infundibulum
[e] fimbriae
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the cervix has a narrow lumen called the [a] which communicates with the [b] via the [c]
and with the [d] via rthe [d]
[a] cervical cana;
[b] uterine cavity
[c] internal os
[d] vagina
[e] external os
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the lower part of the cervix lies inside the vagina creating a recess called [a] around the cervix
vaginal fornices
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the position of the cervix is stabilised by what?
levator ani muscles and ligament which run from the lateral wall of the cervix to the lateral pelvic wall at the base of the borad ligament.
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what is the vagina?
the extretory duct of the uterus
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how long is the vagina?
10cm
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the vaginal terminates belwo at the?
introitus by opening into the vestibule (space) between the labia minora
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the vagina passes through the pelvic floor.
the upper 2/3 of the vagina lie in [a]
the lower 1/3 lies in the [b]
[a] pelvic cavity
[b] perineum
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the urethra is often embedded in the [a] of the vagina
[a] anterior wall of the lower 1/3 of the vagina
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ovaries, uterus, fallopian tubes, cervix, vagina.
all recieve arterial blood supply from [?] except the [?] which is supplied by the [c], a direct branch of the [d] which also contributes tp the blood supply of the [e]
All these structures receive arterial blood via branches of the internal iliac artery, except the
ovary which is supplied by the ovarian artery. The ovarian artery is a direct branch of the
abdominal aorta and also contributes to the blood supply of the uterine tubes.
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what is endometriosis?
condition where endometrial tissue which lines the inside of the uterus is found on the outside, usually in ovaries, tubes, ligaments and rectouterine pouch (although rarely as distal as thorax).
painful periods, heavy bleeding, chronic pelvix pain and pain during intercourse. difficult conceiving.
diagnosed thorugh biopsies during surgical exploration
187
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what are fibroids?
benign growths of the uterus which my be asymptomatic or cause varied symptoms including painful and heavy periods.
vary in size and may grow very large,]may grow into lumen of uterus and make it difficult to conceive.
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symptoms of gynaecological cancers?
pelvic pain, abnormal vaginal discharge, abnormal vaginal bleeding (bleeding between periods, after intercourse or after the menopause), urinary disturbance, abdominal swelling, and more non-specific symptoms of malignancy such as fatigue and weight loss.
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most cases of cervical cancer are caused by?
infection with specific types of human papillomavirus (HPV)
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what is a hysterectomy?
surgical removal of uterus
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what is an ectopic pregnancy?
when the blastocysts implants outside of the body of the uterus, commonly in the urterine tube. This may rupture as the pregnancy progresses and becomes life-threatening.
surgery required.
