L7.2 Pelvic viscera 2 Flashcards Preview

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Flashcards in L7.2 Pelvic viscera 2 Deck (27):
1

Development of the female genital tract

  • 6 weeks → paramesonephric ducts develop into components of the genital tract
    • Uterine tubes
    • Uterus
    • Upper part of vagina
    • Has bilateral BS (2 components coming together to form the genital tract)

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2

Ovaries

  • Differentiated from gonads
  • Descent into pelvic cavity (LAT pelvic wall)
    • Gubernaculum (becomes the vestigial remnant of the round ligament and ligament of the ovary) precedes the descent
  • Imperfect descent - not reached position on LAT pelvic wall
  • Endocrine (estrogen, progesterone, relaxin) & Exocrine

3

Position of the ovary

  • Lies on peritonuem in ovarian fossa next to in/ex iliac vessls, and ON obturator N (on the plane of coccyx to pubis)
    • Ovarian infections → affects & refer pain via obturator N to medial thigh

4

What are the ovaries held in position by?

  • Peritoneal folds (Broad ligament - which are then strengthened by traversing BVessels)
    • Attaches to ovary: via the mesovarium
    • Attaches to uterus: via ligament of the ovary
    • Attaches to LAT pelvic wall: via suspensory ligament

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5

Where does the ovary prolapse into?

Rectouterine pouch

6

5 main parts of the uterine tube

  1. Intramural (within uterus wall)
    • Medial opening = uterine 'os'
  2. Isthmus (straight part)
  3. Ampulla (longest, widest & most tortuous)
    • Where fertilisation takes place
  4. Infundibulum
    • Opening to perineal cavity = abdominal 'os'
    • Infected material able to pass from vagina → peritoneal cavity
  5. Fimbria
    • Finger-like strands → brings ovaries into tube
    • Ovarian-fimbria attaches to ovary

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7

How is the ovary conveyed through the ovarian tube?

  • Conveys fertilised egg via peristalsis & cilia
  • Smooth wall muscles → allows peristalsis

8

Ectopic pregnancy

  • Implanted in the wrong place (most common = ampulla)
  • If ruptured → release material into perineal cavity → hemorrhage

9

Uterus

  • Body narrowing to cervix = internal 'os'
  • Cervix leading to vagina → external 'os'
  • Body (upper 2/3 of uterus) → where implantation occurs
  • Cornus → where uterine tube comes into fundus

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10

Enlargement of uterus during pregnancy

  • Rises into ab cavity
  • 3 months = suprapubic levels
  • 6 months = iliac crest
  • 8 months = xiphisternum → pressure on urinary bladder

11

Cervix

  • Has Supra-vaginal & Vaginal part
  • Normal position:
    • Anteverted cervix (relative to vag) and Anteflexed body (relative to cervix)
  • Laxity of support post birth → variation in position of cervix and body
    • Leads to retroversion and retroflexion → increase risk of prolapse

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12

Support of the uterus

  • L.Ani (form below)
  • Ligaments:
    • Broad
    • LAT (transverse) cervical
    • Pubocervical
    • Uterosacral

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13

What are the two pouches formed by the peritoneum

  • Rectouterine
  • Uterovesical

14

Vagina

  • Upper part (above pelvic floor)
  • Lower part (below pelvic floor in perineum)
  • POS fornix (only part with peritoneal coverings) → where vag meets termination of uterus → If penetrated → goes straight into peritoneal cavity

15

Sphincters holding the vagina in position

  • Pubovaginalis (floor of pelvis)
  • Urethrovaginal (in perineum)
  • Bulbospongiosus (in perineum)

16

Testes and the epididymus

  • Located in scrotum
  • Endo & exocrine
  • Epididymus → stores sperm (at the head)
    • Transmits sperm via peristalsis to vas deferens
  • Testis encapsulated by fibrous tissues
    • Outer: terminal vaginalis
    • Inner: Tunica albuginea

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17

Development of testes

  • In POS ab wall
  • Gubernaculum precedes testis (and draws testes down)
  • L lower than the R
  • Undescended testes → becomes non-viable
    • Cryptochidism → testes NEVER reaches the scrotum
    • Ectopic testes → lies close the ab cavity

18

Pathway of Vas deferens

  • From epididymus → into inguinal canal → back of bladder → pierce seminal vesicle (which secretes semen) → forms ejaculatory duct → pierces prostatic urethra

19

Prostate 

  • Prostatic urthrea is the widest in young males (but narrows with age as it hypertrophies)
  • On the POS wall of prostatic urethra → elevated area = seminal colliculus (Where ejac ducts opens into urethra)
    • Prostatic sinus (where semen comes in) on seminal colliculus
  • Prostatic duct drains into urethra through prostatic sinus

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20

Lobes of the prostate

  • Median
    • May be enlarged with age → projects into bladder → obstructs outlet of bladder
  • L & R LAT lobes

21

Capsule of prostate

  • Contains BS and NS
    • Pudendal N - responsible for erectile function in males and females
    • Susceptible to injury in procedures involving removal of prostate gland (i.e. for prostatic cancer)
      • 40% will involve in some loss of control following prostate surgery

22

Function of the bulbourethral gland

  • Bulbourethral gland = mucus secretions

23

Rectovesical septum

  • Lies behind prostate, has fascial layer → protective of infection & cancer cells to prevent or slows passage of cancer cells (an embryological structure)

24

Zones of prostate

  • Transition zone:
    • Site of benign prostatic hypertrophy/hyperplasia
    • Encroaches on the urethra
  • Peripheral zone:
    • Area for prostatic cancer zones

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25

Penis

  • Made up of cavernous tissues
    • Corpora caveronsa (vascular spaces)
      • Contains the erectile tissues which is filled with blood during erection
      • The erect position of penis = anatomical position
      • Originate from the bulb (root of the penis)'
    • Corpus spongiosum
      • Also have cavernous tissues (Contributes to erectile state)
      • Spongy(penile) urethra passes through it
    • Glands of penis = glands
  • Prepuce = foreskin
    • Inside of prepuce very sensitive to AIDS

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26

Navicular fossa

  • Navicular fossa in male penis
    • Dilation distal to the opening narrowing
    • Navigating pelvic floor and urthrea is the tricky part

27

Fascia of the penis

  • Erection surrounded by fascia
  • Dartos fascia (superficial)
  • Deep penile fascia (Deep)

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