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What are the pouches for males in the peritoneum?

Vesicorectal pouch - this is where the peritoneum goes over the viscera.


What are the pouches for females in the peritoneum?

Vesicouterine pouch (between bladder and uterus) and rectouterine pouch (between rectum and uterus) - aka pouch of dougals.


What is the clinical importance of the pouches?

They are potential sites for fluid to collect in.


What are the muscles in the perineum?

1. Ischiocavernosus.
2. Bulbospongiosus.


Describe the ischiocavernosus muscle?

It is attached along the ischiopubic rami and it aids erections in males and tenses the vagina in females.


Describe the bulbospongiosus?

It is attached posteriorly to the perineal body.


Describe the variation of bulbospongiosus muscle between males and females?

In males - it is attached in midline raphe (also surroudn the bulb of the penis).
In females - it is split either side of the vaginal orifice.


Describe the function of bulbospongiosus?

In males - erection and ejaculation (can also be used to aid micturition).
In females - clitoral erection and feelings of orgasm.


What is the erectile tissue in females?

1. Crus of clitoris - contributes to the body and head of the clitoris.
2. Bulb of vestibule - contributes to head of clitoris and surrounds the vaginal orifice.


What is the erectile tissue in males?

1. Crus of penis - becomes the corpus cavernous of the penis.
2. Bulb of penis - becomes the corpus spongiosum and glans penis (which contains the urethra).


Describe the vasculature of the penis?

All the branches come from the internal pudendal artery or vein. There are two dorsal arteries that accompany the dorsal nerve of the penis (which comes from the pudendal nerve) and there is one deep dorsal vein. There are also two deep arteries that are inside the corpus cavernosum. There is also the superficial dorsal veins of the penis under the superficial fascia.


Describe the scrotum?

It is an out-ouching of skin from the abdominal wall.


What does the scrotum contain?

Testes, epididymis and lower end of spermatic cords - inner layer of scrotum is the same as the spermatic cord.


Describe the superficial fascia of the scrotum?

The superficial fascia is continuous with the abdominal scrap's fascia but fat is replaced by smooth muscle - Dartos Fascia. Darts is continuous posteriorly with deep fascia or perineum (Colle's fascia).


What is the function of the cremaster muscle in the scrotum?

Raise the testes and scrotum upwards for warmth and protection.


Where does the scrotum receive blood from?

Both internal and external pudendal arteries.


Describe the development of the scrotum?

Mesenchyme cells condense to form the gubernaculum through the inguinal canal to labio-scrotal swelling. In the male testes come through the inguinal canal in 7-8th month in utero, they follow the path of the gubernaculum so same coverings as inguinal canal. In females the gubernaculum are stuck to the uterus so ovaries stay in the pelvis; round ligament goes through the inguinal canal.


Describe the testicular artery?

It comes off the aorta at L2 and it supplies the testes and the epididymis.


Describe the testicular veins?

These come from the pampiniform plexus. The right testicular vein goes to IVC. The left testicular vein goes to left renal vein.


Describe the lymphatic vessels of the spermatic cord?

These go to para-aortic nodes at the root of the testicular artery at L2.


Describe the autonomic nerves of the spermatic cord?

These are sympathetic on the artery from the testicular plexus.


Describe the cremasteric artery?

It comes from the inferior epigastric artery and it supplies the cremaster muscle.


Describe the artery of the vas deferens?

It comes from the inferior vesicle artery and it is important in vasectomies.


Describe the genital branch of the genitofemoral nerve?

It supplies the cremaster muscle and the skin of the scrotum.


Describe the testes?

These create sperm, they have a tough fibrous capsule which surrounds each testis. Each lobule has 1-3 seminiferous tubules which opens into the rate testis. Efferent ductules connect rate to epididymis. The testis are 3 degrees celsius cooler than the abdomen = darts, cremaster and heat exchange between artery and veins aid cooling.


What does the epididymis do?

It stores sperm and it eventually becomes the vas deferens.


Describe the vas deferens?

It is a muscular tube that travels in the spermatic cord through the inguinal canal. They join the duct from the seminal vesicle to form the ejaculatory duct (this goes into the prostate to join the urethra).


Describe the vas deferens course to the prostate?

1. It enters the body cavity lateral to the inferior epigastric artery (from the spermatic cord).
2. It crosses over the external lilac vessels passing medially towards the prostate.
3. It then passes over the top of the ureter to join seminal vesicles (and form ejaculatory duct).

"Water Under the Bridge".


Describe the seminal vesicles?

5cm long (uncoiled = 10-15cm) vesicles that secrete liquid component of semen and fructose. They are posterior to the bladder and superior to the prostate.


Describe the prostate gland?

This gland is inferior to the bladder. Ir produces proteolytic enzymes and acid phosphate. It contains the prostatic urethra and the ejaculatory duct.


What vasculature supplies the prostate gland?

Branches of the internal iliac artery (internal pudendal, middle rectal and inferior vesicle arteries). The deep dorsal veins of the penis drain into the plexus and then into the internal iliac veins.


Describe prostatic enlargement?

It may affect all or part of the prostate. It may be benign or malignant. it is commonly seen in the DR (benign enlargement in males aged 50+). End up with feeling of never being empty.


Describe the lymphatic drainage?

1. External iliac nodes.
2. Deep inguinal and iliac nodes.
3. Internal iliac nodes.
4. Aortic nodes at root of testicular artery at L2.
5. Skin of penis and wall of scrotum go to superficial inguinal nodes.


Describe the features of the uterus?

[Starting out from outside of the body.]
-Fornix - recess where vagina joins to cervix.
1. Body of the uterus.
2. Fundus - most superior.
3. Uterine tube = isthmus, ampulla and infundibulum.
4. Fimbrae.


Describe the peritoneum of the female reproductive system?

As it sweeps over the uterus the peritoneum gets a name - bored ligament. The uterus is slightly angled.
1. Anteversion - angle at the cervix. This flips the uterus forward anteriorly.
2. Anteflexion - angle in the body of the uterus.
These angles push the uterus to lay on top of the bladder to give it support.


Describe the broad ligament?

As the peritoneum sweeps over the uterus it becomes known as the broad ligament. As it reflects over the uterine tubes = mesosalpinx. As it reflects over the ovaries = mesovarium. As it reflects over the uterus = mesometrium.

The round ligament goes through the inguinal canal and helps to pull the uterus forwards.


Where does the ureter pass in females?

It passes under the uterine artery.


Describe the ovarian ligaments?

1. Mesovarian.
2. Ovarian ligament - remnant of gubernaculum. Remains fixed to the uterus.
3. Suspensory ligament of ovary - where ovarian vessels go through.


What is the function of the ovaries?

Egg and hormone production (oestrogen and progesterone).


What is the arterial supply of the ovaries?

Ovarian artery - comes off the abdominal aorta at L2.


What is the venous drainage of the ovaries?

Ovarian vein. The right ovarian vein drains to the IVC and the left ovarian vein drains to the left renal vein.


What is the nervous supply of the ovaries?

Ovarian plexus.


Describe the external female genitalia?

1. Vestibule - this is enclosed by the labia minor. It contains the opening of the urethra and the greater vestibular glands (produce mucus).
2. Clitoris - contains erectile tissue and corresponds to the male penis.


Describe lympahtic drainage of the womb?

The ovaries drain back to para-aortic nodes at L2 (root of ovarian artery). Everything else will go to external and internal iliac nodes. As you become close to the skin the lymphatics go from internal iliac to superficial inguinal nodes.


Describe bartholin's glands?

These are glands that irresponsible for muscus secretion. They are slightly posterior and lateral from the opening of the vagina. They're analogous with the bulbourethral glands in males but in the superficial pouch (the bulbourethral glands are in the deep puch).


Describe bartholin's cyst?

These are caused by blockage of the bartholin's glands. These can lead to infections -> abrtholin's abscess. It is bacterial - not necessarily a STD cause.