Lecture 21

Question 1

What are the pouches for males in the peritoneum?

Answer 1

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

Question 2

What are the pouches for females in the peritoneum?

Answer 2

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

Question 3

What is the clinical importance of the pouches?

Answer 3

They are potential sites for fluid to collect in.

Question 4

What are the muscles in the perineum?

Answer 4

1. Ischiocavernosus.

2. Bulbospongiosus.

Question 5

Describe the ischiocavernosus muscle?

Answer 5

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

Question 6

Describe the bulbospongiosus?

Answer 6

It is attached posteriorly to the perineal body.

Question 7

Describe the variation of bulbospongiosus muscle between males and females?

Answer 7

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.

Question 8

Describe the function of bulbospongiosus?

Answer 8

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

Question 9

What is the erectile tissue in females?

Answer 9

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.

Question 10

What is the erectile tissue in males?

Answer 10

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).

Question 11

Describe the vasculature of the penis?

Answer 11

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.

Question 12

Describe the scrotum?

Answer 12

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

Question 13

What does the scrotum contain?

Answer 13

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

Question 14

Describe the superficial fascia of the scrotum?

Answer 14

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).

Question 15

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

Answer 15

Raise the testes and scrotum upwards for warmth and protection.

Question 16

Where does the scrotum receive blood from?

Answer 16

Both internal and external pudendal arteries.

Question 17

Describe the development of the scrotum?

Answer 17

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.

Question 18

Describe the testicular artery?

Answer 18

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

Question 19

Describe the testicular veins?

Answer 19

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

Question 20

Describe the lymphatic vessels of the spermatic cord?

Answer 20

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

Question 21

Describe the autonomic nerves of the spermatic cord?

Answer 21

These are sympathetic on the artery from the testicular plexus.

Question 22

Describe the cremasteric artery?

Answer 22

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

Question 23

Describe the artery of the vas deferens?

Answer 23

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

Question 24

Describe the genital branch of the genitofemoral nerve?

Answer 24

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

Question 25

Describe the testes?

Answer 25

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.

Question 26

What does the epididymis do?

Answer 26

It stores sperm and it eventually becomes the vas deferens.

Question 27

Describe the vas deferens?

Answer 27

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).

Question 28

Describe the vas deferens course to the prostate?

Answer 28

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".

Question 29

Describe the seminal vesicles?

Answer 29

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.

Question 30

Describe the prostate gland?

Answer 30

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

Question 31

What vasculature supplies the prostate gland?

Answer 31

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.

Question 32

Describe prostatic enlargement?

Answer 32

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.

Question 33

Describe the lymphatic drainage?

Answer 33

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.

Question 34

Describe the features of the uterus?

Answer 34

[Starting out from outside of the body.] - Cervix. - 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.

Question 35

Describe the peritoneum of the female reproductive system?

Answer 35

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.

Question 36

Describe the broad ligament?

Answer 36

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.

Question 37

Where does the ureter pass in females?

Answer 37

It passes under the uterine artery.

Question 38

Describe the ovarian ligaments?

Answer 38

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

Question 39

What is the function of the ovaries?

Answer 39

Egg and hormone production (oestrogen and progesterone).

Question 40

What is the arterial supply of the ovaries?

Answer 40

Ovarian artery - comes off the abdominal aorta at L2.

Question 41

What is the venous drainage of the ovaries?

Answer 41

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

Question 42

What is the nervous supply of the ovaries?

Answer 42

Ovarian plexus.

Question 43

Describe the external female genitalia?

Answer 43

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.

Question 44

Describe lympahtic drainage of the womb?

Answer 44

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.

Question 45

Describe bartholin's glands?

Answer 45

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).

Question 46

Describe bartholin's cyst?

Answer 46

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.