Module 9 Male and Female Reproductive System Flashcards
(230 cards)
1
Q
– primary sex organs
- Testes in males
- Ovaries in females
- produce gametes (sex cells) and secrete hormones
A
Gonads
2
Q
Sperm vs Ova
A
Sperm – male gametes
Ova (eggs) – female gametes
3
Q
The male organ of copulation and is the common outlet for urine and semen.
A
Penis
4
Q
Ligamentous support of the Penis
A
- Fundiform ligament
- Suspensory ligament
5
Q
– from the membranous layer of subcutaneous tissue of the lower abdomen (Scarpa’s fascia)
A
Fundiform ligament
6
Q
– thick triangular fibroelastic band that keeps the penis pointed up during erection. Attached to the deep fascia and the anterior symphysis pubis.
A
Suspensory ligament
7
Q
Free fold of skin covering the penile shaft from the base(radix) to the glans penis.
A
PREPUCE OR FORESKIN
8
Q
- is the removal of the foreskin that covers the glans penis, It is performed as a therapeutic medical procedure for pathologic phimosis, chronic inflammation of the penis, and penile cancer. It is also performed for cultural, religious, and medical reasons.
A
CIRCUMCISION
9
Q
Retracted Foreskin
A
Kailangan linisin yung penis kasi nag-aaccumulate yung dirt (cheesy material called SPEGMA) sa junction ng retracted foreskin at corona of glans penis. Pwedeng maging infection (balanitis) ito hanggang maging cancer na may kakaibang amoy.
10
Q
- Prepuce opening is still small enough to be retracted back after retraction
- Accidental retraction na hindi na naibabalik kasi masikip. Nasasakal yung head part ng penis and magkakaroon ng inflammation. Pwede ng magnecrosis kasi blocked na yung blood supply. This is an emergency na parang nagcicircumcise ka lang, just cut the prepuce. The importance is just to release the glans penis
A
Paraphimosis
11
Q
Layers of the penis
A
- Skin
- Superficial (dartos) fascia
- Deep (Buck’s) fascia
- Tunica albuginea
12
Q
– contains the dorsal veins
A
Superficial (dartos) fascia
13
Q
– contains the dorsal arteries and nerves, and the corpus spongiosum
A
Deep (Buck’s) fascia
14
Q
– encloses the 2 corpora cavernosa
- Outer longitudinal layer
- Inner circular layer
A
Tunica albuginea
15
Q
- Composed of three cylindrical bodies of erectile tissue called corpora, enclosed by a dense white fibrous capsule called tunica albuginea.
A
Penis
16
Q
Three erectile cavernous tissues:
A
Corpus spongiosum Corpora cavernosa (2)
17
Q
The paired __ lie side-by-side, fused medially, and separate posteriorly forming the two crura.
A
corpora cavernosa
18
Q
- The crura are attached on each side to the conjoint rami of the pubis and ischium.
- Ventral to the corpora cavernosa is the corpus spongiosum.
A
Corporal bodies
19
Q
The posterior portion of the c. spongiosum is called the __.
A
bulb of the penis
20
Q
The __ is within the c. corpora spongiosum.
A
spongy urethra
21
Q
The most distal portion of the c. spongiosum is the __. This has the greatest concentration of sensory nerve endings in the penis.
A
glans penis
22
Q
The margin of the glans is called the __.
A
corona
23
Q
Distal portion of the glans is the __.
A
external urethral orifice or meatus
24
Q
The skin and fascia of the penis are prolonged as a free fold just underneath the neck of the penis. Called the __ which is excised during circumcision.
A
prepuce
25
The __ is a median fold passing from the prepuce up to the meatus.
frenulum
26
- is made possible due to the spongy tissue of the cavernous bodies which consists of interlacing and intercommunicating spaces which is filled with arterial blood during erection.
Erection
27
Long muscular tube, 15 to 20 cm, and conveys urine from the urinary bladder to the exterior through the external urethral orifice, located at the tip of the glans penis.
Male Urethra
28
- Part engulfed by the prostate.
- In normal men, it is the widest part of the urethra (most dilatable)
- Starts after the BLADDER NECK and ends at the UROGENITAL DIAPHRAGM.
- The posterior wall has a median longitudinal ridge called the URETHRAL CREST.
Prostatic Urethra
29
- Groove on each side called PROSTATIC SINUSES.
| - On the middle is the SEMINAL COLLICULUS OR THE VEROMONTARUM.
Urethral Crest
30
- After the prostatic urethra.
- SHORTEST PORTION (1-2cm), also the thinnest, and most prone to damage.
- This is compressed by the UROGENITAL DIAPHRAGM which is responsible for the maintenance of urinary continence.
Membranous Urethra
31
- Longest part of the urethra.
- Starts at the BULB OF THE PENIS through the corpus spongiosum and ends at the MEATUS.
- There are small bulbourethral glands in the proximal end.
- Arterial supply is through the bulbar artery, while venous drainage is through the bulbar veins. Both are supplied/drained by their corresponding internal pudendals.
Spongy urethra
32
A condition wherein the urethral meatus opens on the ventral side of the penis proximal to the tip of the glans penis.
HYPOSPADIAS
33
Components of Hypospadias:
1. chordee (vental bending and bowing of the penile shaft)
2. abnormal (hooded) appearance of the penis caused by absent or deficient ventral foreskin
3. stenotic urethral meatus.
34
Classification of Hypospadias
1. Glandular – proximal to the glans
2. Coronal – at coronal sulcus
3. Penile shaft -
4. Penoscrotal
5. Perineal
35
Manifestation of Hypospadias
- Difficulty directing urine during voiding
- Chordee will cause bowing of the penile shaft
- Failure to obtain satisfactory erection
- Stenosis of urethral meatus
- Associated with undescended testis
- Ambiguity of genitalia – warrants further investigation of genetic sex
36
urethral meatus is displaced dorsally
EPISPADIAS
37
Classification of Epispadias
1. Glandular – dorsum of glans
2. Penile – urethral meatus is broad, gaping and located between pubis and coronal sulcus
3. Penopubic – located peno-pubic junction w/ distal dorsal groove extending up the glans penis
38
Manifestation of Epispadias
1. Urinary incontinence – due to maldevelopment of urethral sphincter
* 95% penopubic, 75% penile
2. Dorsal chordee
39
Arterial Supply of the Penis
From the internal pudendal artery:
1. Dorsal artery – runs superior to the corpora cavernosa
2. Deep arteries – pierce the crura and run within the corpora cavernosa.
3. Helicine or circumflex arteries – branches that open into the cavernous spaces.
40
Venous Drainage of the Penis
- Blood from the cavernous spaces is drained by VENOUS PLEXI.
- Then they drain into the deep dorsal vein located in the deep fascia.
- This drains into the prostatic venous plexus.
- Blood from the SPONGIOSUM DRAINS into the bulbourethral and bulbar veins which go into the INTERNAL PUDENDAL VEINS.
- Superficial dorsal veins drains into the SUPERFICIAL EXTERNAL PUDENDAL VEIN.
41
Lymphatic Drainage of the Penis
- Most of the penis drains into the SUPERFICIAL INGUINAL LYMPH NODES.
- Vessels from the glans drains into the DEEP INGUINAL LYMPH NODES.
42
(Innervation of the Penis)
- gives rise to the dorsal nerve of the penis and the perineal nerve.
* The dorsal nerve supplies both the skin and the glans.
Pudendal nerve
43
(Innervation of the Penis)
- from the inferior hypogastric or pelvic plexus. Stimulation of the cavernous nerves induces erection.
Cavernous nerves
44
(Sexual Innervations)
– sympathetic stimulation, causes the clonic spasms of the bulbospongiosus muscle, innvervated by the perineal branch of the pudendal nerve.
Ejaculation
45
(Sexual Innervations)
– parasympathetic stimulation, causes relaxation of the cavernous smooth muscles, causing blood to rush into the spaces.
Erection
46
(Sexual Innervations)
The __ contract compress the venous plexi, impeding the return of venous blood, thus maintaining the erection.
bulbospongiosus and ischiocavernosus muscles
47
- At the bulb of the penis, anterior to the anus.
- Forms a sphincter and compresses the bulb to aid in erection.
- During ejaculation, clonic contractions propel the seminal fluid.
Bulbospongiosus muscles
48
- Surround the crura in the root of the penis.
- Origin from the ischial tuberosity and ramus and inserts into the sides and ventral surface of the crura.
- Also aids in erection
Ischiocavernosus muscles
49
(MALE SEXUAL DYSFUNCTION)
- The inability to obtain or maintain penile erection (or both) sufficient for satisfactory sexual performance.
Erectile dysfunction
50
(MALE SEXUAL DYSFUNCTION)
Persistent or recurrent occurrence of ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it.
Premature (rapid) Ejaculation
51
(MALE SEXUAL DYSFUNCTION)
Undue delay in reaching a climax during sexual activity.
Retarded Ejaculation
52
(MALE SEXUAL DYSFUNCTION)
Backflow of semen into the bladder during ejaculation owing to an incompetent bladder neck mechanism.
Retrograde Ejaculation
53
(MALE SEXUAL DYSFUNCTION)
Inability to achieve an orgasm during sexual activity , although nocturnal emission may occur.
Anorgasmia
54
A loose cutaneous fibromuscular sac located posteroinferior to the penis and inferior to the pubic symphysis.
Scrotum
55
Layers of Abdomen vs Layers of Scrotum
1. Skin = Skin
2. Subcutaneous Fat = Dartos muscle
3. Scarpa’s fascia = Colles fascia
4. External oblique aponeurosis = External spermatic fascia
5. Internal oblique= Cremasteric muscle
6. Transversus abdominis = None
7. Fascia transversalis = Internal spermatic fascia
8. Peritoneum = Tunica vaginalis
56
- Contraction of the dartos and cremasteric muscles causes the testis to be drawn up against the body.
- Seen in cold weather.
- Spermatogenesis needs a specific temperature.
Cremaster muscle
57
Neurologic test for L1 and L2 motor nerves through the __.
cremasteric reflex
58
Arterial supply of Scrotum
- Anterior aspect of the scrotum comes from the EXTERNAL PUDENDAL ARTERY.
- Posterior aspect comes from the INTERNAL PUDENDAL ARTERY
59
Innervation of the Scrotum
- Anterior portion is supplied by the ILIOINGUINAL NERVE.
- Posterior portion is supplied by the medial and lateral scrotal branches of the PERINEAL NERVE and the perineal branch of the POSTERIOR FEMORAL CUTANEOUS NERVE.
60
Lymphatic Drainage of the Scrotum
- SUPERFICIAL INGUINAL LYMPH NODES.
- Note that the scrotum and the testis have different lymphatic drainage.
- Testicular lymphatics drain into the PARA-CAVAL, PRE-AORTIC AND PARA-AORTIC LYMPH NODES.
61
collection of fluid within the tunica or processus vaginalis. Most commonly seen surrounding the testis
HYDROCOELE
62
Clinical manifestations of Hydrocoele
1. Painless cystic mass in the scrotum
| 2. Cystic mass that is soft in the morning and becomes tense in the afternoon (communicating type).
63
- dilatation of the pampiniform plexuses above the testis
- Etiology
1. Incompetent valves more on left side
2. Renal tumor
VARICOCOELE
64
Clinical manifestations of Varicocoele
1. Dilated veins (bag of worms) in scrotum above testis extending up to spermatic cord
2. Infertility – sperm motility and concentration is significantly decreased
3. Testicular atrophy
4. Scrotal discomfort
65
INTERNAL GENITAL MALE ORGANS
1. Ductus Deferens/Vas Deferens
| 2. Epididymis
66
- Thick walled muscular tube.
- The continuation of the epididymal tail. Passes within the spermatic cord, through the inguinal canal, crossing over the iliac vessels and ureter.
- Ends into the ampulla of the vas at the posterior portion of the bladder.
The Ductus Deferens or Vas Deferens
67
- After the ampulla of the vas, it joins the ducts of the seminal vesicles and enters the prostate.
- Ends at the ejaculatory duct which opens through the VERUMONTANUM into the prostatic urethral lumen.
Ductus Deferens
68
(Ductus Deferens)
Arterial supply is through the artery of the vas which comes from the __.
testicular artery
69
(Ductus Deferens)
Innervation is through the __.
inferior hypogastric or pelvic plexus
70
(Ductus Deferens)
Lymphatic drainage is through the __
external iliac nodes
71
- Comma shaped structure applied to the superior and posterolateral surface of the testis.
- Site of sperm maturation and temporary storage of sperm prior to ejaculation
Epididymis
72
Epididymis
- EPIDIDYMAL HEAD contains the efferent ductules of the testis which transmit the sperm.
- The EPIDIDYMAL BODY contains the duct of the epididymis.
- The EPIDIDYMAL TAIL is continuous with the ductus deferens or the vas deferens
73
- Suspends the testis in the scrotum.
- Begins at the deep inguinal ring.
- Ends at the posterior border of the testis, near the tail of the epididymis.
Spermatic Cord
74
Spermatic Cord contents (1-3)
1. Ductus or vas deferens
2. Arteries – testicular artery, artery of the vas, cremasteric artery
3. Veins – pampiniform plexus
75
Spermatic Cord contents (4-6)
4. Nerves – autonomic sensory nerves, genital branch of the genitofemoral nerve.
5. Lymphatics – lumbar and preaortic lymph nodes
6. Cremasteric muscle
76
- Thin-walled, pear-shaped structure about 5 cm long. Actually a coiled tube 10 to 15 cm when stretched out.
- Located on the posterior bladder, lateral to the ampulla and medial to the ureters.
- Secretes a thick alkaline fluid which contributes to the seminal fluid providing most of the volume.
Seminal Vesicle
77
- Produces a thick, alkaline,yellowish secretion (60% of semen)
* Fructose (sugar)
* Choline
* Vitamin C
* Prostaglandins
* Other substances that nourish and activate sperm
Seminal Vesicle
78
Fructose provides a forensic determination for occurrence of rape, whereas choline crystals provide the basis for the determinationof the presence of semen.
Florence test
79
- Slender tubes formed by the union of the ducts of the seminal vesicles and vas.
- Passes through the substance of the prostate.
- Exits into the prostatic urethra.
Ejaculatory Ducts
80
- The largest accessory gland of the male reproductive system.
- Partly glandular and partly fibromuscular.
- Has a base, apex and four surfaces (posterior, anterior and two inferolateral surfaces).
- Encircles the upper part of the urethra
Prostate
81
- Covered by a dense fibrous capsule (true capsule) which is enclosed by a loose sheath derived from the pelvic fascia called the prostatic sheath (false capsule)
Prostate
82
- separates the bladder, seminal vesicles and prostate from the rectum.
Rectovesical septum(Denonvillier’s)
83
- Secretes a milky fluid
* Helps to activate sperm
* Enters the urethra through several small ducts
- Secretes prostatic secretion which is a thin milky fluid, admixing with semen. Provides 20% of the volume of semen.
- Secretes Prostate specific antigen(PSA), prostaglandin, citric acid, acid phosphatase, proteolytic enzymes.
Prostate
84
(Lobes of Prostate)
- lies in front of the urethra and is devoid of glandular substance
anterior lobe (or isthmus)
85
(Lobes of Prostate)
- lies between the urethra and the ejaculatory duct and is prone to BPH, obstructing the internal orifice
middle (median) lobe
86
(Lobes of Prostate)
-lies behind the urethra and below the ejaculatory duct, contains glandular tissues and is prone to CA transformation.
posterior lobe
87
(Lobes of Prostate)
- are situated on either side of the urethra and form the main mass of the gland.
Lateral lobes (right and left)
88
Arterial Supply of the Prostate
Mainly from the INFERIOR VESICAL AND MIDDLE RECTAL ARTERIES which come from the internal iliac arteries.
89
Venous Drainage of the Prostate
- Veins from the prostate form the prostatic venous plexus around the sides.
- These drain into the internal iliac veins, then communicates with the vesical venous plexus and the vertebral venous plexi.
90
Lymphatic Drainage of the Prostate
- Lymph vessels terminate chiefly in the INTERNAL ILIAC AND SACRAL LYMPH NODES.
- Some from the posterior surface go to the EXTERNAL ILIAC NODE
91
Nerve Supple of the Prostate
- Parasympathetic fibers from the PELVIC SPLANCHNIC NERVES (S2, S3, and S4).
- Sympathetic nerves from the INFERIOR HYPOGASTRIC OR PELVIC PLEXUS.
92
- Pea-sized gland inferior to the prostate
- Produces a thick, clear mucus
* Cleanses the urethra of acidic urine
* Serves as a lubricant during sexual intercourse
* Secreted into the penile urethra
Bulbourethral glands
93
- Mixture of sperm and accessory gland secretions
- Advantages of accessory gland secretions
* Fructose provides energy for sperm cells
* Alkalinity of semen helps neutralize the acidic environment of vagina
* Semen inhibits bacterial multiplication
* Elements of semen enhance sperm motility
Semen
94
- Main reproductive organs, ovoid in shape and suspended in the scrotum by the spermatic cord.
- Produces haploid cells (spermatazoa) which fertilize the female ova producing a zygote.
- Also produces male hormone (androgens)
Testes
95
The testis is contained within the __, between them is a small amount of clear fluid.
tunica vaginalis
96
The testis is covered by the __.
tunica albuginea
97
Within are small ducts called __, which join to form the rete testis. Small efferent ductules connect the rete testis to the head of the epididymis.
seminiferous tubules
98
- Production of sperm cells
- Begins at puberty and continues throughout life
- Occurs in the seminiferous tubules
Spermatogenesis
99
(Processes of Spermatogenesis)
| __ undergo rapid mitosis to produce more stem cells before puberty
Spermatogonia (stem cells)
100
(Processes of Spermatogenesis)
__ modifies spermatogonia division
*One cell produced is a stem cell
*The other cell produced becomes a primary spermatocyte
Follicle stimulating hormone (FSH)
101
- Late spermatids are produced with distinct regions
* Head – contains DNA covered by the acrosome
* Midpiece
* Tail
- Sperm cells result after maturing of spermatids
Spermiogenesis
102
Spermatogenesis takes __
64 to 72 days
103
- The most important hormone of the testes
| - Produced in interstitial cells
Testosterone
104
Its rounded contour at the anterior chest wall and most of its volume is composed of subcutaneous fat
Breast
105
Located anteriorly and also partly the lateral aspect of the thorax. It Extends:
- Superiorly to the 2nd rib
- Inferiorly to the sixth costal cartilage
- Medially to the sternum
- Laterally to the mid-axillary line
106
Base of the Breast
2/3 of the breast lies over the pectoral fascia overlying the PECTORALIS MAJOR while 1/3 is by the fascia covering the SERRATUS ANTERIOR
107
- Located between the 4th and 5th ribs, approximately 10cm from the midline
Nipple-Areola Complex
108
- Natural lines of skin tension
- Extend outwards circumferentially from the nipple-areola complex
- Guide for surgeons during biopsies/ excisions
Langer Lines
109
Types of Breast Biopsy
1. Fine Needle Biopsy - use fine needle
2. Core-Needle Biopsy - gold standard for breast biopsy; use big needle (Gauge 14)
3. Surgical Biopsy - follow the langer line
110
Lateral midaxillary line is the lateral edge of __
Latissimus Dorsi
111
- A loose subcutaneous tissue plane or potential space located between the breast and the pectoral fascia
- Contains a small amount of fat which allows some degree of movement on the pectoralis fascia
- Where implants are placed
Retromammary Space
112
- axillary tail of Spence
- A small part of the mammary gland may extend along the inferolateral edge of the pectoralis major toward the axillary fossa
Axillary Process
113
- Modified sweat glands - No capsule or sheath
- Rudimentary and functionless in male; Accessory to reproduction in females
- Under the influence of the ovarian hormones, the mammary glands gradually enlarge and assume their hemispherical shape in females at puberty
- Consist of a system of ducts embedded in connective tissue that does not extend beyond the margin of the areola
Mammary Glands
114
Each mammary gland consists of __ that radiate outward from the nipple
15 to 20 lobes
115
Drains each lobe to open separately at the nipple
Main Lactiferous Duct
116
A dilated portion deep to the areola wherein small droplets of milk accumulates in the nursing mother
Lactiferous sinus
117
- Connective tissue septa separating each lobe
- Firmly attaches mammary glands to the dermis of the overlying skin
- Particularly well developed in the superior part of the gland, which help support the lobes and lobules of the mammary gland
Suspensory Ligament of Cooper
118
- Contains sebaceous glands
* Secrete oily substance that provides a protective lubricant for the nipple and areola
- Montgomery Tubercle
- Enlarge during pregnancy
Areola
119
- Conical or cylindrical prominences in the centers of the areola
- No fat, hair or sweat glands
- Tips are fissured with the lactiferous ducts opening into them
- Composed mostly of circularly arranged smooth muscle fibers that compress the lactiferous ducts during lactation and erect nipples in response to stimulation
Nipple
120
Breast Development (1)
- Derived from epidermal thickenings that develop along the ventral surface of the body, along the so-called milk line at approximately 7 weeks gestation.
- The ducts arise from the ectodermal mammary ridge which develops into a budding stage by the 12th week.
121
Breast Development (2)
- The milk line extends from the axilla to the groin and is responsible for vestigial accessory nipples.
- However the axilla to groin concept of the nipple line in humans has been challenged as accessory nipples are only found in the axillo-pectoral region
122
The most common embryological vestige is __
accessory breast in the axilla
123
Breast Development (3)
In female, growth and branching of the mammary glands progress slowly during prepubertal years then increases dramatically at puberty
- Further branching of ducts, formation of acini buds and dramatic proliferation of interductal stroma
- Results in formation of a Breast Bud
* Sudden appearance of breast bud sometimes cause concern
* Excision of a breast bud will prevent development of the mammary gland
124
Breast Development (4) Pregnancy and Lactation
- During pregnancy, the intralobular ducts develop rapidly, forming buds that become alveoli, and the stromal/glandular proportions in the breast are reversed
- By the end of pregnancy, the breast is composed almost entirely of glandular units separated by small amounts of stromal tissue.
- Following lactation, the acini atrophy, ductal structures shrink, and the whole breast markedly diminishes in size
125
Breast Development (5): Onset of Menopaus
- With the onset of menopause, the acini regress further, with loss of both interlobular and intralobular connective tissue. With time, the acini structures may be completely absent from the breast in the postmenopausal female.
- the morphologic appearance of the breast in postmenopausal women is much different from that of women during their premenopausal years.
* Both the ductal structures and connective tissue of the breasts are markedly diminished in size
126
Blood Supply of the Breast
Derived primarily from
- the Internal Mammary Artery (a.k.a. Internal Thoracic Artery)
- the Lateral Thoracic Artery (branch of the axillary artery)
127
- gives rise to the posterior intercostal arteries, and branches of the intercostal arteries penetrate the deep surface of the breast.
- branch of subclavian artery
Internal Mammary Artery
128
Venous Drainage of the Breast
- Mainly to the Axillary Vein
| - Some drainage to the internal thoracic vein
129
Lymphatic Drainage of the Breast
- Importance: Role in the metastasis of cancer cells
- ~75% drains to the AXILLARY LYMPH NODES
* Especially from the lateral breast quadrants
* Initially to the Anterior or Pectoral nodes
- Remaining 25% drains to the PARASTERNAL LYMPH NODES
- Lymph Nodes from the inferior quadrants may pass deeply to ABDOMINAL LYMPH NODES SUCH AS SUBDIAPHRAGMATIC INFERIOR PHRENIC LYMPH NODES
130
(Lymphatic Drainage of the Breast)
Central and lateral parts of the gland (75%) drain into __.
pectoral group of axillary lymph nodes
131
(Lymphatic Drainage of the Breast)
Upper part of the gland drains into __.
apical group of axillary lymph nodes
132
(Lymphatic Drainage of the Breast)
Medial part drains into __, forming a chain along the internal thoracic vessels.
internal thoracic (parasternal) lymph nodes
133
(Lymphatic Drainage of the Breast)
Some lymphatics from the medial part of the gland pass across the front of sternum to anastomose with that of __.
opposite side
134
(Lymphatic Drainage of the Breast)
Lymphatics from the inferomedial part anastomose with lymphatics of rectus sheath and linea alba, and some vessels pass deeply to anastomose with the __.
subdiaphragmatic lymphatics
135
(Lymphatic Drainage of the Breast)
| Surgically, the nodes are described in relation to the pectoralis minor:
Level 1 - nodes lying below the pectoralis minor
Level 2 – nodes behind the muscle
Level 3 – nodes between the upper border of the pectoralis minor and the lower border of the clavicle
136
(Lymphatic Drainage of the Breast)
- Collection of large lymph vessels situated under the areola
- Not considered as a collecting zone of lymph but it communicates with the lymphatics of the breast tissue
Subareolar plexus of Sappey
137
(Lymphatic Drainage of the Breast)
- Interpectoral Group of lymph nodes
- Nodes in the space between the pectoralis major and minor
Rotter’s nodes
138
Nerves of the Breast
- Derived from the ANTERIOR AND LATERAL CUTANEOUS BRANCHES OF THE 4TH – 6TH INTERCOSTAL NERVES
- Convey sensory fibers from the skin of the breast and sympathetic fibers to the blood vessels of the breast and smooth muscle overlying the skin and nipple.
139
FEMALE REPRODUCTIVE TRACT (boundaries)
Anterior - Symphysis pubis
- important landmark for female reproductive
Posterior - Recto-sigmoid
Most posterior - Vertebral column (sacro-coccygeal vertebrae)
Most inferior - Anal canal
Superior - Intestine; Loops of ileum
140
OVARIES
- Ovarian surface
- Ovarian fossa (Also known as Waldeyer’s fossa)
* Boundaries: iliac vessels
* 1.5 x 0.75”
- Ligaments
* Broad (mesovarium)
* Suspensory
* Round
141
Ovaries (Boundaries)
Lateral: Internal and external iliac vessels
Superior: Fallopian tube and peritoneum (supports the ovary)
Medial: The ovary is attached to the uterus via utero-ovarian ligament / round ligament of ovary
142
Laterally position of the ovary is held by the __. It is very important as it carries within the blood vessels and nerve that supply the ovary. Why mention? If going to surgery, that is the area that could be accidentally cut in the ureter which will cause the patient to have renal failure which will make the patient need dialysis.
suspensory ligament of the ovary / infundibular-pelvic ligament
143
Ovaries (Artery and Veins)
Artery: Ovarian artery (L2)
Venous Drainage
Ovarian vein
*Right >> IVC Left
*Left >> renal vein >> IVC
144
Ovaries (Lymphatic Drainage and Nerve Supple)
Lymphatic Drainage
- Para-aortic nodes (L1)
Nerve Supply:
Aortic plexus - found anterior to the abdominal aorta
145
(Female Reproductive System)
- It is both a diagnostic and therapeutic procedure.
- More expensive as compared to ultrasound
- Used for seeing (diagnostic) and if something is found, then it could be remove (therapeutic)
Laparoscopy
146
Just remember that __ leads to the development of a female. The mesonephric duct (Wolffian duct) which is more on the male and the paramesonephric duct (Mullerian duct). Sa babae ang mesonephric duct ay na-obliterate as it develops. The Mullerian duct heralds the genital ducts, at the start you have two pairs of the ducts at each side.
absence of testosterone
147
The remnants become the __, thus could be a source of cystic formation. Usually it drains the fluid inside or removes it. The Gartner gland usually enlarges on the vaginal wall. It manifest as a tumor.
epoopheron and paroopheron
148
- 10-12 cm long each
- Lie in upper border of broad ligament
- Connects the peritoneal cavity in the region of the ovary with the cavity of the uterus
UTERINE TUBE/FALLOPIAN TUBE
149
(UTERINE TUBE/FALLOPIAN TUBE: Parts)
- Abdominal ostium
- 20-30 fimbriae
- It is the most expanded
Infundibulum
150
(UTERINE TUBE/FALLOPIAN TUBE: Parts)
- Widest and longest
- Where most fertilization happens
- Encloses antero-posteriorly by the broad ligament
Ampulla
151
(UTERINE TUBE/FALLOPIAN TUBE: Parts)
- Narrowest part
Isthmus
152
(UTERINE TUBE/FALLOPIAN TUBE: Parts)
- Interstitial
- The shortest segment
- Found in the myometrial wall
Intramural
153
UTERINE TUBE/FALLOPIAN TUBE: BLOOD SUPPY AND VENOUS DRAINAGE
Blood Supply
- Ovarian artery (from Abdominal aorta)
- Uterine artery (from Internal iliac artery)
Venous Drainage
- Ovarian vein
- Uterine Vein
154
UTERINE TUBE/FALLOPIAN TUBE: Lymphatic Drainage and Nerve Supply
Lymphatic Drainage
- Internal iliac LN
- Para-aortic LN
Nerve Supply
- Autonomics of Inferior hypogastric plexus - it is important as it supplies the female reproductive organ
155
- It could be categorized as acute, subacute, and chronic
| - The most common source of obstruction of fallopian tube
Pelvic Inflammatory Disease (PID)
156
- Uterine malignancy is rare and any malignancy that is rare is dangerous
Ectopic Pregnancy
157
- It is for sterilization but could be temporary
- We separate the broad ligament from the fimbrae then itatahi
- Under anesthesia procedure
Tubal Ligation
158
- Gamete Intra-Fallopian tube Transplantation (GIFT) is the injection of the artificially fertilized egg back to the womb
In vitro Fertilization
159
- Chromo – color; tubation – test tube
- Insert of dye (methylene blue) through the cervix to check if it will seep through the fimbrae
- If spotted, then the fallopian tube is obstructed
- If methylene blue is not available, get milk and sterilize it
Laparoscopy – Chromotubation
160
- Located between bladder and rectum
- Pear-shaped
- Size: 3x2x1 inches
- Triangular cavity
- Thick muscular wall
- Functions: Reception, retention, nutrition
UTERUS
161
UTERUS: Boundaries
Anterior - Bladder
Posterior - Rectum
*Utero-rectal pouch / Recto-utero pouch / Cul-de-sac / Pouch of Douglas
Lateral - Adnexae (a collective term (ovary, etc.) for anything that is lateral to the uterus)
162
- it is the deepest of the area
| - it is here one can get samples of fluid that is used for the test
Utero-rectal pouch / Recto-utero pouch / Cul-de-sac / Pouch of Douglas
163
Anterior and posterior is a recess called __. Good landmark for x-ray, ultrasound and pelvic examination. It should be in the middle, if not, then something is pushing it.
uterovesical pouch
164
Vaginal wall have reflection called fornices. What are the different types of fornices?
Posterior fornices – the deepest
Anterior fornices – the shallowest
Lateral fornices – deep but not as deep as the posterior
165
UTERUS: PARTS
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- 2 main portions:
o Body – superior 2/3, “kuwelyo ng matres”
o Cervix – inferior 1/3, “bahay bata”
*Endocervix
*Exocervix / Portio vaginalis
- Isthmus
- Fundus – usual area of implantation
- Cornua – the part of the fundus and myometrium; where the fallopian tube will push through
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166
- Junction between the body and cervix
- Important landmark to find the ovarian and uterine arteries
- Chances of accidentally cutting the ureter in operations
- It is the only part of the uterus that could revert to its pre-pregnant state
Isthmus
167
– the part of the fundus and myometrium; where the fallopian tube will push through
Cornua
168
UTERUS: Blood Supply and Venous Drainage
Blood Supply: Uterine artery
| Venous Drainage: Uterine vein
169
UTERUS: Lymphatic Drainage and Nerve Supply
Lymphatic Drainage
- Fundus: Para-aortic nodes
- Body and cervix:
* Internal and external iliac LN
* Superficial inguinal LN
Nerve Supply: Autonomics of Inferior hypogastric plexus
170
- Fold of peritoneum that encloses uterus
- Extends from side of uterus to lateral pelvic wall and floor
- Uterine tubes found in free edge
- Does not provide much support to the uterus but only encloses and protests it from outside structure
BROAD LIGAMENT
171
UTERINE POSITIONS
Antero verso flexion – pag paharap, this is normal
Retro verso flexion – pag patalikod
Retro flexion – pag diretso at the isthmus
172
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UTERINE SUPPORT
(For support, maintains the position in the pelvic cavity.)
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- Pelvic diaphragm
o Levatorani muscles
o Coccygeus
- Urogential diaphragm
- Cardinal ligament
- Uterosacral ligament
- Pubocervical ligament
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173
- anterior of the fallopian tube, it is a good landmark. It attaches to the labia majora of the female. That is why in advance pregnancy masakit ito, “Doc masakit po ang singit ko”. It is because of the stretching of the round ligament. If the patient can’t stand the pain then provide analgesic
Round Ligament of the Uterus
174
The greatest ligament support is the __.
Transverse cervical ligament / Cardinal ligament / Makendrol ligament
175
__ is a contributory attachment from the vertebrae.
Sacrocervical ligament / Uterosacral ligament
176
The __ which is from the pubic bone to the cervix is an additional attachment.
Pubocervical ligament
177
(Cesarean section)
– incision is at the body of the uterus. Once cut in a classical way, then patient can only deliver in classical cut always in elivery. As normal delivery can cause rupture of the uterus.
Classical
178
(Cesarean section)
– incise right above the isthmus. The patient may choose for the next delivery transverse or normal delivery. As it is not prone to rupture as compared to classical. However it is still possible to have rupture of uterus.
Transverse cervical
179
- It has a classification of first till third degree.
- The third degree is also called procidentia, in which the uterus has exited. Nasa labas na siya, so what we do is remove that part.
Prolapse / Procidentia
180
- Leio – uterus, myoma – benign tumor
| - It is the most common smooth muscle tumor
Leiomyoma
181
Positions of uterus:
o Anteversion – the long axis of uterus is bent forward on the long axis of vagina
o Anteflexion – the long axis of the body of uterus is bent forward at the level of internal os with the long axis of cervix
o Retroversion – Fundus and body of uterus are bent backward on vagina so that they lie in the rectouterine pouch
o Retroflexion – body of uterus is bent backward on the cervix
182
FEMALE REPRODUCTIVE SYSTEM: BS, VD, LD, NS
Vagina: Vaginal artery, Internal pudendal artery
Uterus: Uterine artery, Ovarian artery
Ovary: Ovarian artery
Uterine tubes: Uterine artery, Ovarian artery
183
FEMALE REPRODUCTIVE SYSTEM: LYMPHATIC DRAINAGE
External Iliac LN - 8-10 in number; Drain bladder, male internal organs, and uterus
Internal Iliac LN - From all pelvic viscera; Deep part of perineum
Sacral LN - From posterior pelvic wall, rectum, prostate/cervix
184
FEMALE REPRODUCTIVE SYSTEM: LYMPHATIC DRAINAGE (2)
Common Iliac LN
Lateral group:
o Common iliac vessels
o Lymph from external and internal LN
Median group:
o Angle between vessels
o Lymph directly from pelvic viscera
185
(NERVER SUPPLY (PELVIC AUTONOMIC SYSTEM): FEMALE REPRODUCTIVE)
- Anterior to bifurcation of aorta
- Inferior prolongation of intermesenteric plexus
- Drains to right and left hypogastric plexus
Superior Hypogastric Plexus
186
(NERVER SUPPLY (PELVIC AUTONOMIC SYSTEM): FEMALE REPRODUCTIVE)
- Mingle with pelvic splanchnic nerves
Right and Left Hypogastric Plexus
187
(NERVER SUPPLY (PELVIC AUTONOMIC SYSTEM): FEMALE REPRODUCTIVE)
- Superior hypogastric plexus and pelvic splanchnic nerves
- Surrounds internal iliac artery
- Drains to Pelvic plexus
- Found in the uterosacral ligament
Inferior Hypogastric Plexus
188
(NERVER SUPPLY (PELVIC AUTONOMIC SYSTEM): FEMALE REPRODUCTIVE)
Pelvic Plexus
- Formed from inferior hypogastric plexus
Middle rectal plexus – innervates rectum
Vesical plexus – innervates urinary bladder
Prostatic plexus – innervates male internal reproductive organs
Uterovaginal plexus
189
- Narrow area between the thighs
- Consists of 2 triangles
1. urogenital triangle - external genitalia; urethra
2. anal triangle - anal canal; ishiorectal fossa
Perineum
190
Boundaries of the Perineum
- Pubic symphysis
- Pubic arch
- Sacral tuberosity
- Sacro-tuberous ligament
- Coccyx
191
Inside the anal triangle behind the slit, fatty space, will be the __, laterally obturator muscle.
ischioanal fossa
192
- Thin sheet of striated muscle that covers anterior part of inferior pelvic aperture
- Stretches between 2 sides of pubic arch
- 2 muscles:
o Sphincter urethrae muscle
o Deep transverse perineal muscle
- Innervated by the perineal nerve, branch of pudendal nerve
UROGENITAL DIAPHRAGM
193
- Fibers pass medially toward urethra
- Males: acts as a voluntary sphincter
- Females: compresses urethra and vagina
- Acts as a sphincter for urinary purpose for both sexes, as it compresses the urethra
- Sa lalake it is more on the base
Sphincter Urethrae Muscle
194
- Fibers attach to perineal body
- Contributes to the general supportive role of urogenital diaphragm for the pelvic floor
- Sa female, it surrounds the vaginal wall
Deep Transverse Perineal Muscle
195
Layers of the perineum
1. Superficial fascia – fatty and membranous layers
o Superficial layer (fatty layer) is continuous with Camper’s fascia of abdomen
o Membranous layer is continuous with Scarpa’s fascia / Colles fascia
o Male: fatty layer contains less fat, especially at the scrotum where it is substituted by Dartos muscle
o The Dartos muscle is a smooth muscle that encloses the scrotum. When it contracts, raises the scrotum closer to the wall to adjust the temperature.
2. Perineal membrane
3. Urogenital diaphragm
196
- Crura of the c. cavernosa and clitoris
- Bulb of penis or vestibule
- Greater vestibular gland
SUPERFICIAL PERINEAL POUCH
197
- Space enclosed by the superior and inferior fascia of UD
DEEP PERINEAL SPACE
198
Attachments of the Deep Perineal Space:
o Lateral: Pubic arch
o Anterior: Apex of urogenital diaphragm
o Posterior: Base of urogenital diaphragm
199
Contents of the deep perineal pouch
- Deep perineal artery and veins
- Dorsal nerve of the penis
- Perineal membrane- delineates the deep from the superficial perineal pouch
- Deep transverse perineal muscle
- External urethral sphincter
- Cowper’s gland
- Compressor urethrae
- Urethrovaginal sphincter
200
- Occupies space between the 2 triangle between the vaginal opening and anal opening
- It is a very important clinical part of the female
- Wedge-shaped fibrous tissue in center of perineum
- Where several muscles converge:
o Bulbospongiosus
o Transverse perineal
o Levator ani
- Important structure in childbearing women
PERINEAL BODY
201
- Surgical incision to widen vaginal orifice during delivery
Types:
o Median: skin, vaginal mucosa, perineal body, superficial transverse perineal muscle
o Mediolateral: skin, vaginal mucosa, bulbospongiosus, superficial transverse perineal muscle
EPISIOTOMY
202
MUSCLES OF THE FEMALE PERINEUM
- Transverse perineal muscle
- Sphincter vaginae (accelerator urinae)
- Erector clitoridis (erector penis)
- Compressor urethrae
203
BLOOD SUPPLY of the PERINEUM
Branches of the Internal Pudendal Artery
- Muscular
- Inferior hemorrhoidal
- Superficial perineal
- Transverse perineal
- Artery of the bulb
- Artery of the corpus cavernosum
- Dorsal artery of the penis/clitoris
204
– common to the traumatized due to saddle injury, as when sitting the whole perineal is taken. So when there is an accident, CRACK! It is the most common artery to be traumatized. Injury may cause large hematomas. In females, it is near the labia minora.
Accessory pubic artery
205
- It is found in the ischioanal fossa particularly in the lateral wall
- Composed of the pudendal artery, vein and nerve
Pudendal Canal / Alcock’s Canal
206
- Perineal nerve cutaneous / superficial perineal muscular
- Dorsal nerve of the clitoris
- Inferior hemorrhoidal
Pudendal Nerve and Branches
207
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Boundaries:
o Imaginary line joining the ischial tuberosities
o Tip of coccyx
o Sacrotuberous ligament
- Gluteus maximus muscle overlies it
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- Contents:
o Anal canal
o External anal sphincter
o Ischioanal fossa
ANAL TRIANGLE
208
- Located between the skin of the anal region and pelvic diaphragm
Apex – where levator ani muscle arise from obturator fascia
Base – formed by perianal skin
Ischioanal Fossa
209
Boundaries of Ischioanal Fossa
o Lateral: Ischium, inferior part of obturator internus muscle
o Medial: Anal canal
o Posterior: Sacrotuberous ligament, gluteus maximus muscle
o Anterior: Base of urogenital diaphragm
210
Contents of Ischioanal Fossa
o Ischioanal fat
o Pudendal canal
- Internal pudendal vessels, inferior rectal vessels
- Pudendal nerve, inferior rectal nerve
- Cutaneous nerves, perforating branch of S2 and S3
211
- Collection of pus in ischioanal fossa
- Pathogenesis:
o Inflammation of anal sinuses (cryptitis)
o Extension from pelvirectal abscess
o Tear in the anal mucous membrane
o Penetrating wound in anal region
- Diagnosis: Tenderss and fullness
- May spontaneously open to rectum, anal canal
ISCHIOANAL ABSCESS
212
- Vagina pierces the UD
- Urethra is anterior to the wall of vagina
- Clitoris does not contain part of the urethra
- Embryonic labioscrotal and urogenital folds remain unfused: Labia majora and minora
FEMALE PERINEUM
213
- Pudendum
- Female external genital organs
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- Consists of the following:
o Mons pubis
o Labia majora and minora
o Vestibule of vagina
o Clitoris
o Bulb of vestibule
o Greater vestibular glands
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VULVA
214
SUPERFICIAL PERINEAL MUSCLES
Superficial transverse perineal - From ischial ramus to perineal body
Ischiocavernosus - Ischial ramus to crus of clitoris
Bulbiospongiosus - Perineal body to clitoris
215
- Rounded fatty elevation anterior to pubic symphysis
- Consists mainly of fatty connective tissue
- Becomes covered with hair during puberty
MONS PUBIS
216
- Folds of fat free hairless skin located between labia majora
- Core of spongy tissue with blood vessels
- Encloses the vestibule of the vagina
* Clitoral hood or prepuce
* Frenulum of clitoris
* Frenulum of fourchette
LABIA MINORA
217
- Space between the labia majora
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- Structures that open into vestibule:
o Urethra
o Vagina
o Ducts of greater vestibular glands
o Ducts of minor vestibular glands
o Ducts of Skene’s glands
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VESTIBULE OF VAGINA
218
- 2-3 cm posterior to clitoris
- Ducts of paraurethral gland (Skene’s gland)
o Open on each side of external urethral meatus
o Homologous to prostate
- May become easily infected
EXTERNAL URETHRAL MEATUS
219
- 2 symmetrical folds of skin
- Situated on each side of pudendal cleft
- Anterior and posterior labial commissure
- Contains subcutaneous fat
- Homologous to scrotum
LABIA MAJORA
220
- Located inferior and posterior to urethral orifice
| - Size and appearance varies with condition of hymen
VAGINAL ORIFICE / INTROITUS
221
o Fold of mucous membrane surrounding the vaginal orifice
Hymen
222
- Located on each side of the vestibule
- Ducts open on each side of the vaginal orifice
- Secrete lubricating mucus into the vestibule during sexual arousal
- Homologous to Bulbourethral glands/ Cowper’s glands
GREATER VESTIBULAR GLANDS
223
- Small glands on each side of vestibule of vagina
- Ducts open between urethra and vaginal orifice
- Secrete mucus into the vestibule
- Helps in lubricating the vagina
LESSER VESTIBULAR GLANDS
224
- Located posterior to the anterior labial commissure
- Homologous to penis
- Composed of erectile tissue
- Highly sensitive to touch, pressure and temperature
- Contains many nerve endings
CLITORIS
225
CLITORIS
- Prepuce of clitoris – homologous to male prepuce
- Frenulum of clitoris – homologous to male frenulum
Parts of clitoris:
o Crura
o Corpora cavernosa
o Glans of clitoris
226
- 2 elongated masses of erectile tissue
- Lies along the side of the vaginal orifice
- Covered by bulbospongiosus muscle
- Homologous to bulb of penis
BULBS OF VESTIBULE
227
BS, VD, LD, NS OF FEMALE EXTERNAL GENITALIA
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Blood Supply
- 2 External pudendal arteries
- Internal pudendal artery
o Supplies the perineal muscles and external genitalia
o Branches:
*Labial arteries
*Dorsal artery of clitoris
*Deep artery of clitoris
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Lymphatic Drainage
- Superficial inguinal LN
- Deep inguinal LN
Nerve Supply
Ilioinguinal nerve – genital branch of genitofemoral nerve
Perineal nerve – branch of pudendal nerve
228
- Under parasympathetic stimulation
- Increased secretions from paraurethral glands and vestibular glands
- Erection of clitoris
- Enlargement of vestibular bulbs
SEXUAL AROUSAL
229
- Injection of local anesthesia into tissues surrounding the pudendal nerve
- Pudendal canal – ischial spines
PUDENDAL BLOCK
230
PUDENDAL BLOCK: 2 TYPES
1: Transvaginal method – needle is passed through vaginal mucosa membrane toward the ischial spine
2: Perineal method – needle is inserted on the medial side of the ischial tuberosity to a depth of about 1 in. (2.5 cm) from the free surface of the tuberosity
