Practical class 1: Pelvis and male reproductive structures Flashcards
(120 cards)
1
Q
What makes up the superior pelvic aperture?
A
The pelvic inlet and pelvic brim
2
Q
What makes up the inferior pelvic aperture?
A
Pelvic outlet
3
Q
How to identify a male pelvis?
A
> Deep greater pelvis > Narrow and deep lesser pelvis > Heart-shaped pelvic inlet > Comparatively small pelvic outlet > Acute less than 90o Subpubic angle > Round obturator foramen > Large acetabulum
4
Q
How to identify a male pelvis - Greater pelvis (Pelvis major)?
A
Deep greater pelvis
5
Q
How to identify a male pelvis - Lesser pelvis (Pelvis minor)?
A
Narrow and deep lesser pelvis
6
Q
How to identify a male pelvis - Pelvic inlet?
A
Heart-shaped pelvic inlet
7
Q
How to identify a male pelvis - Pelvic outlet?
A
Comparatively small pelvic outlet
8
Q
How to identify a male pelvis - Subpubic angle?
A
Acute less than 90o Subpubic angle
9
Q
How to identify a male pelvis - Obturator foramen?
A
Round obturator foramen
10
Q
How to identify a male pelvis - Acetabulum?
A
Large acetabulum
11
Q
How to identify a female pelvis - Greater pelvis (Pelvis major)?
A
Shallow
12
Q
How to identify a female pelvis - Lesser pelvis (Pelvis minor)?
A
Wide and shallow
13
Q
How to identify a female pelvis - Pelvic inlet?
A
Oval and rounded
14
Q
How to identify a female pelvis - Pelvic outlet?
A
Comparatively large
15
Q
How to identify a female pelvis - Subpubic angle?
A
Obtuse: greater than 90o
16
Q
How to identify a female pelvis - Obturator foramen?
A
Oval
17
Q
How to identify a female pelvis - Acetabulum?
A
Small
18
Q
Which parts of the pelvis are termed the true pelvis?
A
The lesser pelvis
19
Q
Which parts of the pelvis are termed the false pelvis?
A
The greater pelvis
20
Q
Which parts of the pelvis are termed the false pelvis?
A
The greater pelvis
21
Q
What type of joint is the sacroiliac joint?
A
Bicondylar synovial (Plane and syndesmosis)
22
Q
What type of joint is the pubic symphysis?
A
Secondary cartilaginous (Hyaline and fibrocartilage)
23
Q
With regards to the diameter of the pelvic outlet what is the narrowest point?
A
Transverse = 11 cm
24
Q
With regards to the diameter of the pelvic inlet what is the narrowest point?
A
Anteroposterior = 11 cm
25
What is the anterior wall of the pelvic cavity formed by?
The bodies and rami of the pubic bones and the pubic symphysis
26
Which muscle(s) occupy the lateral pelvic wall? Identify this in an atlas.
Obturator internus muscle
27
Which muscle(s) occupy the posterior pelvic wall? Identify this in an atlas.
Piriformis muscle
28
Which nerve network lies on the muscle forming the posterior wall of the pelvis (Piriformis muscle)? Identify this in the atlas.
The sacral plexus (L4, L5, S1, S2, S3, S4)
29
Which nerve roots form the sacral plexus?
L4, L5, S1, S2, S3, S4
30
Which nerve roots make up the lumbosacral trunk?
L4 and L5
31
Which nerves make up the sciatic nerve?
Common fibular (Perineal) nerve and the tibial nerve
32
Which nerve roots supply the Obturator nerve?
L2, L3, L4
33
What muscles form the Levator ani?
> Iliococcygeus
> Pubococcygeus
> Puborectalis
34
What divides the pelvis from the perineum?
The pelvic floor
35
What are the perineal and annococcygeal bodies?
Complex musculotendinous structures in which gives an insertion (anococcygeal)/ attachment (Perineal) of the perineal muscle and the levator ani respectively
36
What are the two muscles which make up the floor of the pelvis (pelvic diaphragm)?
1) Coccygeus muscle
2) Levator ani:
- Puborectalis muscle
- Pubococcygeus muscle
- Iliococcygeus muscle
37
Give two functions of the pelvic floor (diaphragm)?
1) Support the abdominopelvic viscera (Bladder, intestines, uterus etc)
2) Resistance to increases in intra-pelvic/abdominal pressure (e.g. heavy lifting or coughing)
3) Helps with urinary and faecal continence
38
What is the innervation of the pelvic floor/diaphragm?
1) Levator ani = Branches of the pudendal nerve (S2, S3 and S4)
2) Coccygeus = Anterior rami of S4 and S5
39
What is a cystoceole?
Bladder prolapse into the vagina
40
What is a rectocoele?
Rectum prolapse into the vagina
41
If the pelvic floor is damaged during childbirth what can occur as a result?
1) Urinary stress incontinence
2) Rectal incontinence
3) Prolapse (Cystoceole or Rectoceole)
42
Why may an episiotomy minimise long term damage in childbirth?
Helps to prevent uncontrolled tearing of the perineal muscles
If the medial fibres of the puborectalis muscle are torn it may lead to rectal herniation (Rectoceole)
43
If the medial fibres of the puborectalis muscle are torn what will often happen?
Rectal herniation (Rectoceole)
44
Why is a mediolateral episiotomy preferable to midline episiotomy?
Midline leads to increased risk (14.8% versus 7% in mediolateral) of deep perineal tears
45
Which is preferable mediolateral episiotomy or midline episiotomy?
Mediolateral episiotomy
46
When performing a digital rectal examination on a male what may you be able to palpate?
1) Prostate gland**
2) Seminal vesicle
3) Vas deferens
47
When performing a digital rectal examination on a female what may you be able to palpate?
1) Perineal body*
2) Cervix*
3) Problems with reproductive organs (Uterus/ovaries)
48
Which arteries supply most of the pelvic organs, perineum and gluteal regions? What isn't supplied by them?
Right and Left internal iliac artery
The testis, ovary and upper part of the rectum have different supplies.
49
What is the superior and inferior vesical arteries a branch of?
What does it supply?
Internal iliac (Part of umbilical artery)
Supplies the bladder, seminal gland and prostate in males
50
What is the gonadal aftery a branch of?
What does it supply?
Aorta
Supplies the gonads (Ovaries and testis)
51
What is the uterine artery a branch of?
What does it supply?
Internal iliac artery
Supplies the uterus, ureter and uterine tube
52
What is the superior rectal artery a branch of?
What does it supply?
Inferior mesenteric artery
Supplies the Superior 1/3rd of the rectum
53
What is the middle and inferior rectal arteries a branch of?
What does it supply?
Internal iliac artery
Supplies the middle inferior 1/3rd of the rectum
54
What is the vaginal artery a branch of?
What does it supply?
Uterine artery
Supplies the vagina
55
What is the internal pudendal artery a branch of?
What does it supply?
Internal iliac artery
Main artery to the perineum
56
What is the obturator artery a branch of?
What does it supply?
Internal iliac artery
Pelvic muscles, ilium and head of the femur
57
The venous drainage of the pelvic structures consists of which 5 different veins?
1) Internal iliac veins
2) Superior rectal veins
3) Median sacral vein
4) Gonadal veins
5) Internal vertebral venous plexus
58
Which part(s) of the rectum drain(s) into the portal circulation?
Superior 1/3rd, which drains into the portal circulation, via the inferior mesenteric vein
59
Which part(s) of the rectum drain(s) into the systemic circulation?
Inferior 1/3rd which drains into the systemic circulation, via the internal iliac vein
60
What is the significance of understand the venous drainage of the rectum?
Identifying the cause of haemorrhoids
61
Why might haemorrhoids be associated with cirrhosis of the liver?
Due to portal hypertension leading to decreased venous return
62
The veins along the sides and base of the prostate join to form what?
The prostatic venous plexus
63
With which venous plexus does the prostatic venous plexus communicate on its posterior side?
Drains into the internal iliac vein which connects with the vertebral venous plexus
64
What is the clinical significance of the prostatic venous plexus connecting with the vertebral venous plexus?
Hypothesised to be the route for metastasis of prostate cancer to bone
65
What forms the somatic nerve supply of the reproductive organs?
1) Ilioinguinal nerve
| 2) Genitofemeral nerve
66
What does the ilioinguinal nerve originate from?
L1
67
What does the genitofemoral nerve originate from?
L1 and L2
68
What does the ilioinguinal supply?
Supply skin at the root of the penis in the male and the labia in the female
69
Where does the ilioinguinal nerve enter the inguinal canal?
The superficial inguinal ring
70
Where does the genitofemoral nerve enter the inguinal canal?
Deep inguinal ring
71
What structure(s) in the male are supplied by the genital branch of the genito-femoral nerve?
Sensation to upper anterior thigh, skin of scrotum in males and mons pubis in females
72
What is the clinical significance of the genital branch of the Genito-femoral nerve?
Hypoesthesia over the anterior thigh below the inguinal ligament
73
What does the pudendal nerve supply?
Innervate the skin and the muscles of the perineum
74
What is the nerve supply of the pudendal nerve?
S2, S3 and S4
75
Where does the pudendal nerve arise from?
The sacral plexus
76
The course of the pudendal nerve follows what?
The pudendal nerve follows the course of the pudendal artery
Travels from pelvis to perineum, via the gluteal region
77
Which nerve is targeted for nerve block during childbirth? Which landmark do you use?
A pudendal nerve block can be administered trans-vaginally using the ischial spine as a bony landmark
78
Sympathetic fibres from L1, L2 via the hypogastric plexus supply what?
Vas deferens, seminal vesicles, prostate and epididymis in the male
79
Sympathetic fibres from the pelvic and ovarian plexus and parasympathetic nerve fibres from the pelvic splanchnic nerves (S2, S3 and S4) supply what?
The female genital tract
80
Parasympathetic fibres from S2, S3, S4 via the hypogastric plexus supply what in both males and females?
Innervate the erectile tissue in both male and female
81
What are the erectile structures in males?
1) Corpora cavernosa of the penis become engorged with arterial blood, tumescence, during erection
2) Lesser so the corpus spongiosum of the penis
82
What are the erectile structures in females?
1) Corpora cavernosa, positioned to the left and right of the vaginal oriface (vestibular bulbs)
2) The clitoris
83
After rectal surgery, why are some men unable to ejaculate?
Retrograde ejaculation can occur when damage to the muscles or nerves that controls the muscles of the bladder
Damage to autonomic nerve plexus
84
What are the four primary nodes present in the pelvis receiving the lymphatic drainage of the pelvic organs?
1) External iliac lymph nodes
2) Internal iliac lymph nodes
3) Sacral lymph nodes
4) Common iliac lymph nodes
85
What does the external iliac lymph nodes drain?
Pelvic viscera, inguinal
86
What does the internal iliac lymph nodes drain?
Gluteal region, deep perineum and inferior pelvic viscera
87
What does the sacral lymph nodes drain?
Postero-inferior pelvic viscera
88
What does the common iliac lymph nodes drain?
Drainage from the three main groups: external, internal and sacral lymph nodes
89
The male reproductive organs can be grouped into 3 categories, which are?
1) The external genitalia.
2) The gonads, where gametes or sex cells are produced, also the site for the production of important sex hormones.
3) The tube system for conveying the sperm and ovum enabling them to unite with resultant zygote being implanted.
4) The accessory glands which support the gametes and lubricate the copulatory organs.
90
The male internal reproductive organs include what?
```
> Testis
> Ductus deferens or Vas deferens
> Seminal glands
> Prostate
> Epididymis
> Bulbourethral glands
```
91
What is the purpose of the testis being located outside the abdominopelvic cavity?
The maintain the temperature of the testis 1oC lower than the core body temperature which is necessary for the survival of sperm
92
Migration of the testes from the abdominal cavity during development leads to which structure being produced?
The inguinal canal
93
What are the main contents of the spermatic cord?
1) Vas deferens
2) Genito-femoral nerve
3) Testicular (gonadal) artery
4) Pampiniform plexus (venous) which empties into the gonadal vein
94
The ovoid testes are suspended by what in the scrotum?
The spermatic cords
95
What is the tough outer fibrous layer of the testis?
Tunica albuginea
96
What is the sac covering the testis?
Tunica vaginalis
97
What are the two layers of the tunica vaginalis ?
1) Parietal (lines scrotal cavity)
| 2) Visceral layers (Overlies the tunica albuginea)
98
What material is present between the two layers (parietal and visceral layers) of the tunica vaginalis? What is its role?
Thin (Serous) fluid layer to reduce the friction between the testis and the scrotum
99
What is a hydrocele?
A collection of serous fluid in a part of the tunica vaginalis
100
What is a haematocele?
Testicular injury, leading to rupture of one of the vessels of the tunica
101
At which vertebral level do the testicular arteries arise from the abdominal aorta?
L2 and L3
102
The testicular arteries pass retroperitoneally and cross which two important structures?
1) Ureters
| 2) External iliac arteries
103
What is the term for the 8-12 anatomising veins associated with the testis?
The pampiniform (venous) plexus
104
What is the function of the pampiniform plexus?
Other than venous return, temperature regulation of the testis
105
Into which vein does the right testicular vein drain into?
Inferior vena cava
106
Into which vein does the left testicular vein drain into?
Left renal vein
107
What is a varicocele?
Enlargement of the veins in the scrotum
108
Which two groups of lymph nodes receive lymph from the testis?
1) Para-aortic lymph nodes
| 2) Pre-aortic lymph nodes
109
Where does the vas deferent start?
From the tail of the epididymis
110
Where does the vas deferent terminate?
It terminates by joining the duct of the seminal gland to form the ejaculatory duct
111
What secretions are produced by the seminal vesicles? pH?
Produce 60% of semen:
- Sugar (fructose)
- Proteins
- Prostaglandins
- Clotting factors
Slightly alkaline
112
What secretions are produced by the prostate? pH?
Produces 30% of semen
Slightly acidic
113
Why might an enlarged prostate gland cause retention of urine?
Puts pressure on the urethra
114
What is the clinical significance of drainage from the prostatic venous plexus?
Drains into the internal iliac vein which connects with the vertebral venous plexus, this is hypothesised to be a route for bone metastasis of prostatic cancer
115
What are the bulbourethral (cowper's) glands?
These are small, paired structures located in the urogenital diaphragm which empty into the penile/spongy urethra
116
What secretions are produced by the bulbourethral (cowper's) glands?
Pre-ejaculate (Cowper's fluid)
117
What are the lymphatic drainage of the prostate?
Internal iliac and sacral node groups
118
What are the lymphatic drainage of the seminal vesicle?
External and internal iliac lymph nodes
119
What are the lymphatic drainage of the scrotum?
Superficial inguinal lymph nodes
120
What are the lymphatic drainage of the penis?
Deep inguinal nodes
