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Flashcards in Reporductive anatomy Deck (41)
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1

What are the branches of the internal iliac artery?

Branches in posterior (has iliolumbar, sacroilial and superior gluteal branch) and anterior (has umbilical, superior vesicle, vaginal, middle rectal, obturator, internal pudendal, inferior vesicle (uterine in female))

2

Which ligament forms the greater and lesser sciatic foramen?

The sacrospinal ligament

3

Which uterine related structure is intraperitoneal?

Fallopian tubes. All others are infraperitoneal as not completely surrounded by peritoneum

4

What is the cardinal ligament?

Connects cervix to lateral pelvic wall. Carries uterine arteries.

5

What is the round ligament?

Remnant of gubernaculum. Runs from near uterine horns to labia majora (through inguinal canal). Can become strained and painful during pregnancy.

6

What is the suspensory ligament?

Peritoneal fold running from abdomainal wall (lateral) to ovary - has ovarian blood vessels.

7

What is the ovarian ligament?

Runs between ovary and uterus

8

What passes through the greater sciatic foreman?

Above piriformis: Superior gluteal A&N
Below piriformis: Internal pudendal N; inferior gluteal A,N,V; ob int. nerve; quad fem. nerve; post.fem.cut nerve; sciatic nerve

9

What passes through the lesser sciatic foramen?

Internal pudendal artery, internal pudendal nerve, obturator internus tendon and nerve.

10

Arterial supply to the scrotum

Anterior supplied by external pudendal artery (from femoral). Posterior supplied by internal pudendal artery

11

Nerve supply to scrotum

Anterior scrotal nerves derived from the genital branch of genitofemoral (L1,L2 also gives upper anterior thigh) and ilioinguinal nerve (L1).Posterior scrotal nerves derived from the perineal branches of the pudendal nerve and posterior femoral cutaneous nerve.

12

Scrotal layers

Some damn Englishman Called it The Testes
Tunica albuginea, tunica vaginalis (=peritoneum), Internal spermatic fascia (internal abdominal fascia), Cremasteric fascia (tranversus abdominus/internal oblique), external spermatic fascia (external abdominal fascia), dartos fascia (scarpas, colles in UG triangle), skin
Cremaster lifts testes, dartos wrinkles skin for temp control

13

Spermatic cord has

-Testicular artery, ductus deferens artery and cremasteric artery
-Internal spermatic fascia, cremasteric fascia and external spermatic fascia
-Genital branch of genitofemoral nerve, sympathetic nerves and ilioinguinal nerve (runs outside)
-ductus deferens, lymphatics and pampiniform plexus
Spermatic cord twists in testicular torsion.

14

Penis layers

-Skin
-Superficial dorsal vein, superficial lateral veins
-Dartos fascia (superficial fascia) - contains muscle helps to contract foreskin
Buck's fascia (deep fascia)
-Dorsal artery, dorsal nerve, deep dorsal vein
-Tunica albuginea
Corpus spongeosum (with urethra), corpus cavernosum (with deep arteries in each) - corpus spongeosum separated from cavernosum compartment by intercavernous septum of deep fascia.

15

Penis innervation

Neurovascular supply to the penis travels via deep perineal pouch and through pudendal (Alcock's) canal.
Pudendal nerve (S2-S4) gives off perineal nerve (perineal skin and scrotum) and dorsal nerve of the penis.
Neurovascular bundle runs close to suspensory ligament of the penis.
Parasympathetic nerves enable erection (pelvic splanchnic S2,S3,S4) run to inferior hypogastric plexus, then prostatic plexus and then cavernus nerve,
Sympathetic nervous system for ejaculation - L1,L2, close off internal urethral sphincter, ductus deferens peristalsis, prostate contraction and seminal vesicles contraction as well as contraction of muscle (skeletal) over bulb of penis.

16

Blood supply to penis

Arterial supply is from the internal pudendal artery - gives deep and dorsal penile arteries.
Penile venous drainage is from dorsal (superficial/deep) going to prostatic venous plexus and then internal iliac vein.
Erection involves straightening of helicine arteries - allows blood to fill corpus cavernosum.
Bulbospongiousus and ischiospongeosus muscles compress venous plexus to retain blood in penis.

17

Bulbourethral glands

These are in the deep perineal pouch in the male (but superficial perineal pouch in the female).
Cowper's glands in males, neutralises urethral for semen passage.
Batholins glands in women

18

Prostate gland blood supply

middle rectal and inferior vesicle arteries (from anterior internal iliac).
Venous blood goes to prostatic venous plexus, then internal iliac veins.

19

Prostate lymph drainage

Internal iliac nodes

20

Prostate secretions

20% of seminal fluid; It contributes to semen production (e.g. zinc, proteolytic enzymes

21

Prostate pathology

Prostate can be divided into zone (peripheral, central and transitional) - transitional zone associated with BPH, peripheral zone with cancer and can be palpated from the rectum.

22

Seminal fluid

Seminal vesicles don't store spermatazoa, but instead secrete an alkaline fluid (as vaginal pH is slightly acidic and this neutralises it as well as has nutrients (e.g. fructose). This makes up around 75% of semen.

23

Seminal vesicles A,V,L

The blood supply is via the inferior vesical and middle rectal artery, while drainage is via the vesical and prostatic venous plexus.
The lymph drainage is via the internal and external iliac nodes, as well as the sacral nodes.

24

Muscles assisting with erections

Ischiocavernosus (runs from ischium to corpus cavernosus) helps maintain penile and clitoral erections by compressing venous plexus and preventing venous drainage.
Bulbospongiosus covers the bulb of the penis so facilitates emptying urethra during ejaculation and urination (although in the female, the greater vestibular glands are emptied by bulbospongiosus). Also supports the perineal body.

25

Female genitalia innervation

Clitoris is the pudendal nerve (dorsal nerve of the clitoris), anterior vulva (labia majora and mons pubis) is the ilioinguinal. Posterior vulva and inner labia is the pudendal branch (perineal nerve)

26

Female reproductive innervation

Distal 1/5 of vagina of somatic pudendal S2-S4)
Above pelvic pain line, T12-L2 afferents.

27

Levator ani innervation
ischiococcygeus innervation

Leavtor ani is S2-S4
Coccygeus is S4-S5

28

Boundaries of inguinal canal

Roof is: Tranversalis fascia, internal olbique, tranversus abdominus
Posterior wall is transversalis fascia
Floor is lacunar ligament and inguinal ligament
Anterior wall is apeunorosis of internal oblique/external oblique

29

Pelvic plexus

Superior hypogastric plexus has sympathetic L3-L4
Plexus splits into right and left hypogastric nerves
Parasympathetics (s2-S4) join the inferior hypogastric plexi, plus sacral part of sympthatic chain joins

30

Uterine innervation

Sympathetic is T12-L2 (via superior, and then inferior hypogastric plexus)
Parasymathetic is S2-S4 pelvic splachnic, via inferior hypogastric plexus
Visceral afferents follow sympathetic efferent T10-L2