Repro Session 4 Flashcards Preview

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Flashcards in Repro Session 4 Deck (185):
1

What is the adult remnant of the processus vaginalis in the male?

Tunica vaginalis

2

What are the two coverings of the testis?

Tunica vaginalis and tunica albuginea

3

What invaginates the testis and splits it into lobules with fibrous septae?

Tunica albuginea

4

Describe the descent of the testes.

7 wks: gonads develop retroperitoneally within mesonephric ridge. 7 months: descend through abdomen and cross inguinal canal 8 wks before delivery. 9 months: exit anterolateral abdominal wall taking layers with them

5

Why might a premature delivery lead to testes outside of the scrotum?

They don't cross the inguinal canal until 8 weeks before delivery

6

What gives arterial supply to the testes?

Direct branch of the abdominal aorta, the testicular artery

7

Where does the venous drainage of the testes empty?

R testicular vein into IVC and L into L renal vein

8

What are the three components of the epididymis?

Head, body and tail

9

How does the epididymis connect to seminiferous tubules?

Via effect tubules ductules and rete testis

10

Describe the path of the spermatid cord.

Deep inguinal ring, lateral to inferior epigastric vessels via inguinal canal and superficial inguinal ring to posterior border of testis

11

What are the contents of the spermatic cord?

Testicular artery, cremastic artery, artery to vas, pampiniform plexus, genital branch of genitofemoral nerve, vas deferens, lymphatics and processus vaginalis

12

How does the pampiniform plexus aid spermatogenesis?

Veins forming it wrap around arteries to reduce blood temperature

13

What covering of the spermatic cord does the external abdominal oblique aponeurosis form?

External spermatic fascia

14

What forms the cremasteric muscle and fascia in the spermatic cord?

Internal abdominal oblique and transversalis fascia

15

What forms the internal spermatic fascia in the spermatic cord?

Transversalis fascia

16

What is the order of spermatic cord coverings from superficial to deep?

External spermatids fascia, cremasteric muscle and fascia, internal soermatic fascia

17

Why are indirect inguinal hernias often called congenital despite not presenting at birth?

Have a developmental basis

18

What is an indirect inguinal hernia?

Reopening of the processus vaginalis creating a potential continuity between the peritoneal cavity and the tunica vaginalis

19

Where does the spermatic cord usually twist in testicular torsion?

Just above the upper pole of the testis

20

What gives innervation to the anterior surface of the scrotum and testis?

Lumbar plexus

21

Where does the sacral plexus give innervation to in the scrotum and testis?

Posterior and inferior surfaces

22

Where does lymph from the testis drain to?

Paraaortic nodes

23

Why do the testis not drain to local lymph nodes?

Due to the developmental origin of the testis

24

Where does lymph from the scrotum drain?

Superficial inguinal nodes

25

Describe the passage of the ductus deferens.

Ascends in spermatic cord, inguinal canal, pelvic side wall, dilated ampulla, ejaculatory duct

26

What proportion of the ejaculate volume is secreted by the seminal vesicle?

70-80%

27

Where is the seminal vesicle positioned?

Retroperitoneal between the bladder and rectum at the diverticulum of vas deferens

28

What does the combination of the spermatic vesicle and vas deferens ducts form?

Ejaculatory duct

29

Describe the position of the prostate gland.

Base adjacent to neck of bladder, apex adjacent to urethral sphincter and deep perineal muscles, anterior surface adjacent to urethral sphincter, posterior adjacent to ampulla of rectum and inferolateral adjacent to levator ani

30

What divides the prostate into anatomical lobes?

Urethra and ejaculatory ducts as they pass through

31

What are the four anatomical lobes of the prostate gland?

Inferoposterior, inferolateral, superomedial and antero medial

32

Which anatomical lobes tend to be affected in BPH?

Superomedial and anteromedial

33

Where is the central zone of the prostate found?

Around ejaculatory ducts

34

What is the embryological origin of the central zone of the prostate?

Wolffian duct

35

Where is the transitional zone of the prostate found?

Centrally around the urethra

36

What is the embryological origin of the transitional and peripheral zones of the prostate?

Urogenital sinus

37

Where is the peripheral zone of the prostate found?

Forms the main body, located posteriorly

38

To which nodes might malignancy spread from the peripheral zone of the prostate?

Internal iliac or sacral

39

Describe the path a metastatic cancer may take in the venous drainage from the peripheral zone of the prostate.

Internal vertebral plexus through the vertebrae to the brain

40

Which zone of the prostate is examined by DRE?

Peripheral

41

What type of tissue makes up the prostate gland?

Fibromuscular

42

What are the three components of the penis?

Root, body and glans

43

What gives arterial supply to the penis?

Branches of internal pudendal arteries

44

What are the four parts of the male urethra?

Pre-prostatic, prostatic, membranous and spongy

45

What does the prostatic urethra receive?

Ejaculatory ducts

46

Why is the membranous urethra the least distensible portion of the male urethra?

Surrounding fibrous pelvic floor and perineum

47

What does the distal expansion of the ventral corpus spongiosum form?

Glans penis

48

What happens to the dorsal pair of corpora cavernosa during erection?

They swell with blood

49

How does ischiocavernous help maintain erection?

Compresses veins in the root

50

What does bulbospongiosus help to do in the male?

Expel last drops of urine and with autonomic supply maintains erection

51

Are ischiocavernosus and bulbospongiosus found in the male and female?

Yes

52

What are the contents of the labioscrotal folds?

Testis, epididymis, 1st part of spermatic cord

53

What can cause enlargement of the scrotum?

Inguinal hernia, hydrocoele, haematocoele, varicocoele, epipdidymitis

54

What is hydrocoele?

Serous fluid in the tunica vaginalis usually due to failure of the processus vaginalis to close

55

What is haematocoele?

Accumulation of blood in the tunica vaginalis

56

What is varicocoele?

Dilation of testicular veins

57

Why is varicocoele usually seen in the left?

Left testicular vein drains into the smaller L renal vein rather than the IVC

58

How are hydro- and haematocoele differentiated clinically?

Transillumination

59

What do the scarpa and camper layers of the abdominal wall become in the scrotum?

Darts fascia and muscle

60

Is the scarpa or camper layer of the SC tissue of the anterior abdominal membranous?

Scarpa

61

What are the corresponding scrotal coverings of the anterior abdominal wall muscles?

External oblique and its fascia --> external spermatic fascia. Internal oblique --> cremaster muscle. Fascia of superficial and deep internal obliques --> cremasteric fascia. Transversalis fascia --> internal spermatic fascia

62

What does the peritoneum become in the scrotum?

Tunica vaginalis

63

What gives the rugose appearance of the scrotum?

Smooth muscle fibres of dartos muscle

64

How does the dartos muscle help reduce heat loss when the scrotum is exposed to cold air?

Fibres contract causing scrotum to wrinkle. This thickens the integumentary layer, decreases surface area and helps the cremaster muscle to hold the testes closer to the body

65

What gives arterial supply to the scrotum?

Posterior scrotal branches of perineal artery (internal pudendal), anterior scrotal branches of deep external pudendal artery (femoral) and cremasteric artery (inferior epigastric)

66

What accompanies the arteries in the scrotum?

Scrotal veins

67

What suspends the testes in the scrotum?

Spermatic cord

68

Which testis is usually more inferior?

Left

69

What is the sinus of epididymis?

Slit-like recess of tunica vaginalis between the body of epididymis and posterolateral testis

70

What is the mediastinum of testis?

Thickened ridge of tunic albuginea on the internal posterior aspect of the testes that gives rise to fibrous septae that split the gonad info lobules

71

What are the rete testis?

Network of canals in the mediastinum of the testis

72

Describe the venous drainage from the testes to the IVC/ L renal vein.

Arise from testis and epididymis, into pampiniform plexus that converges superiorly to R and L testicular veins

73

Describe the passage of the testicular arteries.

Arise from anterolateral AA just inferior to renal artery and move retroperitoneally crossing the ureters, moving inferior to external iliac artery through the inguinal canal into the spermatic cord

74

What do the testicular arteries anastomose with?

Artery of ductus deferens

75

What forms the thermoregulatory system of the testes?

Pampiniform plexus, cremasteric muscle and dartos muscle

76

What gives autonomic innervation to the testes?

Testicular plexus of nerves on the testicular artery

77

What is epipdidymitis?

Inflammation of the epididymis usually due to bacterial or viral infection

78

Describe the passage of sperm through the epididymis.

Rete testis, efferent ductules, duct, head, body and tail of epididymis

79

Describe the structure of the duct of epididymis.

Appears solid due to tightly compacted convolutions. Gets smaller from head to tail

80

What happens to sperm in the duct of epididymis?

Stored and mature

81

Describe the structure of the head of epididymis.

12-14 efferent ductules coiled ends form lobules in the superior extended part

82

Describe the structure of the body of epididymis.

Major part of structure with tightly convoluted duct of epididymis

83

What is the tapering tail of epididymis continuous with to transport sperm to the ejaculatory duct for expulsion?

Ductus deferens

84

What gives innervation to the epididymis?

Autonomic and sensory fibres from the renal and aortic plexus via the testicular plexus

85

What gives arterial supply to the epididymis?

Testicular arteries

86

What gives venous drainage to the epididymis?

Pampiniform plexus

87

Where does lymph from the epididymis drain?

Lumbar and pre aortic nodes at L1

88

Which structures in the male reproductive tract derive from the mesonephric duct?

Seminal vesicles, Ejaculatory ducts, Epididymis and Ductus deferens (SEED)

89

What innervates the loops of striated cremaster muscle in the spermatic cord?

Genital branch of genitofemoral nerve (L1&2) from the lumbar plexus

90

What happens in the cremasteric reflex?

Stroking the superior medial thigh causes elevation of the testis on that side

91

What is tested when assessing the cremasteric reflex?

Afferent ilioinguinal/genitofemoral nerve and efferent genital branch of genitofemoral

92

Where does the artery of ductus deferens arise from?

Inferior vesical artery

93

Where are the nerve fibres found in the spermatids cord?

Sympathetic on arteries and sympathetic and parasympathetic on ductus deferens

94

How can the vestige of processus vaginalis be identified?

Fibrous thread anteriorly extending between abdominal peritoneum and tunica vaginalis

95

What would severe and sudden pain in one or both testes following exercise indicate?

Testicular torsion

96

How is testicular torsion investigated?

US or colour Doppler

97

What are the layers of muscle found in the vas deferens?

Inner longitudinal, intermediate circular and outer longitudinal smooth muscle

98

What is the ductus deferens?

45 cm long straight muscular tube that conducts sperm from epididymis to ejaculatory duct

99

Why do the ductus deferens require a rich autonomic supply?

For peristalsis

100

Where does lymph from the vas deferens drain?

External and internal iliac nodes

101

Describe the passage of the vas deferens.

Tail of epididymis, inguinal canal, lateral pelvic wall close to ischial spines, turns medially to pass between bladder and urethra and forms ejaculatory duct with seminal vesicle

102

Where are the seminal vesicles found?

Between bladder fundus and rectum

103

What separates the seminal vesicles from the rectum superiorly and inferiorly?

Superiorly: retro vesicle pouch
Inferiorly: retro vesicle septum

104

Describe the structure of the seminal vesicles.

Honeycombed, lobulated structure with pseudostratified so lumbar epithelium

105

What happens to the epithelium of the seminal vesicles with higher levels of testosterone?

Grows taller

106

What is the function of the seminal vesicles?

Secrete 70% of the volume of the ejaculate and play a key role in its normal function

107

What are the components of the seminal vesicle secretions?

Alkaline fluid, fructose, prostaglandins and clotting factors

108

What is the function of the alkaline fluid secret by the seminal vesicle?

Neutralises male urethra and femal vagina for spermatozoa survival

109

What is the energy source for spermatozoa in the ejaculate?

Fructose

110

What is the function of the prostaglandins secreted by the seminal vesicle?

Suppress female immune response to foreign semen

111

What is the function of the clotting factors secreted by the seminal vesicle?

To keep the semen in the female reproductive tract post-ejaculation

112

What gives arterial supply to the seminal vesicles?

Inferior vesical, internal pudendal and middle rectal arteries

113

What type of innervation do the seminal vesicles receive?

Sympathetic

114

Where does lymph from the seminal vesicle drain?

External and internal iliac lymph nodes

115

What gives venous drainage to the seminal vesicles?

Veins accompanying the supplying arteries

116

Approximately what size are the seminal vesicles?

5 cm

117

Describe the passage of structures that join to form the ejaculatory duct that drains into the prostatic urethra.

Seminal gland ducts and ductus deferens near the neck of bladder run anteroinferiorly close together to the posterior prostate, alongside the prostatic utricle to converge on the seminal colliulus

118

What is found at the seminal colliculus allowing drainage of the ejaculatory ducts?

Tiny slit-like apertures

119

Do prostatic secretions enter the ejaculatory ducts as it passes through the prostate?

No, not until it terminates in the urethra

120

What gives arterial supply to the ejaculatory ducts?

Arteries to ductus deferens

121

What gives venous drainage to the ejaculatory ducts?

Prostatic and vesical venous plexuses

122

Approximately how long are the ejaculatory ducts?

2.5 cm

123

Which is the largest accessory gland of the male reproductive tract?

Prostate

124

What proportion of the ejaculate is secreted by the prostate?

20%

125

What is the function of the secretions from the prostate in the ejaculate?

Activate sperm

126

What is the composition of the prostate tissue?

2/3 glandular, 1/3 fibromuscular

127

What are the two coverings of the prostate?

Fibrous capsule and visceral layer of pelvic fascia (fibrous prostatic sheath)

128

Describe the fibrous capsule of the prostate.

Dense and neurovascular with prostatic venous and nervous plexuses

129

Describe the fibrous prostatic sheath.

Thin anteriorly, continuous with puboprostatic ligaments anterolaterally and thick posteriorly where it blends with the retrovesical septum

130

Describe the isthmus of the prostate.

(Anterior lobe) fibromuscular anterior to urethra, a continuation of the EUS to the bladder neck

131

Why do the superomedial and anteromedial lobes of the prostate undergo hormone-induced hypertrophy in old age?

Due to embryonic median lobe origin

132

What gives innervation to the prostate?

Inferior hypogastric plexus

133

What gives arterial supply to the prostate?

Prostatic arteries, branches of internal iliac and pudendal arteries and middle rectal arteries

134

What gives venous drainage to the prostate?

Prostatic venous plexus that drains into internal iliac veins that communicate with vesical and internal vertebral plexuses

135

What separates the anterior aspect of the prostate gland from the pubic symphysis?

Retroperitoneal fat

136

What is felt on DRE in prostatic malignancy?

Hard and irregular tissue

137

What increases the risk of cystitis and kidney damage in BPH?

Straining

138

How can DRE be used to assess an abscess rupture that has caused pus to enter the peritoneal cavity?

If bladder is moderately full it can be palpated and massaged to release secretions that can be tested for gonococci

139

What are the bulbourethral (Cowper) glands?

2 pea side glands that secrete alkaline mucus-like fluid into the urethra during sexual arousal

140

Describe the path secretions from Cowper's glands take.

Ducts through perineal membrane into bulb of penis to empty through miniature apertures into proximal spongy urethra

141

Where are the bulbourethral glands located?

Posterolateral to intermediate urethra, largely embedded in EUS

142

What gives arterial supply to the bulbourethral glands?

Arteries to the bulb of penis

143

What gives innervation to the bulbourethral glands?

Autonomic fibres from the prostatic plexus

144

Where does lymph drain to from the bulbourethral glands?

Internal and eternal iliac nodes

145

Which nerve roots are involved in the erectile bodies of the penis?

S2&3

146

What do the presynaptic sympathetic fibres from T12-L2/3 supply in the male reproductive tract?

Components of lumbar splanchnic nerves and hypogastric and pelvic plexuses

147

What do the presynaptic parasympathetic fibres from S2&3 give rise to in the male reproductive tract?

Pelvic splanchnic nerves and prostatic nerve plexus

148

What does sympathetic stimulation cause in the male orgasm?

Contraction of IUS, persistaltic-like contractions of vas deferens and combined contraction and secretion from seminal glands and prostate

149

Which two muscles form levator ani?

Pubococcygeus and iliococcygeus

150

Which muscles form the pelvic diaphragm?

Pubococcygeus, iliococcygeus and coccygeus

151

Which muscles form perineum?

Pubococcygeus, iliococcygeus, coccygeus, bulbospongiosus and ischiocavernosus

152

Which two muscles of the perineum are more superficial?

Bulbospongiosus and ischiocavernosus

153

Describe the position of the root of the penis.

Most proximal portion, fixed in superficial perineal pouch of pelvic floor

154

What does the root of the penis contain?

3 erectile tissues and 2 muscles

155

What are the 3 erectile tissues found in the root of the penis?

L and R crura and bulb of penis

156

What separates the L and R crura in the penis?

Septum of penis

157

What are the crura attached to?

Ischial rami

158

What traverses the bulb of the penis?

Urethra

159

Why does the ventral corpus spongiosum fill to a pressure that is lower than that seen in the dorsal corpora cavernosa?

Prevent occlusion of the urethra

160

What do the L and R crura become in the body of the penis?

Dorsal corpora cavernosa

161

What does the bulb become in the body of the penis?

Ventral corpus spongiosum

162

Describe the structure of the body of the penis.

Free part suspended from public symphysis consisting of 3 cylinders of erectile tissue

163

What forms the conical shape of the gland of the penis?

Distal expansion of corpus spongiosum

164

What goes the glans of the penis contain?

External urethral orifice

165

What forms the fundiform ligament?

Condensations of abdominal SC tissue

166

How does the fundiform ligament support the penis?

Extends from linea Alba, slings around penis and attaches to the pubic symphysis

167

What forms the suspensory ligament of the penis?

Condensations of the deep fascia of the penis

168

What are the 2 fascial coverings around each erectile tissue mass in the penis?

Superficially the deep fascia of penis from the deep perineal fascia. Deep to this is the tunica albuginea around each cavernous body

169

What are the most common aetiologies of erectile dysfunction?

Vascular e.g. Hypertension, hyoercholestrolaemia or psychological e.g. Anxiety, depression

170

What is priapism?

Erection for >4 hrs without sexual stimulation due to trapping of blood in the erectile bodies

171

What can result from priapism?

Scarring and erectile dysfunction

172

How does the suspensory ligament support the erectile bodies of the penis?

Attaches them to the public symphysis

173

Describe the skin of the penis.

More heavily pigmented, attached to tunica albuginea by loose CT

174

What is the prepuce?

Double layer of skin and fascia at the neck of the glans that covers it to a variable extent

175

What connects the prepuce to to the skin of the glans of the penis?

Frenulum-median fold of skin on the ventral aspect of the penis

176

What is the preputial sac?

Potential space between the glans and prepuce

177

What gives arterial supply to the penis?

Dorsal and deep arteries of the penis and bulbourethral artery (branches of internal pudendal from anterior internal iliac)

178

Which arteries of the penis supplies the corpora cavernosa?

Deep arteries of the penis

179

What gives venous drainage to the penis?

Deep dorsal vein drains cavernous spaces into prostatic venous plexus. Superficial dorsal veins drain skin and cutaneous tissues

180

Which spinal cord segments give innervation to the penis?

S2-4

181

What supply do the nerves in the penis give?

Dorsal nerve of penis gives sensory and sympathetic innervation to skin and glans of penis. Cavernous nerves from prostatic nerve plexus give parasympathetic stimulation for vascular changes in erection

182

What are hypospadias?

Congenital conditions where the urethra opens into the ventral surface of the penis

183

What is phimosis?

Prepuce is tightly over glans and cannot be retracted causing irritation when smegma accumulates in the preputial sac

184

What is paraphimosis?

Retraction of prepuce and glans causes constriction of glans neck and obstructing venous and lymph drainage so that glans enlargers and prepuce cannot move over it

185

What is Peyronie's disease?

When scar tissue causes abnormal shaft curvature leading to a painful erection