11. Uro-Genital System (TT) Flashcards
What are the three bones of the hip and how are they joined?
Aside from the hip bones, what are the other bones found in the pelvis?
- Sacrum
- Coccyx
What is the acetabulum and where is it found?
- It is the concave cavity found in the hip bone, formed by the ilium, ischium and pubis bones.
- It is where the head of femur articulates with the hip.
How is the pelvis attached to the axial skeleton?
The sacro-iliac joint joins the hip bones to the spine.
What joint joins the sacrum to the ilium in the hip? What type of joint is this?
- Sacroiliac joint
- It is plane synovial, but multiple ligaments mean that it is very stable
What joint joins the pubis bones at the anterior side of the pelvic girdle? What is the notch inferior to this called?
- Pubis symphysis
- This forms the pubic arch inferior to it
What is the name for the two small bumps on the pubis bones near the pubic symphysis?
Pubic tubercles
What are the two arms that join the pubis and ischium?
Superior and inferior pubic rami
What is the name for the two wing-like parts of the ilium bones?
Ala
What is the inner surface of the ilium bone called?
Iliac fossa -> It is noramlly covered by the iliacus muscle.
What is the name for the hole in the pelvic girdle formed by the ischium and rami of the pubis?
Obturator foramen
What are the pelvic inlet and outlet, and what bones border each? [IMPORTANT]
- Pelvic inlet
- This is the superior opening to the pelvis
- Formed by the pubic symphysis anteriorly, and the pectineal line of the pubis, the arcuate line of the ilium, and the sacral promontory
- Pelvic outlet
- This is the inferior opening to the pelvis
- Formed by the inferior margin of the pubic symphysis anteriorly, and the ischiopubic ramus, the ischial tuberosity, the sacrotuberous ligament, and the inferior tip of the coccyx posteriorly
Draw a diagram to show what marks the border of the pelvic inlet.
What two bones form the obturator foramen?
- Pubis
- Ischium
What are the main landmarks of the pelvis? Which of these are palpable?
Ilium:
- Iliac crest (palpable)
- Anterior superior iliac spine (ASIS) (palpable)
- Posterior superior iliac spine (PSIS) (palpable)
- Anterior inferior iliac spine (AIIS)
- Greater sciatic notch
Ischium:
- Ischial spine
- Ischial tuberosity (palpable)
Pubis:
- Pubic tubercle (palpable)
What are the two ligaments that stabilise the sacroiliac joint? Where do these attach?
- Sacrospinous -> From ischial spine to the sacrum
- Sacrotuberous -> From ischial tuberosity to the sacrum
Describe the greater and lesser sciatic notches and foramen. What structures form these?
- The sacrospinous and sacrotuberous ligaments form two foramen (greater and lesser sciatic foramen)
- The points on the bone at the superior corner of each foramen are called the greater and lesser sciatic notches
What passes through the greater and lesser sciatic formamen?
- Greater sciatic foramen:
- Piriformis muscle
- Pudendal vein, artery and nerve
- Lesser sciatic foramen:
- Obturator internus muscle
What sections does the pelvic inlet divide the pelvis into?
- Greater pelvis (around the abdominal cavity)
- Lesser pelvis (around the pelvic cavity)
Describe how the pelvis is angled.
- It is angled so that the sacrum actually forms the roof of the pelvis
- The pubic symphysis and ASIS lie in the same plane, which is tilted about 50-60 degrees forward
- This is different to how it is usually presented (with the outlet at the top and inlet at the bottom)
Compare the shape of the pelvis in males and females.
- In females, the pelvic inlet is more oval shaped and wider, to allow for the passage of a baby. The pubic arch is less acute. The bones are thinner.
- In males, the sacrum is more prominent in males and protrudes into the pelvic inlet, making it more heart-shaped. The pubic arch is more acute. The bones are thicker.
What is the pelvic floor?
- Pelvic floor muscles are the layer of muscles that support the pelvic organs and span the bottom of the pelvis.
- Separates the pelvic cavity above from the perineal region (including perineum).
What forms the pelvic floor and what is the collective name for this?
- Sheets of muscle
- Collectively, they are called the levator ani muscles (and the coccygeus muscle)
Where do the levator ani muscles attach?
They run from the inner surface of the pubis and ischium to the coccyx.
Describe the muscles of the pelvic floor.
What nerves innervate the pelvic floor?
S3 and S4
What structures are found along the midline of the pelvic floor?
From posterior to anterior:
- Anococcygeal raphe
- Gap where the anus and rectum pass
- Perineal body
- Genital hiatus
Draw all of the structures of the pelvic floor.
In females, what structures have to pass through the pelvic floor and where?
- Through the small gap behind the peineal body -> Anus
- Through the genital hiatus -> Vagina and urethra
What is the function of levator ani? Which muscle in particular has a notable role?
- As the name suggests, they elevate the anus in towards the body
- The pubo rectalis muscle (a.k.a. puborectal sling), passes around the anorectal junction and helps with continence
What is the perineum?
- The perineum is the space between the anus and scrotum in the male and between the anus and the vulva in the female.
- It is the region of the body between the pubic symphysis (pubic arch) and the coccyx (tail bone), including the perineal body and surrounding structures.
Describe the position of the perineum relative to the pelvic floor.
It is inferior to the pelvic floor.
What are the two main areas of the perineum?
- Urogenital triangle (anterior)
- Anal triangle (posterior)
What structure defines the urogenital traingle and anal triangle? Draw the structure.
- The triangular perineal membrane forms the urogenital triangle
- Everything anterior to the perineal membrane is the anal triangle
What is the perineal membrane and what is its importance?
It is a triangular membrane that defines the urogenital triangle (and therefore also the anal triangle posterior to it).
What defines the boundaries of the perineum?
What structures pass through the perineum in males and females?
Urogenital triangle (i.e. perineal membrane):
- Urethra
- Vagina (only in females)
Anal triangle:
- Anus
What is the perineal body and where is it found?
- A pyramidal fibromuscular mass in the middle line of the perineum at the junction between the urogenital triangle and the anal triangle.
- It is between the urethra and anus (in men) or between the vagina and anus (in women)
In which sex is the perineal body more important and why?
Females, because it can tear during childbirth.
What important structures attach to the perineal body? What is the importance of this?
- Levator ani muscles
- Perineal muscles and membrane
- Supporting structures of the uterus and cervix (in females)
The perineal body can tear during childbirth, which means that the support to the structures that attach to it are weakened.
What is the name for the entrance and exit point of the kidneys?
Hilum
What is the name for the part of the urethra that passes through the perineal membrane?
Membranous part of the urethra
Draw a diagram to show the position of the abdominal cavity, pelvic floor, pelvic cavity and perineum.
Note that behind the peritoneal cavity in the abdomen is the retroperitoneal space.
Describe the position of the kidneys within the abdomen.
- Hilum of the kidneys is about 5cm lateral to the midline
- The upper poles are not symmetrical:
- Left at T11
- Right at T12
Which kidney lies higher in the abdomen and why?
Left, because of the liver.
Describe the position of the kidneys in relation to the muscles in the abdomen.
The kidneys lie on the muscles of the posterior abdominal wall: Psoas, quadratus lumboram and transversus abdominis.
Describe the position of the kidneys in relation to the peritoneum. What is the name for this?
They are posterior to the peritoneum -> This is called being retroperitoneal.
How are the kidneys protected?
- Superior parts are protected by the 11th and 12th ribs
- Kidneys are also surrounded by a layer of peri-nephric fat
Describe how the kidneys relate in position to the duodenum, pancreas and spleen.
- Duodenum passes on the right-hand side of the body, covering the hilum of the right kidney
- Pancreas covers hilum of the left kidney
- Spleen covers left border of the left kidney
Draw a diagram to show what organs cover the different parts of the kidneys.
Describe the structure and different layers of the kidneys, starting from the outside and going in. [IMPORTANT]
- Capsule -> Tough, fibrous layer
- Cortex -> Contains the nephrons
- Medulla -> Contains the collecting ducts
- Pelvis -> Drains the collecting ducts (via minor and major calyces) -> This is at the hilum of the kidney
- Ureter -> Pelvis then drains into the ureter
Draw an image of a specimen of the kidneys labelled.
Describe what can be seen in this image.
Also note: ureters extend caudally, over the psoas muscle.
Compare the appearance of the renal veins and arteries in vivo.
Which is longer: the right renal artery or left renal artery?
Right renal artery -> Because it passes behind the IVC.
Describe the blood supply to the kidneys.
- The renal arteries branch as they enter the kidney into anterior and posterior branches.
- These then branch into interlobar arteries, which are “end arteries” that supply a segment of the kidneys.
- Each interlobar artery gives rise to arcuate arteries, which in turn form interlobular arteries (and give off the vasa recta), which supply the nephrons.
Note the difference between interlobar and interlobular!
Do interlobular arteries form anastamoses?
No, they are end arteries and do not supply other lobes of the artery.
Draw a diagram to show the branching of the interlobar arteries in the kidneys.
What is the function of the ureter?
Passes urine from the kidneys to the bladder.
Describe the position of the ureter in the abdomen and its path.
It is retroperitoneal (IMPORTANT):
- Emerges from the hilum of the kidney
- Passes across psoas
- Then over the common iliac artery and vein
- Enter the bladder at the posterior wall
What sort of movement occurs in the ureter?
- There are peristaltic movements caused by the smooth muscle.
- So urine can be seen moving in small blobs down the ureter.
On what side and in which direction do the ureters enter the bladder? What is the function of this?
- Posterior side of the kidney
- Enter obliquely -> Prevents backflow of urine and increased pressure within the bladder compresses the distal ends of the ureters shut
What is the trigone and what structures form it?
- A flat, triangular section at the base of the bladder
- The entrances of the ureters form two edges of the triangle, while the urethra exit forms the third
What forms the base of the bladder? Does this part change shape as the bladder fills?
Trigone - it does not change shape as the bladder fills.
What are the structures on this image?
- Arrows point towards the ureters
- The triangle is the trigone of the bladder
What forms the majority of the bladder walls?
- Smooth detrusor muscle
- Lined by transitional epithelium
What type of epithelium is in the bladder?
Transitional
Draw the structure of the bladder.
What is the peritoneal covering of the bladder?
The peritoneum is thin membrane that lines the abdominal and pelvic cavities, and covers most abdominal organs.
Remember to understand the difference between perineal, peritoneal and peroneal.
- Perineal -> The perineum is the space between the anus and scrotum in the male and between the anus and the vulva in the female.
- Peritoneal -> The peritoneum is the serous membrane forming the lining of the abdominal cavity and the organs in the abdomen.
- Peroneal -> To do with the lateral compartment of the leg.