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Anatomy 2. Semester > 3. Urinary system, Genital organs, Pelvic cavity, Perineum > Flashcards

3. Urinary system, Genital organs, Pelvic cavity, Perineum Flashcards

1
Q

Kidney - Topography

A
  • retroperitoneal organ, from T12 to L3 vertebrae
  • right kidney lower than left (bc.: right lobe of liver)
  • medial side: hilum w/ ureter, vessels + nerves
  • Relationships:
    • superior:
      • diaphragm
    • inferior:
      • psoas major m. (medial)
      • quadratus lumborum m. (anterior)
      • transverse abdominis m. (lateral)
  • Layers:
    1. Fibrous capsule (outermost)
    2. Adipose capsule
    3. Renal fascia (innermost)
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2
Q

Kidney - Anatomy

A
  • bean shaped organ, consisting of:
    1. Renal capsule
    2. Cortex
      • outer part of kidney
      • highly ​​vascular ​​
    3. Medulla
      • inner part of kidney
      • 8-12 renal pyramids w/ straight- + collecting tubules
      • apex of pyramids: Papilla
        • 10 to 25 collecting tubules open into minor- + major calxy → renal pelvis → ureter
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3
Q

Kidney - Blood supply

A

Arteries

  • Renal artery (2x, from abdominal aorta)
    • right one is longer (abdominal aorta is slightly left!)

Veins

  • Renal veins (2x, from IVC)
    • left one passes inferir to superior mesenteric artery
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4
Q

Kidney - Histology

A

functional unit of kidney: Nephron

  1. Renal corpuscle
    • Bowman’s capsule
      • Parietal: simple squamous epithelium
      • Visceral: podocytes
    • Glomerulus
      • highly vascular
      • covered with glycocalyx
  2. ​Renal tubule​s
    1. ​​​Proximal tubule
      • simple cuboidal epithelium
      • narrow lumen, rich in mitochondria
    2. Intermediate tubule
      • simple squamous epithelium
      • narrow lumen
    3. Distal tubule
      • simple cuboidal epithelium
      • round lumen
    4. Reunient tubule
      • simple cuboidal epithelium
    5. Collecting tubule
      • simple cuboidal epithelium
      • Chief cells w/ vasopressin
      • Intercalated cells
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5
Q

Kidney - Microcirculation

A
  • before entering hilum: renal artery divides into 5 segmental arteries
  • 5 segmental art.
    • interlobar art.
      • 2 arcuate art.
        • interlobular art. (→ nephrons)
          • afferent arterioles
          • glomerular capillaries
          • efferent arterioles
        • → veins
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6
Q

Ureter - Anatomy

A
  • retroperitoneal, 25 cm muscular tube
  • from: renal pelvis → urinary bladder
  • runs down abdominal wall anterior to psoas major m.
  • Crosses at 3 sites:
    1. Gonodal vessels (posterior to them)
    2. Common iliac vessels (anterior to them)
    3. Deferent duct/Uterine artery (posterior to them)
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7
Q

Ureter - Blood supply

A

​Arteries

  • Aorta
  • Renal art.
  • Gonodal art.
  • Common + internal iliac art.
  • Umbilical art.
  • sup. + inf. vesical art.
  • middle rectal art.
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8
Q

Ureter - Histology

A
  1. Tunica mucosa
    1. Mucous epithelium lamina
      • urothelium
    2. Proper lamina
      • thick, loose CT, blood vessels, nerves
      • star shaped lumen
  2. Tunica muscularis
    • inner layer: longitudinal m. layer
    • outer layer: circular m. layer
  3. Tunica adventitia
    • CT, blood- and lymph vessels, nerves
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9
Q

Urinary bladder - Anatomy

A
  • infraperitoneal, lemon shaped organ
  • walls: detrusor muscle (thick)
  • sits in lesser pelvis (when empty)
  • consists of:
    1. Apex
      • connected to median umbilical lig.
    2. Base
      • inverted triangle shape
      • upper corners:
        • 2 ureters enter
        • lateral umbilical lig. attach
      • lower corner:
        • neck with int. urethral sphincter
      • between corners: trigone (smooth area on inside of the bladder)
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10
Q

Urinary bladder - Supporting structures

A
  • supported by paracysticum:
    • males: puboprostatic lig.
    • females: pubovesical lig.
  • superior:
    • peritoneum
    • median umbilical lig.
  • inferior: levator ani muscle
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11
Q

Urinary bladder - Blood supply

A

Arteries

  • sup. + inf. vesical art (from internal iliac art.)

Veins

  • vesical venous plexus (to internal iliac vein)
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12
Q

Urinary Bladder - Innervation

A

Sympathetic

  • Lumbar paravertebral splanchnic nerve

Parasymphathetic

  • Sacral plexus
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13
Q

Urinary bladder - Histology

A
  1. Tunica mucosa
    1. Mucous epithelium lamina
      • urothelium
    2. Proper lamina
      • thin CT
      • star shaped lumen
  2. ​​Tunica muscularis
    • inner layer: longitudinal m. layer
    • outer layer: circular m. layer
  3. Tunica adventitia
    • CT, elastic fibres, blood- and lymph vessels, nerves
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14
Q

Scrotum - Anatomy

A
  • sac consisting of layers
    • “some damn englishman called it testes”:
    • S: skin (middle: raphe)
    • D: dartos fascia and muscle
    • E: external spermatic fascia
    • C: cremasteric fascia
    • I: internal spermatic fascia
    • T: tunica vaginalis
    • T: tunica albuginea
  • contains:
    • external spermatic fascia
    • testes
    • epididymis
    • deferens duct
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15
Q

Scrotum - Blood supply

A

Arteries

  • ant. + post. scrotal art. (from pudendal art.)

Veins

  • testicular vein (to IVC)
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16
Q

Scrotum - Innervation

A
  • Genitofemoral nerve
  • ant. + post. scrotal nerves
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17
Q

Spermatic cord

A
  • begins at deep inguinal ring, exits at superficial inguinal ring
  • enclosed 3 layers
    1. internal spermatic fascia
    2. cremasteric fascia
    3. external spermatic fascia
  • contents:
    • deferens duct
    • deferens duct artery (from inf. vesical artery)
    • testicular artery (from abdominal aorta)
    • pampiniform plexus of veins (to testicular veins)
    • cremasteric art. + vein
    • genital branch of genitofemoral nerve
    • lymph vessels
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18
Q

Inguinal canal

A

→ slit-like passage above and parallel to the lower half of the inguinal ligament

  • begins at deep inguinal ring
    • opening of ​tubular evagination of tranversal fascia which hosts:
      • men: the spermatic cord
      • women: round ligament of uterus
  • ends at superficial inguinal ring
    • ​superior to pubic tubercle
    • in aponeurosis of external oblique m.
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19
Q

Testes - Anatomy

A
  • plum-shaped retroperitoneal organ
  • develops in abdominal cavity, passes through inguinal canal
  • covered by tunica vaginalis (derived from peritoneum)
  • Parts:
    • Capsule
    • Lobules divided by septa
      • inside: seminiferous tubules, draining through efferent ducts into epididymis
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20
Q

Testes - Blood supply

A

Arteries

  • testicular art. (from abdominal aorta)

Veins

  • pampiniform plexus (to testicular vein)
  • right testicular vein → IVC
  • left testicular vein → left renal vein (!)
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21
Q

Testes - Histology

A
  • Covered by tunica albuginea (type 1 collagen fibres)
  1. Convoluted + straight seminiferous tubule
    • Germinal epithelium (simple cuboidal epithelium)
    • contains sertoli cells
  2. Deferens duct
    • simple cuboidal non-ciliated epithelium
    • simple columnar epithelium
    • star shaped lumen
  3. Epididymis duct
    • pseudostratified columnar epithelium with stereocilia
    • contains fluid from sertoli cells

Layers:

  1. Epithelium
    • Sertolli cells
  2. Limiting membrane
    • carries spermatogenic cells
  3. Connective tissue
    • Leydig cells: synthesize and secrete testosterone
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22
Q

Epididymis - Anatomy

A
  • on posterior surface of testes
  • covered by tunica albuginea (NOT t. vaginalis!)
  • Parts
    1. Head
      • efferent ducts form testes enter here
    2. Body
    3. Tail
      • → deferens duct
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23
Q

Epididymis - Blood supply

A

Arteries

  • Head: testicular art. (from abdominal aorta)
  • Body + Tail: deferential art. (from internal iliac art.)

Veins

  • Pampiniform plexus (to testicular vein)
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24
Q

Epididymis - Histology

A
  • ciliated tall columnar cells
  • basal cells
  • clear cells
  • intraepithelial lymphocytes

Has muscular coat for sperm movement!

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25
Q

Spermatogenesis

A

→ production of spermatids (non-mature sperm cells)

  • Sertolli cells are essential
    • provide support for developing sperm cells
  1. Spermatogonia
    • at periphery of seminiferous tubules
    • divide by Mitosis: only one daughter cells becomes a primary spermatocyte
  2. Primary spermatocyte
    • ​​divide in Meiosis I : forms haploid secondary spermatocytes
  3. Secondary spermatocyte
    • ​​divide in Meiosis II : forms spermatids
  4. Sperm cells
    • ​​spermatids differentiate into sperm cells
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26
Q

Deferent duct - Anatomy

A
  • contination of tail of epididymis
  • transports spermatozoa from testes to prostatic urethra
  • “ampulla” unites with duct of seminal vesicle
    • → forms: ejaculatory duct
  • Parts: E F I P A
    1. Epididymic part
    2. Funicular part
    3. Inguinal part
    4. Pelvic part
    5. Ampullaric part
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27
Q

Deferent duct - Blood supply

A

Arteries

  • Deferential art. (from inf. vesical art.)
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28
Q

Deferens duct - Histology

A

3 layers:

  1. Tunica mucosa
    1. Lamina epithelium
      • pseudostratified columnar epithelium with stereocilia
    2. Lamina propria
  2. Tunica submucosa
    • connective tissue
  3. Tunica muscularis
    • ​​inner: longitudinal
    • middle: circular
    • outer: longitudinal
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29
Q

Seminal vesicle

A
  • paired gland, produces alkaline part of seminal fluid
  • lower ends from duct, which joins the ampullae of the deferens ducts

Blood supply:

Arteries

  • inferior vesicle art.

Veins

  • inferior vesicle vein
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30
Q

Seminal vesicle - Histology

A

3 layers:

  1. Epithelium
    • simple columnar epithelium (glandular)
    • secretes fructose (energy source for sperm)
    • mucosal folds
  2. Lamina propria
    • CT
    • inner: circular layer
    • outer: longitudinal layer
  3. Lamina adventitia
    • Fibroelastic CT
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31
Q

Prostate - Anatomy

A
  • inferior to urinary bladder
  • surrounds urethra
  • basic secretion neutralizes acidic pH in vagina
  • consists of muscles
    • internal urethral sphincter (smooth muscle)
    • external urethral sphincter (skeletal muscle)
  • 3 lobes: right, left + middle
32
Q

Prostate - Blood supply

A

Arteries

  • inf. vesical art.
  • internal pudendal art.
  • inferior rectal art.

Veins

  • prostatic venous plexus (to internal iliac veins)
33
Q

Prostate - Histology

A

2 layers:

  1. Proximal
    • urothelium
  2. Distal
    • stratified columnar epithelium

2 types of tissues

  1. Fibromuscular tissue - 30%
    • CT + smooth muscle
  2. Glandular tissue - 70%
    • opens into prostatic sinus

3 types of glands

  1. Mucosal glands
  2. Submucosal glands
  3. Main prostatic glands
34
Q

Male urethra - Anatomy

A
  • 3 major portions:
    1. Prostatic portion
      • widest part of urethra
      • Urethral crest
        • opening of submucosal ducts and prostatic glands
      • Seminal colliculus
        • opening of ejaculatory ducts (2x)
    2. Membranous portion
      • ​​passage through urogenital diaphragm
      • controlled by ext. urethral sphincter
    3. Spongy portion
      • ​​longest of the 2 portions
      • in spongy body of penis
      • opens at penile head, forms navicular fossa
35
Q

Male urethra - Blood supply

A

Arteries

  • inferior vesical art.
  • middle rectal art.
36
Q

Male urethra - Histology

A
  1. Prostatic part
    • ​​Urothelium
  2. Membranous part
    • Stratified columnar epithelium
  3. Spongy part
    • Stratified columnar epithelium
  4. Navicular fossa
    • Stratified squamous non-keratinized epithelium
37
Q

Penis - Anatomy

A
  • can be divided into 5 major parts:
    1. Head
    2. Body
    3. Root
    4. Corpus cavernosum
      • fills with blood to cause erection
    5. Corpus spongiosum
      • contains urethra and bulb of penis
38
Q

Penis - Blood supply

A

Artery

  • Dorsal penis artery (from internal pudendal art.)

Vein

  • Dorsal penis vein
39
Q

Penis - Innervation

A
  • Pudendal nerve
40
Q

Penis - Histology

A
  1. Corpus cavernosum
    • surrounded by tunica albuginea
      • CT + smooth muscle
  2. Corpus spongiosum
    • surrounded by tunica albuginea
    • Urethra (stratified columnar epithelium)
    • more CT, less smooth muscle
41
Q

Erection mechanism

A
  • Deep art. of penis → helicine art. (has special smooth muscle valves called “Ebner’s cushions”)
  • During sexual excitement, cushions open, allowing blood to flow
  • Blood flow inhibits venous drainage → erection
42
Q

Ovaries - Anatomy

A
  • almond shaped organ, 2.5-5cm long
  • behind to broad ligament, attached to it posteriorly by the mesovarium
  • expells ovum/oocyte into peritoneal cavity and then into uterine tube
43
Q

Ovaries - Ligaments

A
  • Mesovarium
  • suspensory lig.
    • contains ovarian art.
  • utero-ovarian lig.
44
Q

Ovaries - Blood supply

A

Arteries

  • ovarian art. (from abdominal aorta)
  • uterine art. (from internal iliac art.)
  • vaginal art. (from ovarian branch)

Veins

  • right ovarian vein (to IVC)
  • left ovarian vein (to left renal vein)
45
Q

Ovaries - Histology

A

2 layers:

  1. Covering epithelium
    • germinal epithelium = simple cuboidal epithelium
  2. Tunica albuginea
    • dense CT
    • divided into cortex and medulla

Medulla

  • large vessels, nerves and CT

Cortex

  1. ​Primordial follice
  2. Primary follicle
  3. Secondary follicle​​
  4. Premature follicle
46
Q

Oogenesis

A

→ makes ovum from oogonium

  1. Oogonia (Mitosis)
    • produces more oogonia and primary oocytes
  2. Primary oocytes (Meiosis I)
    • forms large secondary oocyte + polar body
  3. Secondary oocytes (until Meiosis II metaphase)
  4. Ovum
    • ​​completion of Meiosis II converts secondary oocyte into a zygote and a second polar body
47
Q

Ovarian folliculli - Histology

A
  1. ​Primordial follice
    • oocyte w/ granulosa cells
  2. Primary follicle
    • oocyte w/ granulosa cells
    • zona pelucida starts to form
  3. Secondary follicle​​
    • oocyte covered by zona pelucida w/ granulosa cells
    • covered theca cells​
  4. Tertiary follicle
    • ​​cytoplasm filled with granulosa cells
    • contains antrum
48
Q

Uterus - Anatomy

A
  • 4 main parts
    1. Fundus - superior and anterior
    2. Body
    3. Isthmus - constricted part between body +
    4. Cervix - narrow part, continues to vagina
  • anteverted and anteflexed (90° vagina vs. longitudinal axis of uterine body)
  • lies between urinary bladder and rectum
    • vesico•uterine pouch
    • recto•uterine pouch (Douglas p.)
  • enclosed by peritoneum = broad lig.
49
Q

Uterus - Ligaments

A
  • infraperitoneal; enclosed by broad lig.
  • suspended by:
    • pubo•vesical lig
    • cardinal lig.
    • recto•uterine lig.
    • round lig.
  • supported by:
    • pelvic diaphragm
    • urogenital diaphragm
50
Q

Uterus - Blood supply

A

Arteries

  • uterine art. (from internal illiac art)

Veins

  • uterovaginal venous plexus (between 2 layers of broad lig.)
  • cervical plexus of uterus
51
Q

Uterus - Histology

A

Layers:

  1. Endometrium
    • simple columnar epithelium
    1. Stratum functionale
      • simple tubular glands
    2. Stratum basale
      • ends of tubular glands
      • straight arteries
  2. Myometrium
  3. Perimetrium
    • tunica subserosa + - serosa
52
Q

Cervix - Histology

A

Layers:

  1. Endometrium
    • Mucous epithelium
      • simple columnar epithelium
    • Lamina propria mucosa
      • branched tubular glands
  2. Myometrium
    • few smooth muscle fibres
    • many CT fibres
  3. Perimetrium
    1. ​​​Nabothian cysts
      • mucous filled pouches
    2. Papanicolau smear
      • detection of cervial cancer
53
Q

Uterine tube

A
  • from uterus towards ovaries
  • connect uterine- with peritoneal cavity
  • 4 main parts
    1. uterine part
    2. isthmus
    3. ampulla
    4. infundibulum
  • place of fertilization by spermatozoa (transported by smooth muscle action!)
54
Q

Uterine tube - Blood supply

A

Arteries

  • uterine art.

Veins

  • uterovaginal venous plexus (to uterine veins)
55
Q

Uterine tube - Histology

A

Layers:

  1. Tunica mucosa
    1. Epithelium mucosae
      • simple columnar epithelium
      • ciliated cells, secretory cells
    2. Lamina propria
  2. Tunica muscularis
    • inner: circular muscle
    • outer: longitudinal muscle
  3. Tunica subserosa
  4. Tunica serosa
56
Q

Structures of female and male lesser pelvis

A

Male, anterior to posterior:

  • pubic symphysis
  • testes + epididymis + spermatic cord
  • urinary bladder
  • prostate gland
  • seminal vesicle
  • rectum

Female

  • pubic symphysis
  • urinary bladder
  • vesico•uterine pouch
  • vagina + uterus + uterine tubes
  • recto•uterine pouch
  • rectum
57
Q

Lesser Pelvis - Pelvic spaces

A
  1. Subperitoneal cavity
    • bordered by Pelvic diaphragm:
      • Levator ani m.
      • Sup. + inf. pelvic diaphragmatic fascia
  2. Ischiorectal fossa
    • ​​bordered by Urogenital diaphragm:
      • deep transverse perineal m.
      • perineal membrane
58
Q

Lesser Pelvis - Perineal spaces

A
  1. Deep perineal space
    • men: bulbourethral glands
    • women: major vestibular glands
  2. Superficial perineal space
    • men: Bulbus penis
    • women: Bulbus vestibuli
  3. Subcutaneous perineal space
59
Q

Female genitalia - Anatomy

A
  • consists of:
    • mons pubis
    • labia majora + minora
    • clitoris
    • vestibule
    • Bartholin’s gland
      • mucus secretion
    • vaginal orifice
    • urethral orifice
60
Q

Female genitalia - Blood supply

A

Arteries

  • vaginal art. (from internal illiac art.)

Veins

  • vaginal veinous plexus
61
Q

Female genitalia - Innervation

A

Sympathetic

  • lumbar splanchnic plexus

Parasympathetic

  • pelvic splanchnic plexus
62
Q

Female genitalia - Histology

A

Layers:

  1. Tunica mucosa
    1. Epithelium mucosae
      • non-keratinized stratified squamous epithelium
    2. Lamina propria mucosa
      • loose CT
  2. Tunica muscularis
    • inner: circular muscle
    • Outer: longitudinal muscle
  3. Tunica externa
    • dense CT
63
Q

Internal iliac artery - Branches

A

Parietal:

  • iliolumbar art.
  • lateral sacral art.
  • obturator art.
  • superior + inferior gluteal art.
  • internal pudendal art.

Visceral:

  • umbilical art.
  • superior + inferior vesical art.
  • deferential-/uterine art.
  • vaginal art.
  • middle rectal art.
64
Q

Pelvic organs - Lymphatic drainage

A
  1. Superficial inguinal lymph nodes
    • approximately 10
    • receive lymph from:
      • gluteal region
      • perineum
      • lower abdominal wall
    • drain into external iliac nodes
  2. Deep inguinal lymph nodes
    • up to 3, medial to femoral vein
    • receive lymph from
      • glans penis
      • clitoris
    • connect with superficial nodes
    • pass through “lacuna lymphatica” (Rosenmüller’s lymph nodes)
65
Q

Pelvic organs - Veins

A

→ drainage happens through internal iliac vein!

visceral tributaries:

  • lateral sacral veins
  • middle hemorrhoidal vein
  • vesical vein
  • uterine vein
  • vaginal veins
66
Q

Pelvis - Autonomic NS

A

​check drawing

67
Q

Sacral plexus branches

A
  • arise from sacral spinal nerves S2 - S4 to provide parasympathetic innervation
  • in front of piriformis muscle
  • leave through the greater sciatic foramen

Pudendal nerve (mainly)

  • innervates levator ani m. + coccygeus m.
  • anal sphincter
  • urogenital mm. (internal + external)
68
Q

Pelvis - Sphincters

A
  1. Internal anal sphincter
    • pelvic splanchnic n.
  2. External anal sphincter
    • pudendal n.
  3. Internal urethral sphincter
    • lumbar splanchnic n.
    • inferior hypogastric plexus
  4. external urethral sphincter
    • deep branch of perineal n.
69
Q

Levator ani muscle - Anatomy

A
  • broad, thin muscle running from sides of pelvis towards the inner side of the coccyx
  • forms pelvic floor/diaphragm
  • consist of:
    • pubo•rectalis m.
    • pubo•coccygeus m.
    • ilio•coccygeal m.
70
Q

Levator ani muscle - Blood supply

A

Artery

  • inferior gluteal art. (from internal iliac art.)
71
Q

Levator ani muscle - Innervation

A
  • pudendal nerve
  • perineal nerve
  • inferior rectal nerve
72
Q

Perineum

A
  • diamond - shaped region, with corners:
    • pubic symphesis
    • ischial tuberosity
    • coccyx
  • → “pelvic floor”
    1. Pelvic diaphragm
    2. Urogenital diaphragm
    3. Sphincter and erectile musculature
      • external urethral + anal sphincter
      • bulbospongiosus, ischiocavernosus
73
Q

Male Perineum - Muscles

A

from “top to bottom”:

  • bulbospongiosus m.
  • ischiocavernosus m.
  • deep transverse perineal m.
  • external anal sphincter m
  • adductor magnus m.
  • gluteus maximus m.
74
Q

Female perineum - Muscles

A
  • vaginal orifice m.
  • external anal sphincter m.
  • (ano•coccygeal lig.)
  • gluteus maximus m.
  • levator ani m.
  • superficial transverse perineal m.
  • adductor magnus m.
  • (central tendon of perineum)
  • ischiocavernosus m.
75
Q

Abdominal aorta - Paired vs. unpaired branches

A
  1. Visceral
    1. paired
      • _​​_middle suprarenal art.
      • renal art.
      • gonadal art.
    2. unpaired
      1. _​_sup. + inf. mesenteric art
      2. celiac trunk
  2. Parietal
    1. paired
      • _​​_inf. phrenic art.
      • lumbar art. (4 pairs)
    2. unpaired
      • _​​_median sacral art.
76
Q

Lumbar plexus

A
  • subcostal n.
  • iliohypogastric n.
  • ilioinguinal n.
  • lat. cutaneous n.
  • femoral n.
  • genitofemoral n.
  • obturator.

Anatomy 2. Semester (3 decks)

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