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Anatomy Block 3 > 3 - Urogenital System > Flashcards

3 - Urogenital System Flashcards

1
Q

What are the components of the urinary system? Where is this system located?

A

The kidneys, ureters, urinary bladder, and the urethra.

Whole system is retroperitoneal.

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2
Q

Where are the kidneys located? How do their locations differ?

A

Retroperitoneally, at level of T12-L3

R is slightly lower, located posterior to liver, duodenum, and ascending colon.

L is posterior to the stomach, spleen, pancreas, spleen, jejunum, and descending colon.

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3
Q

What are ureters? Where are they located?

A

Muscular ducts that carry urine from kidneys to bladder.

They adhere closely to parietal peritoneum.

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4
Q

What is the course of the ureters?

A
  1. Run inferiorly from the hilum of kidney pass over pelvis brim of common iliac a. bifurcation.
  2. Along lateral wall of pelvis and turn medially toward bladder. In females, they pass immediately inferior to the uterine vessels just lateral to the cervix.
  3. Enter bladder at an inferomedial angle.
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5
Q

What are the three regions of ureter constriction? Why are these locations important?

A
  1. Junction of renal hilum and ureter.
  2. As it passes over the pelvic brim
  3. Ass it passes through muscular bladder wall.

This is where kidney stones may get caught.

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6
Q

What is the arterial blood supply and venous drainage of the ureters?

A

Art supply: abdominal portion is primarily the renal arteries and some of the gonadal a. pelvic portion by branches off the pelvic arteries.

Venous: renal and gonadal veins

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7
Q

What is the autonomic innervation of the ureters? Where is pain referred to?

A

Autonomic via renal, abdominal aortic, and hypogastric plexuses.

Pain sensation referred to the ipsilateral lower quadrant of the lower abdominal wall and groin.

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8
Q

Where is the bladder located when its full and when its empty? What is the difference in location for adults and before puberty?

A

Posterior to the pubic bones and entirely in the lesser pelvis when empty (for adults).

Before puberty, bladder sits partially in the abdomen.

As it fills, it distends laterally and superiorly along the inner surface of the anterior body wall.

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9
Q

How does urine get squeezed out of the bladder? How is this related to male ejaculation?

A

The detrusor muscle, which is continuous with the involuntary internal urethral sphincter at the neck of the bladder.

The involuntary internal urethral sphincter contracts in males during ejaculation to prevent flow of ejaculate into the bladder.

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10
Q

What is the trigone?

A

A triangular area inside the bladder; corners formed by the ureteric orifices and the internal urethral orifice.

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11
Q

What is the arterial blood supply to the bladder?

A

Superior vesical arteries, inferior vesical arteries (males) or vaginal arteries (females)

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12
Q

What is the venous drainage of the bladder? How does this differ in females and males?

A

The vesical venous plexus.

Females: this plexus is continuous with the uterovaginal plexus and also receives blood from the dorsal vein of the clitoris.

Males: Continuous with the prostatic plexus and the combined plexuses drains the bladder, prostate, seminal glands, ductus deferens, inferior ureters, and deep dorsal veins of penis.

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13
Q

What is the innervation of the bladder?

A

Entirely autonomic via hypogastric plexus and pelvic splanchnic nerves.

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14
Q

Describe the parasympathetic fibers involved in bladder voiding?

A

Parasympathetic fibers are motor to the detrusor muscle and inhibitory to the internal urethral sphincter in males.

Stretching of bladder causes detrusor muscle to contract and void bladder. This reflex is inhibited with toilet training.

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15
Q

What causes contraction of the internal urethral sphincter during ejaculation?

A

Sympathetic innervation.

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16
Q

Describe the urethra in females?

A

Approx 4 cm long and passes anteroinferiorly from internal urethral orifice of bladder to the external orifice.

Immediately anterior to and partially embedded in the anterior vaginal wall.

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17
Q

Describe the male urethra?

A

Approx 18-22 cm long and passes from internal urethral orifice of bladder to external orifice at tip of the glans.

Conveys urine from bladder and semen from junction with ejaculatory ducts.

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18
Q

What are the four parts of the male urethra?

A

Intramural (preprostatic), prostatic, membranous, and spongy.

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19
Q

What is the structure of the vagina?

A

Musculomembranous tube extending between the vestibule to the fornices that surround the cervix.

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20
Q

What is the anatomical relationship between the vagina and the urinary and GI structures?

A

Urethra and bladder lie immediately anterior to the vagina. Urethra is somewhat embedded in the anterior vaginal wall.

Rectum is immediately posterior to the vagina.

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21
Q

What is the arterial supply of the vagina?

A

Vaginal and internal pudendal arteries supply the middle and inferior parts.
Uterine artery supplies superior part.

(all of these branch off the internal iliac)

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22
Q

What is the venous drainage of the vagina?

A

Vaginal venous plexus within the vaginal mucosa and along sides of vagina.

These drain into the internal iliac veins.

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23
Q

What is the innervation of the vagina?

A

Inferior 1/4 (distal part) via somatic innervation from deep perineal nerve (branch of pudendal nerve) - making it only sensitive to touch and temp.

Superior 3/4via uterovaginal nerve plexus which conveys sympathetic, parasymp, and visceral afferent innervation.

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24
Q

What is the location of the uterus?

A

Posterior and superior to the bladder and anterior to the rectum.

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25
Q

What are the three tissue layers of the uterus? Describe each.

A
  1. Endometrium (inner mucous layer) - regularly builds and is shed during cycle. Where embryo implants after conception.
  2. Myometrium (middle smooth muscle) - most of uterus substance, contains neurovascular structures.
  3. Perimetrium (outer serous layer) - simply peritoneum and thin layer of connective tissue.
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26
Q

What is the cervix? What is the opening between the cervix and the vagina called?

A

Cylindrical, narrow, inferior 1/3 of uterus: has supravaginal part between isthmus and vagina and vaginal part.

Opening called the external os, visible during pelvic exam.

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27
Q

What is the arterial supply to the uterus?

A

Primarily the uterine arteries with collaterals from vaginal and ovarian arteries.

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28
Q

What is the venous drainage of the uterus?

A

Uterine venous plexus on either side of the cervix, drains primarily into uterine and vaginal veins and then internal iliac.

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29
Q

What is the innervation of the uterus?

A

Entirely autonomic via uterovaginal plexus, which extends from the inferior hypogastric plexus along the uterine artery to the uterus.

30
Q

Where does pain from the intraperitoneal (fundus, body) parts of the uterus travel?

Where does pain from the subperitoneal part (birth canal) travel?

A

Sympathetic pathway to reach cell bodies in inferior thoracic - superior lumbar spinal ganglia.

Parasympathetic pathway to reach cell bodies in S2-4.

31
Q

How does epidural anesthesia take advantage of the discrepancy between pain pathways from parts of the uterus?

A

By numbing S2-4 nerve roots and therefore sensation of the birth canal while maintaining sensation in the intraperitoneal part of the uterus so contractions can be perceived.

32
Q

What is the function of the uterine tubes and what are their parts?

A

Conduct oocyte from ovary to uterine cavity.

From lateral to medial: infundibulum (finger-like processes to sweep oocyte into tube), ampulla (widest and longest, usual site of fertilization), isthmus (thick more narrow), uterine part.

33
Q

What is the function of the ovaries? Where are they normally found?

A

Female gonads and endocrine glands that make repro hormones and store oocytes.

Located between the uterus and lateral pelvic wall.

34
Q

What is the arterial blood supply and venous drainage of the ovaries?

A

Artery: Ovarian arteries, which travel in suspensory ligament of the ovary.

Venous: ovarian vein that feeds into IVC on right and renal v. on left.

35
Q

What is a broad ligament? What are the layers?

A

Folds created by inferior portion of peritoneum, which drapes over uterine adnexa.

  1. Mesovarius: folds over ovary and ovarian vessel
  2. Mesosalpinx: fold over the tube
  3. Mesometrium, layers of peritoneum hanging lateral to uterus.
36
Q

Describe the descent of the testes during development?

A

They migrate out of the abdomen (retroperitoneally), through the abdominal wall via the inguinal canal and inferiorly into the scrotum.

A remnant of the inguinal ligament, the gubernaculum, guides the testes from the abdominal wall into the scrotum.

37
Q

What do the male genital organs include? Which seem to be external but are actually considered internal organs?

A

Testes, epididymides, ducti deferens, seminal vesicles, ejaculatory ducts, prostate, and bulbourethral glands.

(Testes and epididymides considered internal organs).

38
Q

What is the function of the epididymis?

A

Storage of mature sperm.

39
Q

What is the function of the ductus (vas) deferens?

A

Tough cord-like tube that transports sperm from the epididymis.

40
Q

What is the function of the seminal vesicles? Where are they located?

A

Produce alkaline fluid that is high in fructose to provide an energy source for sperm.

Connect to ductus deferens to form the R and L ejaculatory duct near neck of bladder.

41
Q

What is the function of the prostate gland? Where is it located?

A

produces thin, milky fluid that plays a role in activating sperms.

Immediately inferior to the bladder.

42
Q

What is the function of the bulbouretheral glands? Where are they located?

A

Secrete mucus-like secretion during arousal.

On either side of urethra, mostly within external urethral sphincter.

43
Q

What is the path of ejaculation?

A

Epididymis > ductus deferens > joins with duct of seminal vesical to form ejaculatory duct > passes through prostate and converge with opposite ejaculatory duct > joins prostatic urethra > spongy urethrea > external orifice in glans.

44
Q

What is done during a vasectomy?

A

Small incision in the scrotum used to excise portion of the ductus deferens.

Sperm continue to be made but die when they are not expelled.

45
Q

What is benign hypertrophy of the prostate (BHP)? Who does it affect?

A

Appears in middle age and effects virtually all men.

It’s an enlarged prostate that projects into the bladder and causes partial obstruction.

Results in difficulty/pain on urination.

46
Q

What are the five layers/pouches of the perineum from superficial to deep?

A
  1. Skin
  2. Superficial perineal fascia -fatty layer and colle’s fascia
  3. Superficial perineal pouch - bulbospongiouses, ischiocavernosus, transverseoperineal
  4. Perineal membrane
  5. Deep perineal pouch - deep perineal muscles.
47
Q

What’s the function of the great vestibular (bartholin’s) glands? Where are they located? What pouch?

A

Secrete mucous to provide lubrication.

Slightly below and on either side of the vaginal opening. In the superficial perineal pouch.

48
Q

What is the arterial supply of the female perineum? What is the venous drainage?

A

The internal pudendal artery (branch of internal iliac) and the deep external pudendal artery (branch of femoral)

Drains via internal pudendal vein.

49
Q

What innervates the female perineum?

A

Branches of the pudendal nerve innervate most of the vulva except anterior to the urethra (where skin is innervated by ilioinguinal and genitofemoral nerves)

50
Q

What is the arterial supply to the penis?

A

Internal pudendal artery (branch of internal iliac) and the superficial and deep branches of the external pudendal artery (branch of femoral)

51
Q

What is the venous drainage of the penis from the erectile tissue? What about from the superficial penis?

A

Erectile tissue: venous plexus within penis to deep dorsal vein

Superficial penis: superficial dorsal vein to superficial external pudendal vein

52
Q

What two small branches does the external iliac artery give off before descending into the lower limb? What do these anastomose with?

A

the deep circumflex iliac a. - to anterior body wall

Inferior epigastric a. - anterior body wall

Anastomose with pelvic branches of internal iliac.

53
Q

At what spinal level does the internal iliac artery begin at?

A

L5-S1.

54
Q

What are the branches of the POSTERIOR branch of the internal iliac artery?

A
  1. Superior gluteal a.
  2. Iliolumbar a. (branches into iliac and lumbar)
  3. Lateral sacral arteries
55
Q

What does the posterior branch of the internal iliac artery supply?

A

Primarily musculoskeletal structures.

56
Q

What are the branches of the ANTERIOR branch of the internal iliac artery? Note which differ in men and women.

A
  1. Umbilical artery- gives off superior vesicle arteries
  2. Superior vesicle arteries (usually multiple)
  3. Obturator artery
  4. Men: inferior vesicle a. Women: Vaginal artery
  5. Women: Uterine a.
    Men: no homologous artery
  6. Middle rectal a.
  7. Internal pudendal a.
  8. Inferior gluteal a.
57
Q

Describe the anastomoses of the vessels in the pelvis from the left and right side?

A

They anastomose freely with each other, as do the vessels that supply different sides of the same structure.

For example: the ovarian, uterine, and vaginal arteries freely anastomose.

58
Q

Describe the venous drainage of the pelvis?

A

Interjoining veins from pelvic organs form the pelvic venous plexuses (rectal, vesical, prostatic, uterine, vaginal).

These unite to draine into the internal iliac veins.

59
Q

Not all veins from the pelvis drain into the internal iliac vein. Where do these exceptions drain?

A

Into the portal system through the superior rectal vein which feeds into the IMV.

60
Q

What is the broad ligament?

A

Part of peritoneum that drapes over the ovaries, uterine tubes, and superior uterus.

Neurovasculature lies under these folds.

61
Q

What are the contents of the inguinal canal in males?

A

Spermatic cord, the genital branch of the genitofemoral nerve, and the ilioinguinal nerve (doesn’t go through deep ring).

62
Q

What is the cremasteric reflex and what nerve is involed?

A

Lightly stroking upper inner thigh sensed by ilioinguinal nerve, which creates a reflex motor stimulus in the genitofemoral nerve.

Reflex involves contraction of the cremaster muscle and elevation of testis.

63
Q

What does the inguinal canal contain in females?

A

The round ligament of the uterus and the ilioinguinal nerve.

64
Q

What is the first layer of the abdomen encountered by the testis during their descent? What does this become?

A

The transversalis fascia, which becomes the internal spermatic fascia.

65
Q

What is the second layer that the testis encounters after it is wrapped in the internal spermatic fascia during its descent?

A

The internal oblique, which becomes the cremasteric layer.

66
Q

What is the third layer that the testis encounters after it is wrapped in the internal spermatic fascia and the cremasteric layer?

A

The external oblique fascia, which becomes the external spermatic fascia.

67
Q

What is located in the superficial perineal pouch?

A

Bulbospongiousum, ischiocavernosum, superficial transverse perineal muscles, branches of the pudendal nerve, artery, and vein, and the greater vestibular glands (females).

68
Q

What is the in the Deep pouch?

A

Deep transverse perineal muscles, urethra, sphincter urethrae muscle, pudendal nerve, artery, and vein.

69
Q

What is the key structure of the anal triangle? What are the muscles?

A

Pelvic diaphragm: provides support for pelvic viscera.

  1. Coccygeus - most posterior
  2. Levetor ani: made up puborectalic, pubococcygeus, and the iliococcygeus.
70
Q

What are the branches of the pudendal nerve?

A 
Inferior rectal 
Perineal 
Urethral 
Posterior Labial (scrotal) 
Bulb vestibule (penis) 
Dorsal artery of clitoris (penis) 
Deep artery of clitoris (penis) [to corpus cavernosum).

Anatomy Block 3 (5 decks)

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