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Y2B3 - Reproductive 📘 > Anatomy🫀 > Flashcards

Anatomy🫀 Flashcards

1
Q

what do axillary lymph nodes drain?

A
  1. Whole upper limb
  2. 75% of breast
  3. Anterior wall of trunk above umbilicus
  4. Posterior wall of trunk above iliac crest
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2
Q
A
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3
Q

Location of lateral (humeral - brachial) lymph nodes

A

along lower part (Proximal or begining) of axillary vein

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4
Q

what do lateral (humeral - brachial) lymph nods recieve?

A

lymph from most of the upper limb

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5
Q

what do lateral (humeral - brachial) lymph nodes drain into?

A

central, apical lymph nodes

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6
Q

Location of anterior (Pectoral) lymph nodes

A

lower border of pectoralis minor, along lateral thoracic vessels

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7
Q

what do anterior (Pectoral) lymph nodes receive?

A

lymph from
- Anterior wall of trunk above umbilicus
- Lateral & central parts of breast

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8
Q

Location of posterior (subscapular) Lymph nodes

A

lower border of subscapularis along subscapular vessels

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9
Q

What do anterior (Pectoral) lymph nodes drain into ?

A

central and apical nodes

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10
Q

What do posterior (subscapular) Lymph nodes receive?

A

lymph from
- Posterior wall of trunk above iliac crest
- Axillary tail of breast

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11
Q

What do posterior (subscapular) Lymph nodes drain into?

A

central and apical nodes

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12
Q

Location of Central lymph nodes

most easily palpated

A

in axillary fat in center of axilla

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13
Q

What do central lymph nodes receive?

A

lymph from lateral, anterior and posterior LNs

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14
Q

What do central lymph nodes drain into?

A

apical nodes

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15
Q

Location of Apical (Terminal) LNs

A

at apex of axilla, along upper part of axillary vein

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16
Q

What do Apical (Terminal) LNs receive?

A
  • The other 4 axillary LNs
  • Lymphatics accompany cephalic vein From the thumb
  • Upper part of breast
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17
Q

What do Apical (Terminal) LNs drain into?

A
  • subclavian lymph trunk that terminates in
    Right side: right lymph duct
    Left side: thoracic duct
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18
Q

What are the surgical levels of axillary LNs?

- Axillary dissection is a surgical procedure that incises the axilla to identify, examine, or remove lymph nodes. Axillary dissection has been the standard technique used in the staging and treatment of the axilla in breast cancer.

- Level III axillary lymph node dissection in modified radical mastectomy can reduce the risk of distant metastasis.

A

level I: below the lower edge of the pectoralis minor

level II: posterior the pectoralis minor muscle

level III: above/medial the pectoralis minor muscle

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19
Q

What is the definition of Breast?

A
  • paired structures located on pectoral region.
  • They are present in both males and females, more prominent in females following puberty
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20
Q

When does the breast develop?

A

7th week of pregnancy

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21
Q

What is the origin of breast?

A

ectoderm

Like sweat glands

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22
Q

Process of development of breast

This milk line is complete in some animals like cats and dogs

A
  • The ectoderm form 2 milk lines
  • The milk lines extend from axilla to groin
  • The major part of milk lines disappear
  • Only the upper part of milk line persists as mammary gland
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23
Q

What are the anomalies of breast?

A

Polymastia: a remnant of milk line develops as complete breast (Accessory breast)

Polythelia: accessory nipple develop as remnant of milk line, may present anywhere along milk line but mainly in axillar region

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24
Q

What forms the breast?

A

female breast formed of
- Skin & superficial fascia
- Mammary gland: modified sweat gland
- Blood vessels & nerves

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25
Q

What is the size and shape of breast?

A

depend on:
- Genetic, racial & dietary factors
- Age, parity & menopausal status of the individuals

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26
Q

What is the site of breast?

A

the base (attached surface) of breast extends
Upward: to 2nd rib
Downward: to 6th rib
Medially: to margin of sternum
Laterally: to midaxillary line

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27
Q

What is the axillary tail of breast?

A
  • part extend from sypero-lateral “upper lateral” quadrant of breast along inferior border of pectoralis major to axilla
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28
Q

Where is the breast located and what is it formed of?

positioning the implant – either between your breast tissue and chest muscle, or behind your chest muscle (in case of breast enlargment)

A
  • The breast located over the deep fascia separating it from breast bed
  • consists of:
    Superiorly: pectoralis major & serratus anterior
    Inferiorly: external oblique & its aponeurosis
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29
Q

What is the retromammary space? And what is its significance?

A
  • Loose connective tissue between the breast & the deep fascia covering breast bed
  • Allow movement of the breast over deep fascia
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30
Q

What is the nipple?

A

Conical projection at the center of the breast

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31
Q

What is the site of the nipple?

A

In males & young females: at the 4th intercostal space

In older females: vary according to parity, size & shape of breast

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32
Q

What is the nipple traveresed by?

A

15-20 lactiferous ducts

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33
Q

What is the areola?

A

Circular pigmented skin surrounding the base of nipple

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34
Q

What is the structure of the breast?

A
  • No fibrous tissue capsule (to allow movement)
  • Divided by fibrous septa into 15-20 lobes “From deep fascia”
  • The septa are well developed in upper part forming Suspensory ligaments (of Cooper) that suspend the breast to deep fascia
  • Each lobe has one lactiferous duct that drain separately at the nipple
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35
Q

What is the arterial supply of breast?

A

Perforating branches from:
1. Internal thoracic (mammary) artery
2. 2nd, 3rd 4th and 5th intercostal arteries “posteriorly”

Branches from axillary artery: “From 2nd part”
3. Lateral thoracic artery
4. Acromio-thoracic artery (pectoral branch)

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36
Q

What is the venous drainage of the breast?

A

A. Axillary vein
B. Internal thoracic vein
C. Intercostal veins

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37
Q

Nerve supply of the breast

A
  • Anterior “medial” & lateral cutaneous branches of intercostal nerves (T2-T6) which carry also the sympathetic innervation

As the breast extends between ribs (2-6)

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38
Q

Nerve supply of the nipple

A

supplied by extensive plexus formed by the lateral cutaneous branch of T4

As the nipple is at the 4th intercostal space

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39
Q

What is the secretory activity of mammary glands controlled by?

A

ovarian & pituitary hormones

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40
Q

What are the lymph plexuses of the breast?

lymph passes to it before LNs

A

Subareolar plexus: under skin of areola

Sub-mammary plexus: deep to breast over pectoral fascia

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41
Q

What do regional LNs of the breast represent?

A

75% to axillary lymph nodes

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42
Q

Lymphatic drainage of breast

A

Lateral & central parts pectoral (anterior axillary) lymph nodes

Tail of breast: subscapular (post axillary) LNs

  • The 2 groups drain into apical axillary LNs

Upper part: Apical axillary LNs & few lymphatics go to lower deep cervical LNs

Medial part: Parasternal (internal mammary) LNs In the same & opposite sides

Lower part:
- Sub-diaphragmatic LNs & Lymphatics on rectus sheath
- Some lymphatics from lower lateral part follow posterior intercostal vessels to posterior
mediastinal LNs

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43
Q

What describes metastasis of tumor cells from a side to the opposite one?

A

Parasternal (internal mammary) LNs In the same & opposite sides

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44
Q
A
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45
Q

what is the structure of the penis?

A

formed of hidden part called root & exposed part is called body

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46
Q

what is Bulb of the penis Covered by?

A

Bulbo-spongiosus muscle

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47
Q

what does Bulb of the penis continue as?

A

Corpus spongiosus

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48
Q

what does Bulb of the penis contain?

A

Penile urethra & 2 arteries of bulb

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49
Q

what is Crura of the penis Covered by?

A

Ischio cavernosus

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50
Q

what does Crura of the penis continue as?

A

Corpus cavernosus

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51
Q

what does Crura of the penis contain?

A

deep artery of penis

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52
Q

lymphatic drainage of penis

A

superficial inguinal LNs

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53
Q

Sensory supply of penis

A

dorsal nerve of penis from pudendal nerve

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54
Q

what is the structure of the scrotum?

A

The wall is Formed of:
- Skin
- Dartos muscle: a thin muscle replacing the superficial fascia
- Membranous layer of superficial fascia
- Internal spermatic fascia: From the fascia transversalis
- Cremasteric muscle And fascia: From the internal oblique muscle
- External spermatic fascia: from the external oblique muscle

“nothing from transversus abdominus”

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55
Q

arterial supply of the scrotum

A
  • superficial and deep external pudendal arteries: From femoral artery
  • Posterior scrotal Branches: of the internal pudendal artery
  • Cremastric artery: from inferior epigastric artery
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56
Q

nerve supply of the scrotum

A

Anterior 1/3: ilioinguinal nerve and Genital branch of genitofemoral nerve

Posterior 2/3: pudendal nerve “for penis aswell” posterior cutaneous nerve of the thigh

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57
Q

lymphatic drainage of the scrotum

A

superficial inguinal LNs

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58
Q

temperature regulation of the testis

A
  1. Scrotum is rich in sweat glands (effective cooling).
  2. Scrotal skin has almost no fat (no insulation).
  3. The scrotum has Dartos muscle: wrinkles scrotum (when cold)
  4. Cremastric muscle: pulls testis upward when cold.
  5. The testicular vessels (artery brings warm blood) (The miost important factor)
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59
Q

blood supply of the testis

A

testicular artery arises from abdominal aorta, at the level of L2

Venous—-> from notes

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60
Q

lymphatic drainage of the testis

A

drains into the para-aortic lymph nodes

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61
Q

what is the structure of the testis?

A
  • Tunica vaginalis: Serous sac around the testis which represents the distal part of processus vaginalis
  • Tunica albuginea: Fibrous capsule surrounding the testis.
  • It becomes thickened posteriorly to form mediastimun of testis from which fibrous septa extend dividing the testis into 200-300 lobule.
  • Each lobule contains 1-2 seminifrous tubules which are convoluted tubules that become straight near mediastinum testis to open into the rete testis.
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62
Q

what are seminiferous tubules?

A

convoluted tubules that become straight near mediastinum testis to open into the rete testis.

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63
Q

what are the types of cells of seminiferous tubules?

A
  • Seminifrous tubules contains 2 types of cells:
    Spermatogonia & Sertoli cells
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64
Q

hormonal control of spermatogenesis

A

Pituitary gland secretes:
- FSH: Stimulate mitotic divisions of spermatogonia & Sertoli cells to produce androgen binding protein
- LH: increases testosterone production by Leydig cells

Leydig cells:
- Testosterone: maintains spermatogenesis.

Sertoli cells:

  • Androgen binding protein: concentrates testosterone around sperms
  • Inhibin hormone: inhibits release of FSH to control overproduction of sperms.
  • Mullerian inhibiting hormone: prevents formation of female genital duct.
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65
Q

Rete testis

A

are connected with the head of epididymis by vasa efferentia

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66
Q

what does stroma of testis contain and what do they secrete?

A

Stroma of testis contains leydig cells that secret testosterone

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67
Q

what are the parts of the epididymis?

A

head, body & tail.

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68
Q

what is the function of the epididymis?

A
  1. Site of storage of the sperms.
  2. Site of maturation of the sperms.
  3. Secretion of seminal fluid to nourish the sperms.
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69
Q

what is the length of Vas deference?

A

45 cm

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70
Q

beginning and termination of the Vas deference

A

Begining: from tail of the epididymis.

Termination: join duct of seminal vesicle to form ejaculatory duct

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71
Q

arterial supply of Vas deference

A

artery of the vas deferens from inferior vesical artery.

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72
Q

formation and termination of Ejaculatory duct

A

Begining: the union of the vas deferens with duct of the seminal vesicle.

Termination: opens into the prostatic urethra.

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73
Q

what does the duct of Seminal vesicle unite with?

A

unites with the vas deferens forming the ejaculatory duct.

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74
Q

what is the function of the seminal vesicle?

A

it produces seminal fluid, mucus secretion & it is the main source of prostaglandins

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75
Q

what are the relations of the prostate?

A

Base: pierced by urethra.

Anterior surface: Separated from pubis by the retropubic fat

Posterior surface: related to rectum

Sides: levator ani muscle

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76
Q

what are the structures inside the prostate?

A

Prostatic urethra. & Ejaulatory ducts. & Prostatic utricle

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77
Q

what are the lobes of the prostate?

A

Anterior lobe: in front of the urethra..

Posterior lobe: behind urethra & below ejaculatory ducts

Median lobe: behind urethra & between ejaculatory ducts, It contains prostatic utricle

Right & left lateral lobes: on either side of median lobe.

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78
Q

where do bulbourethral glands open?

A

open in penile urethra.

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79
Q

what is the function of bulbourethral gland?

A

produce pre-ejaculate fluid

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80
Q

what is an important marker for prostate cancer?

A

Acid phosphatase

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81
Q

what are external genitalia, Primary sex organs, Duct system & accessory glands of male genital system?

A

External genitalia:
- Penis
- Scrotum

Primary Sex Organs:
- Testis

Duct system:
- epididymis
- Vas deference
- Spermatic cord
- Ejaculatory duct

Accessory glands:
- Seminal vesicle
- prostate
- Bulbourethral gland

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82
Q

arterial supply of penis

“By 6 arteries”

A

Artery of bulb: branch from internal pudendal artery

Deep & Dorsal artery of penis: terminal branches of internal pudendal artery

  • Erection happens by high blow flow to muscles which helps in contraction of muscles
  • DM causes weakness in the muscles of the walls of blood vessels. So, Decreases blood flow and weakens erection
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83
Q

Venous drainage of the testis

A

Pampiniform plexus form testicular vein which ends in:
- Inferior vena cava: on the right side
- Left renal vein on the left side.

So varicocele is more common on the left side

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84
Q

what is the ovary? and what is it attached to?

A
  • The ovary is the primary sex organ in females.
  • It is attached to the back of the broad ligament by the mesovarium.
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85
Q

Site of the ovary

A
  • Lies against the lateral wall of the pelvis in the ovarian fossa.

Boundaries of the ovarian fossa:
- Anterior: external iliac vessels.
- Posterior: internal iliac vessels and ureter
- Laterally: obturator nerve crosses the floor of the fossa.

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86
Q

Arterial supply of the ovary

A
  • Ovarian artery : from abdominal aorta.
  • Branches from the uterine artery.
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87
Q

Venous drainage of the ovary

A

The right ovarian vein: ends into the inferior vena cava.

The left ovarian vein: ends into the left renal vein.

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88
Q

Lymphatic drainage of the ovary

A

drain into the lateral aortic and pre-aortic nodes.

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89
Q

Nerve supply of the ovary

A

derived from the aortic plexus and accompany the ovarian artery.

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90
Q

Definition of the Uterus

A

The uterus is a hollow muscular pear-shaped organ

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91
Q

what is the site of the Uterus?

A

between the urinary bladder (anterior) and the rectum (posterior).

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92
Q

what are the parts of the uterus?

A
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93
Q

Position of the uterus

A

Normally the uterus is anteverted anteflexed.

  • Anteversion of the uterus: is the position where the long axis of the uterus is bent forward on the long axis of the vagina, forming an angle of 90 degrees.
  • Anteflexion of the uterus: is the position where the long axis of the body of the uterus is bent forward on the long axis of the cervix at the level of the internal os forming an angle of about 170 degrees.
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94
Q

Cavity of cervical canal

A

Communicates above with the cavity of the body through the internal os and below with the vaginal cavity through the external os.

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95
Q

what are the relations of the fundus of the uterus?

A

Is completely covered with peritoneum and related to the coils of the small intestine.

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96
Q

Relations of the body of the uterus

A
  • Anterior: (Vesical surface)
  • Posterior: (Intestinal surface)
  • Lateral: (Lateral border)
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97
Q

Relations of the anterior (Vesical surface) of the body of uterus

A
  • Covered with the peritoneum.
  • Related to the vesico-uterine pouch and the superior surface of the urinary bladder.
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98
Q

Relations of the posterior (Intestinal surface) of the body of uterus

A
  • Covered with peritoneum.
  • Related to recto-uterine (Douglas) pouch containing ileum and sigmoid colon
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99
Q

Relations of the lateral surface of the body of uterus

A

1. Gives attachment to the broad ligament.

2. The uterine artery between the two layers of the board ligament.

3. The uterine tube opens into the uterus at the superolateral angle.

4. Gives attachment to the ligament of the ovary behind the uterine tube.

5. Give attachment to the round ligament of the uterus infront of the uterine
tube

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100
Q

relations of the cervix of the uterus

A
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101
Q

what are the ligaments of the uterus?

A
  • Transverse cervical ligaments (Mackenrodt)
  • Pubocervical ligaments
  • Sacrocervical ligaments (uterosacral ligament)

(These three ligaments are subperitoneal condensations of pelvic fascia on the upper surface of the levator ani muscles.)

  • Ovarian ligament
  • Round ligaments of the uterus
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102
Q

Transverse cervical ligaments (Mackenrodt)

A
  • They are fan-shaped.
  • Connect the lateral aspects of the cervix and the upper vaginal wall to the lateral pelvic wall.
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103
Q

Pubocervical ligaments

A

They are two firm bands which connect the cervix to the posterior surface of the pubis.

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104
Q

Sacrocervical ligaments (uterosacral ligament)

A

Connect the cervix to S2 , 3 vertebrae.

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105
Q

Ovarian ligaments

A
  • They represent the remains of the upper part of the gubernaculum.
  • Extend from the uterine end of the ovary to the superolateral margin of the uterus behind the uterine tube between the two layers of the broad ligament of the uterus
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106
Q

Round ligaments of the uterus

A
  • They represent the remains of the lower part of the gubernaculum.
  • Each begins at the superolateral angle of the uterus anterior to the uterine tube. Passes through the deep inguinal ring, traverses the inguinal canal and emerges through the superficial inguinal ring to the subcutaneous tissue of the labium magus.
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107
Q

what is the definition of Broad ligaments of the uterus?

A

They are two folds of peritoneum which extend from the lateral margins of the uterus to the lateral pelvic walls

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108
Q

Shape of Broad ligaments of the uterus

A
  • Quadrangular, having four borders and two surfaces.
  • Attached to the floor of the pelvis where the two layers separate to cover the pelvic floor
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109
Q

what is the shape of the Broad ligaments of the uterus?

A
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110
Q

Mesosalpinx

A

between the uterine tube and ovarian ligament.

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111
Q

Mesometrium

A

between the body of the uterus, ligament of the ovary and the root of the broad ligament.

112
Q

Mesovarium

A

Short peritoneal fold connecting the ovary to the upper layer of the broad ligament. Through it, the ovarian vessels and nerves enter the ovary.

113
Q

Suspensory ligament of the ovary

A

It is the lateral 1/5 of the broad ligament which extends from the infundibulum of the uterine tube & the upper end of the ovary to the lateral wall of the pelvis. It transmits the ovarian vessels and nerves to the ovary

114
Q

what are the contents of the broad ligament of the uterus?

A

1. The uterine tube in the free anterior border.

2. ligaments:
a) Round ligament of the uterus: anterior.
b) Ovarian ligament: posterior.

3. Vessels:
a) Uterine vessels: on lateral border of the uterus.
b) Ovarian vessels: in the suspensory ligament of
ovary and then through the mesovarium.

4. Nerves:
a) Uterovaginal plexus.
b) Ovarian plexus.

5. Embryological (mesonephric) remnants:
a) Epoophoron and the duct of epoophoron (Gartener’s duct).
b) Paroophoron.

6. Miscellaneous:
a) Lymphatics and lymph nodes.
b) Fibroareolar tissue (parametrium).

115
Q

Support of the uterus

A

1) Pelvic diaphragm:
- It supports the pelvic viscera and resists any rise in intra-abdominal pressure.

2) Perineal body:
- it receives the attachment of pelvic diaphragm and hence it maintains its integrity.

3)
- Pubocervical ligament, Transverse cervical ligament (of mackenrodt) and Sacrocervical ligaments.

4) Round ligaments:
- of the uterus and broad ligaments play a very minor role in supporting the uterus.

5) Uterine axis:
- The anteverted position of the uterus may help in preventing it from sagging down through the vagina.

116
Q

Arterial supply of the uterus

A
  1. Mainly from the uterine artery: a branch of internal iliac artery
  2. Partly from the ovarian artery a branch from abdominal aorta.
117
Q

Venous drainage of the uterus

A

The veins of the uterus form the uterine venous plexus along the lateral border of the uterus. The uterine vein follows the artery and drains into the
internal iliac vein.

118
Q

Nerve supply of the uterus

A

Sympathetic (T12-L1) and Parasympathetic (S2, 3, 4) nerves through the inferior hypogastric and ovarian plexuses.

119
Q

Lymphatic drainage of the uterus

A

Fundus and upper part of the body:
- Lymphatic vessels follow the ovarian artery and drain into the pre- aortic and the lateral aortic nodes.

  • Few lymphatics, however, pass along the round ligament of the uterus to drain into the superficial inguinal lymph nodes.

Lower part of the body and Cervix:
- Drain into the external iliac, internal iliac and sacral lymph nodes

120
Q

what do fallopian tubes connect?

A
  • There are two uterine tubes each connecting the uterine cavity with the peritoneal cavity.
121
Q

Site of Uterine (Fallopian) Tubes

A

In the free margin of the broad ligament of the uterus.

122
Q

Parts of Uterine (Fallopian) Tubes

A
  • Infundibulum (fimbriated end)
  • Ampulla
  • Isthmus
  • Intramural part
123
Q

Infundibulum (fimbriated end)

A

It is the funnel-shaped lateral end of the tube. The free edge of the funnel is broken up into a number of finger- like processes called the fimbriae which overlie the ovary.

124
Q

Ampulla of fallopian tubes

A
  • It is the widest part of the tube. Forms the lateral 2/3 of the tube. It is the site of fertilization.
125
Q

Isthmus of fallopian tubes

A
  • It is the narrowest part. Forms about the medial 1/3 of the tube
126
Q

Intramural part of fallopian tubes

A
  • It is the segment that pierces and lies within the uterine wall, about 1 cm long. Opens into the superior angle of the uterine cavity.
127
Q

Function of Uterine (Fallopian) Tubes

A

Ovum Pick Up: at the time of ovulation, by their free fimbrial end.

Transport Of The Ova: through the tubal lumen, by their peristaltic and ciliary movements.

Production Of Secretions: necessary for capacitation of the sperm and nutrition of the ova during their journey by their lining cells.

128
Q

Arterial supply of Uterine (Fallopian) Tubes

A

Uterine artery and ovarian arteries.

129
Q

Venous drainage of Uterine (Fallopian) Tubes

A

The veins correspond to the arteries and drain into uterine and ovarian veins.

130
Q

Lymphatic drainage of Uterine (Fallopian) Tubes

A
  1. The lymph vessels follow the corresponding arteries and drain into the internal iliac and para-aortic lymph nodes.
  2. The region surrounding the isthmus of the uterine tube is drained by lymphatics which pass along the round ligament of the uterus to end into the superficial inguinal lymph nodes.
131
Q

Nerve supply of Uterine (Fallopian) Tubes

A

from inferior hypogastric plexus.

132
Q

what is the definition of the Vagina?

A

The vagina is a muscular tube extending upward and backward from the vulva to the uterus

133
Q

Site of the Vagina

A
134
Q

Length of the Vagina

A

3 inches

135
Q

what are vaginal fornices?

A
  • The space of vaginal lumen which surrounds the intravaginal part of the cervix is divided into four fornices: Anterior, Posterior and Two lateral fornices
    (on each side of the cervix).
136
Q

what are the relations of the vagina?

A
137
Q

Arterial supply of the Vagina

A
  • it is a very vascular organ.

1- Vaginal artery: a branch on internal iliac artery.

2- Vaginal branch of the uterine artery.

3- Additional branches from middle rectal and internal pudendal arteries

138
Q

Venous drainage of the Vagina

A

the rich vaginal venous plexus drain into the internal iliac vein.

139
Q

Lymphatic drainage of the Vagina

A

Upper 1/3: drains into the external iliac and internal lymph nodes.

Middle 1/3: drains into the internal iliac lymph nodes

Lower 1/3: drains into the medial group of superficial inguinal nodes.

140
Q

Nerve supply of the Vagina

A

Upper 2/3: is pain insensitive and is supplied by sympathetic (LI, 2) and parasympathetic (S2,3) through the inferior hypogastric and utero-vaginal plexuses.

Lower 1/3: is pain sensitive and is supplied by the pudendal nerve.

141
Q

what is the vulva?

A
  • Vulva is the term applied to the female external genitalia.
  • It includes the following parts:
    The mons pubis, labia majora, labia minora, the clitoris and the vestibule of the vagina
142
Q

what is Mons pubis?

A
  • The mons pubis is the rounded, hair-bearing elevation of skin found anterior to the pubis. It is produced by an underlying pad of fat.
143
Q

Shape of pubic hair in females

A
  • The pubic hair in the female has a horizontal superior margin, whereas in the male it extends upward to the umbilicus.
144
Q

what is Labia majora?

A
  • The labia majora are two prominent, hair-bearing folds of skin.
  • They extend posteriorly from the mons pubis to unite posteriorly in the midline in front of the anus.
145
Q

what is labia minora?

A
  • The labia minora are two smaller, hairless folds of soft skin that lie between the labia majora.
  • Their posterior ends are united to form a sharp fold, called fourchette. Their anterior ends split to enclose the clitoris.
146
Q

what is the vestibule of the vulva?

A

The vestibule is a smooth triangular area bounded laterally by the labia minora, with the clitoris at its apex and the fourchette at its base

147
Q

what are the orifices of the vagina?

A
  • Vaginal Orifice
  • Urethral orifice
  • Orifices of paraurethral glands
  • Orifices of the Ducts of the Greater Vestibular (Bartholin) Glands
148
Q

Vaginal Orifice

A

Lies in the posterior part of the vestibule. Partially closed in virgins by the hymen.

149
Q

Urethral orifice

A

A small orifice, Lies immediately anterior to the vaginal orifice and about one inch posterior to the clitoris

150
Q

Orifices of paraurethral glands

A

Small orifices, one on each side of the urethra

151
Q

Orifices of the Ducts of the Greater Vestibular (Bartholin) Glands

A

Small orifices, one on each side, are found in the groove between the hymen and the posterior part of the labium minus.

152
Q

Blood supply of the vulva

A

Branches of the external and internal pudendal vessels on each side.

153
Q

Lymph drainage of the vulva

A

Medial group of superficial inguinal nodes

154
Q

Nerve supply of the vulva

A

The anterior parts of the vulva: Are supplied by the ilioinguinal nerves and the genital branch of the genitofemoral nerves.

The posterior parts of the vulva: Are supplied by branches of perineal nerves and posterior cutaneous nerves of thigh

155
Q

what is the structure of clitoris? and ehat does it correspond in males?

A
156
Q

Arterial supply of the clitoris

A
157
Q

Venous drainage of the clitoris

A

It ends finally in the vaginal and vesical plexuses.It ends finally in the vaginal and vesical plexuses.

158
Q

Lymph drainage of the clitoris

A
  • From the skin and appendages, to the superficial inguinal lymph nodes, to the deep inguinal and femoral lymph nodes of which the lymph node of Cloquet drains the clitoris directly.
  • From the superficial group, lymph pass to the deep pelvic nodes including; the external iliac, common iliac, then para-aortic lymph nodes.
159
Q

Nerve supply of the clitoris

A

The nerve supply is from the pudendal nerve and the pelvic plexuses (parasympathetic).

160
Q

what is the length of the urethra in females?

A

2 - 4 cm.

161
Q

Course of the female urethra

A
  • Passes downwards and forwards, embedded in the anterior wall of the vagina.
  • Begins at the neck of the bladder , traverses the deep perineal pouch and pierces the perineal memebrane to open at once in the vestibule of the vagina just anterior to the vaginal orifice and one inch behind the clitoris.
  • The ducts of paraurethral glands open in the vestibule on each side of the external urethral orifice
162
Q

Arterial supply of the urethra

A

Branches of the vaginal & internal pudendal vessels.

163
Q

Lymph drainage of the urethra

A

Into internal iliac lymph nodes.

164
Q

Nerve supply of the urethra

A

The nerve supply is from the pudendal nerve and the pelvic plexuses (parasympathetic)

165
Q

arterial supply of female genital system

A
166
Q

Venous drainage of female genital system

A
167
Q

Lymphatic drainage of female genital system

A
168
Q

Nerve supply of female genital system

A
169
Q

Length of uterine (Fallopian tubes)

A

10 cm

170
Q

what is the hymen?

A

The vaginal orifice in virgin is partially closed by the hymen which is a mucosal fold perforated at its center.

171
Q

Stages of Development of Genital duct system

A
  • Indifferent stage
  • Different stage
172
Q

Indifferent stage of Development of Genital duct system

A
  • Initially, male & female embryo have 2 pairs of genital ducts develop from intermediate mesoderm one on each side.:
  1. mesonephric (Wolffian) ducts.
  2. paramesonephric (Mullerian) ducts.
173
Q

Different stage of Development of Genital duct system

A

In males: mesonephric duct persists, & other degenerates.

In females: paramesonephric duct persists, & other degenerates.

174
Q

what is the fate of Mesonephric tubules in males?

A
  • Cranial tubules disappear while caudal tubules form:
    1. superior aberrant tubules
    2. vasa efferentia & duct of epididymis,
    3. inferior aberrant tubules
175
Q

what is the fate of Mesonephric tubules in females?

A
  • disappear, except remnants epoophoron & paroophron close to ovary.
176
Q

what is the fate of Mesonephric duct in males?

A

Forms genital ducts: cranial to caudal
1. appendix epididymis
2. Epididymis
3. vas deferens
4. seminal vesicle.
5. prostate
6. fibromuscular frame work of prostate
7. trigone of urinary bladder
8. upper half of posterior wall of prostatic urethra
9. ureteric buds

177
Q

what is the fate of Mesonephric duct in females?

A

disappears, except

  1. its caudal end (Gartner’s duct) close to vagina.
  2. upper half of posterior wall of female urethra
  3. trigone of urinary bladder
178
Q

what are the parts of Paramesonephric Duct (Mullerian Duct)?

A
179
Q

what are the Derivatives of paramesonephric ducts in females?

A
180
Q

what are the Derivatives of paramesonephric ducts in males?

A
181
Q

Development of vagina

A
  • upper 1/3 (mesodermal)
  • lower 2/3 of vagina (endodermal)
  • vestibule of vagina
  • Fibromuscular coat of vagina
182
Q

Development of upper one third of vagina

A

from paramesonephric ducts (utero-vaginal canal)

183
Q

Development of lower two third in vagina

A
  • From endoderm of pelvic part of definitive urogenital sinus (at Mullerian tubercle)

a) 2 masses develop (sinovaginal bulbs).

b) These 2 bulbs fuse together to form (vaginal plate).

c) central cells of vaginal plate (break down)

d) Hymen: lumen of vagina remains separated from definitive urogenital sinus by the hymen. It usually develops a small opening during perinatal life

184
Q

development of vestibule of vagina

A

Develops from urogenital sinus.

185
Q

Development of Fibromuscular coat of vagina

A

Develops from surrounding mesenchyme.

186
Q

what are the anomalies of the uterus & vagina?

A
  • Uterus didelphys
  • Bicornuate uterus: Uterus bicornis
  • Arcuate uterus
  • Bipartite uterus: Septate uterus
  • Unicornuate uterus
  • cervical atresia
  • Vaginal atresia
  • Imperforate hymen
187
Q

what is Uterus didelphys? and what causes it?

A
  • 2 uterus, 2 cervix, 2 vagina
  • Due to Complete failure of fusion of 2 paramesonephric ducts.
188
Q

what is Bicornuate uterus: Uterus bicornis? and what causes it?

A

a) Uterus bicornis bicollis: 2 uterus, 2 cervix & 1 vagina.

b) Uterus bicornis unicollis: 2 uterus, 1 cervix & 1 vagina.

  • Due to Incomplete fusion of 2 paramesonephric
189
Q

what is Arcuate uterus? and what causes it?

A
  • fundus of uterus is depressed in its middle part.
  • Due to Incomplete fusion of intermediate parts of paramesonephric ducts.
190
Q

what is Bipartite uterus: Septate uterus? and what causes it?

A
  • uterine cavity divided by a septum into two cavities.
  • Due to improper fusion [ ] the paramesonephric ducts
191
Q

what is Unicornuate uterus? and what causes it?

A
  • Uterus with one horn & one uterine tube. other is rudimentary or absent.
  • Due to Failure of development related paramesonephric duct.
192
Q

what causes cervical atresia?

A

failure of canalization of cervix

193
Q

what causes vaginal atresia?

A

due to failure of canalization of vaginal plate.

194
Q

what causes imperforate hymen?

A

due to failure of degeneration of central part of hymen.

195
Q

Indifferent stage of development of External genitalia

A
196
Q

Different stage of External genitalia of male

A
197
Q

Different stage of External genitalia of female

A
198
Q

what is the Embryological origin of gonads?

A
199
Q

steps of development of gonads

A
  • Indifferent gonad stage
  • Different Gonad stage
200
Q

Indifferent gonad stage

A
  • At 4 th week, genital ridge (from intermediate mesoderm) appears on posterior abdominal wall
  • coelomic (surface) epithelium proliferates & penetrate underlying genital ridge to form (primitive sex cords).
  • At 6 th week: primordial germ cells migrate from wall of yolk sac close to allantois along mesentery of hindgut & invade genital ridge.
  • Germ cells have an inductive influence on differentiation of gonad into testis or ovary.
201
Q

what happens at fourth week? (concerning gonads development)

A

genital ridge (from intermediate mesoderm) appears on posterior abdominal wall

202
Q

what happens at sixth week? (concerning gonads development)

A

primordial germ cells migrate from wall of yolk sac close to allantois along mesentery of hindgut & invade genital ridge.

203
Q

what ability do germ cells have? (concerning gonads development)

A

have an inductive influence on differentiation of gonad into testis or ovary.

204
Q

different stage for development of testis

A
205
Q

what happens in eighth week? (concerning testis development)

A

interstitial cells of Leydig develop from genital ridge [ ] testis cords. They secrete testosterone

206
Q

what do testis cords contain? and what happens to them later?

A
  • later, testis cords become horseshoe shaped. They contain:
    a) Spermatogonia
    b) Sertoli cells
  • Testis cords canalize forming seminiferous tubules and spermatogonia begin mitosis at puberty
207
Q

summary of development of testis

A
208
Q

different stage of development of ovaries

A
209
Q

summary of development of ovaries

A
210
Q

definition of descent of testis

A

descent from level of L2, traversing inguinal canal to enter scrotum

211
Q

what are the factors that help in descent of testis?

A
  1. Contraction of gubernaculum.
  2. Testosterone; stimulate contraction of gubernaculum.
  3. Processus vaginalis: peritoneal process that passes though and dilates the inguinal canal
  4. Intra-abdominal pressure
  5. compression by surrounding viscera
  6. Lengthening of dorsal body wall: results in caudal shift testis.
212
Q

process of descent of testis

A

Internal descent
- Testis start descent at week 8
- testis reaches iliac fossa: at 10th week.
- It reaches deep inguinal ring: at 12th week. It remains there until 7th month.

External descent
- testis traverses inguinal canal: at 7th month,
- It reaches superficial inguinal ring: at 8th month
- It enters scrotum: at 9th month.

213
Q

where does Gubernaculum develop?

A

develops in intermediate mesoderm as a fibromuscular cord

214
Q

extension of Gubernaculum

A
  • extending from lower pole of testis to scrotum.
  • It traverses through inguinal canal.
215
Q

what is the function of Gubernaculum?

A

Its contraction will pull testis downward.

216
Q

what are the results of the descent of testes?

A
  • Testis drags with it testicular vessels & lymphatics & autonomic nerves from aorta, Inferior vena cava, paraaortic nodes & aortic plexuses, respectively
  • Formation of inguinal canal
  • Testis takes these coverings:
    a) external spermatic fascia from of external oblique muscle.
    b) Cremastric muscle & fascia: from internal oblique muscle.
    c) Internal spermatic fascia: from fascia transversalis.
217
Q

what is the fate of gubernaculum?

A

it forms vestige of gubernaculum ligament at bottom of scrotum.

218
Q

what is the fate of processus vaginalis?

A
  • Proximal part; obliterates and becomes vestige of processus vaginalis.
  • Distal part is invaginated by testis & forms tunica vaginalis
219
Q

Process of the descent of ovary

A
  • from upper lumbar region to pelvis.
  • Gubernaculum: extends from ovary > attached to uterus > through inguinal canal > labia majora.
220
Q

what are the derivatives of the gubernaculum in females?

A
  1. ovarian ligament
  2. round ligament of uterus.
221
Q

when is genetic sex determind?

A

is determined at time of fertilization (if sperm carries y > male embryo ,while if sperm carries x > female embryo)

222
Q

when is gonadal sex determind?

A
  • gonads do not differentiate until 7th week of development after arrival of primordial germ cells into indifferent gonad:

A. If embryo is genetically male; indifferent gonad differentiates into testis.

B. If embryo is genetically female: indifferent gonad differentiates into ovary.

  • When primordial germ cells fail to reach indifferent gonad, gonad remains indifferent or absent
223
Q

what happens when primordial germ cells fail to reach indifferent gonads?

A

gonad remains indifferent or absent

224
Q

Phenotypic Sex & sex of (internal genital organs (genital ducts) & external genitalia in males

A

Sex-determining region Y (SRY), encodes the Testis-determining factor (TDF) which is a DNA- binding protein responsible for the testis formation in male then

225
Q

Phenotypic Sex & sex of {internal genital organs (genital ducts) & external genitalia in females

A
226
Q

what do errors in production of testosterone lead to? (concerning phenotypic sex)

A

Errors in production of testosterone lead to a predominance of female characteristics under influence of maternal & placental estrogens.

227
Q

what are the Anomalies of gonads?

A

Anomalies of formation:
- Gonadal dysgenesis
- Hermaphrodites (intersex)

Anomalies of descent of testis:
- Undescended testis (cryptorchidism)
- Ectopic testis
- Persistent processus vaginalis

228
Q

what does Gonadal dysgenesis mean? And what causes it?

A
  • Improper formation of gonads due to failure of migration of primordial germ cells.
  • Internal & External genitalia & external appearance looks like a female by the maternal estrogens
229
Q

types of hermaphrodites (intersex)

A
  • True hermaphrodites
  • Male pseudo-hermaphrodites
  • Female pseudo-hermaphrodites
230
Q

True hermaphrodites

A

with both ovarian & testicular tissue (external genitalia mostly female)

231
Q

Male pseudo- hermaphrodites

  • Characters
  • Causes
A
  • Male XY with testis but external genitalia are like that of females as the testis does not produce musculizing hormones or the tissues are insensitive to it.
  • Androgen Insensitivity Syndrome most common cause of male pseudo- hermaphrodite, Xy male with testis & testosterone but there is no, or abnormal receptors for testosterone in tissues. So, the external genitalia & external appearance appear as female by maternal estrogens.
232
Q

Female pseudo- hermaphrodites

  • Characters
  • Causes
A
  • female (XX) with ovaries but with external genitalia looking like that of male.
  • Most common cause is congenital adrenal hyperplasia (adrenogenital syndrome) (enzymatic defect causing failure of production of steroid hormones —-> increased ACTH —-> increased androgen release from adrenal cortex causing masculinization of the female genitalia)
233
Q

what is Undescended testis (cryptorchidism)?

A

testis remains in abdomen, iliac fossa or in inguinal canal, and fails to reach scrotum, incomplete descent along normal course

234
Q

what causes Undescended testis (cryptorchidism)?

A

due to defective development of gubernaculum or low testosterone secretion

235
Q

treatment of Undescended testis (cryptorchidism)

A

Testosterone administration helps descent or Operation [ ] 6 & 12 months, to avoid destruction of germ cells or tumor formation.

236
Q

what causes Ectopic testis?

A

due to abnormal lower attachment of gubernaculum and testis follows it.

237
Q

site of Ectopic testis

A

lower part of abdomen, root of penis, perineum, front of thigh

238
Q

what causes Persistent processus vaginalis?

A

Due to Failure of obliteration of processus vaginalis results in a patent communication [ ] tunica vaginalis & peritoneal cavity

239
Q

what does Persistent processus vaginalis lead to?

A

congenital inguinal hernia:intestine loop descends into scrotum.

Congenital hydrocele:tunica vaginalis is filled with peritoneal fluid

240
Q

summary of gonadal development

A
241
Q

Definition of Perineum

A
  • The lower part of pelvic cavity below the pelvic diaphragm
242
Q

Site of Perineum

A
  • inferior to pelvic diaphragm between the thighs
243
Q

Shape of Perineum

A
  • diamond-shaped when seen from below
244
Q

Boundaries of Perineum

A
245
Q

Divisions of Perineum

A

by a line between 2 ischial tuberosities into:

Urogenital triangle: (anterior) Contain 2 perineal pouches & external genitalia

Anal triangle: (posterior) Contain anal canal & ischiorectal fossa

246
Q

What are the boundaries of Anal triangle?

A
247
Q

what are the contents of Anal triangle?

A
  • Anal canal
  • External anal sphincter
  • Ischio-rectal fossa
248
Q

Definition of Perineal membrane

A

a triangular sheet of fibrous tissue stretches across the pubic arch

249
Q

what is the middle of perineal membrane’s posterior surface is attached to?

A

to the perineal body.

250
Q

what are the 2 fascial spaces in relation with each of the superior and inferior surfaces of the perineal membrane in the urogenital triangle?

A

The 2 facial spaces are named superficial and deep perineal pouches.

  • The superficial pouch lies below the membrane.
  • The deep pouch lies above the membrane.
251
Q

Pelvic fascia relation with the superior surface of perineal membrane

A
  • In relation with the superior surface: the pelvic fascia attaches to all its sides forming a completely closed space. This space is called Deep perineal pouch.
252
Q

Membranous fascia of the anterior abdominal wall and its reklation with the inferior surface of perineal membrane

A
  • In relation with the inferior surface: the membranous fascia of the anterior abdominal attaches to the sides and posterior border, but not to its apex, forming an incompletely closed space called Superficial perineal pouch.
253
Q

what are Structures piercing the perineal membrane?

A
254
Q

The superficial fascia of perineum

A
  • Like that of the inferior anterior abdominal wall consists of:

Superficial fatty layer: In male it is replaced by dartos muscle in the scrotum

Deep membranous layer (Cool’s fascia): Attaches posteriorly to the posterior border of perineal membrane forming the superficial perineal pouch (which is opened anteriorly).

255
Q

Site of the pelvic fascia

A

Lies above perineal membrane.

256
Q

Attachment of the pelvic fascia

A

to all side of the perineal membrane forming a completely closed space called Deep perineal pouch.

257
Q

Definition of The perineal body

A

fibromuscular mass at midline of the perineum

258
Q

Site of The perineal body

A

In males: between the anal canal and the bulb of the penis.

In females: between the anal canal and the lower part of the vagina.

259
Q

Muscles attached to The perineal body

A
260
Q

Function of The perineal body

A
  1. It is important especially in females for support of pelvic organs.
  2. Its damage during labour may result in prolapse of the uterus & other pelvic organs.
261
Q

structures passing out of the pelvis should pass through …..

A
  1. Deep pouch
  2. Perineal membrane
  3. Superficial pouch.
262
Q

Definition of Ischio-rectal (ischio-anal) fossa

A
  • Wedge shaped space (gutters) on each side of anal canal
263
Q

Shape of Ischio-rectal (ischio-anal) fossa

A

conical in shape lies in both sides of the anal canal.

264
Q

Boundaries of Ischio-rectal (ischio-anal) fossa

A
265
Q

Contents of Ischio-rectal (ischio-anal) fossa

A
  1. Pad of fat.
  2. Inferior rectal vessels and nerves.
  3. Pudendal canal containing:
    a. Pudendal nerve
    b. Internal pudendal vessels.
266
Q

what forms Pudendal (Alcock’s) canal?

A

Formed by splitting of obturator fascia

267
Q

Site of Pudendal (Alcock’s) canal

A

lies in lateral wall of ischiorectal fossa

268
Q

Content of Pudendal (Alcock’s) canal

A

a. Pudendal nerve.
b. Internal pudendal vessels

269
Q

Boundaries of Superficial perineal pouch

A
270
Q

Content of Superficial perineal pouch in females

A
271
Q

Superficial perineal pouch in males

A
272
Q

Boundaries of Deep perineal pouch

A
273
Q

Content of Deep perineal pouch in females

A
274
Q

Content of Deep perineal pouch in males

A
275
Q

Function of Ischio-rectal (ischio-anal) fossa

A

it gives space of the anal canal to dilate during the process of defecation.

Y2B3 - Reproductive 📘 (9 decks)

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