ANATOMY Flashcards
The pelvic cavity or true pelvis is located within the …
Lesser pelvis
The puborectalis component of the LA muscle:
‐ is tonically contracted maintaining the …
‐ is responsible for…
- anorectal flexure
- rectal continence
Roof of the pelvic cavity
Parietal peritoneum
Space located between the levator ani m (LAM) and the skin
PERINEUM
The … could accidentally go out from the pelvic cavity and enter the peritoneum
Oocyte
•… triangle (ant): urogenital diaphragm and external genitalia
•… triangle (post): anal canal, external anal sphincter, anus
- urogenital
- anal
Contents of the perineum in the anal triangle
Anal canal, external anal sphincter (EAS), anus
Contents of the perineum of the urogenital triangle
- deep layer: urogenital diaphragm
- superficial layer: genitalia
Pelvic organs are …peritoneal
Subperitoneal
The pelvic walls, most of the pelvic viscera and the perineum are supplied by branches of the…
internal iliac artery
Branches of interior trunk of internal iliac artery
- umbilical – superior vesical
• Obturator
• Inferior vesical /uterine
• Middle rectal
• Inferior gluteal
• Internal pudenda
ARTERY OF THE PERINEUM
Internal pudendal artery
Posterior trunk of the internal iliac artery
Iliolumabar, lateral sacral, superior gluteal
Motor and cutaneous innervation of the perineum
pudendal nerve (S2‐S4)
Innervation of the skeletal muscles of the deep and superficial perineal pouches:
pudendal nerve (S2‐S4)
Visceral innervation of pelvic viscera:
inferior hypogastric plexus
The bladder derives from the … The apical part –uracus‐ obliterates and becomes the …
- allantoid diverticulum
- median umbilical ligament
The pelvic cavity has a … orientation and contains …
posteroinferior, the pelvic viscera
The floor of the pelvic cavity is the…
Pelvic diaphragm (lavator ani+coccygeal muscle)
Through the urogenital hiatus… pass
Urethra, vagina and anal canal
Fibromuscular structure that covers the urogenital hiatus. It contains thin skeletal muscles resting on a thick membrane, the perineal membrane.
UROGENITAL DIAPHRAGM: deep perineal pouch
UROGENITAL DIAPHRAGM
Superficial perineal pouch contains…
The genitalia (erectile bodies and associated skeletal muscle)
Superficial perineal pouch
Superficial perineal pouch
The parietal peritoneum forms…
Peritoneal folds and fossae
In the posterior perineum, the … together with the internal pudendal artery and vein travel in the pudendal canal
pudendal nerve
Somatic innervation of the pelvis and the perineum
Sacral plexus
Levator ani and coccigeus muscles innervation
Nerve of the levator ani (S3‐S4) internally, and pudendal nerve, superficially
MOTOR INNERVATION PELVIC VISCERA
Lymphatic drainage pelvis and perineum
Pelvic cavity:
• sacral
• internal iliac
• external iliac
Perineum:
• superficial inguinal
• deep inguinal
Name the following structures and numbers 6, 7, 8
- Sacrum
- Rectum
- Bladder
Anatomy of the male pelvic organs
Structure deep to gonadal vessels and superficial to common iliac/external iliac artery
Abdominal ureter
Rectum starts at … level
S3
Pelvic ureter and urinary bladder development
Mal formation if the Uracus in which the distal part of it is abnormally flattened and makes the urine leak through the umbilicus
URACHAL FISTULA
If only some parts of the uracus flatten and others not, we could have an…
URACHAL CYST
The malformation of the uracus in which the connection with the bladder is sealed but there is a connection with the exterior is called…
URACHAL SINUS
RELATIONSHIPS OF THE URINARY BLADDER
1. It is sitting on the…
2. … passes lateral and superior to the bladder
3. Posteroinferiorly we find the … and …
- Pubic bone
- Vas deferens
- Prostate gland, seminal vesicle
The bladder is anchored inferiorly by condensations of …: … ligaments
Pelvic fascia, pubovesical and puboprostatic
What anomaly can be detected?
INGUINOESCROTAL BLADDER HERNIA
67year‐old male. Study of inguinoscrotal hernia that increases after micturition.
Intravenous urography and post‐voiding films. Images at 30 min, 1 h and post‐micturition
The bladder can also herniate into the spermatic cord
Subdivisions of the male urethra
The preprostatic part of the urethra forms the…
Internal urethral sphincter
Functions of the internal urethral sphincter
It closes the neck of the bladder inhibiting micturition, and it prevents semen from flowing into the bladder (in males)
Emission of semen and closure of the sphincter are activated by the … system
Sympathetic
The membranous portion of the sphincter is contained in the …., forming the external urethral sphincter
Urogenital diaphragm
Blood supply and drainage of bladder and urethra
• superior vesical aa & vv – from the umbilical aa, vv
• inferior vesical aa & vv – from the internal iliac a
Innervation of the bladder and urethra
Symp: stimulate the closure of the internal urethral sphincter (aortic and superior hypogastric plexus, sacral splanchnic nerves)
Psym: stimulate the contraction of the detrusor muscle (pelvic splanchnic nerves=> inferior hypogastric plexus)
VISCERAL AFFERENTS BLADDER AND URETHRA
Distension fibers travel with…
Pelvic splanchnic nerves (PS)
VISCERAL AFFERENTS BLADDER AND URETHRA
Pain fibers travel with…
Above the pelvic line, with symp fibers
Below the pelvic line, with pelvic splanchnic nerves (PS)
The spermatic ducts convey spermatozoa from the.. to the … during sexual arousal
testis, prostatic urethra
- Inguinal vas deferens
4 . Pelvic vas deferens
The vas deferens will pass.
- Lateral to the …, becoming medial and passing over the external iliac vessels on its way to join the urethra
- Superior to the …
At its distal-most part, the Vas deferens becomes known as the… It joins the seminal vesicle’s duct to form the … which enters the urethra.
inferior epigastric arteries, ureters
Deferental Ampulla (or Ampulla of vas deferens), Ejaculatory duct
Ejaculatory ducts
The seminal vesicle originates from the …
Mesonephric duct
Seminal vesicle
Relationships of the seminal vesicle
- Anteriorly related to the …
- Posteriorly related to the …. Between them. There’s a septum, the …. But still, the vesicle can be palpated from the inside of the rectum
- Inferiorly, related to the …
- bladder
- rectum, rectovesical septum
- prostate
Evagination of the urethra into the surrounding mesenchyme
The prostate gland
The … prevents retrograde passage of semen to the bladders
Prostatic urethra
Typical localization of prostate carcinoma:
peripheral zone
Anatomical relations of the prostate gland
- It is inferior to the …
- Superior to the …
- Posteriorly we can find the …
- bladder
- external urethral sphincter
- rectovesical septum
Why can a prostate carcinoma metastasize to the brain?
Because prostate can also drain into lymph nodes anterior to the sacrum, ascending up the spinal cord to the brain.
Innervation of the spermatic ducts
Sympathetic: T0-T11
Sensory fibers
Innervation of the prostate and seminal vesicle
Simp: hypogastric plexus
Sensory fibers
Summary of male reproductive organs
Ligaments of the ovary
Innervation of the ovary
Sympathetic: T10-T11
The uterine tubes and the uterus derive from…
A pair of embryonic ducts:
the craneal portions differentiate into the uterine tubes, the caudal portions fuse to form the uterus
The …. contains ovarian artery and vein
SUSPENSORY LIGAMENT OF THE OVARY
The round ligament of the uterus is located in the …
Inguinal canal
Lymphatic drainage of the ovary
LATERAL CAVAL LYMPH NODES AND LATERAL AORTIC LYMPH NODES
The uterus, uterine tubes and proper ligament of the ovary are covered by parietal peritoneum:
THE BROAD LIGAMENT
The ovary is … from peritoneum
Free
When paramesonephric ducts fuse at the linea alba, they drag the mesoderm which will form the…
BROAD LIGAMENT
Ovaries end up being…
Posterior and retroperitoneal
early sexual activity, multiple sex partners, human papillomavirus (HPV) infection, smoking are risk factors of…
Cervical carcinoma
Sexually transmitted diseases (STDs)
… infections are characterized in both sexes by warty lesions. The virus is commonly spread by skin-to–skin contact. … is highly associated with cervical cancer in women. A common risk factor for both STDs is having multiple sexual partners.
HPV
Age changes through one women’s life (T/F)
True
Benign tumors of smooth muscle cells in the uterus can cause…
Uterine leiomyomas (fibroids)
The uterus has inferiorly the… and the cervix has inferiorly the …
Bladder, rectum
The vagina has anteriorly the… and posteriorly the …
Bladder, rectum
Peritoneal pouches of the female reproductive organ
Angle between vagina & uterus:
version angle - normally 90o in anteversion
Angle between isthmus & body of uterus:
flexion angle – normally 120o in anteflexion
Uterus can be found in other positions
They can present some problems in pregnancy
Blood supply of uterine tubes, uterus and vagina
Fijarte en anastomosis
Venous drainage female genital tract
Lymphatic drainage female genital tract
Fijarte a qué drena cada uno
Innervation female genital tract
Innervation of the female genital tract
Las fibras aferentes de las vísceras pélvicas
intraperitoneales (p. ej., el útero) acompañan a las …
fibras simpáticas a través de los plexos abdominales al tronco simpático y luego a la porción torácica inferior de la médula espinal.
Las fibras aferentes de las vísceras pélvicas
subperitoneales (p. el., el cuello del útero y la parte superior de la vagina) discurren a través de los ….
nervios esplácnicos pelvicos a la porción
sacra de la médula espinal
Las fibras aferentes de la parte inferior la vagina y el periné discurren a través de los ….
nervios pudendos a la porción sacra de la médula espinal.
Endopelvic fascia and ligaments
The ureter passes … the uterine artery
Underneath
Women have an internal urethral sphincter (T/F)
False: women do not have internal urethral sphincter.
Lateral pubovesical ligaments.
In the female’s urinary bladder and urethra we can find:
● Smooth muscle long fibers
● Venous plexuses
● External urethral sphincter
… supports the urethra and vagina
Pubocervical fascia
… can become weak because of an increase in abdominal pressure, this would cause stress incontinence (urethra cannot hold in place and urine leaks out).
Pubocervical fascia
Muscles within the deep perineal pouch in women
• compressor urethrae
• external urethral sphincter
• sphincter urethrovaginalis
ESFÍNTERES URETRALES VOLUNTARIOS DE LA MUJER (músculo estriado)
The superficial perineal pouch in the women reproductive system contains…
the erectile tissues, greater vestibular glands and associated skeletal muscles
Development of the external genitalia
The genital tubercle of the embryo will become the…
Clitoris
Blood supply external genitalia
Mainly the internal pudendal artery
Innervation of deep and superficial perineal pouches
Pudendal nerve
lymphatics from the external genitalia drain into…
superficial and deep inguinal nodes
The … closes the superficial perineal pouch anteriorly .
It is continuous with the membranous layer of the abdominal superficial fascia (Scarpa’s)
superficial perineal fascia (Colles’s)
The two curves of the male urethra:
Infrapubic and prepubic. They may pose an obstacle to transurethral catheterisation.
The urogenital diaphragm in males represents the …
deep perineal pouch
Contents of the male urogenital diaphragm (deep perineal pouch):
- External urethral sphincter
- Deep transverse perineal muscle
- Bulbourethral glands
Bulbourethral glands derive from…
Endoderm of urethra
Testes form in …
The abdominal cavity (from intermediate mesoderm)
Double layer of peritoneum pinched off which becomes the Tunica Vaginalis: it lubricates the movement of the testes.
PROCESSUS VAGINALIS
Testis anatomy
Vascular and nervous structures, that accompany the testis, vas deferens, and their fascial coverings form the…
SPERMATIC CHORD
SPERMATIC CHORD
Partial obliteration of the procesus vaginalis leads to…
HYDROCELE (fluid within the testis)
Patent processes vaginalis can cause…
INGUINAL HERNIA
(Structures from the abdominal cavity herniated)
Blood supply to the testis
Distended veins in the testis can cause…
VARIOCELE
Espacios perineales hombre y fascias
Espacios perineales hombre y fascias
The root of the penis is formed by…
two crura and the bulb, attached to the perineal membrane
Transverse section through the body of the penis
Erections is a … event. Explain it.
Purely vascular
Superficial masculine perineal pouch
Superficial masculine perineal pouch
The …. are continuous with the superficial perineal fascia (Colles’) and with Scarpa’s fascia.
superficial fascia of the penis and scrotum
Ischio-anal fossa
The ischio‐anal fossa extends … to form the anterior recesses of the ischio‐ anal fossae
anteriorly
Striate muscle and cutaneous innervation of perineum:
Pudendal nerve (S2‐S4)
EXAM SHORT QUESTION
Trajectory and main branches of pudendal nerve
Pudendal nerve and branches in the male
Innervation and vascularization of the perineum in men
Branches of internal pudendal artery and vein, and branches of pudendal nerve
Vascularization and lymphatic drainage of the anal canal
Somatic motor innervation of the ischiocavernosus and bulbospongiosus m. travels through the…
Superficial perineal n (pudendal n)
Somatic sensory innervation of the penis:
dorsal nerve of penis (pudendal n)
Somatic sensory innervation of the scrotum:
Anterior innervation: Anterior scrotal n (from ilioinguinal n) and genitofemoral
Posterior innervation: Posterior scrotal n (from pudendal n)
Blood supply to the external genitalia men
Branches of the internal pudendal artery and vein supply the erectile tissues, skeletal muscles of the superficial perineal pouch and the skin of the scrotum posteriorly
The deep dorsal vein of the penis drains to the…
venous prostatic plexus
The anterior aspect of the scrotum is supplied by
Lymphatic drainage of external genitalia
Drenaje linfático del testículo, conducto deferente, próstata y vesícula seminal
Reproductive system is… (male and female have different reproductive systems)
Dimorphic
In embryonic development, the genetic sex drives the…
Differentiation of the gonad
(6th week)
After differentiation of the gonads, one embryonic development, the gonad drives the diff. of the…
genital ducts and external genitalia
(8weeks onwards)
The gonad originates from the …, a thickening of intermediate mesoderm covered by coelomic epithelium
genital ridge
Primordial germ cells migrate towards the gonad during the …. and enter the gonad in the …
4th-5th weeks, 6th week
Primordial germ cells are incorporated in the…
primitive sex cords
If primordial germ cells fail to reach the genital ridge,…
the gonads do not develop
EMBRIOLOGY
The genes expressed by somatic cells of the … determine the fate of the undifferentiated gonad
genital ridges
… gene triggers a cascade leading to testis differentiation
SRY
2 copies of … gene inhibit testicular development and initiate ovarian development
DAX-1
If a normal … chromosome is present, testes are formed
Y
If no … chromosome is present or the … is absent, testes do not
develop
Y, SRY region
Two… chromosomes are needed for a normal ovarian development
XX
The early embryo presents both … ducts and … ducts
mesonephric (Wolffian), paramesonephric (Müllerian)
EMBRIOLOGY
The … drives the differentiation of the genital ducts
gonad
Male spermatic ducts differentiate from the mesonephric duct by the action of …
secreted by the developing testis
testosterone
The … secreted by Sertoli cells induces atrophy of the paramesonephric duct in the male
antimüllerian hormone (AMH)
Female genital tract: in the absence of …, differentiates passively from the paramesonephric ducts, while the mesonephric ducts degenerate in the absence of …
AMH, testosterone
Vaginal plate formation is induced by the development of the …
Paramesonephric ducts
These uterus malformations can be caused by because of…
incomplete fusion of the distal paramesonephric ducts
External genitalia initially form from identical precursors:
bipotential genital tubercle and genital swellings
Female external genitalia is caused because of the absence of … + later estrogenic support:
• … does not enlarge
• …do not fuse
DHT
- genital tubercle
-urethral folds
Undescended testes are called…
Cryptorchidism
Abnormal location of testes is called…
Ectopic testes
Male and female reproductive systems develop from common embryonic precursors:
o undifferentiated gonads
o two pair of embryonic ducts
o genital tubercle and genital swellings
There is a strong interconnection between the urinary and genital systems (T/F)
True
Genetic or chromosomal sex is determined at …
FERTILIZATION
Gonadal sex starts at week… (gonads differentiation)
6
Phenotypic differentiation (differentiation of genitalia) occurs at week…
8
Testes and ovaries develop from a common bipotential structure:
the undifferentiated gonad
Same cell lineages are present in the bipotential gonad (T/F)
True
Epithelial cells in male testes (…) will induce the differentiation of stromal cells (…), which produce testosterone.
STERTOLI CELLS, LEYDIG CELLS
Epithelial cells in female ovaries(…) will induce the differentiation of stromal cells (…).
GRANULOSA/FOLLICULAR, THECA CELLS
DIFFERENTIATION OF TESTES
- Further proliferation of … that detach from the surface epithelium
- Connection of testis cords with thin network of tubules: the …
- Formation of the…
-primitive sex cords
- rete testis
- tunica albuginea
(FIJARTE EN QUE SE TRANSFORMA CADA ESTRUCTURA)
Differentiation of ovary
- … penetrate towards the medulla and finally degenerate
- Surface epithelium keeps proliferating and remain close to the… In the 3rd month they surround each oogonium as
…, giving rise to primordial follicles
- Primitive sex cords
- surface or cortex
- follicular cells
Fetal testicular Testosterone induces:
1. Retention of a subset of … as efferent ductules of the rete testis
2. Persistence of the mesonephric duct and differentiation into …
- mesonephric tubules
- epididymis, vas deferens, seminal vesicle and ejaculatory duct
Remnant structures in the male from the paramesonephric duct
The craneal portion of the paramesonephric ducts differentiate into the …, the caudal portions fuse to form the…
uterine tubes, uterus
Remnant structures in the female from the mesonephric duct
Formation of the uterus and vagina – dual origin of vagina
In the embryo, the cloaca will be separated by the urethra by the …. into urogenital and anal part.
Urorectal septum
Cloacal folds in external genitalia develop into…
Urethral and anal folds
Development of penis and scrotum:
Testosterone converted to DHT in the target organs elicits… development and masculinizes the …
prostatic, external genitalia
Urethral folds in females form…
Labia minora
Genital swellings in females form…
Labia majora
If the urethral folds in males do not fuse, we would find…
HYPOSPADIAS (under the penis) AND EPISPADIAS (on the dorsal side of the penis)
Urine can leak through these abnormal urethral openings.
Gonads originate at … level
L2
TESTICULAR DESCENT
- TRANSABDOMINAL PHASE
- Testis descend from L2 into the …
- Under the control of … hormone
- Occurs between weeks …
- inguinal canal
- INSL-3
- 10 and 15
TESTICULAR DESCENT
- TRANSINGUINAL PHASE
- Testis will descend from the inguinal canal to the …
- Under … control
- Between weeks …
- scrotum
- testosterone
- 25-35
A thick mesenchymal pole is formed below the testis, which directs the descent of the testes:
GUBERNACULUM TESTIS
In the testicular descent, a connection from the peritoneal cavity finally obliterates: … We will end up finding just a parietal layer of the … and a visceral layer of the … surrounding the testes.
VAGINAL PROCESS
Recap – normal sex determination and sexual differentiation
What would happen if there is a chromosomal deffect or mutation in XX or XY?
GONADAL DYSGENESIS (abnormal gonads): NO corresponding genital ducts and external genitalia will be developed.
Syndrome in which there is a missing X chromosome (45, XO). We find streak ovaries, a white streaked fibrotic tissue without oogonia (infertile).
TURNER SYNDROME: GONADAL DYSGENESIS
Syndrome in which we find complete gonadal DYSGENESIS: 46, XY.
We find streak gonads, female genitalia and structures including a vagina, uterus and fallopian tubes. They typically do not have ovaries and are therefore infertile.
15% are due to a mutation in gene SRY
SWYER SYNDROME
DIBUJO PRÁCTICO DISECCIÓN PENE: SABER DIBUJARLO
