ANATOMY Flashcards
Type of epitheium lining the ureters - and function
transitional - allows for stretch
type of epithelium lining the bladder - and function
Columnar/transitional - allows for stretch
type of epithelium lining the urethra (female) - and function
transitional - allows for stretch
Where is transitional epithelium found
bladder, ureters and urethra (female)
Where is pseudostratified epithelium found and what is the function?
trachea and upper resp trach. Absorbs and secretes mucous
Where is columnar epithelium found
uterus, uterine tubes, digestive tract, bladder, bronchi
Absorbs and secretes mucous/enzymes
Where is cuboid epithelium and what is function?
glands/ducts/kidney tubules
Arterial blood supply to ureters
renal
vaginal/uterine
gonadal
middle rectal
nerve supply to ureters
T11-L2
Describe the anatomy of the male urethra.
Where do the cowpers glands enter?
3 parts - prostatic, membranous (after the prostate and before the penis), penile (spongy, cavernous).
15-29cm long
The bulbourethral glands (Cowper’s glands) enter in the membranous portion.
The vas deferens travels from the testicles and then joins the seminal vesicle to formt he ejaculator duct. It then travels into the prostate to join the urethra
Which muscles make up the pelvic floor?
Levator ani - puborectalis, pubococcygeus, iliococcygeus
AND coccygeus muscle
Further up - the ones around the vagina are the iliococcygeus (lateral) and bulbococcygeus (around vagina)
What is the nerve supply to the pelvic floor
S3-S4 spinal nerves
pudendal nerve (sacral plexus)
peroneal (branch of pudendal)
inferior retal (pudendal)
arterial supply to the pelvic floor
inferior gluteal artery
How can the common peroneal nerve compression present in pregnancy and why?
Lithotomy position during delivery
Foot drop - dorsiflexors lost. Sensory loss to lateral lower leg
Foot drop and sensory loss to lateral lower leg
common peroneal
How can the femoral nerve compression present in pregnancy and why?
difficult birth.
Quads not working. extension at the knee.
loss of knee jerk
Sensory loff of knee and anterior thigh
loss of knee jerk caused by palsy of which nerve?
Femoral
Quads not working. extension at the knee.
loss of knee jerk
Sensory loss of knee and anterior thigh
Which nerve palsy?
Femoral
Which nerve can be affected by compression of fetal head and pelvic structures?
What symptoms could this cause?
Obturator nerve
Lack of adduction at the hip
Loss of sensation upper medial thigh
What would a lateral femoral cutaneous nerve palsy cause?
sensory loss of lateral thigh
No motor problems
What are the boundaries of the femoral canal?
What does it contain?
Anterior - inguial ligament
Medial - lacunar ligament
Lateral - femoral vein
Posterior - petinius muscle
CONTAINS:
- Lymphatic drainage of deep inguinal nodes
- Deep node (the lacunar node)
- Connective tissue
Function - allows stuff to exit the abdomen into the leg
Describe the anatomy of the sperm tail
THE AXIAL FILAMENT
9+2
2 central longitudinal fibres called beta fibres
surrounded by 9 longitudinal fibres called alpha fibres
Blood supply to the tesicles
Cats lick their balls MEOW
cremaster artery
artery to vas deferens
testicular artery
Venous drainage of testicles
pampiniform plexus
testicular vein
lymphatic drainage of testicles
lumbar and paraaortic nodes
Describe the fetal skull sutures
Middle one = sagital
Posterior one = lambdoid suture
Anterior one = coronal suture
Anterior continuation of sagital = anterior suture
Nerve supply to testis
spermatic plexus
T10 spinal segment
Which cell forms the blood-testis barrier. What happens within the sertoli cells
sertoli cells. They are the cells of the seminiferous tubules
Progenitor speratogonia cells differentiate gradually into sperm
Which cells form the seminiferous tubules
sertoli cells
What does sympathetic.parasympathetic do to the bladder?
Sympathetic is STORAGE
Parasympathetic is PEEING
T10-L2 for sympathetic
S2-S4 for parasympathetic
Arterial supply to bladder?
INTERNAL ILIAC:
Superior vesicle
Vaginal
Gluteal/obturator
In males, there is supplementation from the inferior vesicla artery (branch of external iliac)
Venous drainage of bladder?
vesical plexus
Lymphatic drainage of bladder?
common iliac nodes
internal iliac nodes
external iliac nodes
Layers of bladder
mucosa - columanar epithelium, lamina proprial
submucosa
detrusor
adventicia
Describe the full structure of sperm
HEAD = acrosome at the front and then nucleus containing genetic material
NECK = contains the centrioles (proximal and distal, which are necessary to initiate zygotic division
Mid piece = contain mitochondria which generate energy for swimming
Tail = longitudinal fibres (2x beta centrally) (9x alpha peripherally)
END PIECE
Describe the degrees of prolapse
0 - no prolapse
1 - >1cm in from the hymen
2 - <1cm in from the hymen - proximal or distal
3 - prolapsed beyond the hymen >1cm but <2cm past the hymen
4 - complete eversion of the vagina
What is the linea terminalis made of
It is basically the inlet of the pelvis (minus the sacral bit). It is made from the arcuate line (medial border or ileum), the pectinial line (the medial border of the superior pubic ramus) and the pubic crest (from the pubic symphsis to the pubic tubercles)
Descibe the inferior border of the pelvic inlet
pubic symphsis –> inferior ischiopubic rami –> ishial tuberosity (the large ligament that covers here is the sacrotuberous ligament
What does the sacrospinous ligament link to
ischial spine and the sacrum
What does the sacrotuberous ligament link to?
Name the bits
sacrum and ischeal tuberosity
What do sertoli and leydig cells secrete?
Which receptors do they have?
Sertoli = secrete inhibin. FSH receptors
Leydig = secrete testosterone, LH receptors
What angle is the pelvic inlet at in anatomical position in comparison to the horizontal
50-60 degrees
Venous drainage of uterus, ovaries, vagina, fallopian tubes, cervix
uterine veins, ovarian vein, vaginal venous plexus, uterine and ovarian veins, uterine veins
Venous drainage of small bowel and large bowel
small = superior mesenteric vein and hepatic portal vein
large = superior and inferior mesenteric veins which drain into the hepativ portal vein
Venous drainage of kidneys, bladder, ureters
renal veins - drain into IVC, vesical venous plexus, renal veins and superior/inferior vesical veins
Venous drainage of spleen, pancreas, stomach
splenic vein, pancreaticoduodenal veins and pancreatic veins, gastric veins and gastroepiplioc veins and short gastric veins
Where do each ovarian vein drain into
left - renal vein
right - IVC
What is the hepatic portal vein made of?
SMA and splenic (IMA drains into this)
What makes up the pudendal nerve?
Branches?
Which muscles does it innervate?
S2-4
Innervates levtor ani, bulbospongiosus, ischiospongiosus, external urethral spincter (women), external anal sphincter,
Branches - inferior rectal, perineal, dorsal nerve of the clitoris
NOT INTERNAL ANAL SPHINCTER - innervated by pelvic splanchnic nerves
What are the layers of an oocyte?
Outer most layer - corona radiata.
Then zona pellucida - for acrosome reaction
Innervation of the anal sphincters
Describe the branches of the pudendal nerve
Internal = pelvic splanchnic (S2-4) is parasympathetic. Involuntary. Sympathetic is hypogastric nerve L1-2
External = inferior rectal branch of pudendal (S2-4)
What is meralgia paresthstica?
Another name for lateral cutaneous femoral nerve entrapment.
Causes tingling or sensory change of lateral thigh with no muscle weakness
Sensory nerve supply to the external femal genitalia
Mons pubis - genital branch from genitofemoral nerve (from the lumbar plexus T12-L2)
Anterior labia - ilioinguinal nerve (branches into anterior labial nerves) From the lumbar plexus T12-L1
Posterior labia - perineal nerve from the pudendal nerve (From sacral plexus S2-S4)
Describe the degrees of perineal tear following birth
1st - vaginal mucosa or frenulum of labia minora
2nd - into perineal muscle but sparing the anal sphincter
3 - extends to anal sphincter
A - partial external anal sphincter tear with <50% thickness
B - partial external anal sphincter tear with >50% thickness
C - involves internal anal sphincter
4 - involves rectal mucosa
How many lobules are within each testi
What is a lobule
250-400
Functional unit of the tesis. Contains about 3 seminiferous tubules. Lobules are separated by fibroud septa which are extensions of the tunica albuginea
What is the boundary of the true pelvis
The pelvic brim.
What divides the pelvis into anterior and posterior
the vagina
What part of the nephron does ADH act on and what does it do?
The collecting duct. It increases the number of aquaporins which reabsorb water
Origins of the following arteries: uterine, vaginal, ovarian
Uterine - anterior division of the internal iliac artery
Vaginal - internal iliac
Ovarian - aorta
Describe the course of the pudendal nerve
Forms from S2-4 and exits the pelvis via the greater sciatic foramen. Travels along the border of the sacrospinous ligament and re-ernters the pelvis by the lesser sciatic foramen
What are the contents of the greater sciatic foramen
Nerves = Sciatic nerve, pudendal nerve, superior and inferior gluteal nerves, posterior femoral cutenous nerve, nerve to quadratis femoria and nerve to obturator internus
Vessels = superior and inferior gluteal artery and vein, internal pudendal artery and vein
Muscles = piriformis
What are the average measurements of the pelvic inlet: oblique, anteroposterior, transverse
oblique = 12cm
anteroposterior = 13cm
transverse = 11cm
What does the femoral sheath contain?
Femoral artery (branches into common and deep)
Femoral vein (branches the great saphenous vein = the saphenofemoral junction)
Femoral canal - which contains the Deep inguinal nodes
The femoral nerve is NOT contained within the sheath, it travels next to it
What are antigen presenting cells?
They find antigens and present them to the T cells. However, most cells can do this via major histocompatability compex (MHC) type 1 and are called non-professional APCs.
Macrophages are professional APCs and present using MHC1 and MHC2 which means they can recruit CD4 (t helper cells) and CD8 (cytotoxic t cells)
Give examples of APCs
macrophages
dendritic cells
B cells
Where do macrophages develop from
monocytes
Describe the anatomy of Hesselbch’s triangle
Describe the antomy of the under side of the peritoneum
Borders of the triangle:
- Medial = lateral border of rectus bdominis
- Inferior = inguinal ligament
- Lateral = Inferior epigastric vessels (branch off external iliac vessels)
- The inguinal fossa is located on the peritoneal surface of the anterior abdominal wall.
It has 3 thicker areas which are:
- lateral umbilical fold - contains the inferior epigastric artery
- medial umbilical ligament: remnant of the umbilical artery
- median umbilical ligament: remnant of urachus
What does urachus become?
What is it?
Fibroud structure in the midline attaching the bladder to the belly button.
It becomes the MEDIAN umbilical ligament
What is the MEDIAL umbilical ligament a remnant of?
umbilical arteries
What is the lateral umbilical?
What does it contain?
Contains the inferior epigastric arteries
Describe the boundaries of the inguinal canal
Anterior = aponeurosis of the external oblique - laterally reinforced by the internal oblique apneurosis
Posterior = conjoint tendon (medial) and transversal is fascia
Floor = inguinal ligament and lacunar ligament
Roof = internal oblique and transverse abdominis
What does the inguinal canal contain?
Females = round ligament of the uterus, ilioinguinal nerve, genital branch of genitofemoral nerve
Males = spermatic cord, ilioinguinal nerve, genital branch of genitofemoral nerve
What contributes to the lumbar plexus
T12-L4
Which nerves come from the lumbar plexus and which spinal roots are they from?
TOTAL PLEXUS = T12-L4
Iliohypogastric - T12/L1
Ilionguinal - L1
Genitofemoral - L1/L2
Lateral cutaneous femoral - L2/L3
Femoral - L2-L4
Accessory obturator - L2/3
Obturator - L2-L4
Lumbosacral trunk
Where does the ilioingiunal nerve come from ?
What does it inneravate?
L1
MOTOR: internal oblique, transversus abdominis
SENSORY: anterior labia, anterior scrotum
Where does the iliohypogastric nerve come from ?
What does it inneravate?
T12/L1
MOTOR: internal oblique, transversus abdominis
SENSORY: mons pubis, upper buttock
Where does the genitofemoral nerve come from?
What does it inneravate?
L1/L2
MOTOR: cremaster muscle, no motor function in females
SENSORY: (femoral branch) upper medial thigh, scrotum or labia majora/mons pubis (genital branch)
Where does the lateral femoral cutaneous nerve come from?
What does it inneravate?
L2/L3
NO MOTOR.
SENSORY: lateral thigh
Where does the femoral nerve come from?
What does it inneravate?
L2-L4
MOTOR: QUADS - quadriceps femoris, pectinius, sartorius, iliopsoas
SENSORY: anterior medial thigh (anterior femoral), medial lower leg (saphenous)
Where does the obturator nerve come from?
What does it inneravate?
L2-L4
MOTOR: ADDUCTORS (magnus, longus, brevis), gracilis, obturator externus
SENSORY: medial upper thigh
Which is the narrowest portion of the male urethra
membranous. Contains the external urethral sphincter
Boundaries of the pelvic outlet
POSTERIOR = tip of coccyx
POSTEROLATERAL = sacrotuberous ligaments
LATERAL = ischial tuberosities
ANTERIOR = pubic arch
What supplies the sympathetic nerves to the uterus and cervix
inferior hypogastric plexus.
T10-L1.
During labour the pain is therefore referred here.
What supplies the PARAsympathetic nerves to the uterus and cervix
mainly the pudendal nerve from S2-4.
Also contributing - branch of the femoral nerve and the genitofemoral nerve
Where doe sthe vagina drain lymph to?
UPPER vagina = internal and external iliac nodes
LOWER vagina = inguinal nodes
Name the drainage of the different parts of the female reproductive tract into the lymph system: breast, ovary, tubes, uterus, cervix, vagina
breast - axillary and parasternal
ovary - para-aortic
tubes - paraaortic
cervix - external iliac
uterus - internal iliac but fundus para-aortic
vagina - lower to inguinal, upper to I/E iliac nodes
Which bone forms the arcuate line
internal border of the ilium.
What are the contents of the broad ligament
2 TUBES, 2 OVARY, 2 UTERUS
fallopian tubes (as in we have two tubes)
ovarian artery, ovarian ligament
uterine artery, round ligament of uterus
Layers of the testis
INNER TO OUTER:
Tunical vascularis
Tunica albuginea
tunical vaginalis (visceral)
tunical vaginalis (parietal)
fascia
dartos muscle
Skin
lymph drainage of the scrotum
superficial inguinal nodes
artery to scrotum
anterior scrotal artery
posterior scrotal artery
vein to scrotum
testicular vein
nerves to scrotum
ilioinguinal nerve (sensation for cremasteric reflex)
genital branch of genitofemoral (motor for cremasteric reflex)
posterior femoral cutaneous
What is the function of piriformis muscle
external rotation of the hip
inserts onto greater trochanter.
originates from the sacrum
Innervated by superior gluteal nerve
parasympathetic innervation of bladder
pelvic splanchnic nerves - S2-4
What is the superficial inguinal ring a hole in
external oblique anoneurosis
Describe the rectus sheath above and below the arcuate line
ABOVE = the rectus abdominis lies in the internal oblique aponeurosis.
BELOW = the rectus pierces the transversalis and travels behind it
Where is the arcuate line
1/3 from the belly button to the pubis
In early labour which deramtome is pain referred to?
T11-T12
What type of joint is the sacroiliac
synovial
What type of joint is the pubic symphsis
secondary cartilaginous
What is the normal functional bladder capacity of a human?
400-600ml
Describe the structure of the detrusor muscle
3 layers
2x outer longitudinal smooth muscle layers with one circular muscle layer in between
Which cells secrete renin in the kidneys
juxtaglomerular cells
What is the juxtoglomerular apparatus made of?
- juxtoglomerular cells - secrete renin
- macula densa - measures changes in NaCl
- extraglomerular mesangial cells
What is the rectus sheath made of
aponeurosis of internal, external oblique and transversalis
Arterial supply to: ascending colon, proximal 2/3 of transverse colon, distal 1/3 of transverse colon, descending colon, sigmoid, upper 2/3 rectum, bottom 1/3 rectum, anus
ascending colon = SMA (right colic)
proximal 2/3 of transverse colon = SMA (middle colic)
distal 1/3 of transverse colon = IMA (left colic)
descending colon = IMA (left colic)
sigmoid = sigmoid (IMA)
upper 2/3 rectum = superior rectal (IMA)
bottom 1/3 rectum = middle rectal (internal iliac)
anus = inferior rectal (pudendal)
Which muscles are in the superficial peroneal pouch?
What about the deep?
Ischiocavernosus, bulbospongiosus, superficial transver peroneal
In the deep:
External urethral sphincter
deep transverse perineal muscles
What does the round ligament of the uterus originate from?
The gubernaculum
Where do the bladder arteries come from
internal iliac
Which part of the kidney are the functional units (nephrons)
In the renal cortex.
Which nucleus in the hypothalamus releases oxytocin, vasopressin, somatostatin, TRH and CRH
paraventricular nucleus
Superior and inferior borders of the deep peroneal pouch?
superior = urogenital diaphragm
inferior = peroneal membrane
Contents = external urethral sphincter, deep transverse peroneal muscle, urethrovaginal sphincter, compressor urethrae muscle
Which nerve innervates the testis
T10, spermatic plexus
Artery to: foregut, midgut, hindgut
Foregut = Coeliac Trunk
Midgut = Superior Mesenteric
Hindgut = Inferior Mesenteric
When can the urge to void first be felt
150ml
Which parts of the urethra are found within the deep perineal pouch
women - proximal
men - membranous
How does the epithelium in the male urethra change
proximal - transitional
middle - stratified columnar
distal - stratified squamous
What is the posterior scrotal artery a branch of?
internal pudendal
How much colder is the scrotum than the body
2 degs
Where does the vaginal artery arise from
usually internal iliac but can come from uterine
What is the anterior scrotal artery a branch of?
And where does this artery come from
External pudendal
The external pudendal is a branch of the femoral artery
Where does glucose reabsorption occur in the nephron
proximal convoluted tubule
Describe the breast anatomy
15-20 lobes
each lobe contains lobules
each lobule contains a group of alveoli
alveoli are milk-secreting cuboidal cells surrounded by myoepithelial cells
how many nephrons does the average kidney contain
1,000,000
Where does the pituitary gland sit?
sella turcica. This is an impression in the sphenoid bone
Where in the brain is the hypothalamus located?
In the diencephalon
What are the branches of the internal iliac artery
ANTERIOR DIVISION
POSTERIOR DIVISION
What is the falciform ligament and what does it contain
It contains the ligamentum teres which is the reminant of the free border of the umbilical vein
It also anatomically divides the left lobe of the liver into medial and lateral sections
Inferior to the umbilicus, what are the peritoneal folds?
One median fold - contains remenant of urachus - attached to bladder
Two medial folds - umbilical artery remnants
Two lateral umbilical folds - deep inferior epigastric vessels
What is the blood supply to the anterior abdominal wall
Superficial layers - superficial to the sheath
- Sueprficial inferior epigastric artery
- Superficial circumflex artery
- BOTH of these arise from the femoral artery from the external iliac artery
Deep layers - deep to the rectus muscles and anterior to posterior sheath
- deep inferior epigastric arteries
- FROM THE EXTERNAL ILIAC
Which type of incision is associated with less nerve injury.
Which nerve is most at risk?
Midline.
Ilioinguinal
What is palmer’s point?
3cm inferior to costal margin in midclavicular line.
Useful in:
- suspected adhesions
- Big masses
- Umbilical hernias
What are the branches of the:
Anterior division
Posterior division
Of the internal iliac artery
Anterior:
- Obturator
- Umbilical (gives rise to superior vesicle artery)
- Uterine artery
- Vaginal artery (in females this replaces inferior vesicular artery - this branches from vaginal)
- Middle rectal
- Internal pudendal
- Inferior gluteal artery (terminal)
Posterior:
- Superior gluteal artery
- Iliolumbar
- Lateral sacral
What are the branches of the external iliac artery
Inferior epigastric arteries
Deep circumflex iliac artery
Becomes the Femoral artery when it exits the pelvis
I Dont give a Fuck about the EIA
What are the boundaries of the femoral triangle
Medial = adductor longus
Lateral = sartorius
Superior = inguinal ligament
Floor = pectinius, adductor longus
Roof = fascia lata
Where do the testicular arteries branch from
AORTA! think like ovarian
Describe the course of the round ligament of the uterus
Uterine horns –> leaves pelvis via deep inguinal ring
Travels through the inguinal canal –> attaches to mons pubis
Where is the uterine artery in relation to th ureter
Crosses ANTERIORLY
How long is the female urethra
4cm
What is the posterior border of the inguinal canal
Transversalis fascia
Reinforced by conjoint tendon
What is the blood supply to levator ani
Inferior gluteal artery
What is the sympathetic supply to the bladder
T10-L2
Which artery exits the pelvis via the greater sciatic foramen and re-enters via the lesser sciatic foramen
Internal pudendal. The other vessels dont re-enter
What are the contents of the femoral triangle
Femoral artery
Femoral vein (and saphenofemoral junction)
Deep inguinal nodes
Femoral nerve and terminal branches
Femoral sheath
DOESNT CONTAIN GENITAL BRANCH OF GF nerve
What is the treatment of gonnorhoea in pregnant vs non pregnant people
Non-pregnant = ceftriaxone + azithromycin one off
Pregnant = SAME AS NON PREGNANT
