Anatomy 2 Flashcards
What does the spemratic cord connect
The spermatic cord is the tube-shaped connection between the pouch in the scrotum and the abdominal wall
where are spermatozoa produced
Spermatozoa are produced by the highly coiled seminiferous tubules
describe what the seminiferous tubules become
- the seminferious tubules become straight tubules which then project into the retentions testes which project form the capsule into the posterior aspect of the gonad
how many ducts originate from the retentions testes
Approximately 12-20 efferent ductules originate from the upper end of the rete testis, penetrate the capsule and connect with the epididymis.
Where is testicular pain referred?
x
How is this plexus involved in regulating the testicular temperature?
x
What is the epididymis and what is the structure of it
The epididymis is a single, long coiled duct that courses along the posterolateral side of the tesis, and consists of:
- The efferent ductules (head of epididymus)
- The true epididymus (body and tail of epididymus)
what is the end of epididymis continuous with
the end is continuous with the vas deferens
what happens to the spermatozoa in the epididymis
During passage through the epididymus, spermatozoa acquire the ability to move and fertilize an egg, and are stored here until ejaculation
what is the ductus deferent
The ductus deferens is a long muscular duct that transports spermatozoa from the tail of the epididymus in the scrotum to the ejaculatory duct in the pelvic cavity/prostate
Where do the gubernaculums develop
This process depends on the development of the gubernaculums, which extends from the inferior border of the developing gonads to the labioscrotal swellings.
What are the structures in the spermatic cord
- The ductus referens
- The artery to ductus referens
- The testicular artery
- The testicular veins (pampiniform plexus of veins)
- The cremasteric artery and vein
- The genital branch of the genitofemoral nerve (to cremaster muscle)
- Sympathetic and visceral afferent nerve fibres
- Lymphatics
- The remnants of the processus vaginalis
what is the inguinal canal
The inguinal canal is a slit-like passage that extends downwards and medially, above and parallel to the inguinal ligament.
It begins at the deep inguinal ring and continues for 4 cm, ending at the superficial ring
- Varicocele -
s
- Hydrocele –
Hydrocele of Testis –
Hydrocele of spermatic cord
s
- Hematocele -
s
- Testicular Torsions –
s
what is a vasectomy
The common method of sterilizing males is deferentectomy, popularily called a vasectomy
what happens in a vasectomy
- During this procedure, part of the ductus deferens is ligated and/or excised through an incision in the superior part of the scrotum.
- Hence the ejaculatory fluid from the seminal glands, prostate and bulbourethral glands contains no sperm.
where does the male bladder sit in comparison to the female bladder
The male bladder sits slightly more superior than the female bladder
what does the male bladder have at its inferior surface
prostate gland
what does the internal urethral sphincter contract for
. This sphincter contracts during ejaculation to prevent retrograde ejaculation of semen into the bladder
What are seminal vesicles and where do they lie
The seminal vesicle glands are two elongated structures approximately 5cm long that lie between the bladder and rectum.
what do seminal vesicles secrete
They are obliquely placed superior to the prostate and secrete a thick alkaline fluid
what does seminal fluid contain
The fluid contains high levels of fructose, that provide energy for sperm, and also a coagulation agent which mixes with the sperms as they pass into the ejaculatory ducts of the urethra
what is the arterial supply of the seminal vesicles
The arterial supply of the seminal vesicles arises from the inferior vesical and middle rectal arteries.
What structures is the prostate related to
- Base: neck of the bladder
- Apex: fascia on the superior surface of the urethral sphincter and deep perineal muscles
- Muscular anterior surface: retropubic space and pubic symphisis
- Posterior: ampulla of the rectum
- Inferolateral: levator ani
how long is the male urethra
18-22cm long
what parts is the part of the male urethra
- pre-prostatic
- prostatic
- membranous(intermediate)
- spongy
describe each part fo the 4 parts of the male urethra
pre-prostatic
- 0.5cm - 1.5cm
- vertical through the neck of the bladder
- surrounded by the internal urehtra sphincter
- prostatic
- 3-4cm
- descends through anterior prostate
- widest and most dilatable ejactlatory ducts, prostatic utricle
- prostatic sinuses open into
- membranous(intermediate)
- 1-1.5cm
- thought deep perineal pouch
- surrounded by circular fibres of external urethra sphincter and the bulbourethral glands
- spongy
- 15cm
- courses through the corpus spongiosum
- longest and most mobile bulburethral gland opens to proximal part
define hyperplasia
increase in number
define hypertrophy
increase in size
what cells undergo hyperplasia in BPE
the epithelial and stromal cells of the prostate undergo hyperplasi
what does the hyperplasia fo stromal and epithelial cells result in which leads to BPE
This results in the formation of nodules in the periurethral region of the prostate.
Once the nodule has increased sufficiently prostatic urethra compression occurs causing urinary symptoms.
How many men develop prostate cancer by the age of 80
More than 80% of men will develop prostate cancer by the age of 80. However, in the majority of cases, it will be slow-growing and harmless.
what different symptoms might men with prostate cancer experience in comparison to BPE
dysuria and haematuria
Where does prostate cancer spread
Prostate cancer is most likely to spread to bone and therefore bone pain and symptoms of hypercalcaemia (bones, groans, stones, thrones, and psychiatric overtones).
what is the treatment of prostate cancer
Treatment is variable depending on both patient factors (such as grade and stage) and also tumour factors (such as grade and stage
- Many men diagnosed with low-risk prostate cancer are eligible for active surveillance.
what does active surveillance in prostate cancer mean
. Active surveillance involves monitoring the tumor for signs of growth or the appearance of symptoms. The monitoring process may involve serial PSA, physical examination of the prostate, and/or repeated biopsies
what does treatment for aggressive prostate cancer involve
Treatment for aggressive prostate cancers involves surgery (i.e. radical prostatectomy), radiation therapy including brachytherapy (prostate brachytherapy) and external beam radiation therapy, high-intensity focused ultrasound (HIFU), chemotherapy, oral chemotherapeutic drugs (Temozolomide/TMZ), cryosurgery, hormonal therapy, or some combination.
Name the muscle which contributes towards erection.
Ischiocavernosus
What is the arterial supply of the penis
The penis receives arterial supply from three sources:
- Dorsal arteries of the penis
- Deep arteries of the penis
- Bulbourethral artery
These arteries are all branches of the internal pudendal artery. This vessel arises from the anterior division of the internal iliac artery.
what is the symapathetic supply of the pensi
Two hypogastric nerves on each side enter the pelvis, which are formed by the separation of the fibres in the superior hypogastric plexus at L5 (ascending parasympathetic and descending sympathetic
what is the inferior hypogastiric plexus formed by
The inferior hypogastric plexus is formed in part by pelvic splanchnic nerves (parasympathetic nerves leaving the anterio rami of the sacral spinal nerves) from S2 to S4
. Parasympathetic nerves derived from these plexuses penetrate the pelvic floor to innervate erectile tissue in both sexes.
Terminal branches from this plexus pass through the deep perineal pouch and innervate erectile tissue. In men, these nerves (also known as cavernous nerves) are extensions from the prostatic plexus
what do the paraysmtpehtic fibres that enter the pelvic plexus do
- Are generally vasodilatory
- Stimulate bladder contraction (detrusor muscle & internal urethral sphincter)
- Stimulate erection
- (Modulate activity of the enteric nervous system)
what does stimulation of the parasympathetic nerves cause in the erectile tissues
Stimulation of parasympathetic nerves causes specific arteries in erectile tissues to relax, allowing blood to fill these tissues (corpora cavernosa and corpus spongiosum), causing the penis (and clitoris in women) to become erect.
where do arteries of the pneis come from
- they come from the internal pudendal artery
what do the sympathetic fibres do
- Innervate blood vessels
- Cause contraction of smooth muscle in the internal urethral sphincter in men and internal anal sphincter in both sexes
- Cause smooth muscle contraction associated with the reproductive tract and with the accessory glands of the reproductive system
- Move semen and secretion from the epididymus and associated glands into the urethra during ejaculation
name the three major terminal branches of the pudnedal nerve
- inferior rectal
- perineal nerve
- dorsal nerve of the penis
describe what the inferior rectal nerve innervates
o Motor: external sphincter muscle, levator ani muscle
o Sensory: anal triangle
describe what the perineal nerve innervates
o Motor: urogenital triangle, superficial and deep perineal pouch
o Sensory: urogenital triangle, posterior scrotal nerve (posterior labial nerve in women)
describe what the dorsal nerve of the penis innervates
o Sensory to glans of penis (or clitoris)
what nerve supples the scrotal skin
Anterior and anterolateral aspect – Anterior scrotal nerves derived from the genital branch of genitofemoral nerve and ilioinguinal nerve
Posterior aspect – Posterior scrotal nerves derived from the perineal branches of the pudendal nerve and posterior femoral cutaneous nerve.
what is the lymphatic drainage of the scrotum
The lymphatic fluid from the scrotum drains to the nearby superficial inguinal nodes.
what is article dysfunction
Erectile dysfunction (ED) is the inability to get and maintain an erection that is sufficient for satisfactory sexual intercourse
what is the treatment for erectile dysfunction
A vacuum pump is a treatment method for ED. It consists of a clear plastic tube that is connected to a pump, which is either hand or battery operated. This creates a vacuum that causes the blood to fill the penis, then a rubber ring is placed around the base of the penis in order to keep the blood in place, allowing the maintenance of an erection for around 30 minutes.
describe the upper 2/3 of the anal canal
- derived from the hindgut
• lined by columnar epithelium
• vertical folds – anal columns joined together inferiorly by semilunar folds – the anal valves
• nerve supply same as rectal mucosa
• arterial supply and venous drainage same as hindgut (inf mesenteric)
• lymphatic drainage along superior rectal artery to inf. mesenteric nodes
describe the lower 1/3 of the anal canal
- derived from ectoderm
• lined by stratified squamous epithelium – merges with skin of anus
• no anal columns
• nerve supply somatic – inferior rectal branch of pudendal
• arterial supply and venous - inferior rectal – branch of pudendal – internal illiac
• lymphatic drainage down to superficial inguinal nodes
what is the pectinate line
The Pectinate Line (also called the Dentate line) is of particular importance clinically because it is visible and represents the hindgut-proctodeum junction.
What sphincters does the anal canal have
The anal canal has an involunatary sphincter the internal anal sphincter and a voluntary external sphincter
what is formed at the junction of the rectum and anal canal
At the junction of the rectum and the anal canal, the internal sphincter, the deep part of the external sphincter and the puborectalis muscles form a distinct ring, called the anorectal ring, which can be felt on rectal examination
What are haemorrhoids?
Hemorrhoids are swollen veins in the lowest part of your rectum and anus. Sometimes the walls of these blood vessels stretch so thin that the veins bulge and get irritated, especially when you poop
what are the symptoms of haemorrhoids
bright red blood after you poo
an itchy anus
feeling like you still need to poo after going to the toilet
slimy mucus in your underwear or on toilet paper after wiping your bottom
lumps around your anus
pain around your anus
what are prolapse haemorrhoids
notice a lump around the anus which may need to be “pushed back” or may return to the anal canal on their own following a bowel movement. These are known as “prolaped” haemorrhoids
What is the treatment of haemorrhoids
The simplest treatment is to increase the amount of fibre (e.g. fruits, vegetables, breads and cereals) and fluids in the diet, avoid straining or spending a long time on the toilet.
what procedures can be performed for treatments for haemorrhoids
- Rubber band ligation
- Injection sclerotherapy
- Hemorrhoidectomy
- Stapled haemorrhoidopexy
what is a perineal haematoma
Patients may suddenly develop a small painful lump at the edge of the anus. This often happens after passing stool and represents a ruptured blood vessel at the edge of the anal canal
how do you treat perineal haematoma
Avoiding constipation and using simple painkillers is often all that is required.
Sitting in warm water for about 10 minutes may also help and the pain usually subsides in a few days.
If the pain is severe or persistent the blood clot can be evacuated using a small incision under local anaesthesia as an outpatient to provide relief.
what is a peri-anal abscess
An abscess forms when one of the glands which surround the anal canal becomes blocked and infected with bacteria
what are the symptoms of a peri-anal abscess
severe pain often associated with fever and feeling generally unwell.
who does a peri-anal abscess develop in
Some groups of patients such as those with Crohn’s disease are more prone to develop these abscesses.
what is the treatment for a peri-anal abscess
The treatment for these abscesses is by surgery.
what is a fistula-in-Ano
An anal fistula is a connection, or tunnel, between the inside of the anal canal and the skin around it. It is the result of a previous abscess which develops when the anal glands become blocked and subsequently infected
when does a fistula-in-Ano present
Fistulas present about 4-6 weeks after an abscess has been treated but may become obvious months or years later
what does a fistula lead to
A fistula leads to persistent discharge of pus or fluid around the anus leading to soiling of underwear and skin irritation
how do you treat fistuala-in-ano
Surgery is the treatment of choice to cure an anal fistula
what is an anal fissure
An anal fissure is a small tear in the skin that lines the anus
How do anal fissures present
They present with pain on defecation and bright fresh rectal bleeding usually o the toilet paper
The pain associated with a fissure may be so severe that patients avoid going to the bathroom, this leads to constipation and even more pain.
When do fissures occur
Fissures typically occur following trauma to the lining of the anal canal, this is commonly due to passing hard dry stool such as with constipation.
what are anal fissures associated with
They may also be associated with inflammatory conditions such as Crohn’s disease.
What are the type of fissures
Fissures are divided into acute, which are of new onset, and chronic which have been present for over 6 weeks or are recurrent.
What are chronic fissures associated with
Chronic fissures are usually associated with a small skin tag at the anal margin known as a sentinel pile.
how do you treat acute fissures
Acute fissures are likely to resolve without the need for surgery. Simple measures to avoid constipation such as increasing the amount of fibre in the diet, increasing liquid intake, using stool softeners are often sufficient
How do you treat chronic fissure
Applying a pea sized lump of 2% diltiazem cream to the anal canal twice a day is a simple measure which causes the anal sphincter muscle to relax and leads to fissure healing in over 50% of people
If creams fail, injecting Botox (botulinum toxin) directly into the sphincter muscle can be attempted and may lead to healing in up to 75% of patients
Surgical treatment
This usually consists of an operation to cut a small portion of the internal anal sphincter muscle (a lateral sphincterotomy
why is GTN not tolerated for treatment for acute fissure
Although some favour the use of GTN ointment, which has the same effect as diltiazem, this may not be tolerated by some people due to the development of headaches
when do anal cancers arise from
Anal cancers usually arise from the skin cells (squamous cells) around the anal opening and are known as squamous cell carcinomas.
What are the symptoms of anal canal
. The symptoms of anal cancer are similar to those of many anal canal lesions such as itching, bleeding, pain, feeling a lump, an alteration in bowel habit and even swollen glands in the groin.
What are the risk factors for anal cancer
Risk factors for developing anal cancer include; age, the presence of anal warts and infection with the human papilloma virus (HPV), anal sex, HIV infection, smoking, impaired immunity and previous pelvic irradiation.
