Anatomy Flashcards
1
Q
Key bony landmarks of the pubis
A
Iliac crest Iliac fossa ASIS Anterior sacro-iliac joint Ischial spine Pubic symphysis
2
Q
Bony tubercle at the top of the femur
A
Lesser trochanter
3
Q
Holes in the pubis next to the pubic symphysis
A
Obturator foramen
4
Q
4 key muscles of the posterior abdominal wall
A
Psoas (medial)
Quadratus
Iliacus
Transversus (lateral)
5
Q
Quadratus lumborum origin
A
Iliac crest
6
Q
Quadratus lumborum insertion
A
12th rib
7
Q
Quadratus lumborum action
A
Supports posterior abdominal wall and 12th rib
Involved in forced expiration and flexing trunk to one side
8
Q
Quadratus lumborum innervation
A
Anterior rami
9
Q
Iliacus origin
A
Iliac fossa
10
Q
Iliacus insertion
A
Lesser trochanter of femur (joins psoas to form common tendon)
11
Q
Iliacus action
A
Hip flexion
12
Q
Iliacus innervation
A
Femoral nerve from L2-4
Only one not innervated by segmental rami
13
Q
Psoas origin
A
T12, L1-L5 vertebral bodies and interverterbral discs
14
Q
Psoas insertion
A
Lesser trochanter of femur (joins iliacus to form common tendon)
15
Q
Psoas action
A
Raises body from supine position
Bends trunk laterally and hip flexion
16
Q
Psoas innervation
A
Anterior rami
17
Q
How many pairs of arteries and veins supply and drain the posterior abdominal wall?
A
5 pairs of arteries and 5 pairs of veins
Arteries come from posterior aspect of aorta
18
Q
Kidney position
A
Retroperitoneal
Both on top of psoas and quadratus lumborum
Right kidney behind and below rib 12
Left kidney behind and below ribs 11 and 12
19
Q
What spinal level does the ureter exit the kidney?
A
L1 - transpyloric plane
20
Q
Fascia and fat around the kidneys
A
Peritoneum
Renal fascia - continuous with transversalis fascia
Perinephric fat immediately surrounding kidney
Paranephric fat separating kidney and perinephric fat from muscles
21
Q
Renal veins
A
IVC anterior to aorta and ureters/renal pelvis
Each hilum has one renal vein branching from L1/L2 level
IVC posterior to splenic vein and body of pancreas
IVC sends small branch to right kidney and 3x longer branch to left kidney
22
Q
Nutcracker syndrome
A
Compression of the left renal vein by the overpassing superior mesenteric artery stops left kidney from draining
23
Q
Renal arteries
A
Aorta sends small branch to left kidney and slightly longer branch to right kidney at L1/L2 level
Renal arteries posterior to IVC
Superior mesenteric artery of aorta descends down anterior to left renal vein
24
Q
Innervation of kidneys
A
Sympathetic: T10/11/12
Parasymapthetic: Vagus
Referred pain to flank (middle outer segments)
25
Lymphatic drainage of kidneys
Para-aortic nodes at L1/L2
26
Morrisons pouch
Potential space - shouldn't be anything there but can fill with fluid
Between liver and kidney
27
Ureters
Smooth muscle tubes that carry urine from kidneys to bladder using smooth muscle contractions and filtration pressure from glomeruli
About 25 cm long
28
Ureteric course
Exit kidneys at the transpyloric plane L1
Extend vertically down from hilum on the surface of psoas muscle
Crosses bifurcation of common iliac artery at anterior sacroiliac joint
Passes on lateral wall of pelvis towards ischial spine
Enters bladder on interior surface at trigone
29
Trigone
Smooth triangular region at base of bladder where the ureters enter to deposit urine and the urethra exits
In between ureteric openings is the inter-ureteric crest
30
Arterial supply of ureters
Superior third: renal artery
Middle third: gonadal arteries and iliac arteries
Inferior third: superior vesical artery from internal iliac artery
31
Venous drainage of ureters
Superior third: renal vein
Middle third: gonadal veins and iliac veins
Inferior third: superior vesical vein to internal iliac vein
32
Nervous supply of ureters
Superior third: renal plexus T11/T12
| Inferior third: hypogastric plexus (superior and inferior)
33
Lymphatic drainage of ureters
Para-aortic nodes at L1/L2 to iliac nodes
34
Ureteric pain
Loin to groin
| Referred to different areas depending on area affected
35
3 constrictions of ureters
Pelvi-ureteric junction (where the renal pelvis becomes the ureter)
Where ureters cross the pelvic brim (anterior crossing of common iliac artery bifurcation)
Ureto-vesicular junction (where they enter the wall of the bladder)
- most common sites of renal calculus obstruction
36
Bladder epithelium
Transitional epithelium
Rugae to help expand as it fills
Smooth muscle coat and smooth muscle sphincters at the neck
37
Bladder muscle
Detrusor muscle, innervated by parasympathetic nerves
38
Arterial supply of bladder
Superior and inferior vesical arteries off internal iliac arteries
39
Inferior vesical artery in females
Normally corresponds to uterine artery
40
Venous drainage of bladder
Vesical plexus which drains to internal iliac veins
41
Nervous supply of bladder
ANS inferior hypogastric plexus at L1/L2
Sympathetic: sacral splanchnic nerves (L1/L2)
Parasympathetic: pelvic splanchnic nerves
Pain referred to suprapubic region at L1/L2 dermatomes
42
Male urethra
4 distinct regions:
1) pre-prostatic (IUS)
2) prostatic (widest part)
3) membranous (thinnest part, through deep perineal pouch)
4) spongy (through corpus spongiosum)
43
Female urethra
No distinct regions, no internal urethral sphincter
44
Male urethral sphincters
EUS: consciously controlled, in the deep perineal pouch (membranous section of urethra)
IUS: sympathetically controlled, present to prevent retrograde ejaculation during sex
45
Drainage of urethra
Main drainage to internal iliac nodes
| Drainage changes as the urethra becomes more distal, more information not important
46
Nerves of the lumbar plexus
```
Subcostal (T12)
Iliohypogastric (L1)
Ilioinguinal (L1)
Genitofemoral (L1 and L2)
Lateral femoral cutaneous (L2 and L3)
Femoral (L2, L3 and L4)
Obturator (L2, L3 and L4)
```
47
Iliohypohastric nerve
L1
Motor: transversus abdominis and internal oblique
Sensory: lateral gluteal and pibuc skin
Emerges at lateral border of psoas and runs obliquely over quadratus lumborum superior to ilioinguinal
Pierces transversus abdominis
48
Ilioinguinal nerve
L1
Motor: transversus abdominis and internal oblique
Sensory: Skin of medial thigh, root of penis and scrotum, mons pubis and labia majora
Emerges at lateral border of psoas and runs obliquely over quadratus lumborum inferior to iliohypogastric
Pierces internal oblique to enter inguinal canal and accompany spermatic cord through superficial inguinal ring
49
Genitofemoral nerve
L1 and L2
Motor: cremaster muscle
Sensory: scrotum, mons pubis, skin of upper anterior thigh
Two branches - genital and femoral
Emerges through and runs on top of psoas
Genital branch enters spermatic cord
Femoral branch passes under inguinal ligament
50
Lateral femoral cutaneous nerve
L2 and L3
Sensory only: skin on anterior and lateral thigh
Emerges from lateral border of psoas and descends obliquely across surface of iliacus
Passes under inguinal ligament at lateral side
51
Bernhardt-Roth syndrome
Numbness of outer thigh due to compression of lateral femoral cutaneous nerve as it passes under the inguinal ligament
Can be caused by exercise, seat belts, tight clothing etc.
52
Femoral nerve
L2, L3 and L4
Motor: pectineus, iliacus and anterior compartment of thigh
Sensory: skin on anterior thigh and medial leg
Emerges from lower lateral border of psoas, runs between iliacus and psoas and passes under inguinal ligament to thigh
53
Obturator nerve
L2, L3 and L4
Motor: obturator externus and medial compartment of thigh
Sensory: skin on medial thigh
Emerges from lower medial border of psoas, passses behind common iliac arteries and lateral to internal iliac and ureters
Exits via obturator foramen
54
3 key pelvic ligaments
Inguinal ligament
Lacunar ligament
Pectineal ligament
55
Inguinal ligament
ASIS to pubic tubercle
| Formed from rolled edge of external oblique aponeurosis
56
Lacunar ligament
Connects inguinal and pectineal ligaments
57
Pectineal ligament
Pectineal line of pubic bone
58
Inguinal canal
Oblique passage through lower abdominal wall
Prevents herniation of abdominal contents
4 cm long
Deep inguinal ring to superficial inguinal ring
Carries ilioinguinal nerve
59
Inguinal canal in males
Carries structures to and from testis and abdomen via spermatic cord
60
Inguinal canal in females
Carries round ligament of uterus from pelvis to labia majora
61
Superficial inguinal ring
Triangular shaped defect in aponeurosis of external oblique
Superior and lateral to pubic tubercle
Margins give rise to external spermatic fascia of spermatic cord
62
Deep inguinal ring
Oval opening in transversalis fascia
| Gives rise to internal spermatic fascia of spermatic cord in men and round ligament fascia in women
63
Mid-inguinal point
Halfway between ASIS and pubic symphysis
64
Conjoint tendon
Common tendon of pubic crest/pectineal line made from transversus abdominis and internal oblique
65
Cremaster muscle
Muscular layer from the internal oblique
| Draws testes up into the body
66
3 layers of spermatic cord
External spermatic fascia
Internal spermatic fascia
Cremasteric muscle
67
Anterior wall of inguinal canal
Aponeurosis of external oblique
| A bit of internal oblique
68
Floor of inguinal canal
Inguinal ligament and lacunar ligament
69
Roof of inguinal canal
Fibres of internal oblique and transversus abdominis
70
Posterior wall of inguinal canal
Transversalis fascia and conjoint tendon
71
Inguinal triangle
Site of direct hernia, where abdominal structures push through weakened abdominal wall
Made up by the rectus abdominis, inferior epigastric artery and inguinal ligament
72
Spermatic cord
Begins at deep inguinal ring and ends at testis
Arises from peritoneal diverticulum (processus vaginalis) and pushes through abdominal wall, pulling a tubular sheath from each layer to make 3 concentric layers to guide structures through the inguinal canal
73
Tunica vaginalis
Remnant of peritoneal outpouching pinching off in the scrotum
74
Scrotum
Outpouching of skin from abdominal wall
| Contains testes, epididymis and lower end of spermatic cords
75
Scrotum blood supply
Internal and external pudendal arteries
76
Fascia of scrotum
Superficial continuous with Scarpas
Fat replaced by Dartos
Dartos continuous posteriorly with Colles
77
Contents of spermatic cord
```
3 arteries:
- testicular
- artery of vas deferens
- cremasteric
3 nerves:
- genital branch of genitofemoral
- sympathetic nerves from testicular plexus
- ilioinguinal (pierces cord halfway down)
3 others:
- vas deferens
- lymphatics
- tunica vaginalis
3 venous plexuses
```
78
Testicular torsion
Spermatic cord twists around, cutting off blood supply causing ischaemia
Absent or decreases cremasteric reflex
Epididymis still has normal blood flow
79
Cremasteric reflex
Stroke superior medial thigh to stimulate sensory fibres of femoral branch of genitofemoral nerve and ilioinguinal nerve
Stimulates motor fibres of genital branch of genitofemoral nerve which draws testes up into body
80
Indirect hernia
Can be congenital - processus vaginalis or inguinal canal not forming properly, creating weak spot
Herniation occurs through deep inguinal ring and through entire inguinal canal into scrotum within spermatic cord
Lateral to inferior epigastric artery
Any age
81
Direct hernia
Abdominal contents herniate through weak spot in fascia of posterior wall of inguinal canal, through inguinal triangle
Medial to inferior epigastric artery
Males and elderly most at risk
82
Femoral hernia
Herniation occurs through femoral canal below inguinal ligament
Uncommon, most likely to occur in females due to more space in the femoral canal
Have to cut lacunar ligament to treat
83
Ala
'Wings' of the sacrum
| For articulation with ilium
84
Sacral openings
Sacral foramen - 4 pairs of anterior and 4 pairs of posterior
Sacral canal at the top
Sacral hiatus at the bottom (where you can do an epidural)
85
Pelvic tilt
60 degrees anteriorly so ASIS is in line with pubic tubercle
| Sacrum tilted 40 degrees
86
Pelvic boundaries
Anterior, posterior and lateral walls are all bone
Muscular floor made from pelvic diaphragm
Perineum below pelvic diaphragm
87
3 key ligaments of the pelvis
Sacrotuberous
Sacrospinous
- together these convert the greater and lesser sciatic notches into greater and lesser sciatic foramen
Posterior sacroiliac ligament
88
2 key joints of the pelvis
```
Anterior sacroiliac joint (synovial)
Pubic symphysis (secondary cartilagenous)
```
89
2 key muscles of the pelvic wall
Piriformis
| Obturator internus
90
Piriformis origin and insertion
Origin: sacrum
Insertion: greater trochanter
91
Obturator internus origin and insertion
Origin: ischiopubic ramus
Insertion: medial aspect of greater trochanter
92
Vessels that pass through the greater sciatic foramen above piriformis
Superior gluteal vessels
| Superior gluteal nerve
93
Vessels that pass through the greater sciatic foramen below piriformis
```
Inferior gluteal vessels
Inferior gluteal nerve
Internal pudendal vessels
Pudendal nerve
Nerve to obturator internus
Sciatic nerve
```
94
Vessels that pass through the lesser sciatic foramen
Internal pudendal vessels
Pudendal nerve
Nerve to obturator internus
Obturator internus muscle
95
Vessels that pass through both the sciatic formamina
Internal pudendal vessels
Pudendal nerve
Nerve to obturator internus
96
Vessels that pass through obturator canal
Obturator nerve
| Obturator vessels
97
Pudendal nerve spinal level
S2, S3 and S4
98
Which nerve is at risk during an intramuscular injection?
Sciatic nerve
99
Which nerve is at risk during a lateral approach to the hip?
Superior gluteal nerve
100
Internal iliac artery branches (Group A Type I)
Superior gluteal 1st
Umbilical 2nd from the other side
Inferior gluteal 3rd
Ends with internal pudendal
101
Venous drainage of pelvis
```
Venous plexuses
- vesical
- prostatic
- rectal
- uterine
- vaginal
All drain to internal iliac veins
```
102
Deep dorsal vein of the penis/clitoris
Passes through anterior deficiency in perineal membrane and then into vesical/prostatic plexuses
103
Sacral plexus
```
L4, L5, S1-4 and anterior rami
Innervates structures external to pelvis
Superior gluteal
Inferior gluteal
Sciatic
Posterior femoral cutaneous
Pudendal
Nerve to levator ani/coccygeous
```
104
Superior gluteal nerve
L4, L5, S1
To gluteus medius and maximus
Passes superior to piriformis
105
Inferior gluteal nerve
L5, S1 and S2
To gluteus maximus
Passes inferior to piriformis
106
Sciatic nerve
L4-S3
Motor and sensory of hamstrings and leg
Tibial usually leaves below piriformis
Common peroneal may leave below, above or through piriformis
107
Nerves to levator ani and coccygeous
S3 and S4
| Motor only for levator ani and coccygeous
108
Pudendal nerve
```
S2-S4, motor and sensory
Supplies perineal muscles including:
- levator ani
- external sphincter
- sphincter urethrae
- bulbospongiosus
- ischiocavernosus
- transverse perineals
```
109
2 nerve plexuses of pelvic viscera
Superior hypogastric at anterior body of L5 and sacral promontory
Inferior hypogastric at pelvic floor
110
Sympathetic supply of pelvic viscera
L1/2 fibres
Descend to pelvis via superior hypogastric plexus and directly from sacral splanchnic nerves
Plexus splits to form two hypogastric nerves
111
Parasympathetic supply of pelvic viscera
S2-4 fibres
Ascend via hypogastric nerves to superior hypogastric plexus into abdomen
Direct into inferior hypogastric plexus
Pelvic splanchnic nerves
112
Sympathetic pelvic viscera function
Contract internal urethral and anal sphincters
Ejaculation
Move secretions along epididymis
113
Parasympathetic pelvic viscera function
Vasodilation of erectile tissues
| Stimulates bladder contraction
114
Pelvic outlet boundaries
```
Pubic symphysis at the top
Ischiopubic ramus (top 2 sides)
Ischial tuberosity at the sides
Sacrotuberous ligament (bottom 2 sides)
Coccyx at the bottom
Forms a diamond shape
```
115
Perineal body
Palpable anchoring point
| Strong fibrous connective tissue mass that muscles can connect to
116
Positions of the urogenital and anal triangles
Urogenital triangle faces inferiorly
| Anal triangle faces posteriorly
117
3 divisions of the levator ani
Ischiococcygeous
Iliococcygeous
Pubococcygeous
118
Levator ani innervation
```
Pudendal nerve (S2-4) and nerve to levator ani (S3/4)
Pudendal nerve sits on top of levator ani inferior to nerve to levator ani
```
119
Puborectalis
Muscular sling that pulls rectum forwards into an angle, allowing faecal control
120
Iliococcygeous
Attaches to fascia of obturator internus
| Prevents prolapse of pelvic viscera
121
Anal canal
Continuation of rectum once it passes beneath pelvic floor
122
Anal columns
Contain anal glands and superior rectal vessels
123
Pecten
Transition between true gut and skin underneath anal columns but before Hilton's white line
124
Hilton's white line
Shows fascial plane between muscles in the anus
125
Internal anal sphincter
Smooth muscle under involuntary control
| Deep to external anal sphincter, separated by connective tissue
126
External anal sphincter
Skeletal muscle under voluntary control
Perineal body to anococcygeal ligament
Closes anus with the help of puborectalis
Innervated by pudendal nerve
127
Arterial supply of rectum
Superior rectal artery from inferior mesenteric
Middle rectal artery from internal iliac
Inferior rectal from internal pudendal
128
Lymphatic drainage of rectum
Pre-aortic nodes at L3
| Internal iliac nodes
129
Lymphatic drainage of anal canal
Superficial inguinal nodes
130
Anorectal venous drainage
Superior rectal vein drains back to portal system
Middle rectal vein drains back to systemic system
- portal-systemic anastomosis results in likelihood of anorectal varices in portal hypertension
131
Haemorrhoids
Can be internal from the internal venous plexus - often painless but can prolapse
Or external from the external venous plexus - painful
Both are likely to bleed
Can clot and thrombose
132
Ischioanal fossa
Fatty wedge shaped space
| Lateral to anal canal, inferior to levator ani, medial to pudendal canal
133
Ischioanal ulcers
Hitting pudendal nerves and vessels can lead to impotence and incontinence
134
3 palpable landmarks of the ischioanal fossa
Ischial tuberosity laterally
Coccyx posteriorly
Perineal body in midline between anus and vagina or scrotum
Used to avoid lateral apex
135
Urogenital diaphragm
Inferior layer of fascia called the perineal membrane
| Sphincter urethrae and deep transverse perineal muscles superior and deep to perineal membrane
136
Deep perineal pouch
Everything superior to perineal membrane
| In women, more muscles for urinary continence due to absence of internal urethral sphincter
137
Bulbourethral glands
Only in men
| Lubricating glands for urethra in the perineal pouch
138
Bartholin's glands
Only in women
| Lubricating glands for vagina in superficial perineal pouch
139
Superficial perineal pouch
```
Structures between perineal membrane and skin
Contains:
- nerves and vessels
- erectile tissues
- perineal muscles
- Bartholin's glands
```
140
Main branches of the internal pudendal artery
```
Inferior rectal
Perineal
Dorsal artery of penis or clitoris
+ others, not important
Toegther, supply everything in the perineum
```
141
Defaecation process
Relaxation of puborectalis to straighten anorectal angle (innervation by pudendal S2-4 and nerve to levator ani S3-4)
Relaxation of internal (pelvic splanchnic S2-4) and external (pudendal S2-4) anal sphincters
Parasympathetic pelvic splanchnic S2-4 causes rectal contraction
Increased intra-abdominal pressure via somatic nervous system by diaphragm contraction and larynx closure
142
Micturition innervation
Sacral stretch reflex
Parasympathetic: pelvic splanchnic S2-4 fires to Detrusor muscle which creates full bladder sensation
Sympathetic: L1-2 fibres contract internal urethral sphincter
Somatic: pudendal S2-4 consciously controls external urethral sphincter
CNS: coordinates muscles and overrides ANS need to urinate
143
Sex and the nervous system
Parasympathetic: pelvic splanchnic S2-4 from inferior hypogastric plexus passes through deep perineal pouch to erectile tissues and vasodilates
Sympathetic: from inferior hypogastric plexus, ejaculation (contraction of smooth muscle) and contraction of internal urethral sphincter in men to prevent retrograde ejaculation
Pudendal nerve S2-4 responsible for sensory and cyclical orgasm
144
Saddle anaesthesia
Compression of cauda equina produces similar effect to epidural
145
Pudendal nerve damage/entrapment
```
Pain
Numbness
Altered sense of ejaculation
Fecal and urinary incontinence
Common in cyclists
```
146
Pouches in genitalia
Men: vesicorectal
Women: vesicouterine and rectouterine (important clinically)
147
Female erectile tissue
Crus of clitoris contributes to body of clitoris and becomes corpus cavernosum
Bulb of vestibule contributes to head of clitoris and surrounds vaginal orifice
148
Male erectile tissue
Crus of penis becomes corpus cavernosum of penis
| Bulb of penis becomes corpus spongiosum of penis and glans penis
149
2 important genital muscles
Ischiocavernosus - attached along ischiopubic rami
Bulbospongiosus - attached posterior to perineal body
Both innervated by pudendal nerve
150
Bulbospongiosus
In men: attached in midline raphe
In women: split either side of vaginal orifice
For erection and orgasm
151
Vasculature of the penis
2 dorsal arteries which accompany dorsal nerves of the penis from pudendal nerve
1 deep dorsal vein which passes through anterior deificiency in perineal membrane to prostate/bladder
2 deep arteries inside corpus cavernosum
Suerficial dorsal veins of penis under superficial fascia
Urethra in corpus spongiosum
152
Tunica albuginea
Tough fibrous capsule that surrounds each testis
153
Epididymis
Sperm storage area that opens into vas deferens
154
Efferent ductules
Connect rete testis to epididymis
155
Testis
Consists of lobules which have 1-3 seminiferous tubules each, all of which open into rete testis
3 degrees cooler than abdomen
156
Testicular supply
Testicular artery: L2 branch of aorta
Testicular veins: pampiniform plexus (right TV to IVC and left TV to left renal vein)
Lymphatic drainage to para-aortic nodes at root of testicular artery L2
Testicular plexus innervation
157
Vas deferens
Muscular tube
Travels in spermatic cord through inguinal canal
Empties into prostate to join urethra
Joins seminal vesicle to form ejaculatory duct
158
Vas deferens pathway
Enters body cavity lateral to inferior epigastric artery from spermatic cord and crosses over the external iliac vessels passing medially toward the prostate. It then passes over the top of the ureter to join seminal vesicles and form ejaculatory duct.
159
Seminal vesicles
5 cm coils that secrete liquid component of semen and fructose
Posterior to bladder and superior to prostate
160
4 zones of prostate
Peripheral
Central
Transitional
Anterior
161
Peripheral prostate
Majority
Surrounds distal urethra
Most cancers start here
162
Central prostate
Surrounds ejaculatory duct
163
Transitional prostate
Portion mostly reponsible for BPH
164
Anterior prostate
Mostly non-glandular
165
Prostatic tissue
Alveoli lines with columnar glandular epithelium innervated by parasympathetic nerves, embedde in a thick fibromuscular stroma innervated by sympathetic nerves
166
Structures that support the prostate
Puboprostatic ligament
| Levator prostatae
167
Prostate gland
Inferior to bladder
Secretes proteolytic enzymes and acid phosphatase
Contains prostatic urethra and ejaculatory duct
Suplied by branches of internal iliac artery and drained by internal iliac vein
168
Fallopian tubes
Isthmus
Ampulla
Infundibulum
Fimbrae
169
Uterus angles
50% population anteflexion
25% middle
25% retroflexion
Commonly, uterus angles up (anterversion) and flexes over (anteflexion)
170
Uterine ligaments
```
Broad ligament (SI support)
Round ligament (anterversion)
Uterosacral (AP support)
Pubocervical (AP support)
Transverse cervical (ML support)
```
171
Broad ligament
Mesosalpinx - where it loops over fallopian tubes
Mesovarium - where it loops around ovaries
Mesometrium - where it loops around uterus
172
Ovarian ligament
Anchors ovary to uterus
| Remnant of gubernaculum
173
Suspensory ligament of the ovary
Anchors ovary to pelvis
174
Ovaries
Ova and hormone production
Supplied by ovarian artery at L2
Drained by ovarian vein
Innervated by ovarian plexus
175
Lymphatic drainage of female reproductive system
Ovaries: aortic nodes at root of ovarian artery, L2
Superficial inguinal nodes via round ligament
Uterus, vagina and cervix all mix of iliac nodes.
176
DHT syndrome
Loss of 5 alpha reductase which converts testosterone to dihydrotestorone which is the more potent form. Lack of DHT causes males to express physically and mentally as females until puberty, at which time a surge of testosterone causes development of male genitalia.
