Anatomy - SUGER COPY Flashcards

1
Q

What is the inguinal canal?
What does it lie superiorly to?

A

-Oblique passageway through the muscles of the anterior abdominal wall
-Lies superior to the medial half of the inguinal ligament

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2
Q

Through where does the inguinal canal pass?

A

-Through each layer of the abdominal wall as it travels medially and inferiorly
-Starting at the transversalis fascia deep and laterally
-Finishing with the external oblique aponeurosis superficially and medially

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3
Q

How long is the inguinal canal in adults and from where does it extend to and from?

A

-5cm long in adults
-Extends from deep inguinal ring (aperature in transversalis fascia) to superficial inguinal ring (aperature in the external oblique aponeurosis)

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4
Q

What do these mark?

A

Entry and exit of inguinal canal

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5
Q

What do these show?

A

Inguinal canal

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6
Q

What forms the anterior border of the inguinal canal?

A

-External oblique aponeurosis
-Laterally only: internal oblique aponeurosis

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7
Q

What forms the posterior border of the inguinal canal?

A

-Transversalis fascia
-Medially only: medial fibres of the aponeuroses of the internal oblique and transversus abdominis (together called conjoint tendon)

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8
Q

What forms the roof and floor of the inguinal canal?

A

Roof:
-Transversalis fascia
-Arching fibres of the internal oblique and transversus abdominis
Floor:
-Inguinal ligament - rolled up lower border of the external oblique aponeurosis

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9
Q

What are the contents of the inguinal canal in females?

A

-Round ligament of uterus
-Ilioinguinal nerve
-Genital branch of the genitofemoral nerve

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10
Q

What is this and what does it form?

A

-Inguinal ligament
-Floor of the inguinal canal

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11
Q

What do these form?

A

(arching fibres of internal oblique)
-Form roof of inguinal canal

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12
Q

What are these?

A

Contents of inguinal canal in females

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13
Q

In males what are all the contents of the inguinal canal contained within?

A

-Spermatic cord
-EXCEPT for ilioinguinal nerve which runs in the canal but lies outside the spermatic cord

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14
Q

What can the contents of the spermatic cord be divided into?

A

-Two nerves
-Three arteries
-Three fascial layers
-Four other structures

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15
Q

What are the nerves spermatic cord?

A

-Gential branch of genitofemoral nerve
-Sympathetic nerve fibres

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16
Q

What are the 3 arteries of the spermatic cord?

A

-Testicular artery
-Cremastatic artery
-Artery to vas deferens

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17
Q

What are the 3 fascial layers of the spermatic cord and their derivations?

A

-External spermatic fascia - EO aponeurosis derived
-Cremaster muscle and fascia - IO muscle derived
-Internal spermatic fascia - transversalis fascia derived

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18
Q

What are these?

A

Three fascial layers of spermatic cord

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19
Q

What are the four other structures in the spermatic cord?

A

-Pampiniform venous plexus
-Lymphatics
-Vas deferens
-Processus vaginalis

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20
Q
A
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21
Q
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22
Q

Describe scrotal skin and what is beneath it:

A

-Thin, wrinkled and more darkly pigmented that elsewhere
-Beneath is a thin layer of superficial fascia and a thin, involuntary muscle called the dartos

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23
Q
A
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24
Q

What does the superficial fascia of the testes extend to form?

A

Extends between the testicles to form a septum dividing the scrotum into right and left halves

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25
Q

What does each half of the scrotum contain?

A

-Testis
-Epididymis
-Lower part of spermatic cord

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26
Q

What is the function of testes?

A

-Male reproductive organs
-Produce sperm and secrete the sex hormone testosterone

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27
Q

Describe the testes and their coverings:

A

-Ovoid structures
-Covered by the same three layers of spermatic fascia that cover the spermatic cord

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28
Q

What are the testes partially covered by and what is it derived from?

A

Partially surrounded by a sac derived from peritoneum called tunica vaginalis

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29
Q

Describe the epididymis:

A

-Coiled tube lying along posterior border of each testis
-Expanded head superiorly
-Body
-Pointed tail lying at the lower pole of the testis

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30
Q
A
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31
Q

Describe the formation and movement of spermatozoa in the testes:

A

-Formed in the testes
-Stored in the epididymis
-Vas deferens carries sperm from the epididymis and travels with the testicular vessels in the spermatic cord

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32
Q

Where do testicular arteries arise?

A

Direct branches from the abdominal aorta

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33
Q
A
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34
Q

What is the venous drainage of the testes?

A

-Venous blood from the testis and epididymis enters the pampiform venous plexus
-Pampiform venous plexus forms testicular vein
-Right testicular vein enters the inferior vena cava
-Left testicular vein joins the left renal vein

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35
Q
A
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36
Q

What is the penis function?

A

Male organ of sexual intercourse

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37
Q
A
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38
Q

What is the penis primarily made up of?

A

-Three cylinders of erectile tissue
-Two corpus cavernosa dorsally (top of penis)
-One corpus spongiosum ventrally (bottom of penis)

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39
Q

What are the cylinders of the penis and what are they enclosed in?

A

-Corpus cavernosa and corpus spongiosum
-Enclosed within deep fascia of the penis - Buck’s fascia

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40
Q
A
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41
Q

Describe the end of the penis:

A

-Called the glans
-Expansion of the corpus spongiosum

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42
Q
A
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43
Q

What carries urine and semen and where does it lie in the penis?

A

-Penile urethra
-Lies within corpus spongiosum
-Approaches end of penis and opens via external urethral meatus

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44
Q
A
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45
Q

What is the arterial supply of the penis?

A

-Penile arteries
-Branch from the internal pudendal arteries which branch from the internal iliac arteries

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46
Q
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47
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48
Q
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49
Q

What is the nerve supply to the penis?

A

-S2-S4 segments
-General sensation + sympathetic innervation = dorsal nerve of penis - branch of pudendal nerve
-Parasympathetic arise from peri-prostatic nerve plexus

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50
Q

What are parasympathetic nerves of the penis responsible for?

A

Dilating arteries of the corpora

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51
Q
A
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52
Q

What are primarily responsible for the increase in size and rigidity of the penis during erection?

A

Corpora cavernosa

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53
Q

What happens to the penis during sexual intercourse?

A

-Arterial blood flow into the corpora of the penis increases
-Corpora become engorged with bloods
-Spongiosum does not engorge to the same extent as the cavernosa

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54
Q

What is the main role of the corpus spongiosum during erection?

A

Prevent the urethra from being compressed, which would prevent ejaculation

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55
Q

What two terms are used interchangeably for the adrenal glands?

A

-Adrenal
-Suprarenal

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56
Q

Where do the adrenal glands lie?

A

-Close to upper pole of each kidney
-Right - lies behind the liver and inferior vena cava
-Left - lies behind the stomach and pancreas

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57
Q
A
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58
Q

What arteries supply each adrenal gland?

A

-3 arteries
-Superior adrenal artery - phrenic artery branch
-Middle adrenal artery - abdo aorta branch
-Inferior adrenal artery - renal artery branch

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59
Q

Label:
What are they?

A

Blood supply to adrenal glands

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60
Q
A
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61
Q

What is the venous drainage of the adrenal glands?

A

-Single vein on either side
-Right adrenal vein - IVC
-Left adrenal vein - drains first into left renal vein which then joins IVC

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62
Q

What is the adrenal gland composed of?

A

-Cortex (outer part)
-Medulla (inner part)

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63
Q
A
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64
Q

What do the cortex and medulla of the adrenal glands produce?

A

-Cortex - steroid hormones including cortisol, aldosterone and testosterone
-Medulla produces adrenaline

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65
Q

Are the kidneys intraperitoneal or retroperitoneal?

A

-Extra-peritoneal
-Retro-peritoneal as they are behind the peritoneum

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66
Q

Where do the kidneys lie?

A

-There is one on either side of the upper lumbar vertebrae

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67
Q

What are the layers that the kidney is embedded in?

A

-Each kidney embedded in perinephric fact
-This fatty layer is covered by renal fascia
-A further layer of paranephric fat is found outside the renal fascia

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68
Q
A
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69
Q

What is found on the medial border of each kidney?

A

-Renal hilum
-Renal vessels, nerves, lymphatics and ureter enter or leave the kidney

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70
Q
A
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71
Q

Where do the renal arteries and veins branch or drain into?

A

-Both renal arteries are branches of abdominal aorta
-Both renal veins drain into IVC

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72
Q

What makes up the internal aspect of the kidney?

A

-Cortex - outer part
-Medulla - inner part arranged into pyramids
-Calyces

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73
Q
A
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74
Q

Which parts of the nephron are in which parts of the kidney?

A

-Glomeruli, bowman’s capsule, proximal + distal convoluted tubules + part of collecting ducts are in the cortex
-Nephron loop (of henle) and rest of collecting ducts are in the renal pyramids

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75
Q

What is the pathway of urine through the kidney?

A

-From collecting ducts, travels down pyramid to renal papilla (apex of pyramid) to enter minor calyx
-Minor calyces merge with others to form major calyx
-Major calyces merge to form renal pelvis which is continuous with ureter

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76
Q

What does the ureter do and describe it:

A

-Carry urine to urinary bladder
-Narrow tubes with muscular walls that transport urine via peristalsis

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77
Q
A
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78
Q

Where do the ureters run?

A

-Anterior to psoas major on posterior abdominal wall
-Cross pelvic brim to enter the pelvis
-Enter bladder on its inferomedial aspect

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79
Q

What is the typical pain felt from obstructing kidney stone?

A

-Loin to groin
-Fibres supplying ureters are from T12 to L2 so pain is referred and felt in these dermatomes

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80
Q

Where is the posterior abdominal wall?

A

-Region behind the abdominal cavity
-Extends from attachments of the diaphragm above to pelvic brim below

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81
Q

What does the posterior abdominal wall consist of?

A

Lumbar spine together with the psoas and quadratus lumborum muscles

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82
Q

What structures pass along the posterior abdominal wall?

A

-IVC
-Aorta with associated autonomic plexuses and lymph nodes
-Sympathetic trunks on either side of the lumbar spine

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83
Q

What pass laterally through the posterior abdominal wall?

A

-Ureters pass down from the kidneys towards the pelvis on surface of psoas muscles
-Gonadal vessels run down over ureters to supply the gonads

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84
Q
A
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85
Q

What plexus forms on the posterior abdominal wall and what forms it?

A

-Lumbar plexus
-Lumbar spinal nerves L1-L4 with contribution with T12

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86
Q
A
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87
Q

What does the lumbar plexus give rise to and what are some notable ones?

A

-Several branches that innervate the skin and muscles of the abdominal wall and thigh
Notable branches:
-Iliohypogastric and ilioinguinal
-Genitofemoral
-Lateral femoral cutaneous
-Femoral
-Obturator

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88
Q
A
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89
Q

What do the iliohypogastric, ileoinguinal and genitofemoral nerves innervate?

A

-Iliohypogastric + ilioinguinal = anterior abdominal wall muscles and skin of external genitalia
-Genitofemoral - skin of external genitalia

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90
Q

What does the lateral femoral cutaneous nerve and femoral nerve innervate?

A

LFC - skin over lateral thigh
Femoral - large nerve supplies muscles and skin of anterior thigh

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91
Q

What does the obturator nerve innervate?

A

Supplies muscles and skin of the medial thigh

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92
Q

What is the pathway of the descending aorta?

A

-Pierces diaphragm at T12 and descends through abdomen as abdominal aorta
-Descends on posterior wall just left of midline
-Terminates by bifurcating into the left and right common iliac arteries at level L4

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93
Q
A
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94
Q

What does the abdominal aorta give rise to?

A

-Several paired and unpaired branches
Unpaired:
-Coelic trunk
-SMA
-IMA
Paired:
-renal
-adrenal
-gonadal
-lumbar

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95
Q

What forms the IVC and where?

A

-Union of left and right common iliac veins
-Approx level of L5

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96
Q

Where does the inferior vena cava ascend in the abdomen and what drains into it?

A

-Ascends on the posterior abdominal wall just right of the midline
-Veins corresponding to the paired arterial branches of aorta drain into IVC
-EXCEPT left gonadal vein drains into left renal vein
-Also receives hepatic vessels

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97
Q

What are the main functions of the bony pelvis?

A

-Numerous functions
-Supporting the spine, torso and upper body
-Locomotion
-Housing and protecting the pelvic viscera

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98
Q

What bones make up the bony pelvis?

A

Three bones:
-Sacrum
-Left and right hip (innominate) bones

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99
Q

What are these and what do they make up?

A

Bony pelvis

100
Q

What makes up the hip bone?

A

Three smaller bones that fuse together:
-Ilium
-Ischium
-Pubis

101
Q

What do these make up?

A

Hip bone

102
Q

What are the articulations of the bony pelvis?

A

-5 articulations
-Hip joint
-Sacroiliac joint
-Pubic symphysis
-Lumbosacral joint
-Sacrococcygeal joint

103
Q

Describe the hip joint:

A

-Between head of femur and acetabulum (socket) of pelvis
-Ilium ischium and pubis of hip fuse at acetabulum

104
Q
A
105
Q

What is this?

A

Hip joint

106
Q

Describe the sacroiliac joint:

A

-Between sacrum and ilium of hip bone
-Very stable and strong and supported by many ligaments

107
Q

Describe the pubic symphysis:

A

-Between two pubic bones
-Almost no movement is permitted

108
Q
A
109
Q

Describe the lumbosacral joint:

A

-Between 5th lumbar vertebrae and the sacrum
-An intervertebral disc lies between the two

110
Q
A

Lumbosacral joint

111
Q
A

Sacrococcygeal joint

112
Q

Describe the sacrococcygeal joint:

A

Between the sacrum and coccyx

113
Q
A
114
Q

Which bony landmarks are useful as surface landmarks for the pelvis?

A

-Iliac crest
-Anterior Superior Iliac Spine
-Iliac tubercle
-Pubic tubercle
-Inguinal ligament
-Mid-inguinal point
-McBurney’s point

115
Q

Why is this a useful landmark?

A

-Intercristal line - highest points of iliac crests
-Marks level of L4/L5 disc space used for lumbar puncture

116
Q

Why is this a useful landmark?

A

-Line between iliac tubercles (most lateral parts of pelvis)
-Division marking of lower 1/3 of abdomen

117
Q

What is this and why is it a useful landmark?

A

-Mid-inguinal point
-Line drawn between ASIS and pubic symphysis
-Femoral artery palpable here

118
Q

What are the main differences between male and female pelvis?

A

-Wider, circular pelvic inlet in females / narrower, heart-shaped pelvic inlet in males
-Obtuse angle formed by inferior pubic rami in females, acute angle in males
-Wider and shorter sacrum in females, narrower, longer sacrum in males

119
Q

What organs does the pelvis contain?

A

-Organs of the GI and GU systems
-Rectum and bladder in males and females
-Uterus, ovaries and vagina in females
-Prostate and seminal vescicles in males

120
Q

What do these show?

A

Contents of pelvis in females
+ovaries

121
Q

What do these show?

A

Contents of pelvis in males

122
Q

What is the main arterial supply of the pelvis?

A

-Left and right internal iliac arteries
-Give rise to several branches in the pelvis that supply the pelvic viscera
-Some branches exit the pelvis to supply the perineum and gluteal region

123
Q
A

Internal iliac arteries

124
Q

What are the key branches of the internal iliac arteries?

A

-Vesical - bladder, prostate and seminal vesicles in men
-Uterine and vaginal in females
-Middle rectal - rectum
-Internal pudendal - supplies perineum
-Superior/inferior gluteal arteries - exit pelvis to supply gluteal region

125
Q

What are these?

A

4 major branches of internal iliac artery

126
Q
A

Major branches of the internal iliac artery

127
Q

What is the venous drainage of the pelvis?

A

-Several venous plexuses drain the pelvic organs
-Plexuses unite and mostly drain into the internal iliac veins

128
Q
A
129
Q

In the pelvis, what do sacral spinal nerves form?

A

Come together to form sacral plexus

130
Q

What are the key nerves arising from the sacral plexus and at what cords?

A

-Sciatic nerve - L4-S3 - lower limb
-Pudendal nerve - S2-S4 - perineum
-Superior and inferior gluteal nerves - L4-S1/ L5-S2 - gluteal region
-Pelvic splanchnic nerves - S2-S4 - para to pelvic viscera

131
Q

label these sacral plexus nerves, which are missing?

A

Pelvic splanchnic nerves

132
Q

What is the pelvic floor?

A

-Collective name for several muscles that support the pelvic organs from below
-Shaped like a bowl or funnel

133
Q

What are the 3 primary functions of the pelvic floor?

A

-Prevent herniation of the pelvic organs inferiorly out the pelvis
-Control continence of urine and faeces by providing a sphincter action on urethra and rectum
-Aid in increasing intra-abdominal pressure

134
Q

What is the pelvic floor made up of?

A

-Two muscles
-Levator ani and coccygeus
Levator ani composed of 3 smaller muscles:
-Puborectalis
-Pubococcygeus
-Iliococcygeus

135
Q

What are these?

A

Muscles of the pelvic floor

136
Q
A
137
Q

Descrive puborectalis muscle:

A

-U-shaped muscle attaches to pubic bones anteriorly and forms sling around rectum
-Pulls on rectum so sharp angle is formed between rectum and anal canal - prevents defecation
-Relaxes to straighten path from rectum to anal canal
-Contributes to control of micturition
-Most anterior levator ani muscle

138
Q

Describe the pubococcygeus muscle:

A

-Lies posterior and lateral to puborectalis
-Attaches to pubic bone anteriorly and coccyx and sacrum posteriorly

139
Q

Describe ileococcygeus:

A

-Lies lateral to pubococcygeus
-Attaches to spines of ischium and coccyx

140
Q

What is levator ani innervated by?

A

-Branch of the S4 nerve
-Some branches of the pudendal nerve (S2-S4)

141
Q

What is the perineum?
What draws its boundaries?

A

-Immediatly superficial and inferior to pelvic floor
-Superficial region between the pubic symphysis and the coccyx and between the medial surfaces of the thighs

142
Q

When viewed from below, what does the perineum look like and how an it be divided?

A

-Roughly diamond shaped and can be split into 2 triangles:
-Anal triangle (post) - opening of anus and external anal sphincter
-Urogenital triangle (ant) - more complicated with several layers

143
Q

What are the layers of the perineum?

A
144
Q
A
145
Q
A
146
Q
A
147
Q

Label these parts of the perineum:

A
148
Q

What sits between the two triangles of the perineum?
What attaches to it?

A

-Perineal body
-Dense mass of fibrous tissue and muscle sits in centre of the perineum
-Acts as attachment for almost all the perineal and pelvic floor muscles including:
-Levator ani
-External anal sphincter
-External urethral sphincter
-Superficial and deep perineal muscles
-Bulbospobiosus

149
Q

What is common amognst all of these?

A

All connect to perineal body

150
Q
A
151
Q

Describe the yellow structures:

A

-Superficial perineal pouch
-Contains most of erectile tissue that unites to form clitoris or penis and muscles overlying them
-Corpora cavernosa are symmetrical + run along ischial rami bilaterally to converge in midline
-Corpora cavernosa connected to ischial ramus called crura of penis or clitoris

152
Q

Describe the corpus spongiosum of the superficial perineal pouch in men:

A

-Sits in midline
-Expanded part proximally which rests on perineal membrane
-This is called the ‘bulb’ of the penis

153
Q

Describe the corpus spongiosum of the superficial perineal pouch in females:

A

-Sits in midline
-Splits into two parts that flank the vaginal opening and also rest on perineal membrane
-These are called bulb of vestibule (or bulb of clitoris)

154
Q
A
155
Q

What muscles covers what corpora?

A

-Corpora cavernosa covered by ischiocavernosus muscles
-Corpus spongiosum covered by bulbospongiosus muscle

156
Q

What muscle is this and what can it help with?

A

Help stabilise erect penis and clitoris

157
Q

What muscle is this and what can it help with?

A

-In males also assists in maintaining erection by compressing veins that drain erectile tissue and contracts to squeeze any remaining urine or semen from the urethra
-In females helps maintain clitoral erection and constricts around vaginal orifice which can help expression of fluid from the greater vestibular glands

158
Q

What is the arterial supply to the perineum?

A

-Internal pudendal artery
-Branch of the internal iliac artery

159
Q

What is this?

A

Internal pudendal artery

160
Q

What is this and what does it innervate?

A

-Pudendal nerve (S2-S4)
-Innervates muscles of the perineum and skin of external genitalia
-Perineal structures also innervated by autonomic nerves in addition to these nerves

161
Q

What is the pathway of the pudendal nerve and artery?

A

-Arise in pelvis but don’t enter perineum by piercing pelvic floor
-Travel through greater and lesser sciatic foramina of the pelvis

162
Q

What are these and what pass through them?

A

internal pudendal artery and pudendal nerve

163
Q

What make up the reproductive organs of the male?

A

-Paired testes
-Epidiymis
-Vasa deferntia
-Seminal vesicles
-Ejaculatory ducts
-Bulbo-urethral glands
-Prostate gland
-Penis

164
Q
A
165
Q

What does the vas deferens do up to the pelvis?

A

Carries sperm from the epididymis up the spermatic cord and through the inguinal canal into the pelvis

166
Q

What does the vas deferens do past the deep inguinal ring?

A

-Passes across the side of the wall of the pelvis
-Turns medially onto the back of the bladder
-Here it has a dilated portion - ampulla which lies medial to seminal vesicles
-Terminates by joining duct of the seminal vesicle to form the ejaculatory duct

167
Q
A
168
Q

Label and describe:

A

-Seminal vesicles
-Each one is a lobulated sac about 4cm long
-Lateral to ampulla of vas deferens
-Secrete a thick alkaline fluid which joins to form the bulk of the seminal fluid
-Duct joins with the vas deferens to become ejaculatory duct which pierces the back of the prostate gland to enter the prostatic urethra

169
Q

Label:
Describe the top structure:

A

-Prostate gland
-Roughly spherical fibromuscular gland about the size of a walnut
-Lies against the neck of the bladder and is pierced by the urethra and ejaculatory ducts
-Secretions of the prostate are added to the seminal fluid during ejaculation

170
Q

What is common about the blood supply of the vas deferens, prostate and seminial vesicles?

A

All supplied by branches of the internal iliac artery

171
Q

What organs does the female pelvis exclusively contain?

A

-uterus
-cervix
-vagina
-uterine tubes
-ovaries

172
Q
A
173
Q

Label and describe:

A

-Uterus
-Hollow muscular organ
-Communicates laterally with the uterine tubes and inferiorly with vagina
-Has a fundus (above uterine tubes), body and cervix

174
Q

label and describe the parts of the uterus:

A

-Body angled anteriorly + lies on superior surface of bladder
-Junction between body and cervix may be tilted anteriorly (anteverted) or posterior (retro-versed)

175
Q

What happens in the uterus if conception occurs?

A

-Developing blastocyst implants into the uterine lining (endometrium) in body
-Middle muscular layer (myometrium) becomes distended as pregnancy continues

176
Q
A
177
Q

What is the uterus covered in and its significance?

A

-Fold on peritoneum
-Adheres to itself at the sides of the uterus to form the broad ligament

178
Q
A
179
Q

Label and describe its significance:

A

-Rectouterine pouch (pouch of Douglas)
-Space behind the uterus but anterior to the rectum
-Lined with peritoneum
-Deepedt point in the peritoneal cavity so it is a common site for accumulation of intraperitoneal fluid or pus

180
Q

Label and describe:

A

-Narrow lumen called the cervical canal which communicates with the uterine cavity and vagina
-Lower part lies inside vagina creating recess - vaginal fornices - around the cervix

181
Q

Label and describe what they connect:

A

-Internal os - communication with uterine cavity
-External os - communication with vagina

182
Q

Label and describe what they connect:

A

-Internal os - communication with uterine cavity
-External os - communication with vagina

183
Q

What are these created by?

A

-They are the vaginal fornices
-Created by cervix lying inside the vagina creating a recess

184
Q

What is the cervix stabilised by?

A

-Position of the cervix is stabilised by the tone of the levator ani muscles and ligaments
-Run from lateral wall of cervix to the lateral pelvic wall at the base of the broad ligament

185
Q

Label and describe:

A

-Fallopian tubes
-Carry ova from ovary towards uterine cavity
-Fertilisation occurs inside these tubes
-Found running in upper border of broad ligament

186
Q

Describe the shape of the uterine tubes:

A

-Near the uterus they have a narrow isthmus
-Laterally the tubes have a dilated ampulla leading into a funnel-shaped infundibulum
-Free edge of infundibulum is broken up into finger-like projections (fimbriae) draped over the ovary

187
Q
A
188
Q

Label and describe:

A

-Almond-shaped
-Almond-shaped
-Attached to the posterior aspect of the broad ligament by short mesentery -> mesovarium

189
Q
A

-Mesovarium
-Short mesentery connecting the ovary to the posterior aspect of the broad ligament

190
Q

Describe the position of the ovaries and what other structures they are in relation to:

A

-Not fixed
-Frequently lies in ovarian fossa -> formed by the angle between the internal and external iliac arteries
-Ureter and obturator nerve and vessels are close relations of the ovarian fossa

191
Q

What are these and what do they mark the boundary of?

A

Ovarian fossa

192
Q

Label and describe:

A

-Female organ of sexual intercourse and excretory duct of the uterus
-Passes through the pelvic floor, upper 2/3 of the vagina lie in the pelvic cavity and lower 1/3 in perineum

193
Q

What are the two ends of the vagina?

A

-Blind-ended vault in the region of the cervix
-Terminates below at the introitus by opening into the vestibule between the labia minor

194
Q
A
195
Q

What is the vagina closely related to?

A

-Bladder anteriorly
-Urethra is often embedded in the anterior wall of the lower 1/3 of the vagina

196
Q

What are the uterus, carvix, uterine tubes, ovary and vagina all supplied blood by?

A

-All via branches of internal iliac artery
-EXCEPT ovary which is supplied by the ovarian artery
-Ovarian artery is a direct branch of the abdominal aorta and contributes to the blood supply of the uterine tubes

197
Q

What is the vessel in green?

A

-Ovarian artery
-Direct branch of abdominal aorta

198
Q

What is the vulva?

A

Collective term for all of the parts of the female external genitalia

199
Q

What is the blood supply to the vulva?

A

Mainly via the internal pudendal arteries -> branches of internal iliac arteries)

200
Q

What is the innervation of the vulva?

A

-Four nerves:
-Ilioinguinal nerve
-Genital branch of genitofemoral nerve
-Pudendal nerve
-Posterior cutaneous nerve of the thigh
THE ERECTILE TISSUE ARE INNERVATED BY PARASYMPATHETIC NERVES

201
Q

Label:
What does this show?

A

Nerve supply to the vulva

202
Q

Label:
What are they all part of?

A

Vulva

203
Q

Label and describe:

A

-Area between labia minor
-Contains vaginal opening, urinary meatus and vestibular glands

204
Q

Label and describe:

A

-Vestibular glands
-Greater (Bartholin’s) - just posterior to vaginal opening and secrete lubricant into the vagina during sexual arousal
-Lesser (Skene’s) - near urehtral opening, function of their fluid is debated however may lubricate vaginal opening or urehtra or have antimicrobial affect

205
Q

label and describe:

A

-Thin membrane that partially covers vaginal opening
-Often ruptures during first episode of sexual intercourse
-Can rupture spontaneously -> exercise, tampons, menstrual cups
-May be absent altogether

206
Q

What is the mons pubis?

A

Elevation of fatty tissue located in front of pubic symphysis causing an elevation of the hair-bearing skin

207
Q

What are the labia major and minora?

A

-Majora - prominent hair-bearing folds of skin that meet at mons pubis anteriorly
-Minora -
-Smaller, hairless folds of skin located medial to major
-Fuse together anteriorly to form hood of clitoris
-Boundaries of vestibule

208
Q

What is the clitoris?

A

-Pea-sized highly sensitive tissue comprised of erectile corpora cavernosa and spongiosum
-Engorged during sexual arousal

209
Q

What is the vaginal opening?
Anatomical name?

A

Entrance to the vagina also known as the vaginal Introits

210
Q

What is the urinary meatus?

A

-Opening of urethra
-Lies posterior to the clitoris but anterior to the vaginal opening

211
Q

What is this?
What is its position?

A

-Urinary bladder - hollow muscular organ
-Located in the pelvis below the peritoneum (infra-peritoneal organ)
-Posterior to pub symphysis and anterior to the vagina and rectum

212
Q

What is the blood supply of the bladder?

A

-Vesical arteries - branches of internal iliac
-Vesical veins draining into internal iliac vein

213
Q

What are the arteries in green and their respective veins?

A

Vesical arteries and veins

214
Q

What is the function of the bladder and how does it do this?

A

-Stores urine and helps squeeze the urine out during micturition
-When empty, bladder may squash down completely
-When full, superior aspect may extend above the pubic symphysis
-Can accomodate approx 400-600ml of urine in an adult

215
Q

What fills the bladder with urine and from where?
What is this area called?

A

-From ureters
-Drain into posterior aspect of bladder near base
-This triangular area is called trigone and has smooth wall

216
Q
A
217
Q

How do the ureters enter the bladder and what is the significance of this?

A

-Enter the trigone at an angle
-Forms a rudimentary valve which prevents reflux of urine into the ureters when bladder is full

218
Q

Describe the inside wall of the bladder:

A

-Trigone = smooth walled
-Rest = corrugated with folds of mucosa called rugae
-Allow bladder to stretch without tearing when it fills
-Walls contain smooth muscle (detrusor) which contracts to forcibly expel urine

219
Q
A
220
Q

What are these and what do they control?
Describe them:

A

-Release of urine
-internal = base of bladder where it opens into urethra, composed of smooth muscle and involuntary
-External = located just after the prostate in males and deep perineal pouch in females, skeletal muscle under voluntary contro

221
Q

Describe the somatic innervation to the urinary bladder and urethral sphincters

A

-Branches of the pudendal nerve (S2-S4)
-Allows conscious control of external urethral sphincter

222
Q

Describe the sympathetic innervation of the urinary bladder and urethral sphincters:

A

-Branches of hypogastric nerve (symp chain T12-L2)
-Causes relaxation of teh detrusor and contraction of the internal urethral sphincter allowing storage of urine

223
Q

Describe the parasympathetic innervation to the bladder and urethral sphincters:

A

-Pelvic splanchnic nerves (S2-S4)
-Causes contraction of detrusor and relaxation of the internal urethral sphincter allowing initiation of micturition

224
Q

Describe the urethra:

A

Carries urine from internal urethral orifice of bladder to external urethral orifice

225
Q

What is the difference between a male and female urethra?

A

-In males external urethral orifice is tip of penis, vestibule in females
-Carries semen in men
-Female urethra is short

226
Q

What is the urethra split up into in men?

A

-Preprostatic
-Prostatic
-Membranous
-Penile

227
Q

What is urination controlled by?

A

-Centres in the cerebral cortex, brainstem and sacral spinal cord
-Sacral spinal cord contains the sacral micturition centre

228
Q

What is the bladder reflex arc?

A

-As bladder fills, stretch of bladder wall is detected
-Relayed to sacral spinal cord via visceral afferents
-These synapse directly with motor neurons
-Motor neurons (via pelvic splanchnic parasympathetic fibres) stimulate bladder contraction

229
Q

In older children and and adults, what happens to the urine reflex arc?

A

-Inhibited by inputs from the cerebral cortex
-Older children and adults can detect bladder filling and consciously control when and where to urinate
-‘potty training’ = infants learn to consciously recognise bladder filling and develop descending pathways that inhibit the reflex

230
Q

What two pathways are interrupted to do with the bladder if a spinal cord injury above the sacral level is sustained?

A

-Ascending pathways conveying sensation of bladder filling to brain
-Descending pathway that exert voluntary, inhibitory control over the external urethral sphincter
Reflex arc still functions below but patient is incontinent as cannot inhibit it

231
Q

What pathway is interrupted to do with the bladder if a spinal cord or cauda equina injury is sustained below the level of the sacral micturition centre?

A

-Reflex arc is disrupted
-Bladder fills with urine without emptying
-Internal urethral sphincter is permanantly contracted
-Bladder continues to fill and pressure in the bladder eventually exceeds strength of the internal urethral sphincter and urination occurs
-Can cause urinary retention and backup

232
Q

What is the rectum?

A

-Terminal part of the large intestine
-Two notable curves (flexures)
-One anteriorly - sacral flexure
-Posteriorly - anorectal flexure
-Storage of faeces prior to defecation
12cm

233
Q
A
234
Q

What is the most distal part of the gastrointestinal tract and where does it extend from?

A

-Anal canal
-Distal rectum to anus
-Lies in anal triangle of perineum

235
Q

What control defecation?

A

-Two anal sphincters
-internal = smooth muscle + involuntary
-external = skeletal muscle + voluntary

236
Q
A
237
Q

What is this and what does it do?

A

-Pectinate line (dentate line)
-Divides superior part of anal canal from inferior
-Superior = endoderm derived
-Inferior = ectoderm derived
-Supplied by different vessels

238
Q

What is the blood supply above the pectinate line?

A

-Part of the hindgut
-Supplies by inferior mesenteric artery (via superior rectal artery)
-Venous drainage via the portal venous system

239
Q

What are the vessels in green?

A

Superior rectal arteries

240
Q

What encircles the superior part of the anal canal?
Describe its innervation:

A

-Lined by columnar epithelium
-Encircled by internal anal sphincter (involuntary)
-innervated by sympathetic fibres from sympathetic trunk and parasympathetic fibres from the pelvic splanchnic nerves

241
Q

What is the blood supply to the inferior anal canal?

A

-Middle and inferior rectal arteries which originate from the internal iliac arteries
-Venous blood enters the systemic venous system

242
Q

What are the vessels in green and the ones below?

A

Middle and inferior rectal arteries

243
Q

What is the inferior anal canal encircled by?
What is this innervated by?

A

-Stratified squamous epithelium lines lumen
-External anal sphincter - voluntary
-Innervated by the pudendal nerve - somatic

244
Q

What is this?

A

Pudendal nerve

245
Q

Draw the lumbar plexus

A

Google it :)