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RDS Test 1 > B8.005 Male Reproductive Tract > Flashcards

B8.005 Male Reproductive Tract Flashcards

1
Q

how are pelvic features used forensically for aging

A

Y shaped growth plate that separates 3 bones, the triradiate cartilage, starts fusing at ages 10-16
fusion ends around age 20

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2
Q

male vs female pelvis

A

sexual dimorphism occurs after puberty

subpublic angle is 90 deg in females and 70 deg in males

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3
Q

characterize pelvic fractures

A

automobile accident: displacement of the pubic symphsis posteriorly, breaking the superior and/or inferior rami
jumping: may lead to displacement of the head of the femur through the acetabulum
pelvis rarely fractures in a single place (it is a ring)

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4
Q

what is the pelvic diaphragm

A

muscular funnel that surrounds the anal canal and is formed by:

1) levator ani muscle
2) coccygeus muscle

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5
Q

where is the pelvic diaphragm located

A

stretches from the pubic symphysis anteriorly, to the coccyx posteriorly, and is laterally attached to the medial surface of the obturator internus muscle

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6
Q

portions of levator ani

A 
3 parts
innervated by S4, some S3 & S5
1. pubococcygeus
2. puborectalis
3. iliococcygeus
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7
Q

pubococcygeus

A

largest part of levator anu

attached from the body of the pubis to the coccyx

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8
Q

puborectalis

A

attached from the medial body of the pubis to form a U-shaped muscular sling around the anorectal junction

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9
Q

iliococcygeus

A

attached from a tendinous arch of fascia on top of the obturator internus muscles and the ischial spine to the coccyx

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10
Q

coccygeus muscles

A

attaches from ischial spine to the distal sacrum and coccyx

innervated by S4 (some S3, S5)

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11
Q

function of pelvic diaphragm

A

maintains the proper positioning of the pelvic organs and is essential for maintaining abdominal, and thus thoracic pressure, during micturation, defecation, parturition, and lifting heavy weights

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12
Q

what passes through the pelvic diaphragm

A

males: urethra and anus
females: urethra, vagina, and anus

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13
Q

relaxation of puborectalis

A

essential during defacation

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14
Q

what are kegels

A

isometric contraction of the pubococcygeus muscle and the pelvic diaphragm and pelvic diaphragm

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15
Q

function of kegels

A

help prevent urinary stress incontinence and fecal incontinence during and after pregnancy
prevent injuries during parturition and help prevent uterine prolapse after vaginal deliveries

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16
Q

perineal membrane

A

connective tissue membrane attaching laterally to the ischial tuberosities, and the ischiopubic rami
tough, connective tissue sheet which serves as a base for the external genitalia structures

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17
Q

spaces created by the perineal membrane

A
  1. superficial perineal space

2. deep perineal space

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18
Q

superficial perineal space

A

contains erectile tissues and muscles of the external genitalia in both male and female

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19
Q

deep perineal space

A

contains striated muscles of the urethra (sphincter and compressor) and a deep transverse perineal muscle that support the free edge of the perineal membrane
also contains nerves and arteries

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20
Q

superficial membranous fascia

A

superficial surface of the superficial perineal space
made of 3 differently named, but continuous membranes:
1. scarpas (anterior abdominal wall)
2. dartos (shaft of penis and scrotum)
3. colles (posterior to scrotum)

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21
Q

bleeding patterns of straddle injuries

A

bleed into superficial perineal space
blood is then limited in its diffusion by the superficial perineal membrane (scarpas, dartos, colles) and where it attaches to deep fascial planes

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22
Q

where does the superficial perineal membrane attach to deep fascia (outline of blood in straddle injuries)

A

superiorly: fascia surrounding anterior abdominal wall muscles
laterally: inguinal ligament and fascia lata of the thigh
posteriorly: posterior edge of perineal membrane

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23
Q

components of external anal sphincter

A

3 parts:

  1. deep external sphincter
  2. superficial external sphincter
  3. subcutaneous external sphincter
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24
Q

innervation of external anal sphincter

A

skeletal muscle under voluntary control

innervated by S4 through the inferior rectal/anal nerve (branch off the internal pudendal nerve)

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25
Q

internal anal sphincter

A

smooth muscle
more superior to external sphincter and directly under the mucosa
innervated by sym and parasym fibers from the pelvic splanchnic nerves
normally, tonically contracted, but relaxes to release gas and fecal material

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26
Q

importance of the pectinate line

A

separates visceral and parietal portions of anal canal

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27
Q

above pectinate line

A

nerves: visceral motor and sensory innervation
arteries: IMA
veins: to portal venous system
lymphatics: to internal iliac lymph nodes

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28
Q

below pectinate line

A

nerves: somatic motor and sensory innervation
arteries: internal iliac
veins: to caval venous system
lymphatics: to superficial inguinal lymph nodes

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29
Q

internal hemorrhoids

A

start superior to the pectinate line

generally painless, often grow quite large before being notices

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30
Q

external hemorrhoids

A

start inferior to pectinate line

generally quite painful and itch

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31
Q

hemorrhoids

A

swollen (redundant) veins within the anal canal that are thought to be due to increased venous pressure caused by: portal HTN, excessive straining (constipation), excessive weight gain

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32
Q

prevalence of hemorrhoids

A

4% of US pop

1 mil new cases per year

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33
Q

degrees of internal hemorrhoids

A

1st: bulges into anal canal during BMs
2nd: bulges from the anus during BM, then goes back in
3rd: bulges from anus during BMs and must be pushed back in with a finger
4th: protrudes from anus all the time

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34
Q

treatment for internal hemorrhoids

A

rubber band ligation, takes 7-10 day for necrotic hemorrhoid to fall off
infrared coagulation for small and medium internal hemorrhoids

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35
Q

anal fissues

A

most common cause of BRBPR at any age
breaks or tears in the skin of the anal canal
generally self healing, but can become chronic

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36
Q

epidemiology of anal fissures

A

1 in 350
most often ages 15-40
90% located in the midline, posterior to the anus, anterior to the coccyx

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37
Q

chronic anal fissures

A

can lead to spasm of the internal anal sphincter, which impairs blood flow to the region, slowing healing

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38
Q

treatments for anal fissures

A

dietary fiber
careful anal hygiene after defecation
placing a cotton ball at anus to keep tissue dry
nitroglycerin or Ca2+ channel blockers, injection of botox

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39
Q

scrotum

A

sac containing testicles and epididymises

keeps cooler than abdominal temperature

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40
Q

testis

A

produce sperm and androgens

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41
Q

epididymis

A
  1. sperm maturation
  2. sperm storage
  3. sperm disposal
  4. absorption of fluid
  5. secretion of proteins
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42
Q

vas deferens

A

connects epididymis to urethra
thick walled
peristaltic contractions of the smooth muscle wall move sperm along the vas

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43
Q

penis

A

common outlet for both urine and semen

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44
Q

scrotal components of the male after the seminiferous tubules

A
  1. tubulus rectus
  2. rete testis
  3. ductuli efferentes
  4. epididymis
  5. vas deferens
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45
Q

tubulus rectus

A

link seminiferous tubule to rete testis

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46
Q

rete testis

A

network of spaces contained within the connective tissue of the mediastinum

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47
Q

ductuli efferentes

A

12 spiral winding tubes arising from the rete testis

become confluent with a single epididymal duct coiled into a compact structure

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48
Q

seminiferous tubules

A

continuous loops with a lumenal fluid/sperm filled space; about a meter long

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49
Q

seminiferous epithelium cell types

A
  1. spermatogenic cells

2. sertoli cells (support cells)

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50
Q

structure of seminiferous epithelium

A

from outside to inside:

  • peritubular (myoid) cells outside of BM
  • basal lamina
  • spermatogonium (stem cells) with interspersed sertoli cells
  • spermatocytes
  • early spermatid
  • late spermatid
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51
Q

sertoli cell overview

A

nonproliferating cells which support spermatogenic cells

contact 3-5 other sertoli and 30-50 spermatogenic cells

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52
Q

receptors on sertoli cells

A

FSH and androgen receptors

both FSH and androgens are required to maintain highly differentiated nature of the cells

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53
Q

proteins secreted by sertoli cells

A 
MIS/AMH
transferrin
ceruloplasmin
androgen binding protein (ABP)
kit ligand/ steel factor
inhibin B
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54
Q

AMH/MIS

A

inhibits mullerian duct development into female repro organs

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55
Q

transferrin

A

transports iron into spermatogenic cells

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56
Q

ceruloplasmis

A

transports copper into spermatogenic cells

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57
Q

androgen binding protein (ABP)

A

high affinity for T and DHT

essential for proper epididymal function

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58
Q

kit ligand/ steel factor

A

required for spermatogenic cell survival (membrane bound)

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59
Q

inhibin B

A

inhibits pituitary FSH release

marker of sertoli cell function

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60
Q

blood testis barrier

A

formed at puberty
tight junctional complex between adjacent sertoli cells
creates a compartment hidden from the immune system

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61
Q

function of meiosis

A

produces 4 unique haploid cells

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62
Q

stages of spermatogenesis

A
  1. spermatogonia stage
  2. primary spermatocyte stage
  3. secondary spermatocyte stage
  4. spermatid development
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63
Q

spermatogonia stage

A

2 weeks

mitotically dividing stem cells

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64
Q

primary spermatocyte stage

A 
4 weeks
meiotically dividing cells
1. preleptotene
2. leptotene
3. zygotene
4. pachytene
5. diplotene
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65
Q

secondary spermatocyte stage

A

8 hours

quick division

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66
Q

spermatid development stage

A

3 weeks
haploids cells undergoing dramatic shape change from round cell to a sperm
spermiogenesis*

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67
Q

total time for spermatogenesis

A

74 days (2.5 months)

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68
Q

sperm structures

A 
acrosome (secretory granule)
head
connecting piece
middle piece of tail
principal piece of tail
end piece of sperm tail
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69
Q

why are sperm immunologically foreign

A
  1. genetic recombination during meiosis creates new combination of maternal and paternal genes
  2. haploid gene expression includes numerous genes products that are unique to spermatogenesis
  3. initiates long after immunological self has been determined (aka during puberty, long after birth)
70
Q

Leydig cell overview

A

interstitial cells

have LH receptors and produce androgens

71
Q

function of T produced by leydig cells

A

stimulate spermatogenesis

inhibit HP axis at hypothalamus and anterior pituitary

72
Q

receptors on spermatogenic cells

A

dont have any!!!

controlled by nearby sertoli cells via direct cell cell interactions

73
Q

regulation of heat in testes

A

normally 2 deg cooler than abdominal temps
result of scrotal location and the counter current heat exchanger from the cooler blood within the pampiniform plexus to the testicular artery

74
Q

result of increased heat in testes

A

seminiferous tube atrophy

leydig production of T decreased over the long term

75
Q

what is klinefelters

A

XXY hypogonadism

extra X chromosome caused testicular failure of both spermatogenesis and androgen production

76
Q

symptoms of klinefelters

A 
decreased T levels
small penis
generally azoospermic
33-50% have breast development
high FSH and LH (trying to increase T)
trouble w language skills
77
Q

diagnosis of klinefelters

A

1 per 600 male births
generally not detected until puberty, unless genetically tested at birth
most common chromosomal abnormality in humans

78
Q

epidemiology of testicular cancer

A

1-2% of male cancers
second most frequent cancer of 20-29 year old males
germ cell tumors most common
treatable

79
Q

structure of the epididymis

A

highly tortuous duct, 6 meters long

takes sperm 3-8 days to travel its length

80
Q

sperm maturation in epididymis

A

nonmotile sperm obtain the ability to swim

takes place in head and body

81
Q

sperm storage in epididymis

A

100 million in each
70% of sperm stored here
a portion released with ejaculation

82
Q

sperm disposal in epididymis

A

after abstinence, a higher percentage of infertile sperm are released
sperm do “age” within the male repro tract
motility and morphology of sperm depressed after 7 days of abstinence

83
Q

absorption of fluid in epididymis

A

most of the fluid produced by sertoli cells is absorbed in the caput

84
Q

secretion in the epididymis

A

secretes a number of proteins which alter the sperm surface

85
Q

epithelium of epididymis

A

columnar epithelium with variable height (star shaped lumen): 1. principal cells and 2. basal cells
height rises and then falls toward the vas deferens
amount of smooth muscle cells surrounding the epithelium increased caudally toward the vas deferens

86
Q

portions of the epididymis length

A
  1. head/caput
  2. body/corpus
  3. tail/cauda
    - continuous with vas deferens
87
Q

principal cells of epididymal epithelium

A

long microvilli on apical surface

88
Q

structure of vas deferens

A

35 cm long, 3 mm in diameter
pseudostratified columnar epithelium with short microvilli
surrounded by 3 layers of smooth muscle (inner and outer longitudinal, middle circular)

89
Q

ampulla

A

lies just superior to the seminal vesicles, before the ejaculatory ducts
stores sperm

90
Q

congenital absence of vas deferens

A

CF gene

91
Q

vasectomy

A

ligation and/or removal of a segment of the vas deferens
spermatogenesis continues at normal or slightly reduced rates
FSH, LH, T unchanged
96% of sperm broken down within epididymis

92
Q

sperm granuloma

A

can develop post vasectomy at site of sperm leakage
macrophages and other WBCs attack the sperm as foreign bodies
very painful in 4% of men who have gotten vasectomies

93
Q

procedure of vasectomy

A

simple, outpatient, performed by many family practice physicians
< 60 min
no sutures required

94
Q

vasovasectomy

A

reversal of vasectomy; reanastomosis & opening of cut and sealed vasal ends
pregnancy rates are lower than expected, probably due to antisperm Abs which develop after vasectomy

95
Q

what is cryptorchidism

A

undescended testicle

congenital malposition resulting in retention of the testes anywhere along the route of descent

96
Q

prevalence of cryptorchidism

A

2-5% of boys under 1
15-20% in premature boys
10% bilateral

97
Q

treatment of cryptorchidism

A

HCG treatment (stimulates Leydig cells to produce androgens) may stimulate descent
otherwise, early surgery (before 6 mo)
reduction in fertility if not treated

98
Q

pampiniform plexus

A

veins that wrap around the tortuous testicular artery

cools the coiled testicular arterial blood with countercurrent heat exchange

99
Q

varicocele

A

insufficient or congenital absence of valves within the spermatic/ pampiniform plexus veins, causing blood reflux within the pampiniform plexus
occur in 10% of men

100
Q

where does varicocele commonly occur

A

L side
due to return of the left testicular vein to the L renal vein (higher pressure vein) than the R testicular vein which drains into the IVC

101
Q

consequences of varicocele

A 
reduced fertility (count)
treatment often increases sperm production
102
Q

grading of varicocele

A

bag of worms

  1. seen only on US
  2. smallest, not visible, but felt w valsalva
  3. not visible, but felt
  4. visible
103
Q

congenital hydrocele

A

congenital, processes vaginalis remains open to peritoneal cavity
most resolve spontaneously during first year of life without intervention

104
Q

appearance of hydroceles

A

scrotum rapidly fills with fluid when straining or sitting up
6% of term males

105
Q

acquired hydrocele

A

abnormal accumulation of serous fluid in the sac of the tunica vaginalis; most often noncommunicating with peritoneal cavity
can also be result of plugged inguinal lymphatic system from repeated, chronic infection

106
Q

testicular torsion

A

sudden twisting of spermatic cord resulting in strangulation of the blood vessels serving the testis and epididymis
normally prevented by gubernaculum remnant
painful, EMERGENCY, must be treated in 4 hours

107
Q

parts of the male urethra

A 
prostatic
membranous (intermediate)
penile
108
Q

penis

A

common outlet for both urine and semen

erect in anatomical position

109
Q

structure of penis

A

3 cylinders of erectile tissue

  • 2 corpora cavernosa on the dorsal surface formed of erectile tissue
  • single corpus spongiosum contains the urethra
  • tunica albuginea connective tissue layer surrounds each cylinder
110
Q

penile ligaments

A
  1. fundiform

2. suspensory

111
Q

fundiform ligament

A

attaches from the deep fascia of the penis to the linea alba superiorly
sling-like structure
more superficial than suspensory

112
Q

suspensory ligament

A

attached from the deep fascia of the penis to the pubic symphysis
deep to fundiform

113
Q

circumcision

A

release and/or removal of a portion of the foreskin and is performed for both hygiene and religious regions

114
Q

purpose of circumcision

A

religious (jewish, islamic)

prevents smegma accumulation (cheesy accumulation of dead skin and sebaceous gland secretions)

115
Q

muscles of the root of the penis

A

bulbospongiosus
ischiocavernosus
contract to help restrict venous blood flow out from the penis and can cause transient increase in internal penile pressure above arteriolar pressure

116
Q

function of bulbospongiosus

A

expels both semen and urine from the base of the penile urethra

117
Q

dorsal penile arteries

A

deep to Buck’s fascia outside the corpora cavernosa

118
Q

deep penile (cavernous) arteries

A

center of each corpora cavernosa

main source of blood to erectile tissue

119
Q

artery of the bulb of the penis

A

to bulb of penis and to bulburethral glands

120
Q

somatic innervation to the penis

A

pudendal nerve
S2-4
becomes dorsal nerve of the penis

121
Q

autonomic innervation of the penis

A

cavernous nerves

  • from inferior hypogastric plexus
  • run next to central cavernous artery within corpora of the penis
  • has sym and para
122
Q

what is required for successful erection and ejaculation

A 
vascular system
smooth and skeletal muscles
urethral sphincters
para and sym ANS
bulbospongiosus muscle
123
Q

erection

A 
parasympathetic stimulation (S2-4) through pelvic splanchnic, inferior hypogastric, and prostatic nerve plexuses and the cavernous nerves
results in vasodilation of the helical arteries allowing more blood flow (5-10x) and enlargement and erection
124
Q

emission

A

delivery of sperm via vas deferens, prostatic secretions, and seminal secretions into the prostatic urethra
requires sym innervation (L1-2) to smooth muscle in walls of vas deferens, prostate, and seminal vesicle

125
Q

ejaculation

A

forceful removal of semen from the urethra
internal urethral sphincter (smooth muscle, sym) must remain CLOSED
external urethral sphincter (skeletal) must OPEN
bulbospongiosus muscles contract (pudendal S2-4) forcing semen from the penis base

126
Q

detumescence

A

loss of an erection
follows sym discharge required for emission
causes constriction of helical arteries, reducing blood flow into the cavernous tissue

127
Q

retrograde ejaculation

A

semen redirected towards the urinary bladder

internal smooth muscle sphincter does not function properly

128
Q

causes of retrograde ejaculation

A

trans-urethral resection of the prostate

diabetes (neuropathy)

129
Q

WBCs in ejaculate

A

<1 million is a normal component

if infected with HIV, prostatic secretions appear to aid the transmission/ spread of HIV from contact with semen

130
Q

black light glow of semen

A

PSA from prostate

semenogelins from seminal vesicle

131
Q

WHO sperm guidelines

A

1.5-6 mL volume
15-200 million per mL
4-44% normal morphology
55% motility (mean)
7.4 pH
coagulates in seconds due to semenogelins from seminal vesicle
liquefaction occurs 10-60 min later caused by prostatic enzymes

132
Q

normozoospermia

A

normal ejaculate

133
Q

oligozoospermia

A

<15 mil per mL

134
Q

asthenozoospermia

A

reduced sperm with forward progression

<32% progressive motility

135
Q

teratozoospermia

A

sperm with abnormal morphology

<4% normal

136
Q

azoospermia

A

no sperm in ejaculate

137
Q

aspermia

A

no ejaculate

138
Q

congenital bilateral absence of vas deferens

A

blockade of the transport of the spermatozoa from the testis or the epididymis to the distal genital tract
oligozoospermia
present in many males with CF

139
Q

how to identify absence of vas deferens

A

fructose analysis of the semen

fructose is made in seminal vesicle, so CBAVD men are fructose negative

140
Q

seminal vesicles

A

secrete 2 ml of viscous, slightly yellow fluid which is present in highest concentration in the last half of the ejaculate
helps wash sperm out of urethra

141
Q

seminal vesicle epithelium

A

psuedostratified or simple low columnar

142
Q

secretions from seminal vesicle

A
  1. fructose
  2. prostaglandins
  3. proteins responsible for semen coagulation: semenogelins
  4. slightly alkaline pH
143
Q

fructose

A

energy source for sperm

144
Q

prostaglandins

A

stimulate smooth muscle contraction in female repro tract, aiding in sperm dispersal

145
Q

semenogleins

A

coagulate semen seconds after ejaculation

146
Q

alkaline pH of seminal vesicle secretions

A

help neutralize acidity of vagina

147
Q

function of prostate gland

A

secretes 0.5 mL of thin, opalescent fluid present in the first portion of ejaculate

148
Q

zones of prostate

A

periurethral zone transitional zone
central zone
peripheral zone
anterior fibrous zone

149
Q

periurethral zone

A

smallest region
immediately around urethra
resistant to inflammation and carcinoma
site of SPH

150
Q

peripheral zone

A

70% of prostate

site of prostatic cancer

151
Q

components of prostatic secretions

A
  1. prostatic acid phosphatase (PAP)
  2. prostate specific antigen (PSA)
  3. spermine
  4. fibrolysin
152
Q

PAP

A

may enhance infectivity of HIV in semen

153
Q

PSA

A

serine protease responsible for liquefaction of semen upon standing and liquefaction of cervical mucus

154
Q

spermine

A

polyamine
antibacterial properties
musk odor of semen

155
Q

fibrinolysin

A

liquefaction of semen

156
Q

prostatic concretions

A

lumenal concretions which are thought to begin as protein and nucleic acid, but may calcify
occur in 20-30% of men over 50
may block ducts or appear in ejaculate

157
Q

what is BPH

A

benign prostatic hyperplasia
obstructs the passage of urine, leading to increased retention and infections
increased difficulty urinating

158
Q

BPH epidemiology

A

seldom seen before age 50

found in 75-80% of non asian men over 80

159
Q

function of stromal cells of the prostate

A

have 5-alpha-reductase enzyme to convert T to DHT

diffuses from these cells into epithelial cells

160
Q

function of DHT in the prostate

A

stimulates production of mitogenic growth factors to stimulate proliferation of both stromal and epithelial cells

161
Q

treatment for BPH

A 
a1 inhibitors (doxazosin)
5-alpha reductase type 2 inhibitors (finasteride)
162
Q

a1 receptor inhibitors in BPH

A

relax contraction of smooth muscle in the stroma

increases urine flow

163
Q

5-alpha reductase type 2 inhibitors in BPH

A

shrink size of the prostate by reducing androgen concentrations

164
Q

difference in feel of BPH and prostate carcinoma

A

prostate cancer: lumps or bumps

BPH: general enlargement

165
Q

prostate adenocarcinoma

A

3rd most frequent cause of cancer death in US males
PSA is used for monitoring
rectal exam used for screening

166
Q

bulbourethral glands

A

compound tubuloalveolar glands that secrete clear mucus upon erotic stimuli

167
Q

mechanism of penile erection

A
  1. nerves produce NO which diffuses into smooth muscle cells
  2. NO activates guanylate cyclase which converts GTP into cGMP
  3. cGMP triggers storage of Ca2+ within the cell (induces relaxation)
  4. relaxed smooth muscle presses against the small veins draining blood from the penis
168
Q

erectile dysfunction

A

repeated inability to achieve and/or maintain penile erection and thus engage in intercourse

169
Q

epidemiology of ED

A

more frequent in diabetic men
30 mil men in US
incidence increases with age

170
Q

sildenafil mechanism

A

inhibits PDE5, an enzyme that promotes degradation of cGMP, which regulates blood flow in the penis
by inhibiting breakdown of cGMP, blood flow to the penis is increased, allowing maintenance of erection sufficient for intercourse

RDS Test 1 (22 decks)

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