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Medicine year 2 semester 1 > Case 14- anatomy 2 > Flashcards

Case 14- anatomy 2 Flashcards

1
Q

Pelvic cavity

A

Located between the pelvic inlet and outlet, location of the pelvic viscera. The rectum is the most distal part of the pelvic cavity and the bladder is the most anterior part, the pubic symphysis is anterior and superior to the bladder

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2
Q

Perineum

A

Below the pelvic outlet/pelvic floor. Includes distal urinary, reproductive and digestive tracts and the external genitalia. The Perineum is inferior to the pelvic floor

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3
Q

Divisions of the Perineum

A

The anal and urogenital triangle (deep and superficial pouch). Divided by a line between the two ischial tuberosities. The Urogenital triangle anchors the external genitalia. The anal triangle contains the anus and external anal sphincter. The pelvic floor forms the roof of the perineum.

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4
Q

The anal triangle

A

The external anal sphincter is the major muscle in the triangle. Contains the Ischio-anal fossae, a pair of fat filled spaces within the anal triangle. This is between the pelvic floor and sacrospinous ligament. Contains the Pudendal neurovascular. Close to the Ischio tuberosity because anaesthetics are injected in this area for surgery, it’s a useful landmark.

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5
Q

Urogenital triangle contents

A

Roots of external genitalia, opening of urogenital system (urethra, vagina), perineal membrane and perineal body. The route of the urethra goes through the urogenital hiatus.

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6
Q

The Perineal body

A

A fibromuscular mass in the midline, it’s the site of muscle attachment and stabilises pelvic and perineal structures. Childbirth may cause it to weaken. The perineal membrane is attached to the ischiopubic rami and is the opening for the urethra and vagina. There are gaps near the pubic symphysis for vessels. Is triangle shaped and has a free edge.

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7
Q

What is the pelvic floor made of

A

Made of the perineal membrane, perineal body, pelvic floor muscles and the deep perineal pouch. The pelvic diaphragm refers to the pelvic floor muscles

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8
Q

Deep and superficial pouch

A

The space between the pelvic floor muscles and the perineal membrane is the deep pouch. The space between the perineal membrane and the skin is the superficial pouch. The deep pouch is superior to the perineal membrane and the superficial pouch is inferior.

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9
Q

Contents of the deep perineal pouch

A

External urethral sphincter, Urethra, deep transverse perineal muscle (in males the bulbourethral gland is within this muscle) and the vaginal openings/sphincters (F).

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10
Q

Nerves of the deep perineal pouch

A

Dorsal nerve and vessels of penis, dorsal nerve and vessels of the clitoris, deep perineal vessels (covered with perineal membrane on right side).

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11
Q

Contents of the superficial pouch

A

Erectile tissue (clitoris, corpus cavernosum of penis), bulb of penis (m), vestibule (F), greater vestibular gland (F).

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12
Q

Muscles of the superficial pouch

A

Bulbospongiosus (covers bulb of penis/vestibule), Ischiocavernosus (covers corpus cavernosum) and the superficial transverse perineal muscle.

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13
Q

Difference between labia and minora

A

The labia majora is covered in hair, the labia minora is not

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14
Q

Prepuce

A

Foreskin

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15
Q

Ways the female pelvis is adapted for childbirth

A
  • Wide/shallow/cylindrical lesser (true) pelvis
  • Oval/rounded/wide pelvic inlet
  • Larger (than male) pelvic outlet
  • Wide pubic arch/subpubic angle
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16
Q

Anatomy of the testis

A

1) It is suspended from the abdomen by the spermatic cord
2) Surrounded by the Tunica vaginalis which is a double layered closed sac, it has a visceral layer and a parietal layer. Between the layers there is fluid.
3) The Tunica vaginalis is derived from the parietal peritoneum, when the gonads descend through the abdomen. It lubricates the surface of the testes allowing friction free movement.
4) The Tunica albuginea is a fibrous capsule internal to the Tunica vaginalis which penetrates into the internal surface of each testes to form septum which separate them into lobules.
5) The interstitium is where hormone production takes place and the Seminiferous tubules is where you get sperm production.

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17
Q

Anatomy of the Epididymis

A

A single heavily coiled tube that is divided into 3 parts. Head (sperm transported here from efferent ductules), body and tail (continues as the ductus deferens). It’s the site of sperm maturation and storage. Its positioned on the posterolateral aspect of each testes.

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18
Q

Anatomy of the Ductus vas deferens

A

Transports sperm from the tail of the epididymis to the ampulla of the ductus deferens, ready for ejaculation. Paired structure. Storage site for sperm, especially the ampulla which is the enlarged portion. Thick muscular walls and a minute lumen.

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19
Q

Location of the Ductus vas deferens

A
  • Posterior to testis within scrotum
  • Travels within the spermatic cord through the inguinal canal to enter abdominal cavity
  • Crosses external iliac vessels and enters the pelvis
  • Travels towards the posterior aspect of the fundus of the bladder
  • Crosses anterior and superior to the ureter on the same side
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20
Q

Anatomy of the Seminal vesicles

A

Glands (one on each side) that contribute to seminal fluid. Its an alkaline fluid that contains, fructose, prostaglandins and coagulants. The duct of the seminal vesicle joins with the ampulla of the ductus deferens to form the ejaculatory duct. It lies between the fundus of the bladder and the rectum, posterior to bladder anterior to rectum. Its obliquely placed superior to the prostate.

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21
Q

Anatomy of the ejaculatory duct

A

There are two ejaculatory ducts, one on each side. The Ejaculatory duct is formed from the duct of the seminal vesicle joining the ampulla of the ductus (vas) deferens. It unites with the prostatic urethra within the prostate.

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22
Q

Anatomy of the Prostate

A

Unpaired, is the largest accessory gland of the male reproductive system. It surrounds the prostatic urethra, 2/3 are Glandular and 1/3 is fibromuscular. The glandular ducts empty into the posterior aspect of the urethral lumen, into the prostatic sinuses. The secretions contribute to the seminal fluid. The prostate is between the two urethral sphincters. Its stabilised by the puboprostatic ligament. The rectum is posterior. The ejaculatory ducts open into the seminal caliculus and into the prostatic urethra.

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23
Q

Seminal caliculis

A

The Utricle is an opening within the seminal caliculis which has no clinical significance but can be used as a surgical landmark. Either side of the seminal caliculis is the Prostatic Sinus where the glandular duct opens into and where prostatic fluid is secreted into the prostatic urethra

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24
Q

Male urethral portions

A

Pre-prostatic (intramural) –> Prostatic (where the ejaculatory ducts join) –> Membranous (intermediate) –> Penile (spongy)

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25
Q

Bulbourethral glands

A

(Cowper’s glands)- two pea shaped glands. Embedded within the muscle of the deep perineal pouch. Opens into the spongy urethra but sit at the level of the membranous urethra. Secrete a lubricant into the seminal fluid, cleans out the urethra (pre-ejaculate).

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26
Q

Male contents of the anal triangle

A

The anal canal, the external anal sphincter. The ischio-anal fossae which is a fat filled space containing the Pudendal neurovasculature- nerves and vasculature going towards the external genitalia

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27
Q

Male and female contents of the urogenital triangle

A

The root of the external genitalia and the uretha

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28
Q

Female contents of the urogenital triangle

A

The roots of the external genitalia including key erectile tissue and the openings of the urogenital system (urethra, vagina). Within the urogenital hiatus is the urethral and vaginal opening. You have the perineal membrane which separates the deep and superficial pouch. The perineal pouch acts as a muscle attachment and stabilises the pelvic floor

29
Q

Male contents of the deep pouch

A

Urethra (membranous portion), external urethral sphincter, Bulbourethral glands, deep transverse perineal muscle and the Perineal neurovasculature. The Bulbourethral gland is within the deep transverse perineal muscle. The Perineal vasculature contains the Dorsal nerve and vessels of the penis and the deep perineal vessels.

30
Q

Male contents of the superficical pouch

A

Erectile tissue which is largely contained within the penis. You have the superficial external genitalia (Penis and Scrotum). The following muscles:
• Superficial transverse perineal- runs from the ischial tuberosity to the perineal body
• Bulbospongiosus- cover and attach to the bulb of the penis. It is anchored posteriorly to the perineal body and attaches to the perineal membrane
• Ischiocavernosus- covers the cura of the penis. It is anchored to the ischial tuberosity and ramus

31
Q

Types of erectile tissue

A
  • The Corpora cavernosa is a paired structure. It is anchored to the ischiopubic rami and is attached by the cura of the penis. The distal end forms part of the body of the penis.
  • Corpus spongiosum- singular structure. The attached part is known as the bulb of the penis, the distal end forms part of the body of the penis with the corpus cavernosa. It contains the spongy/penile urethra. The Corpus spongiosum sits ventrally and the Corpus cavernosa sits dorsally
32
Q

Contents of the deep pouch in females

A
  • Urethra- most anterior part
  • Urethral sphincter
  • Vagina (opening)- posterior to urethra
  • Deep transvers perineal muscle- across the lower border of the urogenital triangle. Stabilises the pelvic floor
  • Perineal neurovasculature- some pass through to the superficial pouch. (Includes dorsal nerve and vessels of the clitoris)
33
Q

Contents of the superficial pouch in females

A

• Erectile structure- Clitoris
• Muscles- same as in males (superficial transverse perineal, Ischiocavernosus and Bulbospongiosus)
• Superficial external genitalia- Vulva
The paired corposa cavernosa helps make up the clitoris. It is anchored to ischiopubic rami and is attached via the crura, the distal end forms the body of the clitoris.

34
Q

Paired bulbs of the vestibule

A

One on each side of the vaginal opening. It is anchored to the perineal membrane and is connected anteriorly to the glans clitoris (pea shaped erectile mass). The bulbs of the vestibule are not part of the clitoris. The corposa cavernosa and the glans clitoris form the clitoris.

35
Q

Greater vestibular glands (Bartholin’s glands)

A

Small mucous glands, posterior to the bulb of the vestibule. The duct of each gland opens into the vestibule of the perineum, this is close to the vaginal opening. Produces secretions during sexual arousal that are released into the posterior walls of the vagina

36
Q

Greater vestibular glands (Bartholin’s glands)

A

Small mucous glands, posterior to the bulb of the vestibule. The duct of each gland opens into the vestibule of the perineum, this is close to the vaginal opening. Produces secretions during sexual arousal that are released into the posterior walls of the vagina

37
Q

The Glans clitoris

A

The Glans clitoris is exposed in the perineum. The Clitoris has an attached part (root) and a free part (body). The root is formed from the 2 crura (not bulbs of vestibule only corposa cavernosa), the body is the unattached part of the crura, embedded in the perineum. Its sole function is sexual arousal. Becomes erect with tactile stimulation.

38
Q

Females- the Ischiocavernosus and Bulbospongiosus

A

They are paired muscles associated with the clitoris, helps with moving blood through the erectile tissues. The Superficial transverse perineal muscle is associated with the perineal body. It overlies the deep transverse perineal in the deep pouch. Location of muscles:
• Ischiocavernosus- covers the crura, anchored to the ischial tuberosity and the ramus. Moves blood from the crura into the body of the clitoris
• Bulbospongiosus- covers and attaches to the bulbs of the vestibule. It is anchored posteriorly to the perineal body and attaches to the perineal membrane. Compresses the corpora cavernosa and the bulb of the vestibule
• Superficial transverse perineal- from the ischial tuberosity to the perineal body. Stabilises pelvic floor and perineal body.

39
Q

Female- list of structures in the deep pouch

A
  • Urethra
  • External urethral spincter
  • Vagina
  • Deep transverse perineal muscle
  • Perineal neurovasculature
40
Q

Females- contents of the superficial pouch

A
  • Erectile corpora cavernosa tissue - clitoris
  • Ischiocavernosus
  • Bulbospongiosus
  • Superficial transverse perineal muscle
  • Greater vestibular glands (Bartholin’s glands)
  • External genitalia- Bulb of the vestibule, Skene’s glands
41
Q

Anatomical position of the penis

A

Its erect in the anatomical view. The front of the penis is the dorsal view and the underside is the ventral view

42
Q

Anatomy of the Scrotum

A

Its two chambers separated by a septum. You have bilateral embryonic formation so both chambers grow together during development, this creates the scrotal raphe down the middle. The raphe continues internally as the septum. It is a cutaneous fibromuscular sac. The scrotal skin is continuous with the peritoneum and the scrotum.

43
Q

Layers of the Scrotum

A 
Originate from the layers of the anterolateral abdominal wall. From outside in:
• Scrotal skin
• Dartos muscle and fascia
• External spermatic fascia
• Cremaster muscle
• Cremasteric fascia
• Internal spermatic fascia
• Tunica vaginalis- was the Processus vaginalis during development, the visceral layer is the internal layer. Covers the anterior and sides of each testes
44
Q

Spermatic cord

A

It is continuous with some of the layers of the scrotum. Including the External spermatic fascia, the Cremaster muscle, the Cremasteric fascia and the Internal spermatic fascia. It is a group of structures that are travelling between the abdomen and scrotum, it goes through the inguinal canal

45
Q

Contents of the Spermatic cord

A
  • Testicular artery
  • Cremasteric artery
  • Artery to the vas deference- branch of the superior or inferior vesicle artey
  • Pampiniform plexus of the testicular veins
  • Genital branch of the genitofemoral nerve
  • Ductus (vas) deferens- transports sperm
  • Remnant of the Processus vaginalis
  • Lymphatic vessels
  • Autonomic nerves
46
Q

Testicular torsion

A

Where the spermatic cord twists upon itself. Can cause strangulation of the testicular artery resulting in necrosis of the testis.

47
Q

Cremasteric reflex

A

The Cremaster muscle is a layer of the spermatic cord and scrotum and is supplied by the genital branch of the genitofemoral nerve. The Ilioguinal and femoral branch of the sensory fibres of the genitofemoral nerve is stimulated when stroking the inner thigh. It causes elevation of the Ipsilateral testis.

48
Q

Divisions of the penis

A

The Penis can be divided into the root, body and Glans penis. The root is the attached section and consists of the crura on each side and the median urethral bulb. The root is within the superficial perineal pouch, sitting on the perineal membrane. The body of the penis is suspended from the pubic symphysis. The body of the penis is made up of erectile tissue. The Glans penis is made up of expanded erectile tissue. The erectile tissue makes up the largest part of the penis.

49
Q

Erectile tissue in the penis

A

Paired corposa cavernosa dorsally (at the top), single corpus spongiosum ventrally (at the bottom. Running through the centre of the corposa cavernosa are the deep arteries. Around the Corposa cavernosa is the Tunica albuginea. The spongy urethra goes through the Corpus Spongiosum. Because its so spongy it stops the urethra from becoming blocked.

50
Q

Structures around the erectile tissue in men

A

Around the erectile tissue you have the Deep (Buck’s fascia) and surrounding that the Superficial (Dartos) fascia. At the dorsal end of the penis there is the dorsal artery and nerve and the deep dorsal vein within Buck’s fascia. Outside the Buck’s fascia but within the Dartos fascia is the superficial Dorsal vein.The two Corpora cavernosa attach to their corresponding ischio-pubic rami. The bulb of the penis attaches to the perineal membrane within the superficial perineal pouch. It is penetrated superficialy by the spongy urethra.

51
Q

Muscles that cover the root of the penis

A

• Ischiocavernosus- this covers the crura, forces blood from the cavernous spaces within the crura towards the distal parts of the Corpora cavernosa. Increases the firmness of the penis during an erection. Contraction also occludes the tributaries of the deep dorsal vein of the penis, maintaining the erection.
• Bulbospongiosus- covers and attaches to the bulb of the penis. It is anchored to the perineal body and attaches to the perineal membrane. Compresses the bulb of the penis and the corpus spongiosum. Aids in emptying the spongy urethra of residual urine and semen. The anterior fibres help in maintaining the erection.
The muscles are stronger then in females.

52
Q

What supports the penis

A

The Fundiform and suspensory ligaments help provide support to the penis. The Fundiform penis is derived from the linea alba and the suspensory ligament is attached to the pubic symphysis.

53
Q

Glans penis

A

The Glans penis is formed from the expansion of the corpus spongiosum. The margin of the Glans penis is known as the Corona of Glans. Between the body of the penis and the corona there is the Neck of glans, which is a groove between the two structures. The External urethral orifice is where semen and urine exit from. The Prepuce (foreskin) covers the Glans penis. The Prepuce is retractable. The Frenulum is a fold that passes from the deep layer of the prepuce to the urethral surface of the glans

54
Q

Phimosis

A

A condition where the foreskin is too tight to be pulled over the head of the glans penis, causes pain and swelling

55
Q

Uterus

A

Posterior and superior to the bladder. It is a thick walled, pear shaped muscular organ. Its about 7.5cm long, 5cm wide and 2cm thick but the size and shape varies. It can be divided into the Uterine corpus (body) and the Uterine cervix.

56
Q

The size and shape of the uterus varies with

A
  • Age- puberty and menopause. The uterus increases in size during puberty and reduces in the menopause
  • Fullness of bladder/Rectum
  • Pregnancy- even after delivery the uterus can stay enlarged
  • Stage of menstrual cycle
57
Q

Divisions of the Uterine corpus (body)

A
  • Fundus – above level of origin of uterine tubes, rounded superior surface
  • Body – majority of uterus
  • Isthmus- where uterine cavity narrows to meet cervix
  • Cavity – inverted triangle when viewed anteriorly, empty space
  • Uterine horns – superolateral regions of uterine cavity, where the uterine tubes enter
58
Q

Layers of the uterus

A
  • Endometrium – Innermost layer, lines uterine cavity. Inner surface sheds during menstruation. Adhered to myometrium, highly vascular and glandular
  • Myometrium – Smooth muscle, contains uterine neurovasculature, distends in pregnancy but becomes thinner. Blood vessels/nerves in this layer. Contracts during childbirth to expel foetus and placenta. Also contracts in menses
  • Perimetrium – Peritoneum over uterus
59
Q

Endometriosis

A

Where the endometrium is found outside the uterine cavity. Causes pain during menses

60
Q

Uterine cervix

A

The inferior 1/3 of the uterus. Its about 2.5cm long but variable. Allows communication between uterus and vagina. Contains the internal os (opening into the uterine cavity) and the external cervical os (opening into the vaginal cavity). Its dome shaped and bulges into the vagina. The vaginal fornicles are gutters around the margin of the cervix and vaginal wall, the posterior fornix is above, the anterior fornix is below. You also have lateral fornices around the vagina.

61
Q

Angle of anteversion

A

The long axis through the vagina plus the long axis through the cervix. Tells us how the vagina relates to the cervix

62
Q

Angle of anteflexion

A

The long axis through the uterine corpus plus the long axis through the cervix. How the uterine body is related to the cervix

63
Q

The angle of anteversion and anteflexion are maintained by

A
  • Cardinal ligaments (cervix to internal iliac vessels)

* Uterosacral ligaments (cervix to sacrum)

64
Q

Fallopian tubes

A

Approx 10cm long, go from the lateral walls of the uterine horns to the ovary. There is no physical connection between the end of the uterine tube and the ovary. At the end of the uterine tube you have Fimbriae which sweep the ovum into the uterine tube. The reproductive tract is open between the abdominal cavity and the outside world. There is potential for spread of infection and for endometrial tissue to enter the abdominal cavity. They extend laterally from the uterus then pass posterosuperior over the ovaries

65
Q

Parts of the uterine tubes

A
  • Fimbriae
  • Infundibulum- funnel shaped, near the ovary, helps guide the egg down the uterine tube
  • Ampulla- fertilisation usually occurs here. The widest part of the fallopian tube
  • Isthmus- narrowest part, connects to the uterus
66
Q

Ovaries

A

Almnd shaped and about 3cm long. Suspended in the mesovarium. The ovarian vessels and nerves pass to/from the ovary within the suspensory ligament of the ovary. They are located laterally between the uterus and pelvic wall. In development they are in the posterior aspect of the abdominal wall, quite high up. Before birth they drop. Next to the pelvic inlet. The ovaries are embedded within a sheet of peritoneum, the vessels are within a peritoneal ligament

67
Q

Vagina

A

Distensible, fibromuscular tube from the cervix to vaginal orifice. Its normally ‘collapsed’ with the anterior wall in contact with the posterior wall. A speculum is needed to open it during examination.

68
Q

Landmarks in the vagina

A

Inferiorly the vagina opens into the vestibule of the perineum, immediately posterior to the external opening of the urethra. The vestibule is a region between the labia minora. Within the vestibule is the vaginal opening and the external urethral orifice.

Medicine year 2 semester 1 (53 decks)

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