Exam IV Flashcards
The kidney functions to remove water, salts, and products of protein metabolism from the blood. It is a bean-shaped retroperitoneal organ which extends from what vertebral levels?
T12-L3
The hilum of the kidney is a vertical fissure located on the medial surface of the organ. What structures does it transmit?
- Renal vein (anteriorly)
- Renal artery (between renal vein and ureter)
- Ureter (posteriorly)
- Autonomic and sensory nerves
This is the expanded superior end of the ureter within the hilum of the kidney.
Renal pelvis
This is a recess located within the hilum of the kidney, which is filled with fat.
Renal sinus
The structures which enter the hilum are known collectively as what?
Renal pedicle
This is the outer portion of the kidney.
Renal cortex
These are projections of the cortex into the medulla between the renal pyramids.
Renal columns
This is the inner portion of the kidney.
Renal medulla
These structures within the renal medulla terminate in an apex known as the renal papilla.
Renal pyramid
These are cup shaped structures into which the renal papillae fit.
Minor Calices
These are 2 to 3 major channels into which the minor calices empty. These channels empty into the renal pelvis.
Major Calices
What is the blood supply of the kidneys?
- Renal artery (from the abdominal aorta)
- Extrahilar arteries
- Renal vein (drains to the inferior vena cava)
This term is used to describe the left renal vein and the 3rd part of the duodenum, which are compressed between the aorta behind and the superior mesenteric artery in front.
Anatomical nutcracker
What are some symptoms of the anatomical nutcracker? Causes?
Symptoms: left kidney pain and vomiting
Causes: compressive abdominal trauma, “cast syndrome”, aortic aneurysm
What is the innervation of the kidneys?
Renal plexus, formed by fibers from the:
- Celiac plexus
- Aortic plexus
- Direct branches from the thoracic and lumbar splanchnic nerves (mainly from the least splanchnic nerve
What are the layers covering the kidney?
- Renal capsule (innermost layer)
- Perinephric fat
- Renal fascia
- Paranephric fat (outermost layer)
What is the function of fat for the kidneys?
- Protection
- Hold in place
- Insulation
This is a membranous layer of extraperitoneal tissue which splits to enclose the kidney.
Renal fascia
This condition is characterized by deposits of calcium oxalate, calcium phosphate, or uric acid in the ureter of a kidney. It can cause intense pain when in the ureter and may become lodged at one of three constrictions blocking flow.
Renal calculi (“kidney stones”)
What can be used to break up most kidney stones?
Extracorporeal shock wave lithotripsy
- Great for calcium phosphate
- Good for calcium oxalate
- Not at all for uric acid
This condition is characterized by the kidney becoming hypermobile and may end up in the renal fascia and turn upside down leading to a twisting of vessels and the ureter.
Nephroptosis (“floating kidney”)
This is a muscular tube which connects the kidney to the urinary bladder. It is retroperitoneal and descends on the psoas major muscle.
Ureter
What are the three constrictions of the ureter?
- Ureteropelvic junction
- Pelvic brim
- Where it enters the wall of the bladder
What is the blood supply of the ureter?
- Renal artery
- Gonadal artery
- Aorta
- Common iliac artery
- Superior vesical artery
What is the innervation of the ureter?
- Renal plexus
- Hypogastric plexus
The suprarenal gland is part of the endocrine system, is essential for life, and consists of what two parts?
- Medulla (secretes epinephrine and norepinephrine)
- Cortex (secretes corticosteroids)
This condition is characterized by a decreased output of hormones from the suprarenal gland.
Addison’s disease or adrenal hypofunction
What is the blood supply of the suprarenal glands?
Arteries:
- Superior suprarenal artery (from the inferior phrenic artery)
- Middle suprarenal artery (from the aorta)
- Inferior suprarenal artery (from the renal artery)
Veins:
-Suprarenal vein
The suprarenal vein drains directly into the ______ while the left suprarenal vein drains into the ______.
Inferior vena cava; left renal vein
What is the innervation of the suprarenal glands?
Primarily sympathetic from:
- Celiac plexus
- Thoracic splanchnic nerves
Where is kidney pain often referred to? What about kidney stone pain?
- Kidney pain is referred to lumbar or “flank” back pain
- Kidney stone pain is referred to the loin (lumbar) to the groin (inguinal) as it passes through the ureter (T11-L2)
The abdominal aspect of the diaphragm consists of what structures?
- Right crus
- Left crus
- Median arcuate ligament
- Medial arcuate ligament
- Lateral arcuate ligament
This structure of the abdominal aspect of the diaphragm originates from teh upper three lumbar vertebrae and splits to surround the esophagus.
Right crus
This structure of the abdominal aspect of the diaphragm originates from the upper two lumbar vertebrae. It is smaller and shorter than the right crus.
Left crus
This structure of the abdominal aspect of the diaphragm is a thickening of fascia which connects the right crus to the left crus, and forms the border of the aortic hiatus.
Median arcuate ligament
This structure of the abdominal aspect of the diaphragm is a thickening of fascia which connects the body of the 1st lumbar vertebra to the transverse process of the 1st lumbar vertebra. It passes over the psoas major muscle and sympathetic trunk.
Medial arcuate ligament
This structure of the abdominal aspect of the diaphragm is a thickening of fascia which connects the transverse process of the 1st lumbar vertebra to the 12th rib. It passes over the quadratus lumborum muscle.
Lateral arcuate ligament
This sign is characterized by pain elicited by thigh extension against resistance.
Psoas sign
What does a right psoas sign typially mean?
Appendicitis
What is the origin of the psoas major muscle?
Transverse processes and bodies of T12-L5 and corresponding intervertebral disks
What is the insertion of the psoas major muscle?
Lesser trochanter
What is the innervation of the psoas major muscle?
Lumbar nerves 1-3
What is the action of the psoas major muscle?
Flexes the thigh and the trunk
What is the origin of the psoas minor muscle?
Bodies and intervertebral disks of T12-L1
What is the insertion of the psoas minor muscle?
Pecten pubis, iliopubic eminence
What is the innervation of the psoas minor muscle?
1st lumbar nerve
What is the action of the psoas minor muscle?
Flexes the trunk
What is the origin of the iliacus muscle?
Iliac fossa, iliac crest, and ala of sacrum
What is the insertion of the iliacus muscle?
Lesser trochanter via the tendon of psoas major
What is the innervation of the iliacus muscle?
Branches of the femoral nerve (L2, L3)
What is the action of the iliacus muscle?
Flexes the thigh and tilts the pelvis forward
What is the origin of the quadratus lumborum muscle?
Iliolumbar ligament and iliac crest
What is the insertion of the quadratus lumborum muscle?
12th rib, transverse processes of L1-L4
What is the innervation of the quadratus lumborum muscle?
Subcostal nerve, lumbar nerves 1-4
What is the action of the quadratus lumborum muscle?
Depresses the 12th rib and flexes the trunk laterally
What is the lumbar plexus formed from?
Anterior primary rami of L1, L2, L3, and part of L4
What are the branches of the lumbar plexus?
- Iliohypogastric nerve (L1)
- Ilioinguinal nerve (L1)
- Genitofemoral nerve (L1, L2)
- Lateral cutaneous nerve of the thigh (L2, L3)
- Femoral nerve (L2, L3, L4)
- Obturator nerve (L2, L3, L4)
What is the innervation of the iliacus muscle?
Branches of the femoral nerve (L2, L3)
What is the action of the iliacus muscle?
Flexes the thigh and tilts the pelvis forward
What is the origin of the quadratus lumborum muscle?
Iliolumbar ligament and iliac crest
What is the insertion of the quadratus lumborum muscle?
12th rib, transverse processes of L1-L4
What is the innervation of the quadratus lumborum muscle?
Subcostal nerve, lumbar nerves 1-4
What is the action of the quadratus lumborum muscle?
Depresses the 12th rib and flexes the trunk laterally
What is the lumbar plexus formed from?
Anterior primary rami of L1, L2, L3, and part of L4
What are the branches of the lumbar plexus?
- Iliohypogastric nerve (L1)
- Ilioinguinal nerve (L1)
- Genitofemoral nerve (L1, L2)
- Lateral cutaneous nerve of the thigh (L2, L3)
- Femoral nerve (L2, L3, L4)
- Obturator nerve (L2, L3, L4)
This branch of the lumbar plexus is sensory to the skin covering the pubis and gluteal region.
Iliohypogastric nerve (L1)
This branch of the lumbar plexus accompanies the spermatic cord (or round ligament of the uterus) through the inguinal canal. It emerges through the superficial inguinal ring to supply sensory innervation to the skin of the scrotum (or labia majora) and the thigh.
Ilioinguinal nerve (L1)
This branch of the lumbar plexus divides into a genital branch which supplies the cremaster muscle and a femoral branch which supplies the skin over the femoral triangle.
Genitofemoral nerve (L1, L2)
This branch of the lumbar plexus supplies the skin of the anterior and lateral aspects of the thigh.
Lateral cutaneous nerve of the thigh (L2, L3)
This branch of the lumbar plexus supplies the muscles and skin of the thigh.
Femoral nerve (L2, L3, and L4)
This branch of the lumbar plexus supplies the muscles and skin of the medial surface of the thigh.
Obturator nerve (L2, L3, and L4)
What are the boundaries of the pelvic outlet?
- Pubic symphysis
- Ischiopubic rami
- Ischial tuberosities
- Sacrotuberous ligament
- Tip of the coccyx
Anterior to the fourth lumbar vertebra, the abdominal aorta bifurcates into the right and left common iliac arteries. Each of these arteries has what two branches?
External and internal iliac arteries
What are the four functions of the pelvis?
- Locomotion
- Parturition
- Support of abdominal viscera
- Protection of pelvic viscera
The pelvis is a basin shaped structure formed by what four bones?
- Left hip bone (ilium, ischium, and pubis)
- Right hip bone (ilium, ischium, and pubis)
- Sacrum
- Coccyx
What are the boundaries of the pelvic inlet?
- Sacral promontory
- Sacral alae
- Arcuate line
- Pecten pubis (pectineal line)
- Pubic crest
The boundaries of the pelvic inlet are collectively known as what?
Pelvic brim
What is the greater (false) pelvis? Lesser (true) pelvis?
- Greater (false) pelvis is the expanded upper portion of the pelvis.
- Lesser (true) pelvis is the pelvic cavity proper. It lies between the pelvic inlet above and the pelvic outlet below.
What does the lesser (true) pelvis contain?
- Lower part of the G.I. tract
- Urinary bladder
- Lower part of the ureter
- Internal reproductive organ
What are the boundaries of the pelvic outlet?
- Pubic symphysis
- Ischiopubic rami
- Ischial tuberosities
- Sacrotuberous ligament
- Tip of the coccyx
This structure is formed by the pubic symphysis, ischiopubic rami, and ischial tuberosities.
Pubic arch
This type of pelvis is characterized by a long A-P diameter and short transverse diameter. Present in some males and approximately 20% of females.
Anthropoid pelvis
This type of pelvis is characterized by a short A-P diameter and wide transverse diameter. Rare in males, present in 2% of females.
Platypelloid pelvis (associated with difficult births)
This type of pelvis is characterized by a heart-shaped inlet. It is present in most males and approximately 30% of females.
Android pelvis
This type of pelvis is characterized by an ovoid or round inlet. It is present in 50% of females and no males. This is the ideal pelvis for childbirth.
Gynecoid pelvis
How does the male pelvic inlet compare to a females?
Male: heart-shaped
Female: oval
How does the male pelvic cavity and pelvic outlet compare to females?
Male: both small
Female: both large
How does the sciatic notch of a male compare to a females?
Male: narrow and deep
Female: broad and shallow
The greater sciatic foramen is bounded by the greater sciatic notch, sacrotuberous, and sacrospinous ligament. It lies above the pelvic floor and transmits what structures?
- Piriformis muscle
- Superior and inferior gluteal vessels and nerves
- Internal pudendal vessels
- Pudendal nerve
- Sciatic nerve
- Posterior cutaneous nerve and thigh
- Nerve to the obturator internus muscle
- Nerve to the obturator externus muscle
This pelvic joint is found between L5 and the sacrum. It contains an intervertebral disc.
Lumbosacral joint
This pelvic joint is found between the sacrum and ilium. It is a synovial joint.
Sacroiliac joint
This pelvic joint is found between the two pubic bodies. It is a fibrocartilagenous joint containing an interpubic disc.
Pubic symphysis
This pelvic joint is found between the sacrum and coccyx. It contains an intervertebral disc and is often fused.
Sacrococcygeal joint
During pregnancy, the joints of the pelvis become loose under the influence of what hormone?
Relaxin
This ligament extends from the sacrum and coccyx to the ischial tuberosity.
Sacrotuberous ligament
This ligament extends from the sacrum and coccyx to the ischial spine.
Sacrospinous ligament
The greater sciatic foramen is bounded by the greater sciatic notch, sacrotuberous, and sacrospinous ligament. It lies above the pelvic floor and transmits what structures?
- Piriformis muscle
- Superior and inferior gluteal vessels and nerves
- Internal pudendal vessels
- Pudendal nerve
- Sciatic nerve
- Posterior cutaneous nerve and thigh
- Nerve to the obturator internus muscle
- Nerve to the obturator externus muscle
The lesser sciatic foramen is bounded by the lesser sciatic notch, sacrotuberous and sacrospinous ligaments. It lies below the pelvic floor and transmits what structures?
- Tendon of the obturator internus muscle
- Nerve to the obturator internus muscle
- Internal pudendal vessels
- Pudendal nerve
What are some intrapelvic causes of sciatica?
- Piriformis syndrome
- Compression by fetal head during pregnancy
- Pelvic tumors
What is the lateral wall of the pelvis primarily covered by?
- Obturator internus muscle
- Obturator fascia
What is the bony framework of the lateral wall of the pelvis?
The portion of the hip bone which lies below the pelvic brim
What is the posterior wall of the pelvis primarily covered by?
- Piriformis muscle
- Coccygeus (Ischiococcygeus) muscle
What is the bony framework of the posterior wall of the pelvis?
The sacrum and coccyx
The floor of the pelvis is composed of structures which give support to abdominal and pelvic viscera. What are these structures?
- Peritoneum (above)
- Pelvic diaphragm (below)
This pouch of the peritoneum is found between the rectum and bladder. It is the lowest point in the peritoneum of the male.
Rectovesical pouch
This pouch of the peritoneum is found between the rectum and uterus. It is the lowest point in the peritoneum of the female.
Rectouterine pouch
This pouch of the peritoneum is found between the bladder and the uterus.
Vesicouterine pouch
What muscles compose the pelvic diaphragm?
- Coccygeus (ishiococcygeus) muscle
- Levator ani muscle
What are the openings found in the pelvic diaphragm?
- Urogenital hiatus
- Anal aperture
What is the origin of the coccygeus (ischiococcygeus) muscle?
Ischial spine and sacrospinous ligament
What is the insertion of the coccygeus (ischiococcygeus) muscle?
Coccyx and lower part of the sacrum
What is the innervation of the coccygeus (ischiococcygeus) muscle?
Anterior primary rami of the 3rd and 4th sacral nerves
What is the action of the coccygeus (ischiococcygeus) muscle?
Supports pelvic viscera, draws the coccyx forward
What is the origin of the levator ani muscle?
Body of the pubis, tendinous arch, ischial spine
What is the insertion of the levator ani muscle?
Coccyx and anococcygeal ligament
What is the innervation of the levator ani muscle?
Anterior primary rami of the 3rd and 4th sacra nerves, perineal branch of the pudendal nerve
What is the action of the levator ani muscle?
As a whole, supports the pelvic viscera. Specialized parts of the levator ani perform other functions
What are the parts of the levator ani muscle?
- Iliococcygeus
- Pubococcygeus
- Puborectalis
This part of the levator ani muscle functions to direct the fetal head during parturition.
Puborectalis
This is a curved thickening of the obturator fascia which gives origin to parts of the pubococcygeus and iliococcygeus.
Tendinous arch of levator ani
Misalignment of the sacrum may affect what?
- Fecal continuance
- Urinary continuance
- Problems with partruition
- Integrity of pelvic floor
What vertebral level does the abdominal aorta bifurcate into the left and right common iliac arteries?
L4
What are the branches of the external iliac artery?
- Deep circumflex iliac artery
- Inferior epigastric artery
The internal iliac artery has an anterior and posterior trunk. What are the branches of posterior trunk?
- Iliolumbar artery
- Lateral sacral artery
- Superior gluteal artery
This branch of the internal iliac artery divides into two branches which supply the iliacus muscle, ilium, psoas major, and quadratus lumborum muscles.
Iliolumbar artery
This branch of the internal iliac artery anastomoses with the median sacral artery.
Lateral sacral artery
This branch of the internal iliac artery exits the pelvis through the greater sciatic foramen superior to the piriformis muscle. It usually passes between the lumbosacral trunk and 1st sacral nerve.
Superior gluteal artery
The internal iliac artery has an anterior and posterior trunk. What are the branches of anterior trunk?
- Inferior gluteal artery
- Internal pudendal artery
- Umbilical artery
- Obturator artery
- Inferior vesical artery
- Middle rectal artery
- Uterine artery
- Vaginal artery
This branch of the internal iliac artery exits the pelvis through the greater sciatic foramen inferior to the pirformis muscle. It passes between the 1st and 2nd or 2nd and 3rd sacral nerves.
Inferior gluteal artery
This branch of the internal iliac artery exits the pelvis through the greater sciatic foramen between the piriformis and coccygeus muscles. It then enters the perineum through the lesser sciatic foramen. It gives off important branches to the perineum, which are discussed with that region.
Internal pudendal artery
The proximal portion of his branch of the internal iliac artery gives off the superior vesical arteries, which supply the superior part of the bladder. One of the superior vesical arteries usually gives rise to the artery of the ductus deferens. The distal portion of this artery is obliterated and continues forward as the medial umbilical ligament.
Umbilical artery
This branch of the internal iliac artery exits the pelvis through the obturator foramen. It supplies the muscles of the thigh.
Obturator artery
This branch of the internal iliac artery supplies the inferior part of the bladder and (in the male) the prostate gland and seminal vesicles.
Inferior vesical artery
This branch of the internal iliac artery supplies the middle portion of the rectum as well as the prostrate (males) and vagina (females).
Middle rectal artery
This branch of the internal iliac artery is homologous to the artery of the ductus deferens in males. It arises from the internal iliac, or from a common trunk with the vaginal or middle rectal arteries.
Uterine artery
This branch of the internal iliac artery arises from a common trunk with the uterine or directly off the internal iliac artery and supplies the vagina and base of the bladder.
Vaginal artery
What is the sacral plexus formed from?
- Lumbosacral trunk (L4, L5)
- Anterior primary rami of S1-S4
What are branches of the sacral plexus?
- Superior gluteal nerve (L4-S1)
- Inferior gluteal nerve (L5-S2)
- Sciatic nerve (L4-S3)
- Nerve to obturator internus muscle (L5-S2)
- Nerve to quadratus femoris muscle (L5-S1)
- Posterior cutaneous nerve of thigh (S1-S3)
This branch of the sacral plexus exits the pelvis through the greater sciatic foramen superior to piriformis. It supplies the gluteus medius, gluteus minimus, and tensor fasciae latae muscles.
Superior gluteal nerve (L4-S1)
This branch of the sacral plexus exits the pelvis through the greater sciatic foramen inferior to piriformis. It supplies the gluteus maximus muscle.
Inferior gluteal nerve (L5-S2)
This branch of the sacral plexus is the largest nerve of the body. It exits the pelvis through the greater sciatic foramen inferior to piriformis, and supplies numerous structures in the lower extremity.
Sciatic nerve (L4-S3)
This branch of the sacral plexus exits the pelvis through the greater sciatic foramen inferior to the piriformis. It then enters the perineum through the lesser sciatic foramen. It supplies the obturator internus and superior gemellus muscles.
Nerve to obturator internus muscle (L5-S2)
This branch of the sacral plexus exits the pelvis through the greater sciatic foramen inferior to piriformis. It supplies the quadratus femoris and inferior gemellus muscles.
Nerve to quadratus femoris muscle (L5-S1)
This branch of the sacral plexus exits the pelvis through the greater sciatic foramen inferior to piriformis. It is sensory to part of the gluteal region and perineum.
Posterior cutaneous nerve of thigh (S1-S3)
What are the branches of the sacral plexus that supply the pelvis?
- Nerve to piriformis muscle (S1, S2)
- Nerves to levator ani and coccygeus muscles (S3, S4)
- Nerve to external anal sphincter (S4)
- Pudendal nerve (S2-S4)
This plexus is formed by the ventral primary rami of S4, S5, and the coccygeal nerve. It supplies the sacrococcygeal joint, the coccyx, and the overlying skin.
Coccygeal plexus
Impingement of what nerve can lead to sexual dysfunction?
Pudendal nerve (S2-S4)
What are the components of the pelvic autonomic system?
- Superior hypogastric plexus
- Left and right hypogastric nerves
- Left and right hypogastric plexuses
- Sacral splanchnic nerves
- Pelvic splanchnic nerves
This the upper limit of the rectum, located at the middle of the sacrum.
Rectosigmoid junction
This is the lower limit of the rectum, located at the upper border of the pelvic diaphragm.
Anorectal junction
This is the dilated terminal portion of the rectum, immediately above the pelvic diaphragm.
Rectal ampulla
These are 5 to 10 longitudinal folds of mucosa which lie in the upper half of the anal canal. Each one contains a small branch of the superior rectal artery and small tributary of the superior rectal vein.
Anal columns
These are crescent-shaped folds which connect the lower ends of the anal columns.
Anal valves
These are recesses located between the anal valves and the wall of the anal canal.
Anal sinuses
This marks the lower limit of the anal valves around the circumference of the anal canal.
Pectinate line
This is a bluish white zone inferior to the pectinate line.
Anal pecten
This is the distal termination of the anal canal, where it meets the skin.
Anocutaneous line
What are the muscular layers of the anal canal?
Internal and external anal sphincters
What is the innervation and action of the external anal sphincter?
- Nerve to external anal sphincter from S4
- Closes anal orifice. Its contraction can be increased voluntarily
What is the blood supply to the rectum and anal canal?
- Superior rectal artery
- Middle rectal artery
- Inferior rectal artery
- Median sacral artery
These are varicosities of the superior rectal vein caused by a bulge of the anal column. They can result in bleeding due to tortuous thin walled varicosities. They are above the pectinate line and therefore painless.
Internal hemorrhoids
These are varicosities of the inferior rectal vein caused by pregnancy, heavy lifting, sitting too much, straining/constipation, or partial hypertension. They are below the pectinate line and therefore painful.
External hemorrhoids
What are the differences between the upper 2/3 of the pectinate line to the lower 1/3?
Above Pectinate line (2/3) Below Pectinate line (1/3)
Epithelium: Columnar/Cuboidal Stratified Squamous
Nerve: Autonomic fibers Pudendal nerve
Vein: Superior rectal Middle, Inferior Rectal
Hemorrhoids: Internal External
Lymph nodes: Internal iliac Superficial Inguinal
What is the mechanism of defecation?
- The sigmoid colon empties its contents into the rectum through mass peristaltic movement.
- The longitudinal muscle layer of the rectum and the anterior abdominal wall muscles contract, increasing pressure within the rectum
- The puborectalis relaxes, decreasing the angle of the perineal flexure
- The internal anal sphincter is opened by the increase in pressure
- The external anal sphincter is relaxed under voluntary control
This is a U-shaped space between the pubis and bladder. It contains the retropubic fat pad.
Retropubic space
What two ligaments function to hold the bladder in place?
- Puboprostatic (or pubovesical) ligament
- Lateral ligament of the bladder
This is a smooth triangular structure located on the posterior and inferior wall of the bladder.
Trigone
This structure extends between each of the ureteric ofifices.
Interureteric crest
This structure is the median ridge which extends above and behind the internal urethral orifice.
Uvula of the bladder
These are bundles of smooth muscle which lie within the wall of the bladder.
Detrusor muscle
This is a circular layer of smooth muscle which surrounds the neck of the bladder in males. It prevents reflux of semen into the bladder during ejaculation.
Internal urethral sphincter
This structure plays a role when the ureter is compressed due to a full bladder or micturation to prevent reflux of urine into the ureters.
Flap valve
What is the blood supply of the bladder?
Arteries
- Superior vesical arteries
- Inferior vesical arteries
- Vaginal arteries
Veins:
- Prostatic (male) plexus of veins
- Vesical (female) plexus of veins
- Both empty into the internal iliac vein
What is the innervation of the bladder?
Prostatic and vesical plexuses, which are extensions of the inferior hypogastric plexus
- Sympathetic fibers from the lower 3 thoracic and upper 2 lumbar levels
- Parasympathetic fibers from pelvic splanchnic nerves (S2-S4)
What is the mechanism of micturation?
- Bladder fullness initiates the micturation reflex
- Activation of parasympathetic fibers from the pelvic splanchnic nerves (S2, S3, S4) causes contraction of the detrusor muscle (in both sexes) and relaxation of the internal urethral sphincter (in males).
- The external urethral sphincter is relaxed under voluntary control
The male internal reproductive organs include what?
- Testis
- Epididymis
- Ductus deferens
- Seminal vesicles
- Ejaculatory duct
- Prostate gland
This is a thick-walled tube which carries sperm from the testis to the ejaculatory duct.
Ductus deferens
This is the dilated terminal portion of the ductus deferens.
Ampulla of ductus deferens
What is the innervation of the ductus deferens?
Superior and inferior hypogastric plexus
These are two lobulated glandular structures which lie lateral to the ampullae of the ductus deferens against the fundus of the bladder. They produce an alkaline component of semen, which neutralizes vaginal acidity.
Seminal vesicles
What is the innervation of the seminal vesicles?
Inferior hypogastric plexus
This structure is formed by the union of the ductus deferens with the duct of the seminal vesicle.
Ejaculatory duct
What is the blood supply to the ductus deferens, seminal vesicle, and ejaculatory duct?
- Artery of the ductus deferens
- Inferior vesical artery
- Middle rectal artery
This is the most common technique for male sterilization via trnasection and ligation of the ductus deferens.
Vasectomy
This is an organ which consists of smooth muscle, glandular tissue, and fibrous tissue. It functions to produce sperm and is situated below the bladder and surrounds the urethra.
Prostate gland
This is the part of the prostate gland which lies anterior to the urethra. It contains no glandular tissue.
Isthmus of prostate
This is the portion of the urethra which is surrounded by the prostrate gland.
Prostatic urethra
This is a median crest located on the posterior wall of the prostatic urethra.
Urethral crest
This is an ovoid elevation located on the urethral crest. The two ejaculatory ducts and the prostatic utricle open onto it. It is also found in the prostatic urethra.
Seminal colliculus
This is a tiny blind pouch located on the seminal colliculus. It is homologous to the uterus of the female and found in the prostatic urethra.
Prostatic utricle
This is a groove located lateral to the urethral crest. It receives the ducts of the prostate gland and is found in the prostatic urethra.
Prostatic sinus
What is the blood supply of the prostate gland?
- Inferior vesical artery
- Middle rectal artery
- Internal pudendal artery
What is the innervation of the prostate gland?
Prostatic plexus from the inferior hypogastric plexus
This condition is characterized by the prostate growing after the age of 40 due to hormones. It can result in a difficulty in micturation.
Benign prostrate hypertrophy
This is the most common cancer in men. It metastasizes through the blood and lymph channels and risk factors include a high fat diet (animal fats).
Prostate cancer
Subluxations of what vertebral level may be related to prostate/bladder problems?
L1, L2
The female internal reproductive organs include what?
- Ovary
- Uterine tube
- Uterus
- Vagina
The ovaries are paired organs which produce oocytes after puberty and which also have endocrine function. What hormones are secreted?
- Estrogen
- Progesterone
- Relaxin
The ovarian fossa, which houses the ovaries, is bounded by what structures?
- Obliterated umbilical artery (anteriorly)
- Ureter and internal iliac vessels (posteriorly)
This structure attaches the ovary to the body of the uterus.
Ligament of ovary
This structure extends from the ovary to the pelvic brim and contains the ovarian vessels.
Suspensory ligament of ovary
What is the blood supply of the ovaries?
- Ovarian artery (from the abdominal aorta)
- Ovarian branch of the uterine artery
What is the innervation of the ovaries?
Ovarian plexus
The uterine tubes transport oocytes from the ovary to the uterus through ciliary action and muscular contraction. They transport sperm in the opposite direction. What are the four subdivisions of the tubes?
- Uterine part: part of the tube which lies inside the uterus
- Isthmus: the narrowest external part
- Ampulla: the longest and widest part
- Infundibulum: the funnel-shaped portion nearest the ovary
This is the opening of the uterine tube near the ovary.
Abdominal ostium
Is there a gap between the abdominal ostium and the ovary?
Yes
These are fingerlike projections around the margin of the infundibulum.
Fimbriae
What is the most common site of fertilization?
Ampulla of the uterine tube
What is the blood supply of the uterine tubes?
- Tubal branches of the uterine artery
- Tubal branches of the ovarian artery
What is the innervation of the uterine tubes?
- Ovarian plexus
- Inferior hypogastric plexus
This condition is characterized by the development of the fetus occurring somewhere other than the uterine cavity. Risk factors include STDs, reversal tubal ligation, and endometriosis.
Ectopic pregnancy
What is the normal orientation of the uterus?
Both anteverted and anteflexed
This is the rounded part of the uterus located superior to the entrance of the uterine tubes.
Fundus of the uterus
This is the main part of the uterus located inferior to the fundus and superior to the isthmus.
Body of the uterus
This is the narrow constricted portion of the uterus between the body and cervix. It is also called the internal os.
Isthmus of uterus
This is the inferior part of the uterus which extends from the isthmus to the opening in the vagina. It consists of a supravaginal and vaginal part.
Cervix of the uterus
This is the opening of the cervical canal into the vagina.
External Os
This structure is a double layer of peritoneum which extends from the uterus to the lateral walls of the pelvis. It encloses the uterine tubes and consists of mesosalpinx, mesovarium, and mesometrium.
Broad ligament
This structure attaches to the uterus below and anterior to the entrance of the uterine tubes. It passe through the inguinal canal and terminates in the labia majora.
Round ligament
This structure is a thickening of pelvic fascia which passes laterally from the cervix to merge with the upper fascia of the pelvic diaphragm.
Transverse cervical (cardinal) ligament
This structure passes backward form the cervix in the rectouterine fold to attache to the sacrum.
Uterosacral ligament
This structure passes forward from the cervix lateral to the urethra to attach to the pubis.
Pubocervical ligament
What structures give support to the uterus?
- Pelvic diaphragm
- Broad ligament
- Pelvic viscera (bladder)
- Pubocervical, transverse cervical, and uterosacral ligaments
What is the blood supply to the uterus?
- Uterine artery
- Ovarian artery
What is the lymphatics of the uterus?
- Lumbar nodes (fundus and upper part of the body)
- External iliac nodes (lower part of the body)
- Internal iliac nodes (cervix)
What is the innervation of the uterus?
Uterovaginal plexus
What are the three functions of the vagina?
- Female organ of copulation
- Lower portion of the birth canal
- Excretory duct for the products of menstruation
This is the recess between the cervix and the walls of the vagina.
Fornix
The fornix is subdivided into what parts?
- Anterior fornix
- Two lateral fornices
- Posterior fornix
This is the superior, expanded portion of the vagina below the cervix.
Vaginal vault
The vagina is supported by what structures?
- Levator ani
- Perineal body
- Perineal membrane
- Pubocervical, transverse cervical, and uterosacral ligaments
What is the blood supply of the vagina?
- Uterine artery (to the upper part of the vagina)
- Vaginal artery
What are the lymphatics of the vagina?
- Internal iliac nodes (upper 3/4 of vagina)
- Superficial inguinal nodes (lower 1/4)
What is the innervation of the vagina?
- Pudendal nerve (lowermost part)
- Uterovaginal plexus
This condition is characterized by damage to the posterior wall of the vagina. There is a bulging of the rectum into the posterior wall of the vagina and may cause difficulty in defecation.
Retocele
This condition is characterized by damage to the anterior wall of the vagina. There is a bulging of the bladder into the anterior wall and may cause difficulty in micturation.
Cystocele
This condition is characterized by the uterus slipping down into the vagina and descending to an abnormally low position in the pelvis. Risk factors include multiple births and retroverted uterus.
Uterine prolapse
Severe menstrual cramps may be related to a subluxation of what vertebral levels?
L1, L2
The perineum is the part of the trunk below the pelvic diaphragm. It is divided into what two triangles by a transverse line connecting the ischial tuberosities.
- Urogenital triangle (anteriorly)
- Anal triangle (posteriorly)
What are the boundaries of the urogenital triangle?
Anterior: pubic symphysis
Anterolateral: ischiopubic rami
Posterior: transverse line through ischial tuberosities
What are the contents of the superficial perineal pouch?
- Perineal body
- Superficial transverse perineal muscle
- Ishiocavernosus muscle
- Crura of the penis (or clitoris)
- Bulbospongiosus muscle
- Bulb of the penis (or vestibule)
- Greater vestibular gland (females)
- Branches of the internal pudendal artery
- Branches of the pudendal nerve
This structure is a fibromuscular mass which is located in the center of the perineum between the anal canal and bulb of the penis (or vagina).
Perineal body
The perineal body is an important point of attachment for what muscles?
- Superficial transverse perineal
- Deep transverse perineal
- Bulbospongiosus
- Levator ani
- Sphincter ani externus
What is the origin of the superficial transverse perineal muscle?
Ischial tuberosity
What is the insertion of the superficial transverse perineal muscle?
Perineal body
What is the innervation of the superficial transverse perineal muscle?
Perineal branch of the pudendal nerve
What is the function of the superficial transverse perineal muscle?
Stabilizes the perineal body
What is the origin of the ischiocavernosus muscle?
Medial surface of the ischial tuberosity and ischiopubic ramus
What is the insertion of the ischiocavernosus muscle?
Crus of the penis or clitoris
What is the innervation of the ischiocavernosus muscle?
Perineal branch of the pudendal nerve
What is the action of the ischiocavernosus muscle?
Impedes venous return by compressing the crus of the penis or clitoris, thereby maintaining erection
What is the origin of the bulbospongiosus muscle in males?
Perineal body, median raphe of the bulb of the penis
What is the origin of the bulbospongiosus muscle in females?
Perineal body, fibers surround the bulb of the vestibule and vagina
What is the insertion of the bulbospongiosus muscle in males?
Corpus spongiosum, deep fascia on dorsum of penis
What is the insertion of the bulbospongiosus muscle in females?
Pubic arch and corpus cavernosum of the clitoris
What is the innervation of the bulbospongiosus muscle in males?
Perineal branch of the pudendal nerve
What is the innervation of the bulbospongiosus muscle in females?
Perineal branch of pudendal nerve
What is the action of the bulbospongiosus muscle in males?
Impedes venous return by compressing the bulb of the penis, thereby maintaining erection. It also constricts the corpus spongiosum to empty the urethra at the end of micturation and during ejaculation
What is the action of the bulbospongiosus muscle in females?
Constricts the vaginal orifice and maintains erection of clitoris
These are two ovoid glands which are located in the superficial perineal pouch, posterior to the bulb of the vestibule. They are homolgous to the bulbourethral gland of the male and secrete mucus which lubricates the vagina during sexual intercourse
Greater vestibular gland
What is the mechanism of erection?
- Parasympathetic activation (S2, S3, S4) causes dilation of the small, coiled arteries within the corpora cavernosa known as helicine arteries
- The flow of blood into the cavernous spaces compresses venous plexuses at the periphery of the corpora, impeding venous return
- The bulbospongiosus and ischiocavernosus muscles contract to maintain erection
What structures does the deep perineal pouch contain?
- Deep transverse perineal muscle
- External urethral sphincter
- Intermediate part of urethra
- Bulbourethral gland (males)
- Branches of the internal pudendal artery
- Pudendal nerve
What is the origin of hte deep transverse perineal muscle?
Medial surface of ischial ramus
What is the insertion of the deep transverse perineal muscle?
Perineal body and median raphe (males) or walls of the vagina (females)
What is the innervation of the deep transverse perineal muscle?
Perineal branch of the pudendal nerve
What is the action of the deep transverse perineal muscle?
Stabilizes the perineal body and supports the prostate gland or vagina
What is the innervation of the external urethral sphincter muscle?
Perineal branch of the pudendal nerve
What is the action of the external urethral sphincter muscle?
Compresses the urethra at the end of micturation
These are two glands which lie posterolateral to the intermediate part of the urethra in the male. They secrete a mucus-like substance and are homologous to the greater vestibular glands of the female.
Bulbourethral glands
What are the boundaries of the anal triangle?
Anterior: transverse line through the ischial tuberosities
Posterolateral: sacrotuberous ligaments
Posterior: tip of the coccyx
What does the anal triangle contain?
- Anal canal
- External anal sphincter
- Ischioanal fossa
This is a space which lies on either side of the anal canal. It extends between the skin of the anal region below and the inferior surface of the pelvic diaphragm above.
Ischioanal fossa
What does the ischioanal fossa contain?
- Fat (allows distension of the anal canal
- Pudendal canal (and its contents)
- Inferior rectal nerve and vessels
- Perineal branch of posterior cutaneous nerve of thigh
The pudendal canal lies on the lateral wall of the ischioanal fossa. It formed by the obturaor fascia. What does it transmit?
- Internal pudendal vessels
- Pudendal nerve
What is the blood supply to the perineum?
- Internal pudendal artery
- External pudendal artery
What are the branches of the internal pudendal artery?
- Inferior rectal artery
- Perineal artery
- Posterior scrotal (labial) artery
- Artery of the bulb
- Urethral artery
- Deep artery of the penis or clitoris
- Dorsal artery of the penis or clitoris
What is the innervation of the perineum?
Pudendal nerve (S2, S3, S4)
What are the branches of the pudendal nerve?
- Inferior rectal nerve
- Perineal nerve (deep and superficial branches)
- Dorsal branch of the penis (or clitoris)
What does the male external genitalia include?
- Scrotum
- Penis
The scrotum is the cutaneous pouch containing what?
- Testes
- Epididymis
- Lower part of the spermatic cord
What is the blood supply of the scrotum?
- External pudendal artery
- Posterior scrotal branch of internal pudendal artery
What is the nerve supply of the scrotum?
- Anterior scrotal branch of ilioinguinal nerve
- Genital branch of the genitofemoral nerve
- Posterior scrotal branch of perineal nerve
- Perineal branch of posterior cutaneous nerve of thigh
The penis is the male organ of copulation. It consists of what?
- Root
- Body
The root of the penis is the attached, nonmobile portion. It lies in the superficial perineal pouch, and consists of three masses of erectile tissue called what?
- Left and right crus of the penis
- Bulb of the penis
The body of the penis is the free, pendulous part. It consists of three cylindrical masses of erectile tissue called what?
- Two corpora cavernosa (continuation of the crura)
- Corpus spongiosum (continuation of the bulb)
This is the expanded end of the corpus spongiosum.
Glans penis
This separates the glans penis from the rest of the organ.
Neck of the penis
This is the prominent margin of the glans penis adjacent to the neck.
Corona of the glans
This is a median slit near the tip of the glans penis.
External urethral orifice
This is a fold of skin which covers the glans penis.
Prepuce
This is a median fold which is attached near the external urethral orifice of the glans penis.
Frenulum of the prepuce
What are the parts of the urethra?
- Prostatic part (within prostate)
- Intermediate part (between prostate and bulb of the penis)
- Spongy part (within the penis)
- Fossa navicularis
- External urethral orifice
This fascia is continuous with the superficial perineal fascia.
Superficial fascia of the penis
This fascia is continuous with the deep perineal fascia.
Deep fascia of the penis (Buck’s fascia)
This fibrous layer of the penis encloses both the corpora cavernosa and corpus spongiosum.
Tunica albuginea of the penis
This ligament arises from the linea alba and the superficial fascia of the abdomen. It splits into left and right parts and encircles the body of the penis.
Fundiform ligament of the penis
This ligament arises from the pubic symphysis and arcuate pubic ligament. It lies deep to the fundiform ligament of the penis.
Suspensory ligament of the penis
What is the blood supply of the penis?
Arteries
- Dorsal artery of the penis
- Deep artery of the penis
- Artery of the bulb
- Helicine arteries
Veins
- Superficial dorsal vein of the penis
- Deep dorsal vein of the penis
What is the innervation of the penis?
- Dorsal nerve of the penis (from the pudendal nerve)
- Cavernous nerves (supply erectile tissue)
What does the female external genitalia consist of?
- Mons pubis
- Labia majora
- Labia minora
- Vestibule
- Clitoris
- Bulb of the vestibule
The female external genitalia are collectively referred to as what?
Vulva
This part of the female external genitalia is a rounded elevation anterior to the pubic symphysis. It contains fat.
Mons pubis
This part of the female external genitalia consists of two elongated folds which run downward and backward from the mons pubis. They are homologous to the scrotum.
Labia majora
This part of the female external genitalia consists of two small folds which lie medial to the labia majora.
Labia minora
This part of the female external genitalia is the cleft between the labia majora.
Vestibule
The vestibule of the female external genitalia contains the openings of what?
- Urethra
- Vagina
- Greater vestibular glands
This part of the female external genitalia is homologous to the penis and consists primarily of erectile tissue.
Clitoris
What are the parts of the clitoris?
- Crura of clitoris (paired)
- Corpora cavernosa of clitoris (paired)
- Glans clitoris
This part of the female external genitalia are paired elongated masses of erectile tissue which surround the vestibule. They are covered by the bulbospongiosus muscle.
Bulb of the vestibule
This is the narrow slit between the labia majora containing the labia minora and vestibule.
Pudendal cleft
This is where the labia majora meet anteriorly.
Anterior labial commisure
This is the depression where the labia majora approach each other (but do not meet) posteriorly. It overlies the perineal body.
Posterior labial commisure
This is a membranous crescentic fold which partially closes the opening of the vagina into the vestibule in virgins.
Hymen
