female and male genitalia clinical cases Flashcards
pelvic relaxation during pregnancy
-pelvic joints and ligaments relax and pelvic movements increase
-relaxation caused by increased levels of sex hormones and hormone -> relaxin
-allows for greater rotation of pelvis and lordotic posture assumed during pregnancy
-facilitates passage of fetus through pelvic canal
-more mobility to allow passage of baby
injury to pelvis nerves
-during childbirth -> fetal head may compress mothers sacral plexus
-produces lower limb pain
-sacral plexus- mostly parasympathetic
-limited mobility -> babys head passes through -> pelvic nerve injury
-levator ani innervated by pudendal nerve
-2,3,4 keep the pelvis off the floor
-perineum, levator ani, pelvic fascia may be injured during childbirth
-puboccygeus- intermediate part of levator ani is often sight of tear
-weakening of portion of pelvic floor often causes urinary stress incontinence during increased abdominal pressure
-episiotomy- a surgical cut made at the opening of the vagina during childbirth, to aid a difficult delivery and prevent rupture of tissues.
male sterilization
-common method of male sterilization is deferentectomy (vasectomy)
-ductus deferens is excised through incision in superior part of scrotum
-ejaculated fluid contains no sperm
-sperm still produced in seminal tubules -> degenerate in epididymis (where sperm is stored)
prostate
-benign hypertrophy of prostate (BPH) and enlargement prostate projects into urinary bladder and impedes urination by distorting the prosthetic urethra
-prostate cancer -> common in men older than 55
-most common area is posterior lateral region of prostate which also palpable during digital rectal exam
-malignant prostate feels hard and irregular
-prostatic urethra can be obstructed
-enlarged prostate can press on bladder -> frequent urination
-irregular type of nodule- cancer
cervical examination
-vagina can be distended with vaginal speculum to enable inspection of cervix and attain sample of cervical cells for cervical cytology
-external os of uterus is seen
hysterectomy
-performed through the lower anterior abdominal wall or through the vagina
-bc uterine artery crosses anterior to ureter near the lateral fornix of the vagina -> ureter is in danger of being inadvertently clamped or severed when the uterine artery is tied off during hysterectomy
-everything typically removed for malignancy
-fundus of uterus taken ONLY- if not for cancerous reasons
-ureter wiggles/spasm - due to urine flow
manual examination
-one hand two fingers -> into vagina and push up
-external palpate uterus
-uterus can be antiflex- uterus body/fundus pointed anteriorly
-retroflexed- flexed more towards back -> back labor, cramping in the back during menstrual pain
regional anesthesia of childbirth
-reduce pain during childbirth
-lumbar epidural - anesthetize somatic and visceral afferent fibers distributed below the waist, uterus , birth canal, perineum, lower limbs
-caudal epidural block, indwelling catheter in the sacral canal, bathes the S2-S4 spinal nerve roots (lower limbs not affected)
-pudendal nerve blocks perineum only
infection of female genital tract
-female genital tract communicates with the peritoneal cavity through the abdominal ostia of uterine tubes, infections at vagina uterus, uterine tubes may result in peritonitis
-long term issue of STI- infertility due to affecting uterine tubes
-high risk for ectopic pregnancy -> can be confused with appendicitis -> always pregnancy test
hysterosalpingogram
-contrast injected into uterus
-look for patency in fallopian tubes
laparoscopic tubal ligation procedure
-sterilization
-clamping or clipping of fallopian tubes
-make sure you are cutting in a way where ectopics still cant happen
ectopic tubal pregnancy
-blastocyst implantation in mucosa of fallopian tube
-tubal rupture and severe hemorrhage constitute a threat to mothers life and results in death of embryo
-ectopic pregnancy is not viable and must removed either surgically or with use of medications
-infundibulum, isthmic, tubal, and even abdominal cavity
-scarring within tube -> blastocyst never pulled in with fimbriae -> can move into abdomen
-fallopian tube rupture - removed
-expansion -> rupture -> hemorrhage -> fatal
-no concern of rupture -> methotrexate -> chemical abortion
rupture of urethra in males
-fractures of pelvic girdle often cause rupture of the intermediate part of the urethra
-rupture of spongy urethra in bulb of penis results in urine passing into superficial perennial space
-urine and blood may pass into loose connective tissue in the scrotum
-around the penis, and superiorly, deep into the membranous layer of subcutaneous connective tissue
erectile dysfunction
-inability to obtain or maintain an erection
-lesion of prostatic plexus or cavernous nerves
-central nervous system and endocrine disorders may result in reduced testosterone
-autonomic nerve fibers may fail to simulate erectile tissues or blood vessels may be insufficiently responsive to stimulation
-vascular, nerve, or hormonal
phimosis, paraphimosis, circumcision
-phimosis- prepuce is tight and cannot be retracted easily if at all
-paraphimosis- retraction of prepuce constricts neck of the gland so that there is interference with the drainage of blood and tissue this may cause the glands to enlarge so much that the prepuce cannot be distracted
-circumcision- Minor surgical operation typically performed on male infants that exposes most or all of the glans
-Religious practice in Islam and Judaism, often done routinely for nonreligious reasons
