Female and male reproductive system Flashcards
What is contained within the pelvic cavity?
Ovaries
Uterine tubes
Uterus
Superior part of vagina
What is contained within the perineum?
Inferior part of vagina Perineal muscles Bartholin's glands Clitoris Labia
What are the primary reproductive organs in women?
Ovaries
What is the function of the inferior part of the parietal peritoneum?
Floor of peritoneal cavity
Roof over pelvic organs
What pouches form in the female peritoneum?
Vesico-uterine
Recto-uterine
How can fluid from the pouch of douglas be drained?
Needle passed through the posterior fornix of the vagina
Where will abnormal fluid collect within the peritoneal cavity in women?
Pouch of douglas; most inferior part of the peritoneal cavity in the anatomical position
Are the pelvic organs intra or sub peritoneal?
Sub
What part of the pelvic organs are intraperitoneal?
Uterine tubes
What is the broad ligament and where can it be found?
Double layer of peritoneum
Extends between the uterus and lateral walls + floor of pelvis
What is the function of the broad ligaments and what is contained within it?
Uterine tubes
Proximal part of round ligament
What is the round ligament?
Embryological remnant
Where does the round ligament attach?
Lateral aspect of uterus
Passes through the deep inguinal ring to attach to the superficial tissue of the female perineum
What are the 3 layers of the uterus?
Perimetrium
Myometrium
Endometrium
Where will the oocyte be fertilised?
Ampulla
Where should the zygote implant?
Body of uterus; anywhere else is an ectopic
What holds the uterus in place?
Uterosacral ligaments
Endopelvic fascia
Levator ani
What can result from weakness of the structures that hold the uterus in place?
Uterine prolapse; inferior movement
What is the most common position of the uterus?
Anteverted
Anteflexed
What does anteverted in terms of the uterus mean?
Cervix tipped anteriorly relative to the axis of the vagina
What does antiflexed mean in terms of the uterus?
Uterus tipped anteriorly relative to the axis of the cervix (mass of uterus lies over the bladder)
What is a very normal and common variation of the standard positioning of the uterus?
Retroverted and retroflexed
Is the vagina usually patent?
No; walls tend to be collapsed
What must be sampled in cervical screening?
Squamocolumnar junction (transformation zone)
What is the “salpinx”?
Tube; refers to fallopian tube
Where do the fimbriated ends of the uterine tubes open into?
The peritoneal cavity to act as a means of communication between the genital tract and the peritoneal cavity
What determines patency of fallopian tubes in a HSG (hysterosalpingogram)?
Radiopaque dye spilling out of the end of the uterine tube and into the peritoneal cavity
What size are the ovaries?
Almond shaped and sized in the lateral pelvic cavity
Where do the ovaries develop?
Posterior abdominal wall and they will move onto the lateral wall of the pelvis (round ligament(
What are the 4 fornix of the vagina?
Anterior
Posterior
2 x lateral
What can be felt on a digital vaginal examination ?
Ischial spines - at 4 and 8 o’clock positions
Position of uterus
Palpation of adnexae
What are the adnexae?
Uterine tubes and ovaries
What is the perineum?
Shallow space between pelvic diaphragm and inferior skin of external genitalia
What do the openings of the pelvic floor allow for?
Passage of distal parts of alimentary, renal and reproductive tracts from pelvis to perineum
What are the 2 triangles of the perineum?
Urogenital
Anal
What are the boundaries of the perineum?
Pubic symphysis at top
Coccyx at bottom
Ischial spines laterally
What is the function of the levator ani muscle?
Tonic contraction
Reflexively contracts further during situations of increased intra-abdominal pressure
Weakness can be a factor in the development of prolapse of the pelvic organs
What supplies the levator ani muscle?
Nerve to levator ani; S3,4,5
?? pudendal nerve
What are the perineal muscles supplied by?
Pudendal nerve
Superficial and deep
What is the perineal body?
Bundle of collagenous and elastic tissue into which the perineal muscles attach
What is the function of the perineal body?
Important to pelvic floor strength
Episiotomy act to preserve perineal body
What is the function of bartholin’s gland?
Mucus secretion for lubrication
What type of tissue lies under the perineal muscles?
Erectile tissue
Where does the bed of the breast extend to and from?
Ribs 2-6
Lateral border of sternum to mid-axillary line
Does the breast extend into the axilla?
Yes; axillary tail of spence
What does the breast lie on?
Deep fascia covering pec major and serratus anterior
What is the retromammary space?
Lies between fascia and breast - allows the breast to move independently of the pec muscle
What attaches the breast tissue to the skin?
Suspensory ligaments
What makes up the breast tissue?
Fat
Non lactating lobues; in pregnant/ breast feeding women these become lactating lobules
What connects the lactating lobues to the areola?
Lactiferous duct
How is the female breast sectioned?
Upper and lower outer
Upper and lower inner
OR
Clock face
How can you assess if a breast lump is “fixed” to underlying pectoral fascia?
Ask patient to place her hands firmly on her hips (and in doing so, there is contraction of pectoral muscles)
Where will 75% of lymph from the breast drain to?
Ipsilateral axillary lymph nodes -> supraclavicular nodes
Where can lymph from inner breast quadrants drain to?
Parasternal lymph nodes which can either drain to supraclavicular ipsilaterally or contralaterally
Where can lymph from the lower inner breast quadrants drain to?
Abdominal lymph nodes
What can be the implication of axillary node clearance?
Lymphedema; as all lymph from upper limb also drains there
What is contained within the axilla?
Brachial plexus
Axillary artery and axillary vein
Axillary lymph
All embedded in axillary fat
What are the different levels of axillary node clearance?
Level 1; inferior and lateral to pectoralis minor
Level 2; deep to pectoralis minor
Level 3; superior and medial to pectoralis minor
What determines the levels of axillary nodal clearance?
In relation to pectoralis minor
What is the arterial supply to the breast?
Internal thoracic forms the internal mammary (from subclavian) Lateral thoracic (axillary artery) Posterior intercostal arteries 2,3,4 at lateral aspect
Does the venous drainage of the breast mirror the arterial?
Yes
What are the male reproductive organs?
Testes
What are the accessory reproductive organs in a male?
Vas
Seminal glands
Prostate gland
Penis
What lies within the corpus spongiosum?
Spongy urethra
What is the more inferior aspect of the peritoneal cavity in males?
Rectovesical
What forms the bladder wall?
Detrusor muscle
What openings are present on the trigone of the bladder?
2 ureteric orifices
Internal urethral orifice
What is the function of the internal urethral sphincter in males?
Contracts during ejaculation to prevent retrograde ejaculation
Where do the testes develop?
Posterior wall of abdo cavity
Through which structure do the testes pass through to reach the scrotum?
Anterior abdominal wall; inguinal canal
What is present in the spermatic cord?
Testicular artery and vein
Vas deferens
Lymph
Nerves; autonomic (vas), somatic (cremaster muscle)
In what structure do the testis sit within in the scrotum?
Tunica vaginalis
What is excess fluid within the tunica vaginalis called?
Hydrocele
Where is sperm produced?
Seminiferous tubules
What muscle controls the temp of the testes?
Dartos
Describe the route of sperm from the seminiferous tubules to vas?
Seminiferous tubules Rete testes Head of epididymis Tail of epididymis Vas
What is the volume of the testis?
12-25ml
What is the arterial supply of the testes?
Testicular artery; lateral aspect of abdominal aorta
What is the venous supply of the testes?
Left testicular vein to the left renal vein
Right testicular vein to the IVC
Through which structure does the blood supply and drainage pass through?
Deep inguinal ring (along with vas, lymph and nerves)
What is the function of the prostatic urethra?
Drains urine from bladder
Passes semen in ejaculatino
What is the function of the bulbourethral gland?
Mucus secretion
Lubricates urethra and neutralises acidity
What makes up the ejaculatory duct?
Vas deferens
Duct from seminal gland
What is the inferior aspect of the prostate gland in contact with?
Levator ani
Where do the majority of prostate cancers arise from?
Peripheral zone (central zone = BPH)
What is the route of the vas?
Superiorly in spermatic cord to deep inguinal ring
At deep inguinal ring, turns medially into pelvis
Travels posterior to bladder
Where do the left and right ejaculatory ducts join?
Within the prostate gland to drain into the urethra
What is the anatomical position of the penis?
Erect
What is paraphimosis?
Retraction of prepuce causing contraction of neck of glans
In what area is the penis?
Within the perineum
Where does the root of the penis attach?
Laterally to ischium of pelvis
What are the 3 cylinders of erectile tissue within the penis?
2x corpus cavernosum
Corpus spongiosum
What are the contents of the corpus cavernosum?
Transmit deep arteries of the penis
What are the contents of the corpus spongiosum?
Spongy urethra
Expands distally to form glans penis
Where does the superficial perineal pouch lie in the male?
Below perineal membrane
What is contained within the superficial perineal pouch?
Root of penis:
Bulb (corpus spongiosum, crurs, corpus cavernosum)
Assoc muscles (bulbospongiosus, ischiocavernosus)
What is the blood supply to the penis?
Deep arteries of the penis:
Branches from internal pudendal artery (from internal iliac)
What is the blood supply to the scrotum?
Via internal pudendal and branches of external iliac
Where does lymph from the testes drain?
Lumbar nodes
Where does lymph from the scrotum and most of penis (not glans) drain to?
Superficial inguinal nodes at the superficial fascia of the groin
What structures pass through the levator ani in the male?
Rectum and urethra
What nerve fibres does the pudendal nerve contain?
Sympathetic
Somatic sensory
Somatic motor
What space does the pudendal nerve pass through in the perineum?
Ischioanal fossa
What are the components of the fluid secreted by the seminal vesicle?
Fructose Proteins Prostaglandins Vitamin C Flavins Phosphorycholine Enzymes
Which part of the ANS is responsible for orgasms?
Sympathetic
What 4 muscles compress to vagina to act like sphincters?
Pubovaginalis
External urethral sphincter
Urethro-vaginal
Bulbospongiosus
What is the blood supply to the vagina?
Superiorly; branches of uterine
Inferiorly; vaginala dn internal pudendal
What is the round ligament of the uterus a remnant of?
Ovarian gubernaculum; descend of ovaries from developmental position on the posterior abdominal wall
What are the layers of the spine transversed in giving a spinal anaesthesia?
From posterior to anterior: Skin Subcutaneous fat Supraspinous ligament, Interspinous ligament Ligamentum flavum Dura mater Subdural space Arachnoid mater Subarachnoid space
What muscles make up the levator ani?
Puborectalis (sling around rectum)
Pubococcygeus
Iliococcygeus
What forms the anterior-inferior pelvic wall?
Bodies and rami of pubic bones and pubic symphysis
What forms the lateral pelvic walls?
Bony framework formed by hip bones, including obturator foramen
Obturator internus
What forms the posterior pelvic wall?
Bony wall and roof in midline (sacrum and coccyx)
SI joint
Piriformis muscle (leaves via greater sciatic foramen)
Sacral plexus
What is the perineum?
Shallow compartment that lies between the levator ani superiorly and perineal skin inferiorly
Function of levator ani?
Roof of perineum
Floor of pelvis
Support to pelvic organs
Maintains faecal and urinary continence
Nerve fibres of pudendal nerve?
Somatic motor (levator ani and muscles of perineum)
Somatic sensory
Sympathetic nerve fibres
Where does lymph from the uterus drain to?
Lumbar/ caval/ paraaortic nodes
Route taken by sperm from production to fertilization
Seminiferious tubules Rete testes Epididymis Vas deferens in spermatic cord Ejaculatory duct Prostatic urethra Membranous urethra Spongy urethra External urethral meatus Vagina Cervix Fallopian tube
Route taken by ovum from production to fertilization
Ovary
Peritoneal cavity
Gathered by fimbriae into infundibulum of fallopian tube
Moved along to ampulla
How can uterine prolapse occur?
Weakened pelvic support
Increased intra-abdominal pressure
Components of fluid secreted by seminal vesicles?
Proteins Enzymes Fructose Mucus Vit C Flalvins Phosphorylcholine Prostaglandin
What is the main function of the fluid secreted by prostate?
Activation of sperm
What are the functions of the fluid secreted by the bulbourethral (cowper’s) glands?
Lubricates urethra and helps to neutralise acid in urethra
Which structures are located in spermatic cord?
Ductus (vas) deferens Testicular artery Venous drainage (pampiniform plexus) Sympathetic nerve fibres Genital branch of genitofemoral nerve Lymphatics
