GENITOURINARY Flashcards
1
Q
what makes up the glomerular filtration barrier
A
fenestrated endothelium, Glomerular basement membrane (double thickness), podocyte foot processes
2
Q
how much of the cardiac output does the kidney receive
A
20 % - 1L
3
Q
what size of molecule can pass through the filtration barrier
A
10kDa or smaller
4
Q
is the glomerular basement membrane positively or negatively charged
A
it is negatively charged - through heparin sulphate
5
Q
what can pass through the glomerular filtration barrier
A
glucose, amino acids, creatinine, sodium, potassium, urea, bicarbonate disulphide and chloride
6
Q
what are mesangial cells
A
they are modified smooth muscle cells - for support
7
Q
what factors effect glomerular filtration
A
hydrostatic pressure out the capillary
hydrostatic pressure out of bowman’s capsule
oncotic pressure in the capillary
together they make the net filtration pressure
8
Q
what is the only protein that should be found in urine
A
Tamm Horsfall
9
Q
how do you calculate the GFR
A
NFP X kF (filtration coefficient)
10
Q
what is the average GFR
A
125ml/min
11
Q
what substance is used to measure GFR in clinic
A
creatinine
12
Q
why is creatinine used to measure GFR
A
it isnt metabolised, it isnt secreted or absorbed by the tubules and it is freely filtered
13
Q
how much plasma is filtered in 24 hours
A
180L in 24 hours (3L of plasma at 125ml every minute)
14
Q
what is renal clearance
A
it is a measure of how much a substance is secreted/absorbed
how long a particular substance is removed from the plasma by the kidney and excreted in the urine
15
Q
what happens to arterioles to increase the GFR
A
dilate the afferent arteriole and constrict the efferent arteriole. it increases the blood at the renal capsule
16
Q
what happens to the arterioles to decrease the GFR
A
constrict the afferent arteriole and dilate the efferent arteriole. it decreases blood in the renal capsule
17
Q
what cells are involved in tubuloglomerular feedback
A
the juxtagloerular apparatus
18
Q
what cells detect a decrease in NaCl
A
the macula densa cells - in the distal convoluted tubule
19
Q
what cells detect a decrease in the blood pressure
A
the granular cells of the afferent arteriole
20
Q
what happens when there is a decrease in sodium and blood pressure in the kidney
A
then renin is secreted from the glomerular cells which acts in the RAA system
21
Q
what is reabsorbed in the proximal convoluted tubule
A
glucose, amino acids, lactate, sodium, phosphate, bicarbonate, hydrogen ions, water and chloride
22
Q
what is secreted in the proximal convoluted tubule
A
organic ions
23
Q
what is the main driver of reabsorption of sodium ions
A
the Na/K ATPase basolaterally - builds up the concentration of sodium
24
Q
what molecules do sodium cotransport
A
glucose, amino acids and lactate
25
what is sodium antiported with in the proximal convoluted tubule
it is antiported with H+ (maintains electrical charge)
26
how is HCO3- reabsorbed
tubular sodium/hydrogen antiporter. H+ and HCO3- in the lumen forms H2CO3 (via carbonic anhydrase) which then dissociated to H20 and CO2. CO2 diffuses into the RCT cell and H2O moves in via aquaporins. in the cell CO2 and H2O combine (carbonic anhydrase) to H2CO3 and this dissociates to H+ and HCO3-.
H+ is antiported into lumen
HCO3- basolaterally absorbed into capillary
27
what are the two sections of the loop of henle
the thin descending and the thick ascending
28
where in the loop of henle is water reabsorbed
in the thin descending loop
29
where in the loop of henle are ions reabsorbed
in the thick ascending loop
30
how does the concentration gradients cause reabsorption in the loop of henle
the descending limb loses H2O and ions remain. Therefore there is an increased concentration. In the ascending limb you lose Na and Cl with water remaining. therefore the concentration descreases
31
what channel transports Na+, K+ and 2CL- from the lumen into the LOH cell
the NKCC2 channel
32
what part of the RAA system acts on the NKCC2
aldosterone
33
what happens in the distal convoluted tubule
there is fine regulation of sodium, chlorine phosphate and water reabsorption
34
where are the macula densa cells found
in the distal convoluted tubule
35
what happens in the collecting duct of the kidney
there is water reabsorption and acid/HCO3- regulation
36
what are the two cell types found in the collecting ducts
the principal cells and intercalated cells
37
what are the features of the principal cells of the collecting duct
there are aquaporin 2 channels - responds to ADH action which increases water absorption
there are ENaC channels which is acted on by aldosterone. the result is more sodium reabsorption and potassium secretion
38
what are the intercalated cells in the collecting ducts for
it is involved in reabsorbing HCO3- and secreting H+
39
What is the distribution of fluid in the ICF and the ECF
42L
- 28L in ICF
- 14L in ECF - 11L in IF and 3L in plasma
40
what is plasma osmolarity
300 mOsm
41
what is fluid volume regulated by in the long term
RAA and ADH
42
what are the factors controlling potassium
diet and aldosterone
43
where is most of the potassium absorbed in the renal tubule
in the proximal convoluted tubule
44
where is ADH/vasopressin made in the body
it is manufactures in the hypothalamus
45
where is ADH /vasopressin secreted from
the posterior pituitary
46
what is ADH/vasopressin affected by
osmoreceptors (a small change activates ADH) and baroreceptors (these arent as sensitive so need a large change to activate)
47
what happens in the body when you drink a lot of water
there is a decrease in fluid mOsm which causes an inhibition of ADH release. this means there is less plasma AQDH and therefore there is an increase water excretion at the loop of henle and the collecting ducts
48
what happens if there is a decrease in the extracellular fluid in the body
there is an increase in baroreceptor firing, which cases stimulation of ADH release. this causes an increase in plasma ADH. and therefore there is a decrease in excretion of water at the LOH and CD
49
what is the RAA system
renin converts angiotensinogen to angiotensin 1. ACE (from the lungs) then converts angiotensin 1 to angiotensin2. angiotensin 2 causes release of aldosterone, as well as increased ADH stimulation and increased blood pressure (acts as a vasoconstrictor)
50
what is the main ECF ion
sodium - sodium determines blood pressure
51
where is aldosterone made
from the zona glomerulosa of the adrenal cortex
52
what is ANP
it is produced by cardia atrial myocytes when there is an increased blood pressure in response to atrial stretch. it is an antagonist to ENaC, aldosterone and increases GFRand increases sodium excretion.
53
what is the link between the parathyroid hormone and the kidney
parathyroid hormone is released from the parathyroid gland, when there is decreased calcium in the plasma. this directly increases calcium reabsorption. it stimulates the active form of vitamin D in the body as well (also involved in calcium absorption)
54
what is the average pH of the body
7.35 - 7.45
55
what is acidemia
when the environment is more acidic but it is still in the normal range
56
what is alkalemia
when the environment is more alkaline but still in the normal
57
what is the equation to calculate the anion gap
[[Na+]+[K+]] - [[Cl-]+[HCO3-]]
58
what is the main urinary buffer
HCO3-
59
what does the concentration of buffer molecules in acid/alkalosis depend on
the driving factor - the thing causing the change (acidosis/alkalosis)
compensation - trying to restore the normal
60
what is the kidneys endocrine function
1. EOP (erythropoietin) which stimulates RBC maturation in the bone marrow, it is produced in the peritubular cells of the renal cortical interstitium
2. activation of vitamin D
61
what causes an increase of EPO in the body
anaemia, altitude, cardiopulmonary disorders
62
what causes a decrease in EPO in the body
polycythemia (increased Hb abnormally in blood), renal failure
63
how does activation of vitamin D occur
calcediol (25-DeH VitD3) in the liver is transported to the kidney where it is activated to calcitriol (1,25 - vitaminD3). this then worked in the intestines, bone, kidney and parathyroid
64
what is the action of active vitamin D in the body
intestines - increased PO4 absorption and increase calcium
bone - increased reabsorption
Kidney - increased PO4 reabsorption and increased calcium reabsorption
parathyroid - decreased parathyroid hormone (low PTH inhibits bone resorption)
65
what is present in the walls of the bladder
detrusor muscles
66
what sort of muscle is present in the internal urethral sphincter
smooth muscle
67
what nerve stimulates the internal urethral sphincter
syplathetic nerve - hypogastric T1-L2
68
what muscle is present in the external urethral sphincter
skeletal muscle
69
what nerve innervates the external urethral sphincter
somatic pudendal nerve - s2, s3, s4
70
what happens during bladder filling
the detrusor relaxes, the internal and external urethral sphincter is shut = contracted (shut)
71
what happens to the bladder during micturition/pee
the detrusor muscle contracts (increased sympathetic tone) and the internal and external urethral sphincter relaxes (opens), due to a reduced sympathetic tone
72
what is the primitive bladder stretch reflex
when there is peeing (until childhood) due to a spinal reflex to a increased bladder filling.
73
what happens if the primitive bladder stretch reflex persists
you get an incontinence syndrome
74
what is the bladder and urinary tract function
store urine at a low pressure, fill to a comfortable volume (receptive relaxation). there is a voluntary initiation to peeing
75
when does the primordial germ cell migrate to the urogenital ridges
6 weeks
76
what causes female sex differentiation
when there is no SRY it means there are no leydig or sertoli cells meaning no testosterone and AMH (wolffian ducts regress). the Mullerian ducts develops, and with the action of oestrogen, the vagina, citerus, ovaries and ova is made
77
what causes male sex development
there is the presence of SRY, causing development of leydig and sertoli cells meaning there is testosterone and AMH present. this causes the development of wolffian ducts, testes and sperm
78
what do sertoli cells produce
AMH
79
what do leydig cells produce
testosterone
80
what does the external genitalia respond to in males
dehydroxytesterone
81
what coverts testosterone to DHT
5 alpha reductase
82
what occurs in gametogenesis (male)
1. mitosis occurs at puberty onwards making spermatogonia type A and B
2. meiosis then occurs - M1 makes the primary to secondary spermatocyte, M2 makes the secondary spermatocyte to the spermatid (M2 continuous after pruberty)
83
where do the spermatids mature in the males
they mature in the epididymis to spermatozoa
84
how long does the spermatids mature in the epididymis
64 days
85
what is the maturation process of spermatogonia to spermatozoa
spermatogonia B develops into primary spermatocyte. these then undergo M1 to make two secondary spermatocyte. M2 then happens and it makes 4x spermatids. these then develop into spermatozoa
86
what is the process of spermatids called spermatozoa called
spermiogenesis
87
what is the process of spermatogonia to spermatid called
spermatogenesis
88
what is the process of gametogenesis in females
1. mitosis occurs at prebirth in the foetus to make primary oocytes.
2. mitosis 1 then occurs to make secondary oocytes, and then M2 occurs to make oogonia.
89
in females when is M1 arrested until
until menarche - the 1st period
90
when does M2 occur in women
it occurs after fertilisation
91
what is the development from primary oocyte to oogonia
the primary oocyte undergoes M1 which becomes secondary oocyte and a polar body. the secondary oocyte M2 to produce oogonia and 3 polar bodies
92
what happens in puberty in women
primary development is by FHS and LH stimulating gonadotropins. secondary development is then caused by adrenal androgens
93
what is the path that sperm takes in the male reproductive system
```
Seminiferous tubules (spermatogenesis) - rete testis - efferent ducts - epididymis - vas deferens - ejaculation duct (joined by seminal vesicles) - (nothing) - urethra - penile urethra
SREEVENUP
```
94
what is the pathway that the testes descends through
it descends through the inguinal canal by the processes vaginalis. It is covered in tunica vaginalis and fibrous capsule tunica albuginea
95
why are the testis found outside the body cavity
cooler - pampiniform plexus descends to exchange heat with the environment and cooler arterial blood to the testis
96
what makes up the blood testis barrier
sertioli cell tight junctions
97
what is the function of the blood testis barrier
to prevent an immune response to sperm and sperm movement into the systemic circulation
98
what is the female HPG axis
the hypothalamus releases GnRH, which then acts on the anterior pituitary to release FSH. this acts on the granulosa cells of the follicle and causes egg maturation.
Inhibitin inhibits FHS release. Oestrogen release acts to increase LH until it reaches threshold and there is an LH surge causing ovulation. The granulosa cells then become the corpus luteum and makes progesterone
99
what is the male HPG axis
GnRH from the hypothalamus then stimulates the anterior pituitary to make FSH and LH. FHS works on sertoli cells to make AMH, and LH works on the leydig cells to make testosterone. Sertoli cells make inhibin which acts on the anterior pituitary to reduce FSH.
testosterone acts on the sertoli cells to make sperm
testosterone is acted on by 5 alpha reductase to make DHT
100
what is DHT needed for in male development
external genitalia
101
where are androgens made in the adrenal glands
in the zona reticularis
102
what are the two stages of the menstrual cycle
follicular/proliferative and the luteal/secretory phases
103
what happens during the follicular phase of the menstrual cycle
there is follicular development and the womb lining proliferates
104
what happens during the luteal phase of the menstrual cycle
the oocyte is released and the follicle becomes the corpus luteum, in the womb lining there are large gaps in the structure with skinnier irregular tubes seen on H+E
105
where is GnRH made in the body
made in the hypothalamus
106
what are the effects of oestrogen production
increased LH (positive feedback), inhibition of FSH and it thickens the endometrium to prepare for ovulation
107
what happens to hormone levels if the oocyte is fertilised
then there is hCG produces as well as progesterone continually produced from the corpus luteum. oestogen also stays high
108
what happens if there is no fertilisation
then the corpus luteum breaks down and progesterone levels drop. this causes the womb lining to shed and the cycle then repeats
109
where does fertilisation occur
in the ampulla of the fallopian tube
110
what are the layers of the uterus
the endo, myo and perimetrium
111
what happens during labour
relaxin and oestrogen causes relaxation of the cervix. oxytosin then stimulates the uterine wall to contract
112
what happens on day 1 of fertilisation
there is the sperm acrosomal reaction at the zona pellucida which causes a calcium influx. this allows the sperm to fertilise the egg and the male and female pronuclei form. Syngamy occurs and the two nuclei combine to make a 2n nucleus
- fertilisation
113
what happens on day 2-3 after fertilisation
there is mitotic division 1-2-4-8 (these cells are totipotent)
- cleavage
114
what happens on day 4 after fertilisation
this is the 16 cell stage called a morula.
| - compaction
115
what happens day 5 after fertilisation
the 32 cell stage, and the formation of the blastocyst. there is an inner cell mass formed called the epiblast, and an outer ring of cells called the trophoblast. the cells are pluripotent at this stage
- cantation
116
what happens day 6 after fertilisation
the zona pellucida is discarded which is key for fertilisation
- hatching
117
what happens 7 days after fertilisation
implantation of the blastocyst
118
what are the three stages of implantation
```
apposition = unstable binding
attachment = stronger adhesion
invasion = lacunar flow: uteroplacental circulation is established by the syncytotrophoblast and maternal sinusoids
```
119
what is the cell type found in the epididymis and the vas deferens
pseudostratified columnal with stereocilia
120
where is urothelium found
renal, pelvis, ureters, bladder and urethra (except penile)
121
what are the different layers of the skin
epidermis, dermis and subcutaneous tissue
122
what are the layers found in the epidermis of the skin
```
the stratum basale (deepest)
the stratum spinosum
the stratum granulosum
the stratum lucidum
the stratum corneum
```
123
what are the functions of the skin
barrier to infection, thermoregulation, protection against trauma, protection against UV, vitamin D synthesis and regulation of H2O loss
124
what are the membranes of the renal corpuscle like
they are fenestrated and negatively charged
125
what are the two layers of the bowmans capsule in the renal corpuscle
the basement membrane and the parietal epithelial cells
126
what are the 3 layers of the glomerulus in the renal corpuscle
endothelial cells - fenestrated
basement membrane - fusion of 2, negatively charged
podocytes - foot processes act as a filtrate barrier
127
in the female what is the three structures found in the inguinal canal
1. round ligament of the uterus
2. ilioinguinal nerve
3. Genital branch of the genitofemoral nerve
128
in males what are the contents of the inguinal canal contained in
the spermatic cord
129
what are the 3 nerves found in the spermatic cord
the ilioinguinal nerve, the genital branch of the genitofemoral nerve, the sympathetic nerve fibres
130
what are the 3 arteries found in the spermatic cord
testicular artery, cremasteric artery and the artery to the vas deferens
131
what are the three fascial layers of the spermatic cord
the external spermatic fascia (from external oblique aponeurosis)
cremasteric muscle and fascia (internal oblique muscle)
internal spermatic fascia (transversalis fascia)
132
what are the 4 other structures found in the spermatic cord
pampiniform venous plexus
lymphatics
vas deferens
processes vaginalis
133
what is a hernia
abnormal protrusion of tissue through an opening
134
what is an inguinal hernia
abdominal contents protrude through the anterior abdominal wall via the inguinal canal
135
what is an indirect inguinal hernia
intra-abdominal contents are forces through the feel inguinal ring and into the canal itself
136
what is a direct inguinal hernia
the intra abdominal contents are forced directly through the posterior wall of the inguinal canal and subsequently through the superficial ring.
137
what are the testes covered with
three layers of spermatic fascia that cover the spermatic cord. as well as a sac derived from the peritoneum called the tunica vaginalis
138
where is sperm stored
epididymis
139
where do the testicular arteries arise from
the abdominal aorta
140
what is the venous drainage of the testis/epididymis
pampiniform venous plexus
141
what are the two types of erectile tissue
corpora cavernosa and corpus spongiosum
142
where is the penile urethra
within the corpus spongiosum
143
what is the arterial supply to the penis
penile arteries
144
what is the nervous supply to penis
sympathetic from the dorsal nerve of the penis (branch of pudendal nerve) and parasympathetics from the peri-prostatic nerve plexus
145
what is primarily responsible for the male erection
the corpus cavernosa - increase in size and rigidity
146
what is the main role of the corpus spongiosum during an erection
to prevent the urethra from being compressed which would prevent ejaculation
147
what is the corpus spongiosum and cavernosa covered in
covered in tunica albuginea and deep fascia (bucks fascia)
148
what is the adrenal gland embedded in
perinephric fat
149
what are the arteries that supply the adrenal glands
superior, middle and inferior adrenal artery
150
what is the superior renal artery a branch of
the inferior phrenic artery
151
what is the middle adrenal artery a branch of
the abdominal aorta
152
what is the inferior renal artery a branch of
the renal artery
153
where does the right adrenal vein drain into
it drains directly into the inferior vena cava
154
where does the left adrenal vein drain into
it drains first into the left renal vein and then this drains into the inferior vena cava
155
what are the two parts of the adrenal gland
the cortex (outer) and the medulla (inner)
156
what is a phaeochromocytoma
a hormone producing tumor of the adrenal medulla which can secrete excess adrenaline
157
are the kidneys retroperitoneal or intraperitoneal
retroperitoneal
158
what are the layers found round the kidney
immediately covered in perinephric fat, then by renal fascia. then by paranephric fat.
159
what are contained within the hilum of the kidney
renal vessels, nerves, lymphatics and ureter
160
what are the right and left renal arteries branches of
the abdominal aorta
161
what is the internal aspect of the kidney composed of
cortex, medulla and the calyces
162
what is the function of the nephrons
filter blood, reabsorb water and solutes, secreting and excreting waste products
163
what part of the nephron is found in the cortex of the kidney
the glomerulus, bowmans capsule, proximal and distal tubules and part of the collecting duct
164
what parts of the nephron are found in the medulla of the kidney
loop of Henle and the rest of the collecting duct
165
as urine is produced in the kidney where does it go
as its made in the collecting ducts it travels down the pyramid towards the renal papilla (apex of pyramid). here is enters the minor calyx, which then merges with other calyces to form the major calyces. these merge to form the renal pelvis which then becomes the ureter
166
how does the ureter move urine to the bladder
via peristaltic contractions
167
what are kidney stones most often made from
calcium oxalate
168
what are the risk factors for kidney stones
high urine calcium, dehydration, obesity and certain medication
169
what are the classic signs for kidney stones
sharp pulsatile pain felt from loin to groin - pain fibers supplying the ureter, originate from T12 to L2 so pain is referred.
170
where are the three narrowings in the ureter were stones are most likely to get stuck
the pelvi-ureteric junction
pelvic brim
vesico-ureteric junction
171
what causes a UTI
bacteria entering the urinary bladder via the urethra. this is most common in females as the urethra is much shorter.
172
what are the three main types of kidney cancer
renal cell carcinomas, transitional cell carcinoma and Wilms tumours
173
what does the posterior abdominal wall consist of
the lumbar spine together with the psoas and quadratus lumborum muscles
174
what structures run along the posterior abdominal wall
the inferior vena cava, the aorta with its associated structures and autonomic plexus, lymphatics and sympathetic trunks either side of the lumbar spine
175
what lumbar spinal nerves form the lumbar plexus
L1-4
176
what are the notable nerve branches that come off of the lumbar plexus
```
iliohypogastric and iliolinguinal nerves
genitofemoral nerve
lateral femoral cutaneous nerve
femoral nerve
obturator nerve
```
177
what does the iliohypogastric and ilioinginal nerves supply
anterior abdominal wall muscles and the skin of the external genitalia
178
what does the genitofemoral nerve supply
the skin of the external genitalia
179
what does the lateral femoral cuneatus nerve supple
supplies the skin over the lateral thigh
180
what does the femoral nerve supply
the skin and muscle of the anterior thigh
181
what does the obturator nerve supply
the muscles and skin of the medial thigh
182
what spinal level does the abdominal aorta divide
L4
183
what are the paired branches of the abdominal aorta
the adrenal, renal, gonadal and lumbar arteries
184
what are the functions of the bony pelvis
supports the spine, tors and upper body, locomotion and housing and protecting pelvic viscera
185
what is the hip bone made up of
the ilium, the ischium and the pubis
186
what are the 5 articulations of the bony pelvis
hip joint, sacroiliac joint, pubic symphysis, lumbosacral joint, sacrococcygeal joint
187
what are the surface landmarks of the pelvis
```
the iliac crest
the anterior superior iliac spine
the iliac tubercle
the pubic tubercle
inguinal ligament
mid-inguinal point
McBurneys point - 1/3 distance from the anterior superior iliac spine to the umbilicus
```
188
what are the differences between male and female pelvic anatomy
in females the pelvis has wider, circular pelvic inlets, in men these are narrower. in females there is an obtuse angle formed by the inferior pubic rami (acute in males) and there is wider and shorter sacrum in females compared to men
189
what is the arterial supply to the pelvis
the right and the left iliac arteries
190
what are the key branches of the iliac arteries
```
visceral arteries - bladder in both sexes (prostate and seminal vesicles in men)
uterine and vaginal arteries in females
middle rectal artery
internal pudendal artery
superior and inferior gluteal arteries
```
191
what are the nerves that supply the pelvis
the pelvis splanchnic nerves made up of parasympathetics from S2-4 to the pelvic viscera. Also have the superior and inferior gluteal neves
192
what is the 3 main functions of the pelvic floor
1. prevent herniation of the pelvic organs inferiorly
2. control continence of urine and faeces by providing a sphincter action
3. aids in increasing intra-abdominal pressure
193
what are the two muscles that make up the pelvic floor
the levator ani and the coccygeus
194
what are the three muscles that makes up the levator ani
the puborectalis, the pubococcygeus and the iliococcygeus
195
what is the function of the puborectalis muscle
it is a U shaped muscle and maintains its tone until defecation. it attached to the pubic bone anteriorly and forms a sling around the rectum. it pulls on the rectum so that a sharp angle is formed between the rectum and anal canal. when it relaxes the path from the rectum to the anal canal straightens and faeces can pass through
196
what arteries supply the perineum
the internal pudendal artery
197
what can the perineum be divided into
the anal triangle (posterior) and the urogenital triangle
198
what are the layers found in the urogenital triangle
the skin, perineal fascia, the superficial perineal pouch , the perineal membrane and the deep perineal pouch
199
what is contained within the superficial perineal pouch
it contains the majority of the erectile tissue that unites to form either the clitoris or the penis
200
what is the function of the corpora cavernosa
it forms a strong foundation for the clitoris or the penis
201
what is the function of the corpus spongiosum
in the males it has a proximal expansion which is the bulb of the penis. in women it splits into two parts to flank the vaginal opening
202
what is the function of the ischiocavernosus muscle
it helps to stabilise the erect penis and clitoris
203
in males what does the bulbospongiosus muscle do
it maintains an erection by compressing the veins that drain the erectile tissues
204
what is the function of the vas deferens
carries sperm from the epididymis up the spermatic cord and through the inguinal canal into the pelvis. it passes by the bladder and terminates by joining the seminal vesicle duct to form the ejaculatory duct
205
what is the function of the seminal vesicles
they secrete thick alkaline fluid which forms the bulk of the seminal fluid
206
what artery supplies the vas deferens, prostate and seminal vesicle
the internal iliac artery
207
what structure(s) passes through the prostate
the urethra and the ejaculatory duct
208
what ligament is the ovary attached to
the broad ligament - via a short mesentery (mesovarium)
209
what is the blood supply to the ovary
the ovarian artery
210
in females what does the internal iliac artery supply
the vagina, cervix, uterine tubes, and uterus
211
what is the term vulva used for
all parts of the female external genitalia
212
what is the main blood supply to the vulva
the internal pudendal arteries
213
what is the innervation of the vulva
the ilioinguinal nerve, the genital branch of the genitofemoral nerve, the pudendal nerve, and the posterior cutaneous nerve
214
what are the parts of the vulva
the mons pubis, the labia majora, the labia minora, the clitoris, the vestibule, the vaginal opening, the hymen, the urinary meatus and the vestibular glands (greater and lesser)
215
what arteries is the bladder supplied by
the vesical arteries
216
what is the bladder stretch reflex
as the bladder fills, stretching of the bladder wall is detected, and info sent via visceral afferent fibres. in the sacral spine these fibres synapse onto motor neurons that directly send information back to the bladder, to contract.
- bladder filling initiates bladder emptying
217
if a patient suffers a spinal injury above the sacral level what are the two pathways that will be interrupted
1. ascending pathways that convey sensation of bladder filling to the brain
2. descending pathway that exert voluntary, inhibitory control over the external urethral sphincter
218
what is the pectinate line
it divides the superior part of the anal canal from the inferior part - marks where endoderm and the hindgut transition to ectoderm
219
what is the foramen between the pubis and the ischium
the obturator foramen
220
what passes through the obturator foramen
the obturator nerves and vessels
221
what is the blood supply to the thyroid
the superior thyroid artery, from the external carotid
| the inferior thyroid artery, from the subclavian
222
what is the action of glucose on beta cells in the pancreas
glucose moves into the cell via GLUT2. ATP is made and there is closure of the ATP sensitive potassium channels. There is opening on voltage gated calcium channels and this makes vesicles containing insulin fuse with the membrane and the insulin is released
223
what is the action of insulin on cells
it mobilises GLUT4 containing vesicles to the cell membrane allowing glucose to be absorbed
224
what stimulates the release of ACTH
CRH from the hypothalamus
225
what is the cell type that releases ACTH
corticotrophs
226
what is the action of ACTH
it causes cortisol release from the zona reticularis #
227
what does cortisol do in the body
it causes gluconeogenesis and carbohydrate motabolism, decreases inflammation and causes proteolysis and lipolysis
228
what is the action of FHS and LH in males
LH causes leydig cells to release testosterone
| FSH causes sertoli cells to produce MIF, as well as inducing spermatogenesis
229
what pituitary cells produce FSH and LH
gonadotrophs
230
what regulates prolactin release from the anterior pituitary
dopamine - it inhibits it
231
the pubic bones joining is an example of what kind of joint
a secondary cartilage joint
232
what is the sacroiliac joint an example of
a specialised synovial joint
233
what protein is produced by follicular cells in the thyroid gland
thyroglobulin
234
what is found within the female urogenital triangle
The female urogenital triangle contains the mons pubis, labia majora and labia minora, the clitoris, and the vaginal and urethral orifices
235
does the vagina pierce the superficial or deep perineal pouch
it pierced both of them
236
where is the perineal body found in women
between the vagina and the anus
237
what does the perineal body attach in women
the perineal muscles, the pubo-vaginalis, the bulbospongiosus and the superficial external anal sphincter
238
what cell type produces growth hormone
somatotrophs
239
what does growth hormone do in the body
causes skeletal growth, muscle strength, protein synthesis, glycogenolysis and lypolysis
240
what inhibits growth hormone
somatostatin
241
what are the contents of the pelvis
the small intestine, the sigmoid colon and rectum, the ureters and bladder, ovaries, fallopian tubes, ureters, vagina, vas deferens, seminal vesicles, prostate, lumbosacral trunk, obturator nerve, sympathetic trunk, sacral plexus, iliac arteries, gonadal and superior rectal arteries
242
what structure suspends the penis from the pubic synthesis
the suspensory ligament of the penis
243
what is the root of the penis
the bulb of the penis plus the right and left crura
244
what does the crura become in the shaft of the penis
the corpora cavernosa
245
what does the bulb of the penis become
the corpus spongiosum
246
what is the corpus cavernosa surrounded by
tunica albunginea
247
what is bucks fascia
it is the deep fascia of the penis
248
what is the blood supply to the rectum
the superior, middle and inferior rectal arteries
- superior from inferior mesenteric
- other two from the internal iliac
249
what is the nervous supply to the rectum
the hypogastric plexus and the pelvic splanchnic nerves
250
what are the bones of the pelvis
ischium, iliac and pubic bone
251
where do the bones of the pelvis join
they join at the acetabulum
252
what are the layers of the scrotum
skin, superficial facia, external spermatic fascia, cremasteric fascia, internal spermatic facia and parietal layer of the tunica vaginalis
253
what is the nervous and blood supply to the scrotum
the anterior and posterior scrotal arteries
| the genitofemoral, ilioinguinal and the pudendal nerves
254
what is the nervous supply to the bladder
```
sympathetic = hypogastric (T12-T2)
parasympathetic = pelvic splanchnic nerve (S2-4)
somatic = pudendal nerves
```
255
where is the inguinal canal found
at the lower edge of the aponeurosis of the external oblique
256
where is the inguinal ligament found
ASIS to the pubic tubercle
257
what is found in the inguinal canal
spermatic cord, round ligament and genitofemoral nerve pass through DIR. Ilioinguinal nerve also found but doesnt pass through DIR
258
in the urogenital triangle what does the deep perineal space contain
the deep transverse perineal muscles, the urethral sphincter, the membranous urethra, the bulbourethral glands, the pudendal vessels and the dorsal nerve of the penis
259
what connects the pelvis to the uterus
the broad ligament
260
what does the broad ligament contain
the ovarian and uterine arteries, the ovarian ligament and the round ligament of the uterus
261
where is the function of the round ligament of the uterus
it connects the body of the uterus through the inguinal canal to the labia majora
262
what vertebral level does the thyroid gland sit
C1-5
263
what two muscle does the thymus sit inbetween
the sternohyoid and the sternothyroid
264
what is the blood supply to the prostate
the inferior vesical and the middle rectal arteries
265
what is the nervous supply to the prostate
```
parasympathetic = pelvic splanchnic nerve
sympathetic = hypogastric
```
266
what are the nerves of the pelvis
the obturator, the sacral plexus, the sacral sympathetics, the inferior hypogastric plexus
267
what is the function of the obturator nerve
supplies the abbductor compartments of the thigh and skin
268
what is the function of the inferior hypogastric plexus
micturition, defaecation, erection, ejaculation and orgasm
269
what is the perineal body
it is the midline fibromuscular tissue that splits the anal and urogenital triangles
270
what attaches to the perineal body
the levator ani, bulbospongiosus, external anal sphincter, deep transverse perineal muscle
271
what are the structures in the external female genitalia
mons pubis, labia majora, labia minora, clitoris, vestibule, bulb of vestibule, greater vestibular glands, vagina and urethral orifice
272
what is the structure of the clitoris
there are two erectile crura attached to the perineal membrane
273
what is the nervous supply of the female external genitalia
internal pudendal, ilioinguinal, labial branch of the pudendal nerve and the femoral cutaneous nerve
274
what are the vessels of the pelvis
the main branch is the common iliac that divides into the internal and external iliac.
- this divides into the iliolumbar, the lateral sacra, the obturator, the superior and inferior gluteal, the superior and inferior vesical, the uterine, the vaginal and the middle rectal
275
what is the perineum made up of
the anterior urogenital triangle and the posterior anal triangle
276
what is found in the anal triangle
iscioanal fossae, anal canal, internal and external anal sphincters, anococcygeal ligament
277
what separates the upper and lower sections of the anus
the dentate line
278
what epithelia is found in the upper 2/3 of the anal canal
simple columnar
279
what epithelia is found in the lower 1/3 of the anal canal
stratified squamous
280
what is the nervous supply to the vagina
```
upper = hypogastric
lower = pudendal and ilioinguinal nerves
```
281
what are the layers in the uterus lining
outer serosa, myometrium (smooth muscle) and endometrium
282
what are the 4 sections of the male urethra
pre-prostatic, prostatic, membranous and spongy
283
what attaches to the apex of the bladder to the umbilicus
the medial umbilical ligament
284
what are the layers found in the bladder wall
the outer serosa, the detrusor muscles and a second circular smooth muscle layer
285
what is the blood supply to the bulb and spongiosum of the penis
the bulbourethral artery
286
what nerves supply the penis
The penis is supplied by S2-S4 spinal cord segments and spinal ganglia.
Sensory and sympathetic innervation to the skin and glans penis is supplied by the dorsal nerve of the penis, a branch of the pudendal nerve.
Parasympathetic innervation is carried by cavernous nerves from the peri-prostatic nerve plexus, and is responsible for the vascular changes which cause erection.
287
what are the three layers of the vagina
the outer fibrous layer which attaches to pelvic viscera, the muscular layer (longitudinal and circular) and the internal surface of stratified squamous epithelia
288
what are the sections of the uterine tube
infundibulum (fibrae found here), ampulla and isthmus
289
where does the uterine artery come from
the internal iliac artery
290
where do the ureters cross the pelvic brim
at the bifurcation of the common iliac vessels
291
what is the ovarian blood supply
the ovarian artery, which is a branch of the abdominal aorta
292
what is the nervous innervation of the ovaries
the ovarian plexus
293
what are the layers of the spermatic cord
the external spermatic fascia (form external oblique), the cremasteric fascia (from internal oblique) and internal spermatic fascia (from transversalis)
294
what are the contents of the spermatic cord
the vas deferens, the testicular artery the vas deferens artery, the cremasteric artery, the veins, lymphatics, genitofemoral nerves and sympathetics, processes vaginalis
295
what are the boundaries of the inguinal canal
```
anterior = external oblique aponeurosis
floor = lower edge of inguinal ligament
roof = lower edge of the internal oblique and transversus muscle
posterior = conjoint tendon and transversalis fascia
```
296
what makes up the lumbar plexus
L1-L4 spinal nerves
297
what are the branches of the lumbar plexus
the lateral cutaneous nerve of the thigh, the femoral nerve, the genitofemoral nerve, the iliohipogastric and the obturator
298
where is oxytocin made
in the paraventricular nucleus of the hypothalamus
299
where is ADH made
the supraoptic nucleus of the hypothalamus
300
what is the nervous supply to the internal and external sphincter of the rectum
```
internal = smooth muscle and innervated by the hypogastric and pelvic plexus
external = striated and under S4 voluntary control and the inferior rectal nerve
```
301
what is the anatomical course of the spermatic cord
begins from the inferior abdomen and ends in the scrotum
302
where is the spermatic cord formed
at the opening of the inguinal canal (deep inguinal ring)
303
what are the blood vessels found within the spermatic cord
the testicular artery, the cremasteric artery and vein, the artery to the vas deferens and the testicular veins
304
what are the nerves found within the spermatic cord
the genital branch of the genitofemoral nerve and the autonomic nerves
305
what other structures (not nerves or vessels) are found in the spermatic cord
vas deferens, processus vaginalis and lymph vessels
306
what is the Processus vaginalis
projection of peritoneum that forms the pathway of descent for testis during embryonic development
307
what is the pampiniform plexus
network of veins responsible for venous drainage of the testes
308
where do the right and left testicular veins drain into
right drains into the inferior vena cava, and the left into the left renal vein
309
what do the walls of the vas deferens consist of
```
inner = longitudinal smooth muscle
intermediate = circular smooth muscle
outer = longitudinal smooth muscle
```
310
what do the walls of the vas deferens consist of
```
inner = longitudinal smooth muscle
intermediate = circular smooth muscle
outer = longitudinal smooth muscle
```
311
when do Leydig cells start producing testosterone
at week 8
312
where is the bladder and the urethra derived from
Bladder and urethra ultimately derived from the cloaca (hindgut structure)
313
what are the three divisions of the anterior urogenital sinus
* Upper part forms bladder
* Pelvic part forms urethra and some of the reproductive tract in females, the prostatic and membranous urethra in males
* Phallic/caudal part forms part of the female reproductive tract and the spongy urethra in males
314
what does the posterior urogenital sinus become
the anal canal
