Genitourinary And Renal System Flashcards
What is the inguinal canal
The inguinal canal is an oblique passageway through the muscles of the anterior abdominal wall and lies superior to the medial half of the inguinal ligament
What does the inguinal canal pass through
It passes through each layer of the abdominal wall as it travels medially and inferiorly
Where does the inguinal canal start and finish
The inguinal canal starts at the transversalis fascia deep and laterally and finishes with the external oblique aponeurosis superficially and medially
How long is the inguinal canal in an adult
5cm long
What makes up the anterior border of the inguinal canal
The anterior border of the inguinal canal is
The external oblique aponeurosis
Laterally only: internal oblique aponeurosis
What makes up the posterior border of the inguinal canal
The posterior border is made up of
The transversalis fascia
Medially only: medial fibres of the aponeuroses of the internal oblique and transversus abdominis known as the conjoint tendon
What makes up the roof of the inguinal canal
The roof of the inguinal canal is made up of
The transversalis fascia
The arching fibres of the internal oblique and transversus abdominis
What makes up floor of the inguinal canal
The floor of the inguinal canal is made up of
Inguinal ligament which is rolled up on the lower border of the external oblique aponeurosis
What does the inguinal canal contain in a female
Round ligament of the uterus
Llioinguinal nerve
Genital branch of the genitofemoral nerve
What does the inguinal canal contain in the male
In males, the content of the inguinal canal are all contained in the spermatic cord except for the ilioinguinal nerve which runs in the canal but outside of the spermatic cord
2 nerves- Genital branch of the genitofemoral nerve and the sympathetic nerve fibres
3 arteries- Testicular artery, cremasteric artery and artery to the vas deferens
3 fascial layers- External spermatic fascia, cremaster muscle and fascia and internal spermatic fascia
4 other structures- Pampinform venous plexus, lymphatics, vas deferens and processus vaginalis
What is the external spermatic fascia derived from
The external spermatic fascia is derived from the external oblique aponeurosis
What is the cremaster muscle and fascia derived from
The cremaster muscle and fascia is derived from the internal oblique muscle
What is the internal spermatic fascia derived from
The internal spermatic fascia is derived from the transversalis fascia
What is the processus vaginails derived from
The processus vaginails is derived from the peritoneum
What is a hernia
A hernia is an abnormal protrusion of tissues or organs from one religion into another through an opening or defect
What is an inguinal hernia
An inguinal hernia is a protrusion of abdominal contents usually part of the greater omentum or loops of small intestines through the anterior abdominal wall and into the inguinal canal
What is an indirect inguinal hernia
An indirect inguinal hernia is when intra-abdominal contents are forced through the deep inguinal ring and into the inguinal canal
Where can an indirect inguinal hernia move to from the inguinal canal
The hernia may migrate into the scrotum in males or into the labia majora in females
What is the potential risk of an indirect hernia
The herniated tissue can strangulate and become ischaemic and a surgical emergency
What a direct inguinal hernia
A direct inguinal hernia where intra-abdominal contents are forced through the posterior wall of the inguinal canal and directly through the superficial ring
What are characteristics of the scrotal skin
Thin
Wrinkled
Darkly pigmented than other areas
What lies beneath the scrotal skin
Below the scrotal skin is a thin layer of superficial fascia and thin involuntary muscles called the dartos
Where does the superficial fascia extend between
The superficial fascia extends between the testicles
What does the superficial fascia form
The superficial fascia forms a septum dividing the scrotum into the right and left halves
What does each half of the scrotum contain
Each half of the scrotum contains a testis, epididymis and lower part of the spermatic cord
What are the testes
The testes are the male reproductive organs which produce sperm and secrete testosterone
What covers the testes
The testes are covered by the same 3 layers of spermatic fascia that cover the spermatic cord
The external spermatic fascia
The cremaster
The internal spermatic fascia
What is the tunica vaginalis
The tunica vaginalis is a sac derived from the peritoneum which partially surrounds the testes
What is the epididymis
A coiled tube lying along the posterior border of each testes
What makes up the epididymis
Expanded head superiorly, a body, a pointed tail
What is the function of the epididymis
Stores spermatozoa formed in the testes
What is the function of the vas deferens
The vas deferens carries sperm from the epididymis and travels with the testicular vessels in the spermatic cord
Where do the testicular arteries branch from
The testicular arteries are branches of the abdominal aorta
Where does venous blood drain to from the testes and epididymis
The venous blood drains from the testes and epididymis enters the pampiniform venous plexus
What does the pampiniform venous plexus form
It forms the testicular vein
Where does the right testicular vein drain into
The inferior vena cava
Where does the left testicular vein drain into
The left testicular vein drains into the left renal vein
What is hydrocoele
Painless swelling caused by peritoneal fluid between the layers of the tunica vaginalis around the testes
What is varicocele
Abnormal dilation of the pampiniform venous plexus
Which side is varicocele more common and why
It is more common on the left side than the right because the left testicular vein drains into the left renal vein before draining into the inferior vena cava
What is epididymo-orchitis
Painful inflammation of the epididymis and testis
What causes epididymo-orchitis
In younger people epididymo-orchitis is often causes by a sexually transmitted infection such as chlamydia or gonorrhea
In older people epididymo-orchitis is often caused by a urinary tract infection
What is testicular torsion
Twisting of the testis on the spermatic cord
What can be caused by testicular torsion and what happens if it is left untreated
Ischaemia of the testes and is a surgical emergency. If left untreated it can lead to necrosis and loss of the affected testis
If a lump on the testis is cancerous what is the treatment plan
Surgery to remove the testis and a length of cord and then chemotherapy or radiotherapy if needed
Where could testicular cancer metastasize and why
If testicular cancer does metastasizes it will likely follow the lymphatic drainage which follows the testicular arteries back to the lymph nodes around the abdominal aorta so the metastases first to the para-aortic or retroperitoneal lymph nodes
What is cryptorchidism
Undescended testis
How does cryptorchidism occur
During the development of a baby the testes form in the abdomen and they descend through the inguinal canal to reach the scrotum before birth but if this fails to occur the infant will be born with 1 or both testes absent from the scrotum and the affected testis will be stuck somewhere along the path of descent
Why is cryptorchidism an issue
Spermatogenesis is optimal just below core body temperature which is reached in the scrotum but in the abdomen the temperature will be too high for sperm production
Undescended testes are also at an increased risk of cancer
What is a vasectomy
Male sterilisation or permanent male contraception
How is a vasectomy performed
The scrotum is incised and the vasa deferentia are located on either side and seperated before lighting cauterising each end preventing the passage of sperm from the testes
What is the penis
The male organ of sexual intercourse
What is the penis primarily made up of
It is primarily made up of three cylinders of erectile tissue
What are the 3 cylinders of the erectile tissue
2 corpora cavernosa dorsally
1 corpus spongiosum ventrally
What encloses the corpora cavernosa and corpus spongiosum
The erectile tissue is enclosed deep within the fascia of the penis
What is the deep fascia of the penis known as
Bucks fascia
What is the end of the penis known as
It is called the glans
What is the end of the penis an expansion of
The glans is an expansion of the corpus spongiosum
Where does the penile urethra located
The penile urethra lies within the corpus spongiosum
Where does the urethra open
As the urethra approaches the end of the penis and opens up via the external urethra meatus
What is the blood supply of the penis
The arterial supply to the penis is via the penile arteries
Where do the penile arteries branch from
They branch from the internal pudendal arteries which branch from the internal iliac arteries
What is the nerve supply to the penis
The nerve supply via the penis is from S2-S4
what nerves carries general sensation and sympathetic innervation to the penis
The dorsal nerve of the penis
What is the dorsal nerve of the penis a branch of
The dorsal nerve of the penis is a branch of the pudenal nerve
What causes an erection
Parasympathetic fibres in the penis
Where do parasympathetic fibres arise from
They arise form the peri-prostatic nerve plexus
What is responsible for the increase in size and rigidity of the penis during an erection
The corpora cavernous
How does an erection occur
During sexual arousal arterial blood flow into the corpora of the penis increases so it becomes engorged with blood. The corpus spongiosum does become engorged as well but not as much as the corpora cavernous
What is the main role of the corpus spongiosum
During erection is to prevent the urethra from been compressed which would prevent ejaculation
What is erectile dysfunction
Erectile dysfunction is a term to describe the inability to achieve or maintain an erection during sexual activity
What does achieving and maintaining an erection reply on
Achieving and maintaining an erection relies on intact nerve pathways, reflexes, controlled blood flow in and out of the corpora cavernous of the penis and psychological arousal
What medications could be used to treat erectile dysfunction
Sildenafil/viagra
What is another word for adrenal
Suprarenal
Where are the adrenal glands located
Adrenal glands lie closely to the upper pole of each kidney
Where is the right adrenal gland located
The right adrenal gland lies behind the liver and inferior vena cava
Where is the left adrenal gland located
The left adrenal gland lies behind the stomach and pancreas
What arteries supply the adrenal glands
Superior adrenal artery
Middle adrenal artery
Inferior adrenal artery
What is the superior adrenal artery a branch of
It is a branch of the inferior phrenic artery
What is the middle adrenal artery a branch of
It is a branch of the abdominal aorta
What is the inferior adrenal artery a branch of
It is a branch of the renal artery
What drains the adrenal glands
They are drained by a single vein on each side the left and right adrenal vein
Where does the right adrenal vein drain to
Directly into the inferior vena cava
Where does the left adrenal vein drain into
The left adrenal vein drains into the left renal vein which then joins the inferior vena cava
What is the adrenal gland composed of
Outer part is the cortex and the inner part is the medulla
What is the function of the cortex
The cortex produced steroid hormones
What hormones are produced in the cortex
Cortisol
Aldosterone
Testosterone
What does the medulla of the adrenal gland produce
Adrenaline
What is a phaeochromocytoma
A rare hormone producing tumour of the adrenal medulla which causes excess secretion of hormones
Signs and symptoms of phaeochromocytoma
Hypertension
Tachycardia
Excessive sweating
What is the average size for a kidney
11cm long
7cm wide
4cm thick
Why are the kidneys described as been extra-peritoneal
They are extra/retro-peritoneal as they are located behind the peritoneum not above or below it
Where are the kidneys located
They are located either side of the upper lumbar vertebrae
What is each kidneys embedded in
Perinephric fat which is covered by renal fascia with another layer of paraphernic fat on the outside of the fascia
What is on the medial border of the kidney
The renal hilum
What is in the renal hilum
Renal vessels, nerves, lymphatics and ureter are located
What are the right and left renal arteries a branch of
The abdominal aorta
Where to the left and right renal veins drain into
They drain directly into the inferior vena cava
What is the internal aspect of the kidney made up of
The cortex, medulla and the calyces
What are the functional units of the kidney
The nephrons
What is the function of the nephrons
Filtering blood
Reabsorbing water and solutes
Secreting and excreting waste products as urine
What is present in the cortex of the kidneys
The glomeruli
Glomerular capsule
Proximal and distal tubules
Parts of collecting duct
What is found in the renal pyramids in the medulla of the kidney
The nephron loops of Henle
Rest of collecting ducts
From the collecting ducts where does urine travel to
Down the pyramid to the renal papilla at the apex of the pyramid where it enters a minor calyx
How is a major calyx formed
Lots of minor calyx merging forms a major calyx
What forms the renal pelvis
Merging of major calyx form the renal pelvis
What is the renal pelvis in continuation with
The ureter
What is the function of the ureter
Carries urine to the urinary bladder
How is urine transported
The urine is transported through narrow tubes by peristalsis
Where do the ureters run
They run anterior to the psoas major on the posterior abdominal wall and cross the pelvic brim to enter the pelvis
Where do the ureters enter the bladder
They enter the bladder on the inferomedial aspect of the bladder
What are kidney stones usually made of
Calcium oxalate
What are risk factors of developing kidney stones
High urine calcium
Dehydration
Obesity
Certain medications
Typical presentation of an obstructing stone
Excruciating pulsating pain from from loin to groin
Why is pain felt loin to groin with a kidney stone
Because the pain fibres supplying the ureters originates in T12-L2 nerves so pain is referred and felt in the T12-L2 dermatomes
What happens if the flow of urine is obstructed
The kidney will fill with urine and swell which can injury the kidney and could cause infection
Where are the 3 regions the ureters narrow where a stone could get stuck
The pelvi-ureteric junction
Pelvic brim
Vesicles-ureteric junction
What is the most common cause of a urinary tract infection
Bacteria usually E.Coli
Who is more common to get urinary tract infections and why
Females because the urethra is shorter
What is an infection of the urinary bladder called
Cystitis
Symptoms of cystitis
Burning sensation when passing urine
Feeling the need to pass urine more frequently
What is pyelonephritis
When the urinary tract infection spreads proximally to the kidney causing a more serious infection needing intravenous antibiotics
What are signs and symptoms of pyelonephritis
Fever
Flank pain
Nausea
Vomiting
What can cancers of the kidneys be divided into
They can be didived into three main types based on there histological origin
Renal cell carcinomas
Transitional cell carcinomas
Wilms tumours
Where do renal cell carcinomas originate
They originate from the lining of the nephron
Where do transitional cell carcinomas originate
They originate from the epithelial lining inside the kidney
Where do wilms tumours originate
They originate from renal stem cells
Symptoms of renal cancers
Pain in the flank
Palpable mass in abdomen
haematuria
Why could the spread of renal cancer be slow
The kidneys are encased in a renal capsule, perinephric fat, renal fascia and paranephric fat so must grow very large and penetrate all these structures before it can invade other organs and structures
Why does a left sided varicocele need an investigation for a renal cancer
A left sided varicocele warrants investigation because the left testicular vein drains into the left renal vein which may be compressed or obstructed by a Renal tumour
What is the posterior abdominal wall and where does it run from and to
The posterior abdominal wall is the region behind the abdominal cavity
It runs from the attachments of the diaphragm to the pelvic brim
What does the posterior abdominal wall consist of and what structures run along it
The posterior abdominal wall consists of the lumbar spine with the psoas and quadratus lumborum muscles
Structures which run along it include the inferior vena cava, the aorta with associated with autonomic plexuses and lymph nodes and the sympathetic trunks on either sides of the lumbar spine. More laterally the ureters run along the surface of the psoas muscle towards the pelvis along with the gonadal arteries
What forms the lumbar plexus
Lumbar spinal nerves from L1-L4 with a contribution from the T12 nerve
What does the lumbar plexus give rise to
The lumbar plexus gives rise to several branches that innervate skin and muscle of the abdominal wall and thigh
Which branches of the lumbar plexus run along the posterior abdominal wall
Iliohypogastric and ilioinguinal nerves which supply the anterior abdominal wall and skin of external genitalia
Genitofemoral nerve which supplies the skin of external genitalia
Lateral femoral cutaneous nerve which supplies the skin over the lateral thigh
Femoral nerve which supplies the muscle and skin of the anterior thigh
Obturator nerve which supplies the muscles and skin of the medial thigh
Where does the thoracic aorta pierce the diaphragm
At the level of T12
After piercing the diaphragm where does the aorta go
The thoracic aorta becomes the abdominal aorta which descend through the abdomen on the posterior abdominal wall just to the left of the midline and the terminates by bifurcating into the left and right common iliac arteries at the level of L4
What are the unpaired arteries given off from the abdominal aorta
Coeliac trunk
Superior mesenteric artery
Inferior mesenteric artery
What are the paired arteries given off from the abdominal aorta
Renal arteries
Adrenal arteries
Gonadal arteries
Lumbar arteries
What unites the to form the inferior vena cava
The inferior vena cava is formed by the union of the left and right common iliac veins at the level of L5 which then ascends on the posterior abdominal wall just right of the midline
What is an AAA
Abdominal aortic aneurysm which is is bulging of the abdominal aorta caused by a weak point in the blood vessel wall
What are the risk factors for developing an AAA
Smoking
Alcohol
Hypertension
Atherosclerosis
How are AAA’s diagnosed
An AAA is diagnosed if the diameter is bigger than 3cm
What happens if an AAA ruptures
Significant intra-abdominal bleeding
What are the functions of the pelvis
Supporting the spine, torso and upper body
Locomotion
Housing and protecting the pelvic viscera
How many bones is the pelvis made up of
3
What are the 3 bones the Levi’s are made up of
The sacrum and the left and right hip bones
What is the hip bones composed of
The hip bones are composed of 3 bones
The ilium
The ischium
The pubis
What are the 5 articulations of the pelvis
Hip joint- between the head of the femur and the acetabulum of the pelvis
Sacroiliac joint- between the sacrum and the ilium of the hip bone
Pubic symphysis- between the two two pubic bones
Lumbosacral joint- between the 5th lumbar vertebrae and the sacrum
Sacrococcygeal joint- between the sacrum and the coccyx
What are bony landmarks in the pelvis that you can palpate
Iliac crests
Anterior superior iliac spine
Iliac tubercle
Pubic tubercle
Inguinal ligament
Mid-inguinal point
McBurney’s point
What are the differences between a male and female pelvis
Females have a wider pelvis with circular pelvic inlet for childbirth but males have a narrower pelvis with heart shaped pelvic inlets in males
Females have an obtuse angle formed by the inferior pubic rami whereas males have an acute angle formed by the inferior pubic rami
Females have wider and shorter sacrum compared to narrower and longer sacrums in males
What does the pelvis contain
Organs from the gastrointestinal and the genitourinary systems
What is the arterial supply of the pelvis
Left and right internal iliac arteries
What branches of the iliac arteries supply the pelvis viscera
Vesical arteries which supply the bladder in both males and females and the prostate and seminal vesicles in males
Uterine and vaginal arteries in females
Middle rectal artery supplying the rectum
Internal pudendal artery which supplies the perineum
Superior and inferior gluteal arteries supplying the gluteal region
Where do the pelvic plexuses drain into
They drain into the internal iliac vein
What is the sacral plexus
Found within the pelvis where the sacral spinal nerves join together
What are key nerves which arise from the sacral plexus
Sciatic nerve
Pudendal nerve
Superior and inferior gluteal nerves
Pelvic splanchnic nerves
What is the pelvic floor
The pelvic floor is a collective name for several muscles that support the pelvic organs
What are the main functions of the pelvic floor
Prevent herniation of pelvic organs inferiorly
Control continence of urine and faeces
Aid in increasing intra-abdominal pressure
What muscles make up the pelvic floor
The pelvic floor is made up of 2 muscles - levator ani and coccygeus
Levator ani is made up of 3 smaller muscles - puborectalis, pubococcygeus and iliococcygeus
What does the puborectalis attach to and what is its function
The puborectalis is a u-shaped muscles which attaches to the pubic bones anteriorly and forms a sling around the rectum, it can pull on the rectum so that the sharp angle is formed between the rectum and anal canal preventing defecation. When it relaxes the path from the rectum to the anal canal straightens to allow faeces to pass
What does the pubococcygeus attach to
The pubococcygeus lies posterior and lateral to puborectalis. It attaches to the pubic bone anteriorly and the coccyx and sacrum posteriorly
What does the iliococcygeus attach to
The iliococcygeus lies posterior to the pubococcygeus. It attaches to the spines of the ischium and the coccyx
What is levator ani innervated by
Levator ani is innervated by a branch of the S4 nerve and some branches of the pudendal nerve
What can cause pelvic floor weakness
Pelvic floor weakness is caused by the pelvic floor muscles been stretched, damaged and weakened by childbirth, ageing, straining or obesity
What can pelvic floor weakness lead to
Incontinence of urine and faeces
Pelvic organ prolapse
What is found immediately superior and inferior to the pelvic floor
The perineum
What are the 2 regions the perineum can be separated into
The anal triangle
The urogenital triangle
What are the layers of the urogenital triangle
Skin
Perineal fascia
Superficial perineal pouch
Perineal membrane
Deep perineal pouch
Where is the perineal body located
Between the two triangles of the perineum
What is the perineal body and what is its function
Dense mass of fibrous tissue and muscle which sits in the Center of the perineum and acts as an attachment for almost all the perineal and pelvic floor muscles
What attaches to the perineal body
Levator ani
External anal spinchter
External urethral spinchter
Superficial and transverse perineal muscles
Bulbospongiosus
What is the superior perineal pouch a part of
The urogenital triangle
What does the superior perineal pouch contain
It contains most of the erectile tissue which unites to form the clitoris or penis and the muscles overlying them
Where do the corpora cavernosa run
The corpora cavernosa runs symmetrically along the ischial rami bilaterally to converge in the midline
What is the part of the corpora cavernosa called which is attached to the ischial rami called
The crura
Where is the corpus spongiosum located
The midline
What is the difference between the corpus spongiosum in males and females
In males the corpus spongiosum has an expanded part proximally which rests on the perineal membrane, which is known as the bulb of the penis
In females the corpus spongiosum splits into two parts that flank the vaginal opening, which are known as the bulb of vestibule or bulb of the clitoris
What is the corpora cavernosa covered by
The corpora cavernosa is covered by ischiocavernosus muscles
What are the corpus spongiosum covered by
The corpus spongiosum is covered by bulbospongiosus muscles
What is the function of the ischicavernosus muscles
They help stabilise the erect penis or clitoris
What in the function of the bulbosponigiosus in males and females
In males the bulbospongiosus assists by maintaining erection by compressing veins that drain the erectile tissue and it contracts to squeeze any remaining urine or semen from the urethra
In females the bulbospongiosus helps maintain clitoral erection and constricts around the vaginal orifice which helps expression of fluid from the greater vestibular glands
What is the arterial supply to the perineum
Via the internal pudendal artery which is a branch of the internal iliac artery
What is the main nerve of innervation to the perineum
Innervation to the perineum is via the pudendal nerve
What is an episiotomy
A pre-emotive incision
When would an episiotomy be needed and why
An episiotomy could be needed during childbirth as the perineal body could be damaged due to stretching or tearing of the perineal tissue which can lead to incontinence and pelvic floor weakness which can lead to prolapse
What are the male organ of reproduction
Paired testes
Epididymides
Vasa deferentia
Seminal vesicles
Ejaculatory ducts
Bulbo-urethral glands
Prostate
Penis
What is the vas deferens
The tube that Carries sperm from the epididymis up the spermatic cord and through the inguinal canal into the pelvis
Where does the vas deferens terminate
It terminates by joining the duct of the seminal vesicle to form the ejaculatory duct
What are seminal vesicles
They are a lobulated sac about 4cm long which lies lateral to the ampulla of the vas deferens
What are the functions of the seminal vesicles
They secrete a thick alkaline fluid which forms the bulk of seminal fluid known as semen
Where does the ejaculatory duct lead to
The ejaculatory duct pierces the back of the prostate gland and enters the prostatic urethra
What is the prostate
The prostate gland is a spherical fibromuscular gland about the size of a walnut which lies against the neck of the bladder
What are the vas defererns, seminal vesicles and prostate gland all supplied by
They are all supplied by branches of the internal iliac artery
What is benign prostatic hyperplasia
The prostate gland completely encircles the urethra and with progressing age the prostate can become enlarged which can lead to compression of the urethra and inability to pass urine which would require catheterisation to drain the urine
Why does prostate cancer commonly metastasises to the vertebrae
Venous blood from the prostate passes into a plexus of veins which lies anterior or the sacrum and communicate with the azygos vein, these veins communicate with veins in the vertebrae bodies and so this is how the cancer can spread to the vertebrae
How is a prostate examined
The prostate can be examined during a rectal exam which involves pushing a finger into the rectum via the anus and flexing it anteriorly to palpate the prostate, you can feel the size contours and firmness
What does the female pelvis contain
Uterus
Cervix
Vagina
Uterine tubes
Ovaries
What is the uterus
A pear shaped hollow muscular organ about 8cm long which communicates laterally with the uterine tubes and inferiorly with the vagina
What is the uterus composed of
A fundus which sits above the uterine tubes
A body which is typically angles anteriorly and lies on the superior surface of the bladder
Cervix
What happens if conception occurs
If conception occurs the developing blastocysts will implant into the uterine lining, the endometrium, in the body of the uterus
The middle muscular layer of the uterus, the myometrium, becomes distended as pregnancy continues
What is the space behind the uterus but anterior to the rectum called
The rectouterine pouch also known as the pouch of douglas
What is the pouch of Douglas
The deepest part of the peritoneal cavity
What are the cervix
The cervix is composed of a narrow lumen and the cervical canal
What does the cervical canal communicate with
The cervical canal communicates with the uterine cavity via the internal os and with the vagina via the external os
What is the vaginal fornices
The vaginal fornices is formed by the recess created by the lower part of the cervix lying inside the vagina
What stabilises the position of the cervix
The position of the cervix is stabilised by the levator ani
What are the uterine tubes
Also known as the Fallopian tubes
They carry the ova from the ovary towards the uterus
They are around 10cm long and around found running along the upper boarder of the broad ligament
What is the infundibulum of the uterine tubes
The infundibulum is a dilated ampulla at the lateral end of the uterine tubes, the free edge is broken up into finger like projections known as fimbriae which are draped over the ovaries
What are the ovaries
They are almond shaped organs which are about 4cm long and 2cm wide, they are attached to the posterior aspect of the broad ligament by a small mesentery known as the mesovarium
Where are the ovaries located
The location is not fixed but they usually lie in the ovarian fossa which is formed by the angle between the internal and external iliac arteries
Apart from the ovaries what else lies in close relation to the ovarian fossa
The ureter and obturator nerve
What is the vagina
The vagina is the female organ for sexual intercourse and the excretory duct of the uterus, which is about 10cm long
Where is the vagina located
The upper 2/3 of the vagina lie in the pelvic floor and the lower 1/3 in the perineum
What is the vagina closely related to
The vagina is closely related to the bladder anteriorly and the urethra is often embedded in the anterior wall of the lower 1/3 vagina
What is the arterial supply to the uterus, cervix, uterine tubes and vagina
All these structures are supplied by branches of the internal iliac artery
What supplies blood to the ovaries
The ovaries are supplied by the ovarian artery
What is the ovarian artery a branch of
The abdominal aorta
What is the vulva
Collective term for all parts of the female external genitalia
What is the blood supply to the vulva
The vulva is supplied mainly by the pudendal arteries which are branches of the internal iliac arteries
What nerves innervate the vulva
The innervation to the vulva is by 4 nerves
The ilioinguinal nerve
The genital branch of the genitofemoral nerve
The pudendal nerve
The posterior cutaneous nerve of the thigh
What are the parts of the vulva
The mons pubis
Labia majora
Labia minora
Clitoris
Vestibule
Vaginal opening
Hymen
Urinary meatus
Vestibular gland
What is the mons pubic
The mound of fatty tissue infront of the pubic symphysis which Causes an elevation of hair bearing skin
What is the labia majora
Prominent hair bearing folds of skin that meet at the mons pubis anteriorly
What is the labia minora
Smaller hairless folds of skin medial to the labia majora
The labia minora fuse anteriorly to form the hood of the clitoris
They form the boundaries of the vestibule
What is the clitoris
A pea-sized mound of tissue which is is highly sensitive comprised of the erectile corpora cavernosa and the corpus spongiosum which can become engorged during sexual arousal
What is the vestibule
It is the area between the labia minora which contains the vaginal opening, urinary meatus and vestibular glands
What is the vaginal opening
The opening to the vagina known as the vaginal introitus
What is the hymen
The hymen is a thin membrane that partially covers the vaginal opening
When could the hymen rupture
The hymen could rupture during the first act of sexual intercourse but can also rupture during exercise, using tampons or can just be absent altogether
What is the urinary meatus
The opening of the urethra which lies posterior to the clitoris but anterior to the vaginal opening
What are the two vestibular glands
The greater vestibular gland
The lesser vestibular gland
What is the greater vestibular gland and where is it located
What is its function
The greater vestibular gland is also known of the Bartholins gland which lies posterior to the vaginal opening
It’s function is to secrete a lubricant into the vagina during sexual arousal
What is the lesser vestibular gland, where is it located and what is its function
The lesser vestibular gland also known as the skenes gland, they lie near the urethral opening
There function is debated but believed to secrete fluid which may lubricated the vaginal opening/urethra and may have an anti-microbial affect
What is an ectopic pregnancy
An ectopic pregnancy is when a blastocyst implants outside of the uterus usually in the uterine tubes
Why is an ectopic pregnancy an emergency
The uterine tube is not accommodated to stretch to accommodate a growing embryo and so may rupture which could cause internal bleeding and can be life-threatening and so surgery would be required to remove the pregnancy from the tube
What is endometriosis
It is a condition where endometrial tissue which lines the inside of the uterus is found outside of the uterus, usually around the ovaries, uterine tubes, uterine ligament and the rectouterine pouch
Signs and symptoms of endometriosis
Chronic pain
Cyclical pain related to menstruation
Pain during intercourse
How is endometriosis diagnosed
Using biopsy samples taken during surgical exploration
Signs and symptoms of gynaecological cancers
Pelvic pain
Abnormal vaginal discharge
Abnormal vaginal bleeding
Abdominal swelling
Urinary disturbances
Fatigue
Weight loss
What is the urinary bladder and where is it located
A hollow muscular organ located in the pelvis below the peritoneum and is an infra-peritoneal organ which is located posterior to the pubic symphysis and anterior to the vagina and rectum
What is the urinary bladder supplied by
It is supplied by the vesical arteries which are branches of the internal iliac arteries
Where do vesical veins drain into
They drain into the internal iliac vein
What is the function of the urinary bladder
It stories urine and helps to squeeze the urine out during micturition
What happens to the bladder when it is completely empty
It may squash down completely
How does the bladder fill with urine
The bladder fills with urine through the ureters which drain into the posterior aspect of the bladder near the base, known as the trigon, which is made up of a smooth wall. The ureters enter here on an angle which forms a rudimentary valve which prevents reflux of urine back into the ureters
Why is the internal wall of the bladder corrugated
It allows the bladder to stretch without tearing when it fills with urine
What muscle does the bladder wall contain
The smooth muscle called the detrusor muscle
What is the function of the detrusor muscle
Contracts to forcibly expel urine
How is the release of urine controlled
The release of urine is controlled by 2 sphincters
The internal urethral sphincter
The external urethral sphincter
Where is the internal urethral sphincter located and what is it composed of
It is located at the base of the bladder where it opens into the urethra
It is composed of smooth muscle which is under involuntary control
Where is the external urethral sphincter located and what is it composed of
The external urethral sphincter is located just after the prostate in males and in the perineal pouch in females
It is composed of skeletal muscle and is under voluntary control
What is the urinary bladder innervated by
The urinary bladder is innervated by somatic, sympathetic and parasympathetic nerves
The somatic nerve fibres come via the branches of the pudendal nerve which allows conscious control of the external urethral sphincter
The sympathetic nerve fibres come from branches of the hypogastric nerve which causes relaxation of the detrusor and contraction of the internal urethral sphincter allowing storage of urine
The parasympathetic nerve fibres come from the pelvic splanchnic nerves which causes contraction of the detrusor and relaxation of the internal urethral sphincter allowing for initiation of micturition
What is the urethra
The urethra Carries urine from the internal urethral orifice of the bladder to the external urethral orifice
How is urination controlled
Urination is controlled by Centers in the cerebral cortex, brainstem and sacral spinal cord through the sacral micturition Centers
As the bladder fills the stench of the bladder wall is detected and is relayed to the sacral spinal cord via visceral afferent fibres, when they reach the sacral spinal cord they synapse onto motor neurons, this stimulate the contraction of the bladder.
This is known as an arc reflex
Why can older children and adults consciously control urination where infants can’t
In older children and adults the reflex arc is inhibited by inputs from the cerebral cortex so they can detect bladder filling and so can consciously control when they urinate. It is achieved in infants through potty training where they learn to recognise bladder filling and develop descending pathways that inhibit the reflex when it is not convenient to urinate
What happens to bladder dysfunction if a patient suffers an injury to the spinal cord above the sacral level
2 pathways will be interrupted
Ascending pathways conveying sensation to the bladder filling to the brain so the patient would be no longer aware of bladder filling
Descending pathways that expert voluntary, inhibitory control over the external urethral sphincter so it will be permanently relaxed
But the reflex arc will still function but the patient doesn’t have any inhibitory control over it so the patient will not realise they need to pass urine and the bladder will automatically empty as it fills and so will be urine incontinent
What happens to bladder dysfunction if the patient suffers an injury to the spinal cord or cauda equina below the sacral level
The reflex arc will be disrupted and the bladder will fill without emptying because the stretch cannot be detected in the sacral micturition Centers
The internal urethral sphincters will be permanently contracted they bladder will continue to fill and so the pressure will eventually exceeds the strength of the internal urethral sphincter so urination will occur but if the pressure never exceeds the maximum a patient will develop urinary retention
Eventually urine will back up in the ureters to the kidneys
What is the rectum
The rectum is the terminal part of the large intestine which is about 12cm long
How many flexures does the rectum have
The rectum has 2 flexures
The curve anteriorly known as the sacral flexure
The curve posteriorly known as the anorectal flexure
What is the function of the rectum
Storage of faeces prior to defecation
What is the anal canal
The most distal part of the gastrointestinal tract which is about 4cm long which extends from the distal rectum to the anus and lies in the anal triangle
what controls defecation
2 anal sphincters the internal and external anal sphincters
What is the internal anal sphincter composed of
Smooth muscle and is involuntary
What is the external anal sphincter composed of
Skeletal muscle and in voluntary controlled
What is the pectinate line
Also known as the denate line
It divides the superior part of the anal canal from the inferior part
What is the superior part of the anal canal derived from embryologically
The superior part of the anal canal is derived from the endoderm
What is the inferior part of the anal canal derived from embryologically
The inferior part of the anal canal is derived from the ectoderm
What is the superior part of the anal canal supplied by
The superior part of the anal canal is part of the hindgut and so is supplied by the inferior mesenteric artery via the superior rectal artery
What is the venous drainage of the superior part of the anal canal
Venous drainage is via the portal venous system towards the liver
What is the superior part of the anal canal encircled by
The internal anal sphincter
What is the internal anal sphincter innervated by
Sympathetic fibres from the sympathetic trunk
Parasympathetic fibres from the pelvic splanchnic nerves
What is the inferior part of the anal canal supplied by
The inferior anal canal is supplied by the middle and inferior rectal arteries which are branches of the internal iliac arteries
What is the venous drainage of the inferior part of the anal canal
The venous blood from the inferior part of the anal canal enter the systemic venous drainage
What is the inferior part of the anal canal encircled by
The external anal sphincter
What is the external anal sphincter innervated by
The external anal sphincter is innervated by The pudendal nerve
What are haemorrhoids
The wall of the anal canal are lined by an abundance of veins that form cushions which aid faecal continence
The cushions are known as haemorrhoids or piles
Where would haemorrhoids be located if they were painless
Above the pectinate line
Where would haemorrhoids be located if they become painful
Below the pectinate line
