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Phase 1 > GU anatomy > Flashcards

GU anatomy Flashcards

1
Q

What is the inguinal canal?

A

Short, oblique passageway through muscles of anterior abdominal wall
5cm long
Walls collapsed around contents to avoid other structure entering and getting stuck

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2
Q

Where does the inguinal canal run?

A

Starts at the transversalis fascia (deep,lateral) at deep inguinal ring
Finishes at superficial inguinal ring in external oblique aponeurosis (superficial and medial)

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3
Q

What is in the inguinal canal in females?

A

Round ligament (from uterine horn to attach to labia majora)
Ilioinguinal nerve
Genital branch of genitofemoral nerve supplying skin of mons pubis and labia majora

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4
Q

What is in the inguinal canal in males?

A

All contents within spermatic cord except ilioinguinal nerve
Ilioinguinal nerve runs in canal but outside cord

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5
Q

What is in the spermatic cord?

A

Genital branch of genitofemoral nerve (supplies cremaster muscle and anterior scrotal skin)
Sympathetic nerve fibres
Testicular, cremasteric arteries and artery to vas deferens
External spermatic fascia, cremaster muscle and fascia, internal spermatic fascia
Pampiniform venous plexus
Lymphatics
Vas deferens
processus vaginalis

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6
Q

What is external spermatic fascia derived from?

A

External oblique aponeurosis

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7
Q

What is cremaster muscle and fascia derived from?

A

Internal oblique muscle

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8
Q

What is internal spermatic fascia derived from?

A

Transversalis fascia

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9
Q

What is an inguinal hernia?

A

Protrusion of abdominal contents through anterior abdominal wall into inguinal canal

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10
Q

What is an indirect inguinal hernia?

A

Intra-abdominal contents forced through deep inguinal ring into canal
More common

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11
Q

What is a direct inguinal hernia?

A

Intra-abdominal contents forced through the posterior wall of inguinal canal and directly through the superficial ring
Less common and easier to reduce

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12
Q

What is the dartos?

A

A thin sheet of smooth muscle directly under scrotal skin
Regulates the temp by wrinkling skin and reducing surface area

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13
Q

What does each half of the scrotum contain?

A

A testis, epididymis and lower part of spermatic cord

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14
Q

What do the testes do?

A

Produce sperm and secrete testosterone

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15
Q

What and where is the tunica vaginalis?

A

Closed sac of parietal peritoneal origin
Partially surrounds testes

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16
Q

What and where is the epididymis?

A

A coiled tube lying along the posterior border of each testis
Has a head (proximal), body and tail (distal, origin of vas deferens)

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17
Q

What is the function of vas deferens?

A

Carries sperm from epididymis to spermatic cord

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18
Q

What is the blood supply and drainage of testes?

A

Supplied by testicular arteries from AA
Venous blood enters pampiniform venous plexus which forms testicular vein
R testicular vein enters IVC, L joins renal vein

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19
Q

What are the three cylinders of erectile tissue in penis?

A

2 corpora cavernosa dorsally
Corpus spongiosum ventrally - contains penile urethra
Enclosed within Buck’s fascia

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20
Q

What is the end of the penis?

A

Glans, expansion of corpus spongiosum

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21
Q

Where does the male urethra open?

A

External urethral meatus

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22
Q

What is the blood supply to penis?

A

Penile arteries branch from internal pudendal arteries from internal iliac

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23
Q

What is the nervous innervation to penis?

A

S2-4
Sensation and symp from dorsal nerve of penis (branch of pudendal)
Parasymp arise from peri-prostatic nerve plexus

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24
Q

How does erection in males occur?

A

Arterial blood flow into corpora increases and corpora enlarge
Corpus spongiosum doesn’t enlarge as much and prevents urethra from being compressed

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25
Q

Where does the R adrenal gland lie and what shape is it?

A

Close to the top of kidney
Behind the liver and IVC
Pyramidal

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26
Q

Where does the L adrenal gland lie and what shape is it?

A

Close to top of kidney
Behind the stomach and pancreas
Semilunar

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27
Q

What are the 3 main arteries to the adrenal glands?

A

Superior adrenal- from inferior phrenic
Middle adrenal- from AA
Inferior adrenal- from renal

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28
Q

Where do the adrenal veins drain?

A

R adrenal drains directly into IVC
L adrenal drains into L renal then IVC

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29
Q

What does the adrenal cortex do?

A

Produces steroid hormones including cortisol, aldosterone and testosterone

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30
Q

What does the adrenal medulla produce?

A

Adrenaline

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31
Q

What are the dimensions of the kidneys?

A

11cm long
7cm wide
4cm thick

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32
Q

What level are the kidneys at?

A

T12-L3

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33
Q

What are the outer layers of the kidney?

A

Renal capsule (deepest)
Perinephric fat layer
Renal fascia
Paranephric fat

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34
Q

What enters through the renal hila?

A

Renal vessels
Nerves
Lymphatics
Ureters

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35
Q

What is the internal kidney composed into?

A

Cortex with nephrons (minus loop of henle + part of CD)
Medulla arranged into pyramids containing loop of Henle and rest of the collecting ducts
Renal papilla
Minor calyces
Major calyces
Renal pelvis which are continuous with ureter

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36
Q

What are the ureters and where do they run?

A

Narrow tubes with muscular walls
Transport urine via peristalsis
Anterior to psoas major on posterior abdo wall
Cross pelvic brim and enter bladder on its inferomedial aspect

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37
Q

What does the posterior abdo wall consist of?

A

L spine
Psoas and quadratus lumborum muscles
IVC, aorta, symp trunk, ureters and gonadal vessels all run along

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38
Q

What forms the lumbar plexus?

A

L1-L4 lumbar spinal nerves with contribution from T12

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39
Q

What does the lumbar plexus give rise to and what do they supply?

A
  • Iliohypogastric and Ilioinguimal nerves supply anterior abdo wall muscles and skin of external genitalia
  • Genitofemoral nerve supplies skin of external genitalia
  • Lateral femoral cutaneous nerve supplies skin of lateral thigh
  • Femoral nerve supplies muscles and skin of anterior thigh
  • Obturator nerve supplies medial thigh
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40
Q

At what level does the AA bifurcate and terminate?

A

L4

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41
Q

What does the AA bifurcate into?

A

L and R common iliac arteries

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42
Q

What unpaired branches does the AA give rise to?

A

Coeliac trunk
SMA
IMA

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43
Q

What paired branches does the AA give rise to?

A

Renal
Adrenal
Gonadal
Lumbar arteries

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44
Q

What forms the IVC?

A

L and R common iliac veins unite at L5

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45
Q

What are the functions of the pelvis?

A

Transfer of weight
Provides attachment for locomotion
Contains and protects pelvic viscera

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46
Q

What bones make up the pelvis?

A

Sacrum
L and R hip (ilium, ischium and pubis fused together)

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47
Q

Which 3 bones fuse to form the hip?

A

Ilium
Ischium
Pubis

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48
Q

What are the 5 articulations of the bony pelvis?

A

Hip joint
Sacroiliac
Pubic symphysis
Lumbosacral
Sacrococcygeal

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49
Q

Where is the hip joint?

A

Between the head of femur and acetabulum of pelvis

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50
Q

What fuse at the acetabulum?

A

Ilium
Ischium
Pubis

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51
Q

Where is the sacroiliac joint?

A

Between the sacrum and ilium of hip bone
Very stable
Supported by ligaments

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52
Q

Where is the pubic symphysis?

A

Between the 2 pubic bones
Almost no movement permitted

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53
Q

Where is the lumbosacral joint?

A

Between 5th L vertebrae and sacrum
Intervertebral disc between the 2

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54
Q

Where is the sacrococcygeal joint?

A

Between the sacrum and coccyx

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55
Q

What does the intercristal line mark?

A

L4-5 disc space for lumbar puncture
Highest point of iliac crests

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56
Q

Where is the iliac tubercle?

A

Most lateral point of the ilium

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57
Q

What does the intertubercular line mark?

A

Lower 1/3 of abdomen from middle 1/3

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58
Q

What does the pubic tubercle mark?

A

Most medial part of the pubic bone

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59
Q

Where does the inguinal ligament run from?

A

ASIS to pubic tubercle

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60
Q

What is palpable at the mid-inguinal point?

A

Femoral artery

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61
Q

Where is the mid-inguinal point?

A

Mid-point of a line from ASIS to pubic symphsis

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62
Q

What is the female pelvis like?

A

Wider, circular pelvic inlet
Obtuse angle formed by inferior pubic rami
Wider and shorter sacrum

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63
Q

What is the male pelvis like?

A

Narrower pelvic inlet
Acute angle formed by pubic rami
Narrower, longer sacrum

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64
Q

What is the arterial supply to the pelvis?

A

L and R internal iliac

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65
Q

What are the key branches of the internal iliac and what do they supply?

A

Vesical arteries- supply the bladder in both sexes, and prostate and seminal vesicles in men
Uterine and vaginal (female)
Middle rectal - rectum
Internal pudendal- perineum
Sup and Inf gluteal- gluteal

66
Q

Where does the pelvis drain?

A

Plexuses unite and drain into internal iliac vein

67
Q

WWhat nerves arise from the sacral plexus?

A

Sciatic nerve
Pudendal nerve
Sup and Inf gluteal nerves
Pelvic splanchnic nerves

68
Q

What forms the sacral plexus?

A

Sacral spinal nerves

69
Q

What forms the pudendal nerve?

A

S2-4

70
Q

What do the gluteal nerves do?

A

Innervate gluteal region

71
Q

What do the pelvic splanchnic nerves do?

A

Carry parasympathetic fibres from S2-4 to pelvic viscera

72
Q

Where are the sympathetic fibres that innervate the pelvis viscera derived from?

A

Lumbar splanchnic nerves

73
Q

What are the 3 primary functions of the pelvic floor muscles?

A

Prevent herniation of pelvic organs inferiorly
Control continence of urine and faeces by providing a sphincter
Aid in increasing intra-abdominal pressure

74
Q

Which two muscles make up the pelvic floor?

A

Levator ani
Coccygeus

75
Q

What makes up leavtor ani?

A

All paired
Puborectalis
Pubococcygeus
Iliococcygeus

76
Q

What does puborectalis do and attach to?

A

Attache to pubic bones anteriorly and forms sling around rectum
Pulls to form sharp angle between rectum and anal canal to prevent defecation
Relax for faeces to pass through

77
Q

What does pubococcygeus attach to and do?

A

Provides stability and support to pelvic organs
Posterior and lateral to puborectalis
Attaches to pubic bone anteriorly
Attaches to coccyx and sacrum posteriorly

78
Q

What does iliococcygeus attach to and do?

A

Lies lateral to pubococcygeus
Attaches to spines of ischium and the coccyx
Elevates pelvic floor and anorectal canal

79
Q

What supplies levator ani?

A

Branch from S4
Some branches from pudendal (S2-4)

80
Q

What is the perineum?

A

Superficial region between the pubic symphysis and coccyx
And betweene medial surfaces of the thighs

81
Q

What can the perineum be split into?

A

Anal and urogenital triangles

82
Q

What does the anal triangle contain?

A

Opening of anus and external anal sphincter

83
Q

What are the layers of the urogenital triangle?

A

Skin
Perineal fascia
Superficial perineal pouch
Perineal membrane
Deep perineal pouch

84
Q

What is the perineal fascia?

A

A continuation of the fascia overlying the abdominal wall muscles

85
Q

What is the superficial perineal pouch?

A

Space containing erectile tissues of penis or clitoris and 3 muscles: ischiocavernosus, bulbospongiosus and superficial transverse perineal

86
Q

What 3 muscles are in the superficial perineal pouch?

A

ischiocavernosus
bulbospongiosus
superficial transverse perineal

87
Q

What is the perineal membrane?

A

A strong fibrous membrane that provides support for the attachment of ischiocavernosus and bulbospongiosus
Has specific holes for urethra and vag

88
Q

What is the deep perineal pouch?

A

A potential space between perineal membrane and pelvic floor muscles
Contains parts of vag, urethra and ext urethral sphincter

89
Q

Where is the perineal body?

A

Between the anal and UG triangles

90
Q

What is the perineal body?

A

A dense mass of fibrous tissue and muscle
Acts as an attachment for almost all the perineal and pelvic floor muscles

91
Q

Which parts of the corpora cavernosa are attached to the ischial ramus?

A

Crura (crus singular)

92
Q

What is the bulb of corpus spongiosum?

A

The part that sits on the perineal membrane

93
Q

What does ischiocavernosus do?

A

Helps stabilise the erect penis/clitoris

94
Q

What does bulbospongiosus do?

A

Assists in maintaining erection
In males: compresses veins that drain erectile tissues and contracts to squeeze fluid
In females: constricts around vaginal orifice to help fluid expression

95
Q

What is the arterial supply to the perineum?

A

Internal pudendal from internal iliac

96
Q

What is the main nerve of the perineum?

A

Pudendal S2-4
Innervates perineum and skin of external genitalia

97
Q

What are the male reproductive organs?

A

Paired testes
Epididymides
Vasa deferentia
Seminal vesicles
Ejaculatory ducts
Bulbo-urethral glands
Prostate gland
Penis

98
Q

What does the vas deferens do?

A

Carries sperm from epididymsi up the spermatic cord and through inguinal canal to pelvis
Terminates by joining the duct of the seminal vesicle to form ejaculatory duct

99
Q

What forms the ejaculatory duct in men?

A

Vas deferens terminates and joins seminal vesicle duct

100
Q

What is the seminal vesicle?

A

A lobulated sac lateral to ampulla of vas deferens
Secrete bulk of semen
Joins vas deferens to become ejaculatory duct

101
Q

What does the prostate do?

A

Lies against neck of bladder
Pierced by urethra and ejaculatory ducts
Secretes enzymes into semen to break down clotting factors and keep fluid

102
Q

What is the arterial supply to vas deferens, seminal vesicle and prostate?

A

Branches of internal iliac

103
Q

What are the parts of the uterus?

A

Fundus
Body
Cervix

104
Q

How is the uterus positioned?

A

Communicates laterally with uterine tubes and inferiorly with vagina
Lies on superior surface of bladder
Ante-flexed

105
Q

Where does the blastocyst implant in the uterus?

A

Endometrium in the body of the uterus

106
Q

What happens to the myometrium if pregnancy continues?

A

Becomes distended

107
Q

What is the uterus covered by?

A

A fold of peritoneum which adheres to sides to form broad ligament

108
Q

What is the space between the posterior uterus and anterior rectum called?

A

Rectouterine pouch (Pouch of douglas)

109
Q

What is the rectouterine pouch?

A

Deepest point in peritoneal cavity so common site for accumulation of fluid/pus
Lined with peritoneum
Between uterus and rectum

110
Q

What is the structure of the cervix?

A

Narrow lumen
Cervical canal communicates with uterine cavity via internal os and vag via external os
Lower part of cervix lies inside vag creating recess (vaginal fornices) around cervix

111
Q

What stabiliises the cervix position?

A

Levator ani muscles and ligaments

112
Q

What are the 4 parts of the fallopian tubes?

A

Isthmus
Ampulla
Infundibulum
Fimbrae draped over ovary

113
Q

Where does fertilisation occur?

A

Ampulla of fallopian tubes

114
Q

Where are the ovaries attached?

A

Posterior aspect of broad ligament by mesovarium
Position not fixed
Frequently in ovarian fossa between internal and external iliac arteries

115
Q

What is the vagina?

A

Excretory duct of the uterus
Female organ of sexual intercourse

116
Q

Where does the vagina run?

A

10cm long
Passes through the pelvic floor
Upper 2/3 lie in pelvic cavity
Lower 1/3 in perineum
Terminates at the introitus by opening into vestibule between labia minora

117
Q

What in the female reproductive system does the internal iliac artery supply?

A

Vagina
Fallopian tubes
Cervix
Uterus

118
Q

What does the ovarian artery supply and where does it come from?

A

Branch of AA
Supply ovaries and contributes to fallopian tubes

119
Q

What is the vulva?

A

All parts of the female external genitalia

120
Q

What is the blood supply to the vulva?

A

Mainly internal pudendal from internal iliac

121
Q

What 4 nerves innervate the vulva?

A

Ilioinguina
Genital branch from genitofemoral
Pudendal
Posterior cutaneous

122
Q

What is the mons pubis?

A

Mound of fatty tissue loacted in front of pubic symphysis causing an elevation of hair bearing skin

123
Q

What is the labia majora?

A

Prominent hair bearing folds of skin that meet anteriorly at mons pubis

124
Q

What is the labia minora?

A

Smaller, hairless folds of skin medial to labia majora
Fuse together to form clitoris hood
Form boundaries of vestibule

125
Q

What is the clitoris?

A

Highly sensitive tissue made of erectile corpora cavernosa and spongiosum
Engorged during sexual arousal

126
Q

Where is the vestibule?

A

Area between labia minora
Contains vaginal opening, urinary meatus, vestibular glands

127
Q

What is the hymen?

A

Thin membrane partially covering vaginal opening

128
Q

What is the urinary meatus?

A

Opening of the urethra
Posterior to clitoris
Anterior to vaginal opening

129
Q

What are the greater vestibular glnads?

A

Bartholins glands
Posterior to vaginal opening
Secrete lubricant into vagina during sexual arousal

130
Q

What are the lesser vestibular glands?

A

Skenes glands
Near urethral opening
Secrete fluid

131
Q

Where is the urinary bladder?

A

Infra-peritoneal below periotneum in pelvis
Posterior to pubic symphysis
Anterior to vag and rectum

132
Q

What supplies the urinary bladder?

A

Vesical arteries from internal iliac
Drain into internal iliac

133
Q

What is the role of the bladder?

A

Stores urine
Squeeze urine out during micturition

134
Q

How much urine can the bladder accommodate?

A

400-600ml in adults

135
Q

What is the smooth wall in the triangular area of the bladder called?

A

Trigone
Where ureters enter

136
Q

What forms at the angle where ureters enter the trigone?

A

Rudimentary valve which prevents reflux of urine into ureters when bladder full

137
Q

What type of muscle does the bladder contain?

A

Smooth

138
Q

Where is the internal urethral sphincter and what is it composed of?

A

Base of bladder
Opens into urethra
Composed of smooth muscle under involuntary control

139
Q

Where is the external urethral sphincter and what is it composed of?

A

Just after prostate in males
In deep perineal pouch in females
Skeletal muscle
Under voluntary control

140
Q

What is the somatic innervation to the bladder?

A

Pudendal (S2-4)
Allows conscious control of the external urethral sphincter

141
Q

What is the sympathetic innervation to the bladder?

A

Hypogastric nerve (T12-L2 symp chain)
Causes relaxation f detrusor and contraction of the internal urethral sphincter
Urine storage

142
Q

What is the parasympathetic innervation to the bladder?

A

Pelvic splanchnic nerves (S2-4)
Causes contraction of the detrusor and relaxation of internal urethral sphincter
Allows initiation of micturition

143
Q

Where does the urethra run?

A

Carries urine from the internal urethral orifice of the bladder to the external urethral orifice

144
Q

How long is the female urethra?

A

3-4cm

145
Q

What are the divisions of the male urethra?

A

Preprostatic
Prostatic
Membranous
Penile

146
Q

Describe the bladder stretch reflex

A

Bladder fills with urine
Walls stretch
Sensory nerves detect
Sacral spinal cord
PS fibres in pelvic splanchnic
Bladder contracts and empties

147
Q

When is the bladder stretch reflex overridden?

A

Potty training, put under conscious control

148
Q

What pathways are interrupted if a an injury is above spinal cord sacral level in bladder dysfunction?

A

Ascending pathways conveying sensation (patient no longer aware of bladder filling)
Descending pathways that exert voluntary control over external urethral sphincter (permanently relaxed)

Reflex arc still in tact, incontinence

149
Q

What happens if a patient suffers injury to spinal cord at cauda equina or below (bladder dysfunction)?

A

Internal urethral sphincter permanently contracted
Bladder fills, pressure exceeds strength of internal urethral sphincter: urination
This is overflow incontinence

If pressure doesn’t exceed, urinary retention, needs catheter to avoid backflow of blood

150
Q

What is the rectum?

A

Terminal part of large intestine
Approx 12cm in adult
Stores faeces prior to defecation

151
Q

What are the 2 flexures on the rectum?

A

Sacral: anterior
Anorectal: posterior

152
Q

Where is the anal canal?

A

Distal rectus to anus
In anal triangle

153
Q

What is the muscle and control of internal anal sphincter?

A

Smooth muscle
Involuntary

154
Q

What is the muscle and control of external anal sphincter?

A

Skeletal
Voluntary

155
Q

What does the pectinate divide?

A

Superior part of anal canal from inferior
Above pectinate line, endoderm derived
Inferior part from ectoderm
Therefore different supplies

156
Q

What supplies the superior part of anal canal?

A

Part of hindgut
Supplied by inferior mesenteric artery via superior rectal artery
Portal venous drainage

157
Q

What epithelia lines the superior part of anal canal?

A

Columnar epithelium lines lumen
Intestinal mucosa

158
Q

What innervates the internal anal sphincter?

A

Sympathetic fibres from sympathetic trunk
PS fibres (pelvic splanchnic)

159
Q

What supplies the part of the anal canal below pectinate line?

A

Middle and inferior rectal arteries from internal iliac
No portal drainage

160
Q

What epithelia lines lumen of inferior anal canal?

A

Stratified squamous

161
Q

What innervates the external anal sphincter?

A

Pudendal nerve

162
Q

What are haemorrhoids?

A

Cushions of veins lining walls of anal canal which aid faecal continence

Phase 1 (18 decks)

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