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
Where does the R adrenal gland lie and what shape is it?
Close to the top of kidney Behind the liver and IVC Pyramidal
26
Where does the L adrenal gland lie and what shape is it?
Close to top of kidney Behind the stomach and pancreas Semilunar
27
What are the 3 main arteries to the adrenal glands?
Superior adrenal- from inferior phrenic Middle adrenal- from AA Inferior adrenal- from renal
28
Where do the adrenal veins drain?
R adrenal drains directly into IVC L adrenal drains into L renal then IVC
29
What does the adrenal cortex do?
Produces steroid hormones including cortisol, aldosterone and testosterone
30
What does the adrenal medulla produce?
Adrenaline
31
What are the dimensions of the kidneys?
11cm long 7cm wide 4cm thick
32
What level are the kidneys at?
T12-L3
33
What are the outer layers of the kidney?
Renal capsule (deepest) Perinephric fat layer Renal fascia Paranephric fat
34
What enters through the renal hila?
Renal vessels Nerves Lymphatics Ureters
35
What is the internal kidney composed into?
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
36
What are the ureters and where do they run?
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
37
What does the posterior abdo wall consist of?
L spine Psoas and quadratus lumborum muscles IVC, aorta, symp trunk, ureters and gonadal vessels all run along
38
What forms the lumbar plexus?
L1-L4 lumbar spinal nerves with contribution from T12
39
What does the lumbar plexus give rise to and what do they supply?
- 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
40
At what level does the AA bifurcate and terminate?
L4
41
What does the AA bifurcate into?
L and R common iliac arteries
42
What unpaired branches does the AA give rise to?
Coeliac trunk SMA IMA
43
What paired branches does the AA give rise to?
Renal Adrenal Gonadal Lumbar arteries
44
What forms the IVC?
L and R common iliac veins unite at L5
45
What are the functions of the pelvis?
Transfer of weight Provides attachment for locomotion Contains and protects pelvic viscera
46
What bones make up the pelvis?
Sacrum L and R hip (ilium, ischium and pubis fused together)
47
Which 3 bones fuse to form the hip?
Ilium Ischium Pubis
48
What are the 5 articulations of the bony pelvis?
Hip joint Sacroiliac Pubic symphysis Lumbosacral Sacrococcygeal
49
Where is the hip joint?
Between the head of femur and acetabulum of pelvis
50
What fuse at the acetabulum?
Ilium Ischium Pubis
51
Where is the sacroiliac joint?
Between the sacrum and ilium of hip bone Very stable Supported by ligaments
52
Where is the pubic symphysis?
Between the 2 pubic bones Almost no movement permitted
53
Where is the lumbosacral joint?
Between 5th L vertebrae and sacrum Intervertebral disc between the 2
54
Where is the sacrococcygeal joint?
Between the sacrum and coccyx
55
What does the intercristal line mark?
L4-5 disc space for lumbar puncture Highest point of iliac crests
56
Where is the iliac tubercle?
Most lateral point of the ilium
57
What does the intertubercular line mark?
Lower 1/3 of abdomen from middle 1/3
58
What does the pubic tubercle mark?
Most medial part of the pubic bone
59
Where does the inguinal ligament run from?
ASIS to pubic tubercle
60
What is palpable at the mid-inguinal point?
Femoral artery
61
Where is the mid-inguinal point?
Mid-point of a line from ASIS to pubic symphsis
62
What is the female pelvis like?
Wider, circular pelvic inlet Obtuse angle formed by inferior pubic rami Wider and shorter sacrum
63
What is the male pelvis like?
Narrower pelvic inlet Acute angle formed by pubic rami Narrower, longer sacrum
64
What is the arterial supply to the pelvis?
L and R internal iliac
65
What are the key branches of the internal iliac and what do they supply?
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
Where does the pelvis drain?
Plexuses unite and drain into internal iliac vein
67
WWhat nerves arise from the sacral plexus?
Sciatic nerve Pudendal nerve Sup and Inf gluteal nerves Pelvic splanchnic nerves
68
What forms the sacral plexus?
Sacral spinal nerves
69
What forms the pudendal nerve?
S2-4
70
What do the gluteal nerves do?
Innervate gluteal region
71
What do the pelvic splanchnic nerves do?
Carry parasympathetic fibres from S2-4 to pelvic viscera
72
Where are the sympathetic fibres that innervate the pelvis viscera derived from?
Lumbar splanchnic nerves
73
What are the 3 primary functions of the pelvic floor muscles?
Prevent herniation of pelvic organs inferiorly Control continence of urine and faeces by providing a sphincter Aid in increasing intra-abdominal pressure
74
Which two muscles make up the pelvic floor?
Levator ani Coccygeus
75
What makes up leavtor ani?
All paired Puborectalis Pubococcygeus Iliococcygeus
76
What does puborectalis do and attach to?
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
What does pubococcygeus attach to and do?
Provides stability and support to pelvic organs Posterior and lateral to puborectalis Attaches to pubic bone anteriorly Attaches to coccyx and sacrum posteriorly
78
What does iliococcygeus attach to and do?
Lies lateral to pubococcygeus Attaches to spines of ischium and the coccyx Elevates pelvic floor and anorectal canal
79
What supplies levator ani?
Branch from S4 Some branches from pudendal (S2-4)
80
What is the perineum?
Superficial region between the pubic symphysis and coccyx And betweene medial surfaces of the thighs
81
What can the perineum be split into?
Anal and urogenital triangles
82
What does the anal triangle contain?
Opening of anus and external anal sphincter
83
What are the layers of the urogenital triangle?
Skin Perineal fascia Superficial perineal pouch Perineal membrane Deep perineal pouch
84
What is the perineal fascia?
A continuation of the fascia overlying the abdominal wall muscles
85
What is the superficial perineal pouch?
Space containing erectile tissues of penis or clitoris and 3 muscles: ischiocavernosus, bulbospongiosus and superficial transverse perineal
86
What 3 muscles are in the superficial perineal pouch?
ischiocavernosus bulbospongiosus superficial transverse perineal
87
What is the perineal membrane?
A strong fibrous membrane that provides support for the attachment of ischiocavernosus and bulbospongiosus Has specific holes for urethra and vag
88
What is the deep perineal pouch?
A potential space between perineal membrane and pelvic floor muscles Contains parts of vag, urethra and ext urethral sphincter
89
Where is the perineal body?
Between the anal and UG triangles
90
What is the perineal body?
A dense mass of fibrous tissue and muscle Acts as an attachment for almost all the perineal and pelvic floor muscles
91
Which parts of the corpora cavernosa are attached to the ischial ramus?
Crura (crus singular)
92
What is the bulb of corpus spongiosum?
The part that sits on the perineal membrane
93
What does ischiocavernosus do?
Helps stabilise the erect penis/clitoris
94
What does bulbospongiosus do?
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
What is the arterial supply to the perineum?
Internal pudendal from internal iliac
96
What is the main nerve of the perineum?
Pudendal S2-4 Innervates perineum and skin of external genitalia
97
What are the male reproductive organs?
Paired testes Epididymides Vasa deferentia Seminal vesicles Ejaculatory ducts Bulbo-urethral glands Prostate gland Penis
98
What does the vas deferens do?
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
What forms the ejaculatory duct in men?
Vas deferens terminates and joins seminal vesicle duct
100
What is the seminal vesicle?
A lobulated sac lateral to ampulla of vas deferens Secrete bulk of semen Joins vas deferens to become ejaculatory duct
101
What does the prostate do?
Lies against neck of bladder Pierced by urethra and ejaculatory ducts Secretes enzymes into semen to break down clotting factors and keep fluid
102
What is the arterial supply to vas deferens, seminal vesicle and prostate?
Branches of internal iliac
103
What are the parts of the uterus?
Fundus Body Cervix
104
How is the uterus positioned?
Communicates laterally with uterine tubes and inferiorly with vagina Lies on superior surface of bladder Ante-flexed
105
Where does the blastocyst implant in the uterus?
Endometrium in the body of the uterus
106
What happens to the myometrium if pregnancy continues?
Becomes distended
107
What is the uterus covered by?
A fold of peritoneum which adheres to sides to form broad ligament
108
What is the space between the posterior uterus and anterior rectum called?
Rectouterine pouch (Pouch of douglas)
109
What is the rectouterine pouch?
Deepest point in peritoneal cavity so common site for accumulation of fluid/pus Lined with peritoneum Between uterus and rectum
110
What is the structure of the cervix?
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
What stabiliises the cervix position?
Levator ani muscles and ligaments
112
What are the 4 parts of the fallopian tubes?
Isthmus Ampulla Infundibulum Fimbrae draped over ovary
113
Where does fertilisation occur?
Ampulla of fallopian tubes
114
Where are the ovaries attached?
Posterior aspect of broad ligament by mesovarium Position not fixed Frequently in ovarian fossa between internal and external iliac arteries
115
What is the vagina?
Excretory duct of the uterus Female organ of sexual intercourse
116
Where does the vagina run?
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
What in the female reproductive system does the internal iliac artery supply?
Vagina Fallopian tubes Cervix Uterus
118
What does the ovarian artery supply and where does it come from?
Branch of AA Supply ovaries and contributes to fallopian tubes
119
What is the vulva?
All parts of the female external genitalia
120
What is the blood supply to the vulva?
Mainly internal pudendal from internal iliac
121
What 4 nerves innervate the vulva?
Ilioinguina Genital branch from genitofemoral Pudendal Posterior cutaneous
122
What is the mons pubis?
Mound of fatty tissue loacted in front of pubic symphysis causing an elevation of hair bearing skin
123
What is the labia majora?
Prominent hair bearing folds of skin that meet anteriorly at mons pubis
124
What is the labia minora?
Smaller, hairless folds of skin medial to labia majora Fuse together to form clitoris hood Form boundaries of vestibule
125
What is the clitoris?
Highly sensitive tissue made of erectile corpora cavernosa and spongiosum Engorged during sexual arousal
126
Where is the vestibule?
Area between labia minora Contains vaginal opening, urinary meatus, vestibular glands
127
What is the hymen?
Thin membrane partially covering vaginal opening
128
What is the urinary meatus?
Opening of the urethra Posterior to clitoris Anterior to vaginal opening
129
What are the greater vestibular glnads?
Bartholins glands Posterior to vaginal opening Secrete lubricant into vagina during sexual arousal
130
What are the lesser vestibular glands?
Skenes glands Near urethral opening Secrete fluid
131
Where is the urinary bladder?
Infra-peritoneal below periotneum in pelvis Posterior to pubic symphysis Anterior to vag and rectum
132
What supplies the urinary bladder?
Vesical arteries from internal iliac Drain into internal iliac
133
What is the role of the bladder?
Stores urine Squeeze urine out during micturition
134
How much urine can the bladder accommodate?
400-600ml in adults
135
What is the smooth wall in the triangular area of the bladder called?
Trigone Where ureters enter
136
What forms at the angle where ureters enter the trigone?
Rudimentary valve which prevents reflux of urine into ureters when bladder full
137
What type of muscle does the bladder contain?
Smooth
138
Where is the internal urethral sphincter and what is it composed of?
Base of bladder Opens into urethra Composed of smooth muscle under involuntary control
139
Where is the external urethral sphincter and what is it composed of?
Just after prostate in males In deep perineal pouch in females Skeletal muscle Under voluntary control
140
What is the somatic innervation to the bladder?
Pudendal (S2-4) Allows conscious control of the external urethral sphincter
141
What is the sympathetic innervation to the bladder?
Hypogastric nerve (T12-L2 symp chain) Causes relaxation f detrusor and contraction of the internal urethral sphincter Urine storage
142
What is the parasympathetic innervation to the bladder?
Pelvic splanchnic nerves (S2-4) Causes contraction of the detrusor and relaxation of internal urethral sphincter Allows initiation of micturition
143
Where does the urethra run?
Carries urine from the internal urethral orifice of the bladder to the external urethral orifice
144
How long is the female urethra?
3-4cm
145
What are the divisions of the male urethra?
Preprostatic Prostatic Membranous Penile
146
Describe the bladder stretch reflex
Bladder fills with urine Walls stretch Sensory nerves detect Sacral spinal cord PS fibres in pelvic splanchnic Bladder contracts and empties
147
When is the bladder stretch reflex overridden?
Potty training, put under conscious control
148
What pathways are interrupted if a an injury is above spinal cord sacral level in bladder dysfunction?
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
What happens if a patient suffers injury to spinal cord at cauda equina or below (bladder dysfunction)?
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
What is the rectum?
Terminal part of large intestine Approx 12cm in adult Stores faeces prior to defecation
151
What are the 2 flexures on the rectum?
Sacral: anterior Anorectal: posterior
152
Where is the anal canal?
Distal rectus to anus In anal triangle
153
What is the muscle and control of internal anal sphincter?
Smooth muscle Involuntary
154
What is the muscle and control of external anal sphincter?
Skeletal Voluntary
155
What does the pectinate divide?
Superior part of anal canal from inferior Above pectinate line, endoderm derived Inferior part from ectoderm Therefore different supplies
156
What supplies the superior part of anal canal?
Part of hindgut Supplied by inferior mesenteric artery via superior rectal artery Portal venous drainage
157
What epithelia lines the superior part of anal canal?
Columnar epithelium lines lumen Intestinal mucosa
158
What innervates the internal anal sphincter?
Sympathetic fibres from sympathetic trunk PS fibres (pelvic splanchnic)
159
What supplies the part of the anal canal below pectinate line?
Middle and inferior rectal arteries from internal iliac No portal drainage
160
What epithelia lines lumen of inferior anal canal?
Stratified squamous
161
What innervates the external anal sphincter?
Pudendal nerve
162
What are haemorrhoids?
Cushions of veins lining walls of anal canal which aid faecal continence