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Sita GenitoUrinary System > Lecture 22: Human Genitalia > Flashcards

Lecture 22: Human Genitalia Flashcards

1
Q

Male and Female Peritoneum and Pouches

A

Males: 1x peritoneal pouches
1. Vesicorectal pouch: shallow, potential site for fluid to collect
Females: 2x peritoneal pouches
1. Vesicouterine pouch (anterior)
2. Pouch of Douglas/ Rectouterine pouch: deeps, extends to back of uterus–> until where vagina meets cervix. Fluid can pool –> spontaneously drain into vagina (or vagina drain into Pouch of Douglas)

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2
Q

State of Peritoneum in pelvic cavity

A

Peritoneum:

  • continuous in the pelvic cavity
  • located ontop of pelvic viscera
  • -> allows pouches to be created
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3
Q

Clinical relevance of Pouch of Douglas re fluid collecting

A

Pouch of Douglas/Rectouterine pouch is deep –> extends right behind uterus –> until where the vagina reaches the cervix
Therefore if fluid collects here (in this peritoneal pouch) –> risk of spontaneous leakage into vagina (and vice versa)

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4
Q

Clinical relevance of Pouch of Douglas re Surgery to remove abdominal tumour/infection

A

Abdominal Tumour infection
- Dont want abdominal scar from Colicysectomy –> access abdominal cavity re Pouch of Douglas/Rectouterine pouch –> Remove gallbladder

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5
Q

Perineal Musculature

A
  1. Ischiocavernosa:
    - attached to Ishiopubic rami + Partially to pubic symphysis
    - Males: Aids erections. Females: Tenses Vagina
  2. Bulbospongiosum:
    - attached to Perineal body
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6
Q

Male Bulbospongiosum Structure and function

A

Forms Penis therefore –> combines/attaches at Midline Raphe –> forms Singular muscle
Function:
1. Erection
2. Ejaculation
3. Increases pressure in horizontal part of urethra –> aids Micturition (urination)

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7
Q

Female Bulbospongiosum Structure and Function

A

Forms Labia of Vagina –> Split either side of the vaginal orifice
Function:
1. Clitoral erection
2. Feelings of orgasm

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8
Q

Female Erectile Tissue

A

Located Posterior to Perineal Musculature and follows similar pattern

  1. Crus of clitoris: (body of clitoris)
    - attaches onto ischial pubic ramus + perineal membrane
    - sweeps up to pubic symphysis –> detaches to form body of clitoris
  2. Bulb of vestibule: a) Head clitoris b) surrounds vaginal orifice
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9
Q

Male Erectile Tissue

A

Located Posterior to Perineal Musculature. Follows similar pattern
Both Crus and Bulb Transfer names as go from urogenital triangle –> form penile structures
- as in males, erectile tissue detaches to become something else
1. Crus of Penis –> once detached/dorsal become Corpus cavernosa of penis (2x)
2. Bulb of penis –> becomes 1x Corpus Spongiosum + Glans Penis (which contains spongy urethra)

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10
Q

Vasculature of the Penis

A

2x Dorsal arteries + 2x Dorsal nerves of penis
1x Deep dorsal vein (b/w ^)
2x Deep (cavernous) artery
Note: Dorsal arteries, nerves + Deep dorsal veins = Below deep fascia of penis
Note: Deep cavernous artery inside Corpus cavernosa
vs Urethra inside Corpus spongiosum
Note: (3x) Superficial dorsal veins of penis = under superficial fascia
Note: ALL arteries/veins in penis = branches of Internal pudendal

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11
Q

Gender differences b/w vasculature of the penis

A

Females have the same, but all are smaller (have shorter courses)

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12
Q

How does the Deep dorsal vein of the penis (located b/w dorsal arteries) enter the penis?

A

Via deficit in peroneal membrane –> vesicular plexus around prostate and bladder

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13
Q

Scrotum

A

Inguinal canal/spermatic cord –> continues into the scrotum of the testes –> creates an outpouching of the skin of the abdominal wall
Scrotum = formed as testes leave the body
Therefore: inner layers of scrotum = same as spermatic cord
Blood supply: branches of Internal (& External) Pudendal arteries

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14
Q

Contents of the scrotum

A

Lower end of spermatic cord
Epididymis
Testes

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15
Q

Fascial changes in the scrotum

A 
Abdominal Superficial Scarpa's fascia --> continuous with Superficial testicular fascia --> fat replaced by smooth muscle --> Dartos fascia
Dartos fascia (smooth muscular superficial fascia) --> continues posteriorly with Colle fascia (deep fascia of perineum)
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16
Q

Function of Cremaster muscle

A

Raise testes and scrotum.
Aiding:
1. Warmth
2. Protection

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17
Q

Embryonic formation of the scrotum

A

Mesenchymal cells condense –> form gubernaculum (still undifferentiated tissue) in inguinal canal –> continue into labio-scrotal swelling –> scrotum remains bound by gubernaculum
At end: Scrotum severes of its connection with the peritoneal cavity –> amkes it harder for structures to herniate through

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18
Q

Gubernaculum in Males and Females

A

Males: testes descend through inguinal canal at 7-8 months –> through gubernaculum path –> have same covering as inguinal canal
Females: Uterus is stuck to gubernaculum –> allows ovaries to remain stuck to pelvis.
In females ROUDN LIGAMENT –> goes through inguinal canal

19
Q

Spermatic Cord contents Review

A
  1. Vas Deferens
  2. Testicular artery: L2 aortic brach supplies –> Testes and Epididymis
  3. Testicular Veins: Pampiniform plexus:
    Right Testicular vein drains to –> IVC
    Left Testicular vein drains to –> L renal vein
  4. Lymph vessels: (travels with arteries) Para-aortic nodes at root of testicular artery L2
  5. Autonomic Nerves: Sympathetic artery from testicular plexus
20
Q

Origins of additional arteries in Spermatic cord

A

Arteries:
Inferior epigastric –> Cremasteric artery
Inferior vesical –> Artery of Vas Deferens
Nerves:
Genital branch of Genitofemoral nerve –> innervates cremaster muscle and skin of scrotum

21
Q

Testes

A 
Create sperm (spermatogenesis)
Tunia Albuiginea: Tough outer fibrous capsule
Made up of Lobules --> each lobule contains 1-2 Seminiferous Tubules --> open into Rete Testis --> Efferent Tubules --> Epididymis(sperm storage) --> Vas deferens
22
Q

Temperature of testes

A

3 degree cooler < abdomen
Cooling is aided by:
1. Dartos fascia (abd. Scarpa fascia fat replaced with muscle –> decreased insulation)
2. Cremaster muscle (allows testes to hang outside)
3. Heat exchange b/w artery and veins

23
Q

Male Internal Genitalia attaching onto epidiymis

A

Vas deferens –> Ampulla(sperm) –+seminal vesicles (liquid) –> Ejaculatory duct –+urethra–> Prostatic urethra

24
Q

Vas deferens

A

Muscular tube
Inside spermatic cord –> therefore Travels within Inguinal canal
Note: there is a vas deferens equivalent in females

25
Q

Vas Deferen’s course to the prostate

A

(DIR) Starts LATERAL to Inferior Epigastric artery –> Runs SUPERIORLY to External iliac vessels (passing medially towards prostate) –> Vas deferens runs SUPERIORLY to ureter(urine) –> Joins seminal vesicles –> forms ejaculatory duct which enters prostate

26
Q

Seminal vesicles

A

Coiled:5cm long –> Uncoiled 10-15cm
Secrete Liquid component of ejaculate (fluid + fructose)
Note: Fructose = sugar = energy for sperm to make journey to egg
Seminal vesicle location: Posterior to bladder, Superior to prostate

27
Q

What are the main components of the prostate gland(s)?

A
  1. Ejaculatory duct

2. Prostatic urethra

28
Q

Prostate gland

A 
Inferior to bladder
Ejaculatory duct + prostatic urethra
Contains:
1. Proteolytic enzymes
2. Acid phosphotase
All arteries supplying are branches of Internal Illiac artery:
1. Internal pudendal
2. Middle rectal
3. Inferior vesicle
Veins of prostate gland:
Deep dorsal vein of penis --> vesicular plexus (good blood supply)--> Internal Illiac
29
Q

Prostatic ligaments

A

Levator Prostate: “levator” = levitate = lift
Located inferior to prostate but anterior to urogenital diaphragm
Function: support prostate

30
Q

Prostatic enlargement

A

Enlargement can be:
- All or partial
- Benign or malignant
Seen commonly in DR as Benign enlargement in 50+ yr old males
Outcomes:
1. Postatic enlargement (esp of median lobe) –> Herniation superiorly through sphincter from bladder –>bladder’s internal sphincter vesicae unable to close properly –> urinary incontinence
2. Pocket created posteriorly in bladder near sphincter –> pool with fluid –> consistent pressure on sphincter –> continuous feeling of needing to pee

31
Q

How do you Ultrasound a prostate?

A

Need to have a full bladder

- Prostate is directly inferior to bladder –> therefore need to point US directly down

32
Q

Lymphatic Drainage of male Reproductive system

A

Testes: para-arotic nodes at root of testicular artery L2 (abdominal > not iliac)
Vas Deferens: External Iliac nodes
Spermatic Vesicles: External and Internal Iliac nodes
Prostate: Internal Iliac nodes
Body of Penis/Corpus Cavernosa: Internal Iliac nodes
Glans Penis: Deep Inguinal and Iliac nodes (as is superficial)
Skin of Penis + Wall of Scrotum: Superficial inguinal
- tracts with veins (recess)

33
Q

Components of the Uterus

A

Vagina –> Fornix –> Cervix –> Body (endo + meso) of Uterus –> Fundus –> Isthmus –> Ampulla –> Infundibulum –> Fimbrae –> Ovaries

  • ovaries arent connected to the uterine tube –> connected via Broad ligament part of uterine perotineum which sweeps overtop of the utersus
  • fimbrae create current to encourage egg into uterine tube –> ectopic pregnancy
  • vagina: muscular tube
34
Q

Fornix

A

Recess created where vagina and cervix meet

- can access abdominal cavity

35
Q

Creations due to Peritoneum of Uterus

A
  1. Pouches (2x)
  2. Broad Ligament (sweeps ontop, and holds ovaries externally onto uterus)
  3. Uterine Angulation:
    a) Bladder is inferior Supporting Uterus –> keeping it angulated and elevated –> Anteflexion –> b) Cervix –> inferior portion of uterus in direction with vagina –> Anteversion
36
Q

Components of Broad Ligament of Uterus

A
  • broad ligament runs through inguinal canal
  • pulls uterus forward –> ontop of bladder
    1. MesoVARIUM (section of broad ligament over ovary) –> a) Suspensory ligament (b/w pelvis + ovary) b) Ovarian ligament (b/w ovary + ligament)
    2. MesoSALPHINX (section of broad ligament over uterine tube)
    3. Round Ligament
    4. MesoMETRIUM (over body) –> Double layer folded over itself
37
Q

Sagital section of Broad ligament diagram

A
38
Q

Functions of Uterine Ligaments

A

Ligaments attached to Uterus:
1. Broad Ligaments: carries vessels, nerves + lymphatics (SI support)
2. Round ligament: Creates pot. Lymphatic pathway (superficial inguinal nodes). Anteversion to inguinal nodes
Ligaments attached to Cervix:
3. Sacrocervical –> AP support
4. Transverse cervical –> ML support
5. Pubocervical –> AP support

39
Q

What is the uterus supported by

A
  1. Bladder

2. Ligaments

40
Q

Overview of ovaries

A

Function:
1. Ova production
2. Hormone production (Oestrogen and Progesterone) –> creates follicular cells
Arterial supply: Ovarian artery (abd. aorta L2)
Venous drainage: Ovarian venous (IVC on right + Left renal vein on Left)
Nerve: Ovarian Plexus

41
Q

External Female genitalia

A
  1. Clitoris (erectile tissue. female version of male penis) –> extremely/most sensitive (contains 8000 nerve endings > male penis less sensitive
  2. Vestibule ( enclosed by Labia majora.) Contains:
    a) opening of urethra
    b) Greater Vestibular glands (produce mucus)
  3. Urethral Orifice
  4. Vaginal orifice
42
Q

Female Repro Lymphatic drainage

A

Ovary + fallopian tube + fundus: Ovarian nodes at root of artery L2
Round ligament: Superficial inguinal nodes
Body of uterus/Broad ligament: External Iliac nodes
Cervix: Internal Iliac nodes (some sacral)
Vagina: 1. Internal Iliac nodes 2. Superficial Inguinal nodes (pathway created via round ligament)
Gonads: para-aortic L2

43
Q

Bartholin’s Glands

A

Greater Vestibular glands –> located in vaginal vestibule –> secrete mucus

  • located posterior + Lateral to vagina
  • Females version of Bulbourethral glands but in SUPERFICIAL pouch
44
Q

Clinical relevance of Bartholin’s Glands

A

Bartolin’s Cyst
a) Bartholin glands –> blockage –> inflammation –> CYST
b) Cyst –+ (not STD) bacteria –> infection –> ABCESS
Treatment depends on severity –> cysts and abcess usually requires drainage

Sita GenitoUrinary System (28 decks)

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