Male & Female Pelvic Organs Flashcards
Which arteries surround the ovary?
Obturator artery
External iliac artery
Anterior internal iliac artery
Where is the ovary found?
Lateral wall of the pelvis in the ovarian fossa - intraperitoneal
What are the functions of the ovary?
Oocyte development
Folliculogenesis
Horomone production (progesterone & oestrogen)
Where does the ovary form embryologically?
On the posterior abdominal wall - it then descends into the true pelvis
What are the functions of the fallopian tubes?
Transit of the ovum
Fertilisation of the ovum (to zygote)
Transit of the zygote
Given that the ovary is not connected to the fallopian tube - how do ovums get there?
The pulsatile movement of the fimbriae draw them in
What is another name for the fallopian tubes?
Uterine tubes
Where is the uterus found?
Midline of the pelvis - between the bladder and rectum
What is the function of the uterus?
Implantation of the zygote
Development and nutrition of the foetus
What is the neck of the uterus?
The Cervix
What are the three layers of tissue in the uterus?
Endometrium
Myometrium
Perimetrium
What is the function of the endometrium?
Functional layer - sheds in menses + has basal layers supported by storm
How many muscle layers does the myometrium have?
3 (transverse, longitudinal & oblique)
What is the perimetrium made of?
Supportive connective tissue inc peritoneum
What are the three histological layers of the endometrium?
Stratum compactum (outermost)
Stratum spongiosum
Stratum basalis (not shed)
What are the parts of the cervix?
Isthmus
Internal os
External os (ectocervix)
Cervical canal (endocervix)
What is the difference between the histological internal os and the anatomical internal os of the cervix?
Anatomical = most internal opening into the uterus
Histological - where the change from simple columnar epithelium (cervix) to pseudostratfied columnar epithelium (uterine) takes place
What epithelium is found in the uterus?
Pseudostratified columnar epithelium
What epithelium is found in the vagina and external os of the cervix?
Stratified squamous epithelium
What epithelium is found in the cervical canal?
Simple columnar epithelium
What is the function of the cervix?
Conduit for spermatozoa
Supports pressures from developing foetus
What is the function of the posterior fornix of the vagina?
Holding tank for seminal fluid
What is the external vaginal opening called?
Introitus
What is the function of the vagina?
Conduit for semen
Storage of semen for liquefaction
Where is the location of the vagina?
Inferior to cervix
Midline pelvis
Passes through pelvic floor
What is the blood supply to the ovary?
Ovarian artery
What is the location of the uterine tubes?
From cornua of uterus to ovaries
What is the blood supply of the uterine tubes?
Uterine artery
Ovarian artery
What is the normal position of the uterus?
Anterverted and anteflexed
What is the blood supply of the uterus?
Uterine artery
What is the blood supply of the cervix?
Uterine & vaginal artery
What is the blood supply of the vagina?
Vaginal artery
Which structure is number 1?
Ovary
Which structure is number 16?
Uterus
What is the function of the testis?
Spermatogenesis
Hormone production - testosterone
When is testicular descent normally complete by?
32 weeks gestation
Why do testes hang outside the body?
2 ° cooler
What is the function of the epididymis?
Storage and transit of the spermatozoa
Maturation of spermatozoa
Which part of the epididymis becomes the ductus deferens?
The tail
What does the ductus deferens ascend in?
The spermatic cord (through the inguinal canal)
What is the ampulla of the ductus deferens?
The dilation where the ducts of seminal vesicles join
What is the function of the ductus deferens?
Transit of spermatozoa
What is the clinical name for the ductus deferens?
Vas deferens
What are the accessory exocrine glands of the male reproductive system?
Seminal vesicles
Prostate
Bulbourethral glands (Cowper’s)
Where are the seminal vesicles located?
Posterior surface of the bladder (base)
What is the function of the seminal vesicles?
To produce 85% of seminal fluid
What do the ductus deferens + the seminal vesicles form?
The ejaculatory duct
Why is fructose important in seminal fluid?
It provides ATP for spermatozoa
Where is the prostate found?
It encircles the neck of the bladder
What is the function of the prostate?
It produces prostatic fluid
What is the homologue of the prostate?
The paraurethral glands (Skene’s)
What is the homologue of the prostatic utricle?
Uterus, vagina & cervix
Where are the bulbourethral glands found?
In the deep perineal pouch, posterolateral to membranous urethra
What is the function of the bulbourethral glands?
Lubrication (glycoproteins) of spongy urethra + neutralisation (alkaline fluid) - neutralises acidic urine to it doesn’t destroy spermies.
What is the homologue of the bulbourethral glands?
The greater vestibular gland (Bartholin’s)
What are the three parts of the penis?
Rooty (Radix-triradiate)
Body (shaft)
Glans
Where is the penis found?
In the urogenital triangle
What is the function of the penis?
Transit of urine & seminal fluid
Erection
What is the blood supply of the testes?
Testicular artery
What is the blood supply of the epididymis?
Testicular artery
What is the blood supply of the ductus deferens?
Artery of ductus deferens (Superior vesicle artery)
What is the blood supply of the seminal vesicles?
Inferior vesical &
Middle rectal artery
What is the blood supply of the prostate?
Inferior vesical,
Middle rectal &
Internal pudendal artery
What is the blood supply of the penis?
Deep and dorsal artery of the penis
Why is the left testis at greater risk of varicocele than the right?
Acute angle of drainage (increased resistance - therefore increased force needed)
What pathology can you get of the testes?
Hydrocele
Varicocele
Indirect inguinal hernia
Intestinal obstruction / strangulation
Cryptorchidism (undescended testis)
What is structure 7?
Epididymis
What are the fossa formed by peritoneal folds in F?
Supravesical fossa
Paravesical fossa
Vesicouterine fossa
Rectouterine fossa
Pararectal fossa
What’s the broad ligament?
Parietal peritoneum reflected over the reproductive viscera
What is the name of the parietal peritoneum over the following:-
- Ovary
- Uterine tube
- Body and fungus of uterus
- Neovasculature
Ovary = mesovarium
Uterine tube = mesosalpinx
Body & fundus of uterus = mesometrium
Neovasculature = suspensory ligament of the ovary
What does the ovarian gubernaculum comprise of?
Ligament of the ovary + round ligament of the uterus
What are the names of fossa formed by peritoneal folds in M?
Supravesical fossa
Paravesical fossa
Rectovesical fossa
Pararectal fossa
What is the gubernaculum?
Is a fibromuscular cord which guides the descent of the gonads.
When do ovaries fully differentiate?
Week 12
When are ovaries found within the true pelvis?
Week 15
Where do ovaries descend from?
Posterior abdominal wall
When do testes differentiate?
Week 7
When are testes found within the true pelvis?
Week 12
When do testes reach the level of the deep inguinal ring?
Week 28
When are testes found within the scrotum?
Week 32
Where is the inguinal region?
From ASIS to pubic tubercle
What is the inguinal canal formed of? What causes its formation?
Formed by laters of the anterolateral abdominal wall.
Occurs due to gonad descent
Where is the location of the inguinal canal?
Parallel and superior to the inguinal ligament
What is the inguinal ligament?
The inferior free edge of the external oblique aponeurosis
Where is the superficial inguinal ring found?
Superolateral to the pubic tubercle
Where is the deep inguinal ring found?
Mid-inguinal point, superior to inguinal ligament and lateral to the inferior epigastric vessels
What is contained in the inguinal canal in women?
Round ligament of the uterus
Ilioinguinal nerve
Genital branch of the genitofemoral nerve
What is contained in the inguinal canal in men?
Spermatic cord
Ilioinguinal nerve
Genital branch of genitofemoral nerve
What’s the clinical significance of the inguinal canal?
Can be a site of herniation
What is an indirect inguinal hernia?
There is a patent processus vaginalis (defect in deep inguinal ring) = allows organs to traverse inguinal canal, descend through the superior inguinal ring and enter the scrotum through the spermatic cord
What is a direct inguinal hernia?
Defect in the posterior wall of the inguinal canal (inguinal triangle) which may traverse distal inguinal canal, and can descend through superior inguinal ring
What are the boundaries of the inguinal triangle?
Linea semilunaris (lateral border of rectus abdominus)
Inguinal ligament
Inferior epigastric vessels
What causes a hydrocoele?
A hydrocele refers to fluid accumulation between the visceral and parietal layer of the tunica vaginalis of the testis. This can occur on either side, and can be congenital or acquired. Congenital hydrocele is typically communicating, which happens when there’s a failure of the processus vaginalis to close up during development. Remember that the processus vaginalis is an embryonic structure that precedes the descent of the testes from the abdomen into the scrotum, and then closes up.
In some cases, the processus vaginalis can remain open and allow for communication between the abdomen and the scrotum. This allows peritoneal fluid to move into the scrotum. Fortunately, most cases of congenital hydrocele resolve spontaneously within the first year of age. On the other hand, acquired hydrocele is typically non-communicating, and most often occurs due to an underlying condition, such as trauma, tumor, or infections; the underlying infection examiners love the most is Wuchereria bancrofti, which is a type of roundworm that causes impaired lymphatic drainage.
Now, regardless of the type of hydrocele, individuals typically present with a soft, fluctuant, non-tender fullness in the scrotum. Complications of a hydrocele include transformation into a hematocele, which is a collection of blood in the scrotum; as well as calcification and testicular atrophy. For diagnosis of hydrocele, remember that in a transillumination test, the scrotum does transilluminate, and that’s a very important difference with varicocele! In addition, an ultrasound can be performed to confirm the presence of an anechoic or echolucent mass around the testis. Most cases of hydrocele resolve on their own and require no treatment, but those that don’t resolve need to be surgically repaired.
What causes a varicocele?
varicocele is characterized by dilation of the pampiniform plexus, which is a network of small veins that drain the testicles and is found within the spermatic cord. This occurs due to increased venous pressure, and venous stasis. For your test, remember that varicocele is more common on the left testis, since the left testicular vein drains into the left renal vein, forming a perpendicular angle before draining into the inferior vena cava, and this increases the resistance to blood flow. In some cases, the left renal vein can be compressed between the aorta and superior mesenteric artery, causing a so-called nutcracker syndrome, which is rare but important to keep in mind for your exams!
On the other hand, the right testicular vein drains directly into the inferior vena cava, so there’s a shorter route and less resistance to blood flow. As a result, varicocele rarely occurs on the right side. What’s extremely important to keep in mind is that right-sided varicocele should raise the suspicion of a retroperitoneal tumor, such as a renal cell carcinoma. That’s because the tumor can promote the formation of thrombi that may obstruct the right testicular vein, or it can grow and invade the inferior vena cava, ultimately blocking the drainage of this side, and leading to varicocele.
Now, varicoceles typically present with a soft scrotal mass. In fact, they are the most common cause of scrotal enlargement in adults! In some cases, varicocele may present with a feeling of pressure or dull, achy scrotal pain, and can even lead to infertility. That’s because a major function of the testicular veins is to draw heat centrally in order to maintain the temperature of the testicles lower than the body temperature. Impaired venous drainage can cause the testicular temperature to increase, ultimately affecting spermatogenesis.
Diagnosis of varicocele is based on physical examination. The key here is that the scrotal mass will feel like a “bag of worms” on palpation. In addition, the mass distends or gets bigger when the person is asked to cough or do the Valsalva maneuver, which is performed by exhaling forcefully against a closed upper airway, in order to increase abdominal pressure. Also remember that in a transillumination test, which is performed by shining a light through the testicle, varicoceles don’t transilluminate. Treatment of varicocele is indicated if the individual complains of pain or infertility, and may involve surgical ligation or embolization of the dilated pampiniform plexus.
What provides venous drainage to the testes?
The pampiniform plexus
Which side of the body is venous drainage of the testes more convoluted?
On left hand side
Where does the right testicular vein drain?
Where does the left testicular vein drain?
Right = Into the IVC
Left = into left renal vein - more convoluted path, can increase pressures = varicocele
What layers of the anterolateral abdominal wall form the following layers of the spermatic cord?
- External spermatic fascia
- Cremaster muscle
- Internal spermatic fascia
- Tunica vaginalis
External spermatic fascia = external oblique aponeurosis
Cremaster muscle = internal oblique muscle
Internal spermatic fascia = transversalis fascia
Tunica vaginalis = parietal peritoneum
What are the contents of the spermatic cord?
Ductus deferens (+ DD artery)
Pampiniform plexus
Testicular artery
Cremasteric artery
ANS nerves
Genital branch of genitofemoral nerve
What embryonic structure gives rise to the round ligament of the uterus?
Embryonic gubernaculum
What does the gubernaculum become in M after gonadal descent?
Scrotal ligament
What are the following reflections of peritoneum called in F?
1) From AAW over superior surface of the bladder
2) Lateral reflections from superior surface of the bladder
3). Fold between base of bladder and anterior surface of the uterus
4) Fold from posterior surface of the uterus and anterior surface of the rectum
5). Lateral reflections from anterior surface of rectum
6). Reflection over the uterine tubes
7). Reflection over the ovaries
8). Reflection over the body of the uterus
1) Supravesical fossa
2) Paravesical fossa
3) Vesicouterine fossa
4). Rectouterine fossa
5). Pararectal fossa
6). Mesosalpinx
7) Mesovarium
8). Mesometrium
What does the suspensory ligament of the ovary cover?
The neurovascular structures which pass to and from the ovaries in the lateral wall of the pelvis
What are the following folds of peritoneum called in M?
1). Reflection from AAW over superior surface of bladder
2). Lateral reflections from the superior surface of the bladder
3). Fold between the posterior surface of the bladder and the anterior surface of the rectum
4). Lateral reflections from the anterior surface of the rectum
1). Supravesical fossa
2). Paravesical fossa
3). Rectovesical fossa
4). Pararectal fossa
What is the histological organisation of the ovary?
Inner medulla
Outer cortex
Where is the ovary located and between which arterial structures?
Located in true pelvis, lateral wall
Between external iliac a., internal iliac a. & obturator a.
Within which part of the uterine tube does fertilisation most commonly occur?
Ampulla
What are the names of the openings to the cervical canal called?
Internal os
External os
Why are there two deeper openings to the cervix - what is the difference between them?
Anatomical internal os = physiological opening into uterine cavity.
Histological internal os = where epithelium changes from that of cervical canal (endocervix - simple columnar) to that of uterine cavity (pseudostratified columnar)
What is the normal position of the uterus in relation to the cervix and the vagina?
Anteverted
The ductus deferens is a continuation of which other structure in the male reproductive system?
Tail of epididymis
Which structures unite to form the ejaculatory duct?
Ampulla of ductus deferens and ducts of seminal vesicles
Which part of the male urethra does the ejaculatory duct opening into?
Prostatic
What are the four parts of the male urethra called?
Pre-prostatic
Prostatic
Membranous
Spongy
Within which perineal triangle are the female genitalia located?
Urogenital triangle
What are the bodies within the shaft of the penis called?
Corpora cavernosa
Corpus spongiosum
What pathway do developing spermatozoa follow?
Seminiferous tubules
Straight tubules
Rete testis
Efferent ductules
Epididymis
Ductus deferens
Ejaculatory ducts
Spongy urethra
What are the spermatic fascial layers that surround the testis and form the spermatic cord?
External spermatic fascia
Cremaster muscle
Internal spermatic fascia
Tunica vaginalis
