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Anatomy - Surgical soc > Male Perineum > Flashcards

Male Perineum Flashcards

1
Q

what are the components of the ale pelvis?

A

ureter, bladder, urethra

prostate, ductus deferens, seminal vesicles, bulbourethral glands

rectum

ABDOMINAL GIT splits into the greater pelvis - caecum, appendix, part of the sigmoid colon and ileum

Vessels, nerves, lymphatics and lots of systems and small spaces

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2
Q

what kind of tissue is scrotum?

How is it embryologically formed?

What is in the scrotum?

A

Fibromuclular cutaneous sac

from two scrotal swellings, fusing to form the SCROTAL RAPHE -> which is biolically resembling the labia major

CONTENT:-
testis - site of sperm production

Epididymis - storage reservoir for sperm

Spermatic cord - a collection of muscle fibres, vessels, nerves and vas def

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3
Q

What muscles form the scrotum?

A

DARTOS MSUCLE-> smooth muscle. Wrinkles the skin to reduce heat loss

Supplied by the genital branch of the GENITOFEMORAL nerve

CREMASTER MUSCLE -> Inner. elevation of testes. Sensory from ilioguinal n. Motor from genitofemoral n.

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4
Q

Where is the sperm made?

A

Seminiferous tubules -> drain through RETE TESTIS -> Efferen ductules into the epipdidymis where they’re stored

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5
Q

parts of the epididymis

A

head, body and tail -> continues to become Vas deferens and leave scrotu

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6
Q

what are the vas deferens?

what is the trajectory of them?

A

Comminicating tubes // the epi and urethra

Travels in spermatic cord (within the inguinal canal)

Then behind the INERIOR EPI ARTERY. -> Passes infront of th ureter. The continues to become the ampulla of ductus deferens before entering the urethra trough the prosptate.

The vas def, seminal vesicle and prostate empty into the prosthetic urethra to make the semen.

The Seminal vesicles are behind the vas def

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7
Q

what are the arterial contents of the spermatic cord?

A

testicular artery
deferential artery
cremasteric artery

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8
Q

what nerves are in the spermatic cord?

A 
nerves to cremaster (genital branch of GF n)
testicular nerve (symp - motor)

Ilio-inguinal runs alongside the sperm cord but isn’t actually in it (sensory to the cremaster)

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9
Q

apart from nerves and vessels - what are the other contents of spermatic cord?

What abnormalities of the testis can occur to give large dilation?

A

V deferens
Pampiniform plexus
Lymph vessles
Tunica vaginalis

VARICOCELE
Abnormal enlargement and dilatation of pampiniform plexus -> Varicocele
Caused by defective valves or compression by nearby structure
Painless
Described as feeling like a ‘bag of worms’

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10
Q

what happens in a testicular torsion?

A

caused by twisted spermatic cord -> ischameia of the testis

surgery required

inflammed testis

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11
Q

what is hydrocele?

A

accumulation of fluid around the testes

caused by fluid secreted from remnant piece of peritoneum wrapped around the testicle

can resolve on its own

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12
Q

what is the lymphatic drainage from the testis lie?

A

Follows testicular arteries back to the para-aortic lymph nodes

the para-aortic lymh nodes contineu superiorly to become the mediastinal LN

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13
Q

where does the lymph drainage of the SCROTUM go?

A

Drains to the superficial inguinal lymph nodes

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14
Q

where are the seminal vesicles located?

How does it correspond with the vas deferens?

A

laterally to the ampullas of VAS DEFERENS

Excretory ducts from each seminal vesicle and corresponding vas deferens = two EJECTORY DUCTS

EJE DUCTS immediately pass through the prostate gland through the subatnce and into the prostatic urethra

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15
Q

where is the bladder in comparison to the prostate?

where are the bulbourethral glands?

A

bladder sits on the prosttae. It’s transfixed by the prostatic urethra

bulbourethral glads are just below the prostate

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16
Q

how is the internal urethral sphincter managed during sympathetic?

A

closed during ejaculation by SYMPATHETIC stimulus

PARASYMO relaxes th sphincter

REMEMBER: EXT SPHINCTER = SKELETAL MUSCLE

17
Q

which structures in males are felt in diital rectal exams of healthy man?

A 
prostate
rectum
full badder
seminal vesicles
bulbi-urethral gland
membranous urethra when catheterised
18
Q

what are the parts of the urethra?

What is often the issue with catheters?

A 
Preprostatic part (1.5cm)
Prostatic (2.5cm)
Membranous (2cm) - first bend happens after this (near where the external urethral is)
Spongy (15cm)

External urethral orifices is the narrowest part of it

They can often get caught int the NAVICULAR FOSSA
- catheter must be able to navigate 90degree bend as it passes from the perineum into the pelvis

19
Q

Describe the structure of the penis

A

Root - most proximal part. in the suferficial perineal pouch of pelvic floor.

Contains three erectile tissues (two crura and bulb of penis) - these then go on to become the corpus cavernosa and corpus spongiosum respectively

AND

two muscles (ischiocavernosus and bulbospongiosus)

Body - free part of the penis - located // the root and the glans. suspended from the pubic symp. - made of 3 cylinders of erectile tissues - two corpora cavernosa and corpus spongiosum (contains the spongy urethra)

Glans - most distal. expansion of the corpus spongiosum

20
Q

what fasica does the penis have?

A

there is the deep fascia and the superficial

21
Q

what is the arterial supply to the penis?

A

Dorsal arteries of th penos

Deep arteries of the penis

Bulbourethral artery - supplying to the bulb corpus spongiosum and glans

  • Then there are branchs that supply to the cavernosus spaces which are usually helical

These arteries are all branches of the internal pudendal artery

This vessel arises from the anterior division of the internal iliac artery.

REMEMBER: BLOOD TO THE TESTES = TESTICULAR ARTERY

22
Q

Blood supply of the rectal canal

A

Superior rectal artery - inferior mesenteric a

Middle rectal artery - internal iliac a

Inferior rectal artery - from internal pudendal a

23
Q

what is the venous drainage of the rectum?

A

Above pectineal line = superior rectal vein -> Inf mesenteric vein

BELOW - Inferior rectal vein -> which empties into the internal pudendal vein

24
Q

what is the frunulum of prepuce?

A

The prepuce (foreskin) is connected to the surface of the glans by the frenulum

25
Q

which arteries supply the cavernosus spae?

A

the helicine arteries that can relax via PSNS allowing blood blow

26
Q

what are haemorrhoids/piles?

A

Normallt the anus has vascular cushions to help stool store.

these can become inflamed and swollen and cause haemorrhoids.

skin covering the blood vessels become inflamed.

Can be internal or externa. diff marked by pectinate line on anus

27
Q

What nerves supply the penis?

A

Somatic: PUDENDL S2-S4

    • sensory = dorsal nerve of penis
    • motor = to perineal muscles; bulbospongisum and ischiocavernosus (causing ejectuation) and external sphincter

PARASYMP S2-4

  • vasodilation of arterioles in erectile tissue
  • secretio in prosate, bulbourethral gland

SYMP - L1-L2

  • contraction of smooth muscle of epididymis, vas deferens, seminal vesicles and prostate causing emission
  • contraction of the internal sphincter urethral sphincter during ejac to prevent the reflux f spern.

SO
PSNS - erectile tissue/secretion
SNS - Emission/ejaculation

28
Q

Describe the neurovascular mechanism of ejaculation

A

1) ERECTION
2) SECRETION
3) EMISSION
4) EJACULATION
5) DETUMESCENCE

29
Q

decsirb the erection aspect of ejaculation

A

Psych stimulation -> central PSNS pathway -> pudendal artery/arteriole relax allowing blood flow into cavernous spaces of erectile tissue

30
Q

describe the secretion aspect of ejac

A

PSNS ganglia stimulation -> protate, seminal vesicles (+ other glands in females)

31
Q

describe the emission aspect of ejac

A

central SNS pathway stimulation -> muscles contaction of vas def, prostate, sem vesi,

symp inhibition action -> bladder muscle contrcation prevented (cntraction of int sphincter)

32
Q

decssirb ethe ejacylation process

A

entry of semen into urethra -> somatoc reflex triggered via pudendal nerve -> contrcation of bulbospongiosum

33
Q

describe the detumescence aspect of ejac

A

activation of selected sympathteic nerve supplying pudundal arterioles -> arteriole constriction to restrict blood supply to cavernosus spaces -> inhbition of erection

34
Q

Outline the pelvic lymph drainage

A

Most organs are drained to the common iliac nodes via internal or external lyph ndes

External iliac LNs
Inguinal nodes
External genitalia
Vagina
Cervix
Bladder
Internal iliac (& sacral) LNs
Cervix
Prostate 
Rectum
Perineum
Buttock
Thigh

Testes & Ovaries -> lumbar group of aortic nodes

Anatomy - Surgical soc (9 decks)

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