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Anatomy > Pelvis > Flashcards

Pelvis Flashcards

1
Q

Sacrum: Description

A

The sacrum is an element of the bony pelvis

Location: forms the posterior aspect of the pelvic ring

Function: transmission of force between the pelvis and the spinal column

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2
Q

Sacrum: Gross anatomy

A

Inverted triangle in shape

Formed by the fusion of 5 sacral vertebrae

Concave anterior

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3
Q

Sacrum: Features

A
  • Sacral prominence
  • Superior articular processes with associated facets
  • Sacral body
  • Alar wings laterally
  • Median sacral crest
  • Sacral canal (triangular in shape)
  • Termination of the sacral canal is at the sacral hiatus
  • First four nerve roots exit via the paired anterior and posterior foramen
  • The fifth sacral nerves exit via the sacral hiatus
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4
Q

Sacrum: Articulation

A
  • Superiorly with the L5 vertebrae via the sacral prominence and the body of L5 and via the superior articular facets with the inferior articular facets of the L5 vertebrae
  • Laterally the sacrum articulates with the ilium via the sacroiliac joints (mixed fibrous/synovial joints)
  • Sacrococcygeal – inferiorly the sacrum articulates with the first coccygeal segment
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5
Q

Sacrum: Ligaments

A
  • Lumbosacral
  • Iliolumbar
  • Sacroiliac ligaments
  • Sacrospinous
  • Sacrotuberous
  • Sacrococcygeal ligaments
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6
Q

Sacrum: Neurovasculature

A

Blood supply:

  • Iliolumbar arteries (Posterior division of the internal iliac arteries)
  • Lateral sacral arteries (post. Div. int. iliac)
  • Median sacral artery from the aorta

Venous drainage:

  • Via the internal and external vertebral plexuses to the median and lateral sacral veins

Lymphatics:

  • Perirectal and internal iliac nodes
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7
Q

Sacrum: Variants

A
  • Lumboralisation of the S1
  • Sacralisation of the L5
  • Sacral agenesis
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8
Q

Hip bone: Description

A

The hip bone is a large paired flat bone of the pelvis.

Function: Forms the lateral and anterior aspects of the bony pelvis

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9
Q

Ilium

A

Superior part of the hip bone

Made up of a body and wing separated by the arcuate line

Forms the sacroiliac joint with the sacrum via the articular surface

Forms the superior aspect of the acetabulum

Anterior and posterior, superior and inferior iliac spines

Forms most of the greater sciatic notch

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10
Q

Ischium

A

Posterior inferior part of the hip bone

Made up of a body and a ramus

Forms the lower acetabulum

Forms the posterior part of the obturator foramen

Forms the lower part of the greater sciatic notch and all of the lesser sciatic notch with the ischial spine between them

Inferiorly is the ischial tuberosity

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11
Q

Pubis

A

Anteromedial body with a superior and inferior ramus

Forms the anterior aspect of the obturator foramen

Symphysial surface of the body of the pubis forms the pubic symphysis

Pubis tubercle located superior and lateral to the pubic symphysis

Forms the anterior aspect of the acetabulum

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12
Q

Sacroiliac Joint: Description

A

Paired symmetrical synovial and fibrous joint between the ilium and the sacrum

Location: S1-S3 level oblique plane

Movement: little movement, main function is transfer of weigh between the axial and lower appendicular skeletons.

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13
Q

Sacroiliac joint: Articulation

A
  • Formed by the irregular articular facets of the ilium and the sacrum.
  • The upper 1/3 is a syndesmosis
  • The lower 2/3 is articular cartilage
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14
Q

Sacroiliac joint: Ligaments

A
  • Has a capsule (due to its synovial element)
  • Interosseous sacroiliac ligaments
  • Anterior sacroiliac ligaments
  • Posterior sacroiliac ligaments
  • Iliolumbar ligaments
  • Sacrospinous and sacrotuberous ligaments
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15
Q

Sacroliac joint: Relations

A
  • Anterior: Internal and external iliac veins and arteries join, ureters, lumbosacral trunk and obturator nerve, piriformis attaches to the anterior capsule
  • Posterior: sciatic nerve
  • Superior: iliolumbar ligaments
  • Inferior: Greater sciatic foramen
  • Lateral: ilium
  • Medial: sacral alar
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16
Q

Sacroiliac joint: Neurovasculature

A

Arterial:

  • Iliolumbar
  • Superior gluteal
  • Superior lateral sacral arteries

Venous: same named veins

Innervation: Branches of the lumbar and sacral plexus

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17
Q

Sacroiliac joint: Variant

A

Accessory sacroiliac joints

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18
Q

Pubic symphyisis

A

The pubic symphysis is a midline secondary cartilaginous joint between the articular surfaces of the pubic bodies

Movement: minimal shift and rotation, may widen during pregnancy and child birth

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19
Q

Pubic symphysis: Gross anatomy

A
  • Wedge-shaped fibrocartilaginous interpubic disc situated between two layers of hyaline cartilage which line the articular sufaces of the pubis
  • Width narrows with age from 10 to 3mm
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20
Q

Pubic Symphysis: Ligaments

A
  • Superior and inferior pubic ligaments
  • Anterior and posterior pubic ligaments
  • Suspensory ligament of the penis
  • Pubocervical ligament
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21
Q

Pubic symphysis: Muscles

A
  • Adductor longus and brevis
  • Rectus abdominis and pyramidalis
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22
Q

Symphysis pubis: Relations

A

Anterior – proximal penile/clitoral shafts

Inferior – Urethra, deep dorsal vein of the penis/clitoris

Posterior – Bladder, retropubic fat, Prostate and prostate venous plexus

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23
Q

Pubic symphysis: Neurovasculature

A

Blood supply:

Obturator and inferior epigastric arteries

Innervation:

Pudendal nerve

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24
Q

Levator ani: Description

A

The lavator ani also known as the muscular pelvic diaphragm is the musculotendinous sheet that forms the majority of the pelvis floor.

Function: supports the pelvic viscera and aided in urinary and faecal continence

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25
Q

Levator ani: Gross anatomy

A

Pubococcygeus:

  • From the inner surface of the pubis merging medially to form the perineal body

Iliococcygeus:

  • From the inner tip of the coccyx to the ischial spine.

Puborectalis:

  • From the body of the pubis forming a sling around the rectum
  • Coccygeus is not formally part of lavatory ani however it is an important element of the pelvic floor. It is between the sacrospinous ligament/ischial spine and the lateral border of the coccyx and sacrum.
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26
Q

Levator ani: Neurovasculature

A

Arterial supply:

  • Inferior gluteal artery

Venous drainage:

  • Inferior gluteal veins

Innervation:

  • Pudendal nerve (internal surface)
  • Branches of S3,4 (external surface)
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27
Q

Levator ani: Variant

A
  • Thinning or aplasia of one side is common ~50%
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28
Q

Piriformis: Description

A

The piriformis muscle is a muscle of the gluteal region

Gross anatomy:

Flat muscle, pyramidal in shape

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29
Q

Piriformis: Gross anatomy

A

Flat muscle, pyramidal in shape

Origin: Sacrum

Course: exits the pelvis via the greater sciatic foramen

Insertion: Greater trochanter of the femur

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30
Q

Piriformis: Neurovasculature

A

Arterial supply: Superior and inferior gluteal arteries, lateral sacral artery

Innervation: Nerve to piriformis (sacral plexus)

Lymphatics:

  • Internal iliac
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31
Q

Piriformis: Relations

A

Structures passing through the greater sciatic foramen pass above or below the piriformis:

Passing above:

  • Superior gluteal nerve and vessels

Passing below (PIN PINS):

  • Posterior cutaneous nerve of the thigh
  • Inferior gluteal vessels and nerves
  • Nerve to quadratus femoris
  • Pudendal nerve
  • Internal pudendal vessels
  • Nerve to obturator internus
  • Sciatic nerve
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32
Q

Piriformis: variants

A
  • Fusion with gluteal muscles
  • Pierced by the fibular nerve
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33
Q

Psoas muscle: Description

A

The psoas major muscle is on the muscle of the posterior abdominal wall.

Location: Posterior the retroperitoneum in the iliopsoas compartment

Action: lateral flexion of the trunk, stabilisation and flexion of the hip

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34
Q

Psoas muscle: Gross anatomy

A

Enclosed by the psoas fascia.

Fuses with the iliacus muscle to form the iliopsoas.

Passes through the retro-inguinal space

Origin: vertebral bodies, discs and transverse processes of T12 to L5

Insertion: Lesser trochanter of the femur

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35
Q

Psoas muscle: Neurovasculature

A

Innervation: L1-L3 nerve roots

Arterial supply: Lumbar, iliolumbar, deep circumflex iliac, external iliac and femoral arteries

Venous: Same named veins

Lymphatics: Para-aortic

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36
Q

Psoas muscle: Variants

A

Asymmetry of the psoas muscle

Psoas minor muscle

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37
Q

Inguinal ligament: Description

A

The inguinal ligament is a ligament that marks the transition from the pelvis to the lower limb

Function: Support of the inferior aspect of the anterior abdominal wall, allows the passage of structures from the pelvis to the superficial anterior pelvis

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38
Q

Inguinal ligaments: Gross anatomy

A

Formed from a thickening of the lower border of the aponeurosis of the external oblique. Extends from the anterior superior iliac spine to the pubic tubercle.

Some fibres attach elsewhere:

  • Superior pubic ramus – Lacunar ligament
  • Pecten pubis – pectineal ligament
  • Crossing the midline – reflected inguinal ligament

The upper surface gives origin to the external spermatic fascia

The ligament is continuous with the fascia lata of the thigh.

Also forms the posterior wall of the inguinal canal

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39
Q

Inguinal ligament: Relations

A

Anterior: Superficial epigastric arteries

Posterior: Retroinguinal space, femoral artery, vein and nerve, iliopsoas

Lateral: iliac wing, circumflex iliac vessels

Medial: Pubic symphysis

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40
Q

Inguinal ligament: Neurovasculature

A

Arterial:

Superficial and inferior epigastric arteries

Superficial circumflex iliac arteries

Venous:

Superficial and inferior epigastric veins draining into the femoral system

Lymphatics:

Superficial iliac nodes

Innervation:

Iliohypogastric nerves

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41
Q

Sacrospinous ligament: Gross anatomy

A

Triangular in shape

Attachments: The base is attached to the anterior sacrum (S2-S4) and the apex is attached to the ischial spine.

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42
Q

Sacrospinous ligament: Relations

A
  • Anterior: coccygeus
  • Posterior Sacrotuberous ligament
  • Superior: forms the lower border of the greater sciatic foramen
  • Inferior: Forms the superior border of the lesser sciatic foramen
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43
Q

Sacrotuberous ligament

A

Gross anatomy:

Also triangular in shape

Attachments: Broad origin from the sacrum and coccyx, apex inserts into the medial aspect of the ischial tuberosity with fibres extending to the ischial ramus called the falciform ligament

Provides extensive insertion of the gluteus maximus muscle

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44
Q

Sacrotuberous ligament: Relations

A

Forms the medial boundary of the greater sciatic foramen

Forms the posterior boundary of the lesser sciatic foramen

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45
Q

Anterior division of internal iliac: Description

A

The internal iliac artery is the primary blood supply to the pelvis, pelvic viscera, external genitals, perineum, buttocks and medial thigh

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46
Q

Anterior division of internal iliac artery: Gross anatomy

A

Origin: The bifurcation of the common iliac artery at the level of the pelvic brim

Course: Posteromedial toward the greater sciatic foramen.

Termination: Divides into the anterior and posterior division just prior to the greater sciatic foramen

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47
Q

Branches of the anterior division of internal iliac artery

A

Rule of 3’s: 3 bladder, 3 muscular, 3 female

ISO POG MUV

  • Superior vesicular
  • Inferior vesicular
  • Obliterated umbilical
  • Inferior gluteal
  • Obturator
  • Internal pudendal
  • Middle rectal
  • Uterine
  • Vaginal
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48
Q

Anterior division of internal iliac artery: Variants

A
  • Persistent sciatic artery
  • Obturator artery origin from the external iliac
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49
Q

Posterior division of internal iliac artery: Gross anatomy

A

Origin: The internal iliac artery divides into anterior and posterior divisions at the superior border of the greater sciatic foramen

Course: Posterior towards the great sciatic foramen

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50
Q

Posterior division of internal iliac artery: Branches

A

Iliolumbar artery – with lumbar and ilial branches – ilium, iliacus, L5/S1 foramen

Lateral sacral artery – with superior and inferior branches – supplies the sacrum and piriformis

Superior gluteal artery – superficial and deep braches – supplies the gluteal muscles

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51
Q

Posterior division of internal iliac artery: Variants

A
  • Persistent sciatic artery
  • Superior and inferior branches of the lateral sacral origin directly from the posterior division of the internal iliac artery
  • Superior gluteal may arise directly from the internal iliac
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52
Q

Venous drainage of the left testis: Description

A

The venous drainage of the testis and the epididymis is via the pampiniform plexus to the testicular veins.

Functions: return of deoxygenated blood, themoregulation of the testis.

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53
Q

Venous drainage of the tesis: Gross anatomy

A

The pampiniform plexus is a venous network of approximately 10 veins. The network surrounds the testicular artery in the spermatic cord and lies anterior to the ductus deferens.

The pampiniform plexus ascends to form four veins at the level of the superficial inguinal ring. Forming a single testicular vein at the level of the deep inguinal ring. It ascends through the inguinal canal within the spermatic cord.

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54
Q

Testicular veins

A

Course: The testicular veins ascend in the retroperitoneum on the psoas major muscle.

Tributaries: in addition to the pampiniform plexus there are multiple small tributaries from the retroperitoneal, abdominal wall and renal capsular veins.

Termination: The left testicular vein drains into the left renal vein, the right testicular vein drains into the inferior vena cava at the level of ~L2

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55
Q

Tersticular vein variants

A

The right testicular vein drains into the right renal vein

Duplication is common

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56
Q

Sacral plexus

A

Sacral plexus (2010)

The sacral plexus is formed by the anterior rami of the L4 to S4 and its branches.

Function: Innervation of the pelvis, perineum and lower limb

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57
Q

Branches of the sacral plexus

A

Sacral plexus forms on the anterior belly of the piriformis from the s1 to s4 nerve roots

SLIP DSP

  • Superior gluteal nerve (L4-S1)
  • Lumbosacral trunk (L4-L5)
  • Inferior gluteal nerve (L5 – S2)
  • Posterior femoral cutaneous (S1 -3)
  • Direct branches to muscles – nerve to piriformis, nerve to obturator internus, nerve to quadratus femoris, nerves to the gemelli
  • Sciatic (L4-S3)
  • Pudendal (S2-S4)
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58
Q

Sacral plexus: Relations

A
  • Anteromedial: common iliac artery and vein, ureter
  • Anterior: lateral sacral artery and vein
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59
Q

Sacral plexus: Variants

A
  • Common peroneal and tibial parts of the sciatic nerve fail to unite and course into the lower limb separately
  • Additional caudal nerve root contribution to the sacral plexus
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60
Q

Pudendal N: Gross anatomy

A

Origin: S 2- 4

Course: Through the greater sciatic foramen, back through the lesser sciatic foramen

Runs along the wall of the obturator internus, in the pudendal canal

Terminates into braches for the skin and muscle of the peritoneum

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61
Q

Pudendal N: Innervates

A
  • External anal sphincter
  • External urethral sphincter
  • Skin of perineum
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62
Q

Lymphatic drainage of the uterus and ovaries

A

The lymphatic drain of the uterus and ovaries generally follows with blood supply to these organs.

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63
Q

Ovaries: Vasculature

A
  • Ovarian arteries from the abdominal aorta
  • Right ovarian vein to the inferio vena cava
  • Left ovarian vein to the left renal vein
64
Q

Uterus: vasculature

A

the ovarian and uterine arteries unite and form an anastomotic network, venous drainage uterine veins into the internal iliac veins

65
Q

Ovaries: Lymphatic drainage

A
  • pre and para-aortic lymph node
66
Q

Uterus: lymphatic drainage

A
  • Uterus fundus – pre and para-aortic lymph nodes due to the anastomotic network
  • Uterus body and cervical – predominantly to the internal and external iliac chains however there is some drainage to the superficial inguinal nodes via the round ligament
67
Q

Lymphatic efferent channels

A
  • Superficial inguinal nodes drain to the external iliac nodes
  • The internal iliac and external iliac node drain to the common iliac nodes
  • The common iliac nodes drain in the para-aortic nodes
  • The para-aortic nodes drain to the cistern chyli which continues as the thoracic duct in the thorax
  • The thoracic duct drains to the junction of the left subclavian and internal jugular veins
68
Q

Anal canal: Description

A

The anal canal is the section of the gastrointestinal tract between the rectum and the anal verge.

Function:

  • Control of defecation
69
Q

Anal canal: Gross anatomy

A
  • Approximately 4cm in length

Origin: anorectal angle (the right angle turn at lavator ani)

Termination: The anal verge

  • Dentate line – separates the anal canal into an upper and lower part. These parts differ in structure and neurovascular supply. The dentate line is formed by the anal columns (of Morgani), which are a series of anal sinuses that drain the anal glands. It is located at approximately the middle of the anal canal.
  • Above the dentate line the epithelium is a mucous membrane and below the dentate line the epithelium is a stratified squamous cells.
  • Anal sphincters – divided into internal and external. Internal is a continuation of the inner rectal muscle, thickened muscular ring, composed of visceral muscle. External skeletal muscle with deep, superficial and subcutaneous parts
  • The anal margin is the 5cm of skin around the anal verse
70
Q

Anal canal: Relations

A
  • Laterally – inchioanal fossa
  • Anterior – bulbospongiosus, perineal body, vagina
  • Posterior – tip of the coccyx
71
Q

Anal canal: Neurovasculature

A

Blood supply:

  • Above the dentate line: superior and middle rectal arteries. (Superior from the inferior mesenteric, middle rectal from the internal iliac artery) and median sacral artery.
  • Below the dentate line: inferior rectal artery a branch of the internal pudendal artery

Venous drainage:

  • Above the dentate line: superior rectal vein to the inferior mesenteric vein (portal system)
  • Below the dentate line: inferior and middle rectal veins to the internal iliac veins

Lymphatic drainage:

  • Above the dentate line: internal iliac nodes
  • Below the dentate line: superficial inguinal nodes

Innervation:

  • Above the dentate line: inferior hypogastric plexus
  • Below the dentate line: Inferior rectal branches of the pudendal nerve (S2-4)
72
Q

Anal canal: Variant anatomy

A

Imperforate anus

73
Q

Rectum: Description

A

The rectum is a part GI system in the hind gut

Location: between the anus and the sigmoid colon in the ishiorectal fossa, at the level of S3 the sigmoid loses its mesentery and becomes the rectum.

Function: Storage of stool and defecation

74
Q

Rectum: Gross anatomy

A

Muscular tube which is the continuation of the sigmoid colon, it is continues with the anus inferiorly

Angulated course due compression from puborectalis

75
Q

Rectum: Neurovasculature

A

Arterial supply:

Superior and middle rectal arteries branches of the IMA and internal iliac arteries

Venous drainage:

Same named veins, superior and middle into the portal system

Innervation:

Upper rectum: Inferior mesenteric plexus

Mid and lower: Superior and Inferior hypogastric plexus

Lymphatics:

Perirectal nodes in the ishiorectal fossa

Inferior mesenteric nodes

Internal iliac group

76
Q

Rectum: Relations

A

Anterior: Vagina or prostate

Posterior: tip of the coccyx

Lateral: ishiorectal spaces

Medial: lumen

Superior: sigmoid colon

Inferior: Anus

77
Q

Rectum: Variants

A

Imperforate rectum

Rectal prolapse

78
Q

Fallopian tubes: Description

A

The fallopian tubes are paired hollow tubes that are part of the female reproductive system located between the ovaries and the uterus

Function: convey ovulated eggs to the endometrial canal

79
Q

Fallopian tubes: Gross anatomy

A

Tubular ~10-12cm in length

Dividable into (Four inches across is impossible):

  • Fimbria – finger like projections draping over the ovaries
  • Infundibulum – funnel segment
  • Ampulla – widest and longest segment
  • Isthmus – narrowest segment
  • Intersitial segment – section within the myometrium

Location: within the mesosalpinx

80
Q

Fallopian tubes: Relations

A
  • Medial: cornu of the uterus
  • Lateral: walls of the pelvis
  • Posterior: Iliac arteries
  • Inferior: right and left adnexa
  • Superior: interabdominal cavity
81
Q

Fallopian tubes: neurovasculature

A

Arteries supply:

  • Uterine and ovarian arteries

Venous drainage:

  • Uterine and ovarian veins

Lymphatics:

  • Predominantly the para-aortic nodes like the ovaries

Innervation:

  • Ovarian and uterine plexus (T11-L1)
82
Q

Fallopian tube: variants

A
  • Absent
  • Fallopian tubes duplication
  • Cyst
83
Q

Uterus: Description

A

The uterus is a primary reproductive organ of females

Function:

Gestation of an embryo to birth

Location: Extraperitoneal pelvis, peritoneum drapes over the fundal uterus

84
Q

Uterus: Gross anatomy

A

Inverted pear shaped, most of the bulk is myotrium -> smooth muscle

Typically 7.5cm in length, can grow to 40 in length during pregnancy

Consists of:

  • Body
  • Isthmus between the body and the cervix
  • Cervix at the base
  • Rounded fundus superiorly above the plane of the insertion of the fallopian tubes
  • Cornu laterally
  • Endometrial cavity internally which is lined with endometrial tissue
85
Q

Uterine ligaments

A
  • Pubocervical
  • Uterosacral
  • Transverse cervical
  • Broad ligament
  • Round ligament
  • Suspensory ligament of the ovaries
  • Ovarian ligament
86
Q

Uterus: Neurovasculature

A

Blood supply:

Uterine arteries, branches of the anterior division of the internal iliac arteries

Venous drainage:

Uterine veins into the internal iliac veins

Lymphatics:

  • Fundus: para-aortic nodes
  • Body/cervix: internal and external iliac nodes, superficial inguinal nodes via the round ligament

Innervation:

Inferior Hypogastric plexus, uterovaginal and ovarian plexus

87
Q

Uterus: Relations

A
  • Posterior: Rectum and pouch of Douglas
  • Anterior: Urinary bladder, uterovesical pouch
  • Lateral: the adexal spaces, multiple vessels, the ovaries, broad ligament
  • Superior: the intraabdoinal cavity
  • Inferior: vagina
88
Q

Uterus: Variants

A
  • Bicornate
  • Arcuate
  • Septated
  • Unicornated
  • Agenisis
  • Anteverted
  • Retroverted
  • Uterus didephys
89
Q

Ovary: Description

A

The ovary is the female gonad

Location: Paired organs in the adnexa bilaterally

Function: Ovulation and hormone production (estrogen and progesterone)

90
Q

Ovary: Gross anatomy

A
  • Ovoid in shape
  • 1 to 10cc in volume
  • Outer capsule surrounding an outer cortex and inner medulla
91
Q

Ovary: Ligaments

A
  • Located within the mesovarium of the broad ligament
  • Attached to the uterus by the ovarian ligament
  • Attached to the wall of the uterus by the suspensory ligament of the ovary, this ligament contains the ovarian neurovasculature
92
Q

Ovary: Neurovasculature

A

Arterial supply:

  • Ovarian artery (origin aorta)

Venous drainage:

  • Pampiniform plexus to the ovarian veins (right vein to the inferior vena cava, left vein to the left renal vein)

Innervation:

  • Ovarian plexus from the aortic, renal, superior and inferior hypogastric plexuses

Lymphatics:

  • Para-aortic
93
Q

Ovary: Relations

A
  • Anterior – broad ligament, mesovarium, ovarian vessels, obliterated umblical artery
  • Posterior – ureter, internal iliac vessels, pelvic wall
  • Superiorly – external iliac vessels
  • Inferiorly – levator ani
  • Medially – ovarian ligament
  • Laterally – obturator vessels and nerves
94
Q

Ovary: Variants

A
  • Agenesis
  • Ectopic location
  • Thyroid tissue in ovary
95
Q

Epidydimys

A

The epididymis are folded tubular structures that located in the scrotum

Function: transport, collection and maturation of sperm

Location: between the vas deferens and the rete testis on the posterior aspect of the testis

96
Q

Epidydimys: Gross anatomy

A
  • ~6cm long however 6m of tubing

Dividable into:

  • Head
  • Body
  • Tail
  • Drains the rete testis via efferent ductules
  • Epididymus drains into the vas deferens
97
Q

Epidydymis: Relations

A
  • Anterior: testicles
  • Posterior: posterior wall of the scrotum
  • Lateral lateral wall of the scrotum
  • Medial: scrotal septa
98
Q

Epididymis: Vasculature

A

Arterial supply:

  • Deferential artery a branch of the superior vesicular artery
  • Testicular artery

Venous drainage:

  • Pampiniform plexus

Lymphatics;

  • Para-aortic nodes
99
Q

Epididymis: Variants

A
  • Epididymal cyst
  • Appendix of the epidymal head
  • Spermatocyte
  • Patent process vaginalis
100
Q

Testis: Description

A

The testes are the male gonads

Location: within the scotum

Function: Production of sperm and testosterone

101
Q

Testis: Gross anatomy

A
  • 12-20ml adult
  • Ovoid in shape
  • Covered in a tough membrane called the tunica albuginea with the tunica vaginalis covering exteriorly.
  • Tight junctions between Sertoli cells form a blood testis barrier
102
Q

Production and maturation of sperm

A
  • Seminiferous tubules
  • Tubuli recti
  • Rete testis (within the medistinum testis)
  • Efferent ductules (10-15) in number
  • Head of the epididymis uniting to form a single duct
  • Vas deferens
103
Q

Testis: Neurovasculature

A

Arterial:

Testicular arteries from ~L2 level abdominal aorta

Venous:

Pampiniform plexus draining into the testicular veins

Innervation:

Spermatic plexus from the para-aotic ganglion

Lymphatics:

Para-aortic

104
Q

Testis: Variants

A
  • Asymmetry in size
  • Polyorchidism
  • Agenesis
  • Cryptorchidism
  • Testicular appendix
  • arrest of testicular descent
  • both testes in one scrotal sac
105
Q

Ductus deferens

A

Paired 30-45cm muscular tubes.

Origin: Continuation of the tail of the epididymus

Course:

  • Runs in the spermatic cord
  • through in the inguinal canal
  • into the abdominal cavity running extra-peritoneal
  • laterally through the pelvis
  • passing anterior the ureters
  • inferior to the bladder

Termination: unites with seminal vesicles to form the ejaculatory duct within the prostate

106
Q

Ductus deferens: vasculature

A

Arterial: deferential artery from the superior vesical artery

Venous: veins of the ductus deferens drain into the pelvic venous plexus

Lymphatic drainage:

Drains to the external and internal iliac nodes

107
Q

Ducus deferens: Variants

A

Agenesis of the ductus deferens

108
Q

Spermatic cord: Gross anatomy

A

Origin: deep inguinal ring

Course: through the inguinal canal

Termination: at the posterior border of the testis

109
Q

Spermatic cord: Contents

A

3 arteries, 3 nerves, 3 other things:

  • 3 arteries: deferential artery, testicular artery, cremasteric artery
  • 3 nerves: genital branch of the genitofemoral, cremasteric nerve, sympathetic nerves
  • 3 other things: ductus deference, pampiniform plexus, lymphatic vessels
110
Q

Spermatic cord: Layers

A
  • External spermatic fascia from the external oblique
  • Cremaster fascia from the internal oblique
  • Internal spermatic fascia from the transversalis fascia
111
Q

Prostate gland: Description

A

The prostate gland is part of the male reproductive system.

Location: Surrounding the proximal urethra

Function: Ejaculation

112
Q

Prostate gland: Gross anatomy

A

Inverted pyramidal shape

Composed of 70% glandular and 30% fibromuscular tissue

The base of the prostate is in continuity with the bladder

The prostate is compose of three zones:

  • Peripheral zone – largest in volume, surrounds the posterior aspect and distal urethra
  • Central zone – Surround the ejaculatory ducts, most common area from BPH
  • Transition zone - Surrounds the Proximal ureter
113
Q

Structures within the prostate gland

A

Membranous urethra

Ejaculatory ducts

114
Q

Prostate gland: Neurovasculature

A

Arterial supply:

Inferior vesicular artery (a branch of the internal iliac artery)

Venous drainage:

Prostatic venous plexus to the internal iliac veins

Lymphatic drainage:

Internal iliac nodes

Innervation:

Inferior hypogastric plexus

115
Q

Prostate gland: Relations

A
  • Anterior – retropubic space, pubic symphysis
  • Posterior – rectovesicular fascia, rectum
  • Lateral – Prostatic venous plexus
  • Medial – membranous urethra
  • Superior – urinary bladder
  • Inferior – urogenital membrane
116
Q

Male urinary bladder: Description

A

The urinary bladder is a hollow muscular organ that is part of the urinary tract.

Location: extraperitoneal within the true pelvis

Function: storage of urine and micturition

117
Q

Male urinary bladder: Gross anatomy

A
  • Triangular shape with a posterior base, anterior apex and an inferior neck.
  • Becomes ovoid when full of urine
  • Lined with tough trabeculated transitional cell epithelium except at the trigone
  • The trigone is a triangular area of smooth mucosa located between the ureteric orificies and the urethral orifaces
  • The urethra orinates from the neck of the bladder
  • Ureters insert posteriorly and follow a short course within the wall of the bladder
118
Q

Male urinary bladder: Muscles

A
  • Detrusor muscle
  • Internal urethral sphincter
119
Q

Urinary bladder: Neurovasculature

A

Arterial supply:

Superior and inferior vesicular arteries (branches of the anterior division of the internal iliac arteries)

Venous drainage:

Into the interal iliac veins via:

Male: Vesical and prostatic venous plexus

Female: Vesical and uterovaginal plexus

Innervation:

Vesicular nerve plexus supplied by the Inferior hypogastric plexus (and pelvic splanchnic nerves)

Lymphatics:

Internal iliac nodes

120
Q

Urinary bladder: Male relations

A
  • Anterior: pubic symphysis
  • Posterior: rectovesical pouch and rectum
  • Inferior: prostate, levator ani
  • Superior: peritoneum
  • Laterally: ischiorectal fossa
121
Q

Urinary bladder: Female relations

A
  • Anterior: pubic symphysis
  • Posterior: vesiculouterine pouch, uterus, cervix, vagina
  • Lateral: ischiorectal fossa
  • Superior: uterus and peritoneum
  • Inferior: Perineal membrane
122
Q

Urinary bladder: variants

A

Double bladder, septation, agenesis, uterocele

123
Q

Male urethra: Description

A

The male urethra is a fibromuscular tube the from the neck of the bladder to the external urethral meatus.

Function: transportation of urine and semen

124
Q

Male urethra: Gross anatomy

A

18-20cm in length.

Origin: Internal urethral orifice

Dividable into parts: (Prime minister, big prick)

  • Prostatic urethra – Neck of bladder through the internal urethral sphincter, travels through the transitional zone of the prostate, ejaculatory ducts enter
  • Membranous urethra – Passes through the urogenital diaphragm, though the external urethral sphincter
  • Bulbar – Transverses the root of the penis, receives the bulbourethral glands
  • Penile – longest portion, within the corpus spongiosum, distally it dilates as the fossa navicularis
125
Q

Male urethrea: Neurovasculature

A

Arterial supply:

  • Internal Pudendal artery
  • Urethral artery (internal pudendal)
  • dorsal artery of the penis (internal pudendal)

Venous drainage:

  • Internal Pudendal veins
  • Internal iliac veins

Lymphatics:

  • Internal iliac nodes and deep inguinal nodes

Nerves:

Pudendal nerves

126
Q

Male urethra: Sphincter

A
  • Internal urethra sphincter
  • External urethral sphincter
127
Q

Male urethra: Variants

A
  • Urethral valves
  • Urethral Stricture
  • Hypospadius
128
Q

Female urethra: Gross anatomy

A

4cm in length

Origin: Neck of the bladder

Course: Transverse the deep and superficial perineal pouches to exit midline between the labia minora in the vestibule

129
Q

Female urethra: Muscles

A

Internal urethral sphincter

External urethral sphincter -> compressor urethrae, urethrovaginal muscle, sphincter urethrae

130
Q

Female urethra: Relations

A

Superior: Urinary bladder

Anterior: Clitoris

Posterior: Vagina

Lateral: puborectalis

131
Q

Female urethra: Neurovasculature

A

Nerves:

Pudendal nerve S2-4

Artery:

Internal pudendal artery and vaginal artery

Venous drainage:

Internal pudendal vein and vaginal veins

Lymphatics:

Internal iliac nodes

132
Q

Female urethra: Variants

A

Urethral agenesis

133
Q

Penis:Description

A

The most distal part of the male urogenital system

Function: urination, reproduction

134
Q

Penis: Gross description

A

Divided into 3 sections:

Skin:

  • Loosely connected to the tunica albuginea
  • distally folded to form the prepuce (foreskin) at the corona of the penis
  • the frenulum is a median fold of skin at the urethral aspect of the glans running between the orifice and the deep surface of the prepuce

Root:

Consists of three cylindrical structures of erectile tissue:

  • penile crura (paired) attach to the pubic arch. These join towards the symphyseal border and continue as the corpora cavernosa
  • the bulb of the penis is a median structure found between the crura and is attached to the perineal membrane. It narrows to continue as the corpus spongiosum. The urethra pierces its deep aspect to traverse the bulb as the bulbar urethra and continues to the corpus spongiosum.

Body:

  • the corpora cavernosa (right and left) and the corpus spongiosum (median)
  • the urethra courses through the corpus spongiosum and opens at the tip of the penis (glans) via the meatus
  • two suspensory ligaments support the body - fundiform and triangular ligaments
135
Q

Penis: Neurovasculature

A

Arterial supply:

  • Artery of the bulb of the penis – corpus spongiosum and the bulbourethral glands
  • Caversonal artery (internal pudendal) -> corpus cavernosum
  • Dorsal artery of the penis – corpus cavernosum and penile skin

Venous drainage:

  • deep dorsal vein (unpaired) drains the corpus cavernosum and corpus spongiosum
  • superficial dorsal vein (unpaired) drains the prepuce and penile skin

Lymphatic drainage:

  • Inguinal and iliac nodes

Innervation:

  • pudendal nerve and pelvic plexusi (S2-4)
136
Q

Penis: Variants

A
  • hypospadias
  • epispadias
  • phleboliths in the corpus cavernosum
137
Q

Ischiorectal fossa: Description

A

Is a fat filled paired triangular space of the perineum

Location: surrounding the rectum/anus

Function: Allows movement of the anus with defecation

138
Q

Ischiorectal fossa: Boundaries

A
  • Roof: lavator ani
  • Floor: Perineal fascia
  • Medial: external anal sphincter and anal canal
  • Lateral: Obturator internus and ischial tuberosity
139
Q

Ischiorectal fossa: Contents

A
  • Ischioanal fat pad
  • Pudendal canal
  • Inferior rectal braches of the pudendal nerve
  • Lymphatics
140
Q

Ischiorectal fossa: Neurovasculature

A

Lymphatics:

  • Drain to the internal iliac chain and the inguinal nodes

Nerves:

  • Perineal nerve
  • Internal rectal nerve
141
Q

Sciatic foramen: description

A

The great sciatic foramen is one the major foramen of the pelvis

Function:

It transmits piriformis and the neurovasculature of the gluteal region

142
Q

Sciatic foramen: Boundaries

A
  • Superior: Sacroiliac ligament
  • Inferior: Sacrospinous ligament
  • Medial: sacrotuberous ligament
  • Lateral: Greater sciatic notch
143
Q

Sciatic foramen: Contents

A

Piriformis muscle

Above piriformis:

Superior gluteal vessels

Superior gluteal nerve

Below piriformis:

Pin Pins

  • Pudendal nerve
  • Inferior gluteal vessels and nerve
  • Nerve to obturator internus
  • Posterior femoral cutaneous nerve
  • Internal pudendal vessels
  • Nerve to quadratus femoris
  • Sciatic nerve
144
Q

Lesser sciatic foramen: Boundaries

A

Lesser sciatic notch

Sacrospinous ligament

Sacrotuberous ligament

145
Q

Lesser sciatic foramen: Contents

A

Obturator internus and nerve to obturator internus

Pudendal nerve and (internal) vessels

146
Q

Perineum: Description

A

Diamonds shaped space between the pubis/ischial tuberosities/coccyx

Function: Transmits the urethra, anus and vagina in females

147
Q

Urogenital triangle

A

-Contains the perineal membrane attachment to bulb and cura of penis

The membrane divides the superficial and deep perineal pouches

Superficial: bulb of penis /root clitoris

Deep: external urethral sphincter / vagina in women

148
Q

Anal triangle

A
  • Contains the anus and its sphincter
  • Ischiorectal fossa
  • Anococcygeal body
149
Q

Perineum: relations

A
  • Bounded by the pubis anteriorly
  • The ischial tuberosities anterolaterally
  • Sacrotuberous ligaments posterolaterally
  • Coccyx posteriorly
150
Q

Perineum: Neurovasculature

A

Arterial supply:

Internal pudendal artery

Venous drainage:

Internal pudendal vein

Lymphatics:

Internal iliac nodes

Nerves:

Pudendal nerve (S2-4)

151
Q

Inguinal canal:description

A

A passage from the abdomen to the superficial tissue of the anterior abdominal wall

Function: to allow the passage of structures from the abdomen

152
Q

Inguinal canal: Gross anatomy

A
  • Superior wall: Internal oblique and transversus abdominus
  • Anterior wall: aponeurosis of external oblique and internal oblique
  • Lower wall: Inguinal ligament and the lacunar ligament
  • Posterior wall: conjoint ligament and transversalis fascia
153
Q

Inguinal canal: Transmits

A

Deep inguinal ring: o shaped opening in the transversalis fascia

Superficial inguinal ring: v shaped opening in the external oblique fasica

The spermatic cord in males or the round ligament in females and the ilioinguinal nerve in both

154
Q

Inguinal canal: Relations

A

Posterior: retroinguinal passage

155
Q

Inguinal canal: Variants

A

Indirect inguinal hernia

Anatomy (11 decks)

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