pelvis- internal genitalia Flashcards
which testicle lies lower?
left
what do the visceral and parietal layers of the tunica vaginalis cover?
Visceral covers epididymis & testicle
Parietal lines internal spermatic fascia
what two structures is the epididymis continuous with?
Continuous with rete testis (via mediastinum) & ductus deferens
what is the firm muscular continuation of the epididymis?
ductus/vas defrens
what does the ductus defrens pass anteromedially to?
ureter, to merge with seminal vesicle
what path does the ductus defrens take come from the testes, through the inguinal canal and out of the deep ring? (where does it go from here?)
Crosses external iliac vessels to enter pelvis
Passes along lateral pelvic wall deep to peritoneum
where does the vas defrens get its blood supply from?
branches from superior vesicle artery (forms ductus defrens artery)
branches from inferior vesicle artery (more to lower- ejac duct area)
what covers the superior end of seminal vesicle?
by peritoneum of ureteric fold
where do the seminal glands/vesicles get there blood supply from?
Supplied by branches of inferior vesical arteries & middle rectal arteries
what is the path of the ejac ducts?
formed from vas defrens and seminal gland duct
Pass anteroinferior to enter prostate
Open into urethra via apertures on seminal colliculus
what type of fluid does the prostate secrete?
Contributes alkaline, milky fluid to semen
the superior base of the prostate contacts what? what about it’s inferior apex?
Superior base contacts bladder neck
Inferior apex contacts external urethral sphincter
what are the anterior and posterior surfaces of the prostate in contact with?
Anterior surface separated from pubic symphysis by retropubic (prevesical) space
Posterior surface contacts rectal ampulla
what portion of the prostate is palpable on exam?
inferior portion of posterior lobe
*BPH is most commonly here
what are the 5 different lobes of the prostate?
- anterior/isthmus lobe
- middle lobe
- posterior lobe
- right lateral lobe
- left lateral lobe
what was the prostate historically divided into? what is the prostate currently divided into?
old- 5 “ lobes”
now- 4 “ zones”
which lobe has no glandular tissue (mostly muscular) AND has the prostatic commissure?
anterior lobe (isthmus)
what are the boundaries of the middle prostate lobe?
between urethra and ejac ducts
what is the posterior prostate lobe behind?
ejac duct
what separates the right and left lateral prostate lobes?
“furrow” - slight indentation
what are the 4 “zones” that prostate is now divided into? (kinda weeds)
anterior, intermediate, central (includes “posterior lobe”), peripheral (lateral lobes)
how many prostatic ducts are there? where do they open into?
20-30 prostatic ducts open into prostatic sinuses of urethra
Lateral to seminal colliculus
what artery supply the prostate?
Supplied by prostatic branches of inferior vesical artery
what is the purpose of the SNS and PSNS for the prostate/vas/seminal glands?
SNS: Stimulates peristalsis of vas, secretion by seminal glands/prostate
PSNS: function unclear
how does the innervation of the testes reflect posterior abd. origin?
PSNS: Vagal (CN10)
SNS: T10, T11
the ovary is truly intraperitoneal. its Suspended within the ________ portion of broad ligament
Not covered by _________
mesovarium peritoneum (mesothelium)
what are the lateral and medial attachments of the ovary?
lateral: attach to pelvic wall via SUSPENSORY LIGAMENT
medial: attach to uterus via OVARIAN LIGAMENT
what runs through the suspensory ligament?
ovarian neurovasculature
what runs through the ovarian ligament?
uterine branches (veins and artery)
what ligament is a remnant of the fetal gubernaculum?
ovarian ligament
what are the fallopian tubes located (where do they run?) and what are they suspended by?
Extend from uterine horns to ovaries
Suspended by mesosalpinx- portion that holds the tubes in place on superior edge of broad ligament
fallopian tubes are analogous to what male structure (in terms of function)?
vas defrens
what is the most superior structure in the broad ligament?
fallopian tubes
describe the mesosaplinx, mesovarium and mesometrium: where area they located and how many layers in each?
superior mesosalpinx: double layer on either side of fallopian tube
posterior mesovarium: double layer around ovary
inferior mesometrium: double layer around the bottom- under fallopian tube, round ligament, ovary
what is the infundibulum portion of the fallopian tube like?
Funneled distal end
Opens into peritoneal cavity via ostium
Numerous fimbria drape around ovary
Ovarian fimbria provide attachment
what is the isthmus of the fallopian tube like? where is it?
Thick-walled
Enters uterine horn
what is the uterine portion of the fallopian tube like?
Intramural segment
Opens into uterine cavity via ostium
what are the arterial supply of the ovaries and fallopian tubes?
by abdominal & pelvic sources:
Ovarian arteries from abdominal aorta
Ascending branch of uterine artery from internal iliac
where do the ovaries and fallopian tubes drain to (venous drainage) ?
Ovarian veins drain to IVC & left renal vein
where is the uterus in relation to bladder and rectum?
Lies between (& superior to) bladder & rectum
how are most uteruses sitting in the body? describe these terms
Anteverted (angled anteriorly relative to vagina)
Anteflexed (bent anteriorly relative to cervix)
–Typically transverse & mostly rests on bladder
how many supports are there for the uterus, what plane are they in?
2 coronal (really more like 3) 2 transverse
what are the two (really 3) uterine supports in the coronal plane?
- ovarian ligament & round ligament (lie between layers of broad ligament)
- broad ligament
what is the broad ligmament?
Double layer of peritoneum
-Drapes over ovarian/round ligaments & uterine tube
-Covers ovarian vessels laterally
-Extends from sides of uterus to pelvic walls & floor
Mesometrium
what are the two uterine supports in the transverse plane?
cardinal and uterosacral ligaments
what forms the cardinal ligament and what does it attach and what does it contain?
Condensation of endopelvic fascia
Attach cervix to lateral pelvic wall
Contains uterine vessels
what does the uterosacral ligaments attach?
Attach cervix to sacrum (coming off posterior uterus)
ovarian and round support lateral uterus. ovarian on _____ side, round on _____ side
ovarian- anterior
round- posterior
what is the superior portion of the birth canal?
cervix (lower 1/3 of uterus)
how is the uterus broken down into body and cervix ?
body: superior 2/3
cervix: inferior 1/3
which part of the uterus is “mobile” ?
body (upper 2/3)
how is the uterus demarcated from the cervix?
where is the superior fundus” ?
Demarcated from cervix by isthmus constriction
Superior fundus above uterine ostia
cervix: supravaginal vs vaginal portions
Supravaginal portion: between isthmus & vagina
Bears internal os
Vaginal portion: protrudes into vagina
Bears external os
Surrounded by vaginal fornix
where does the uterine “cavity” extend from? what provide the entry point for uterine tubes into the cavity?
Extends from fundus to external os Superolateral horns (cornua) provide entry for uterine tubes
where is the inferior fusiform cervical canal? (between what and what? )
Between internal & external os
what are the 3 parts of the uterus wall?
perimetrium (outermost)
myometrium
endometrium (innermost)
what is the perimetrium portion of the uterus wall?
Visceral peritoneum
what is the myometrium?
Thick muscle coat
Hormonally responsive
what is the endometrium? what is it responsive to?
Functional layer
Cyclical changes in response to ovarian hormones
Uterine (menstrual) cycle
which two layers of uterus wall are hormonally responsive?
myometrium and endometrium
where does the vagina extend from? (from where to where?)
Extends from mid cervix to vaginal orifice
Cleft between labia minora
where are the lateral walls of the vagina collapsed? where are the anterior/posterior walls collapsed?
Lateral walls usually at orifice
Anterior/posterior walls in canal
what are the 3 different portions of the vaginal fornices? which is right near the rectouterine pouch?
Anterior, lateral, posterior portions
Deep posterior fornix abuts rectouterine pouch
what is the arterial supply of the vagina?
vaginal branch of uterine (upper) internal pudendal (lower) arteries
why is pelvic pain referred?
visceral afferents follow autonomics (SNS and PSNS)
where do pelvic visceral afferents follow SNS? where do they enter the CNS?
in abdominal cavity
-Abdominopelvic splanchnic/lumbar splanchnic nerves
Sympathetic trunk
White rami communicantes
Enter CNS at inferior thoracic/upper lumbar levels
T6-L2
where do pelvic visceral afferents follow PSNS? enter the CNS where?
Travel with parasympathetics distal to mid-sigmoid
Enter CNS at S2-S4
what is the term for the “inferior/lower limit of the peritoneum”? what is the significance of this? where is it?
pelvic pain line: threshold/boundary determining the course of visceral pain sensation
- runs just along the inferior peritoneum (top of bladder)
- -> females: crosses just above cervix (lower 1/3 uterus)
structures above or in contact with inferior peritoneum (pelvic pain line) convey visceral pain sensation via what nerves? what about those below inferior peritoneum (pelvic pain line)
above/in contact: pain via SNS lumbar splanchnic nerves
below: pain via PSNS pelvic splanchnic nerves
which nerves have white rami communicantes?
sympathetics: T12-L2
so only for those visceral afferents above pelvic pain line
where does the digestive tract “switch” in regards to innervation?
mid-sigmoid colon (pelvic pain line level)
which have longer postsynaptic nerves, SNS or PSNS?
SNS
