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Year 3 Anatomy - Reproductive > Practical class 1: Pelvis and male reproductive structures > Flashcards

Practical class 1: Pelvis and male reproductive structures Flashcards

1
Q

What makes up the superior pelvic aperture?

A

The pelvic inlet and pelvic brim

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2
Q

What makes up the inferior pelvic aperture?

A

Pelvic outlet

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3
Q

How to identify a male pelvis?

A 
> Deep greater pelvis 
> Narrow and deep lesser pelvis 
> Heart-shaped pelvic inlet 
> Comparatively small pelvic outlet 
> Acute less than 90o Subpubic angle 
> Round obturator foramen
> Large acetabulum
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4
Q

How to identify a male pelvis - Greater pelvis (Pelvis major)?

A

Deep greater pelvis

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5
Q

How to identify a male pelvis - Lesser pelvis (Pelvis minor)?

A

Narrow and deep lesser pelvis

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6
Q

How to identify a male pelvis - Pelvic inlet?

A

Heart-shaped pelvic inlet

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7
Q

How to identify a male pelvis - Pelvic outlet?

A

Comparatively small pelvic outlet

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8
Q

How to identify a male pelvis - Subpubic angle?

A

Acute less than 90o Subpubic angle

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9
Q

How to identify a male pelvis - Obturator foramen?

A

Round obturator foramen

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10
Q

How to identify a male pelvis - Acetabulum?

A

Large acetabulum

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11
Q

How to identify a female pelvis - Greater pelvis (Pelvis major)?

A

Shallow

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12
Q

How to identify a female pelvis - Lesser pelvis (Pelvis minor)?

A

Wide and shallow

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13
Q

How to identify a female pelvis - Pelvic inlet?

A

Oval and rounded

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14
Q

How to identify a female pelvis - Pelvic outlet?

A

Comparatively large

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15
Q

How to identify a female pelvis - Subpubic angle?

A

Obtuse: greater than 90o

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16
Q

How to identify a female pelvis - Obturator foramen?

A

Oval

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17
Q

How to identify a female pelvis - Acetabulum?

A

Small

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18
Q

Which parts of the pelvis are termed the true pelvis?

A

The lesser pelvis

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19
Q

Which parts of the pelvis are termed the false pelvis?

A

The greater pelvis

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20
Q

Which parts of the pelvis are termed the false pelvis?

A

The greater pelvis

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21
Q

What type of joint is the sacroiliac joint?

A

Bicondylar synovial (Plane and syndesmosis)

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22
Q

What type of joint is the pubic symphysis?

A

Secondary cartilaginous (Hyaline and fibrocartilage)

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23
Q

With regards to the diameter of the pelvic outlet what is the narrowest point?

A

Transverse = 11 cm

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24
Q

With regards to the diameter of the pelvic inlet what is the narrowest point?

A

Anteroposterior = 11 cm

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25
Q

What is the anterior wall of the pelvic cavity formed by?

A

The bodies and rami of the pubic bones and the pubic symphysis

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26
Q

Which muscle(s) occupy the lateral pelvic wall? Identify this in an atlas.

A

Obturator internus muscle

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27
Q

Which muscle(s) occupy the posterior pelvic wall? Identify this in an atlas.

A

Piriformis muscle

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28
Q

Which nerve network lies on the muscle forming the posterior wall of the pelvis (Piriformis muscle)? Identify this in the atlas.

A

The sacral plexus (L4, L5, S1, S2, S3, S4)

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29
Q

Which nerve roots form the sacral plexus?

A

L4, L5, S1, S2, S3, S4

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30
Q

Which nerve roots make up the lumbosacral trunk?

A

L4 and L5

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31
Q

Which nerves make up the sciatic nerve?

A

Common fibular (Perineal) nerve and the tibial nerve

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32
Q

Which nerve roots supply the Obturator nerve?

A

L2, L3, L4

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33
Q

What muscles form the Levator ani?

A

> Iliococcygeus
Pubococcygeus
Puborectalis

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34
Q

What divides the pelvis from the perineum?

A

The pelvic floor

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35
Q

What are the perineal and annococcygeal bodies?

A

Complex musculotendinous structures in which gives an insertion (anococcygeal)/ attachment (Perineal) of the perineal muscle and the levator ani respectively

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36
Q

What are the two muscles which make up the floor of the pelvis (pelvic diaphragm)?

A

1) Coccygeus muscle

2) Levator ani:
- Puborectalis muscle
- Pubococcygeus muscle
- Iliococcygeus muscle

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37
Q

Give two functions of the pelvic floor (diaphragm)?

A

1) Support the abdominopelvic viscera (Bladder, intestines, uterus etc)
2) Resistance to increases in intra-pelvic/abdominal pressure (e.g. heavy lifting or coughing)
3) Helps with urinary and faecal continence

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38
Q

What is the innervation of the pelvic floor/diaphragm?

A

1) Levator ani = Branches of the pudendal nerve (S2, S3 and S4)
2) Coccygeus = Anterior rami of S4 and S5

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39
Q

What is a cystoceole?

A

Bladder prolapse into the vagina

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40
Q

What is a rectocoele?

A

Rectum prolapse into the vagina

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41
Q

If the pelvic floor is damaged during childbirth what can occur as a result?

A

1) Urinary stress incontinence
2) Rectal incontinence
3) Prolapse (Cystoceole or Rectoceole)

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42
Q

Why may an episiotomy minimise long term damage in childbirth?

A

Helps to prevent uncontrolled tearing of the perineal muscles

If the medial fibres of the puborectalis muscle are torn it may lead to rectal herniation (Rectoceole)

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43
Q

If the medial fibres of the puborectalis muscle are torn what will often happen?

A

Rectal herniation (Rectoceole)

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44
Q

Why is a mediolateral episiotomy preferable to midline episiotomy?

A

Midline leads to increased risk (14.8% versus 7% in mediolateral) of deep perineal tears

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45
Q

Which is preferable mediolateral episiotomy or midline episiotomy?

A

Mediolateral episiotomy

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46
Q

When performing a digital rectal examination on a male what may you be able to palpate?

A

1) Prostate gland**
2) Seminal vesicle
3) Vas deferens

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47
Q

When performing a digital rectal examination on a female what may you be able to palpate?

A

1) Perineal body*
2) Cervix*
3) Problems with reproductive organs (Uterus/ovaries)

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48
Q

Which arteries supply most of the pelvic organs, perineum and gluteal regions? What isn’t supplied by them?

A

Right and Left internal iliac artery

The testis, ovary and upper part of the rectum have different supplies.

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49
Q

What is the superior and inferior vesical arteries a branch of?

What does it supply?

A

Internal iliac (Part of umbilical artery)

Supplies the bladder, seminal gland and prostate in males

50
Q

What is the gonadal aftery a branch of?

What does it supply?

A

Aorta

Supplies the gonads (Ovaries and testis)

51
Q

What is the uterine artery a branch of?

What does it supply?

A

Internal iliac artery

Supplies the uterus, ureter and uterine tube

52
Q

What is the superior rectal artery a branch of?

What does it supply?

A

Inferior mesenteric artery

Supplies the Superior 1/3rd of the rectum

53
Q

What is the middle and inferior rectal arteries a branch of?

What does it supply?

A

Internal iliac artery

Supplies the middle inferior 1/3rd of the rectum

54
Q

What is the vaginal artery a branch of?

What does it supply?

A

Uterine artery

Supplies the vagina

55
Q

What is the internal pudendal artery a branch of?

What does it supply?

A

Internal iliac artery

Main artery to the perineum

56
Q

What is the obturator artery a branch of?

What does it supply?

A

Internal iliac artery

Pelvic muscles, ilium and head of the femur

57
Q

The venous drainage of the pelvic structures consists of which 5 different veins?

A

1) Internal iliac veins
2) Superior rectal veins
3) Median sacral vein
4) Gonadal veins
5) Internal vertebral venous plexus

58
Q

Which part(s) of the rectum drain(s) into the portal circulation?

A

Superior 1/3rd, which drains into the portal circulation, via the inferior mesenteric vein

59
Q

Which part(s) of the rectum drain(s) into the systemic circulation?

A

Inferior 1/3rd which drains into the systemic circulation, via the internal iliac vein

60
Q

What is the significance of understand the venous drainage of the rectum?

A

Identifying the cause of haemorrhoids

61
Q

Why might haemorrhoids be associated with cirrhosis of the liver?

A

Due to portal hypertension leading to decreased venous return

62
Q

The veins along the sides and base of the prostate join to form what?

A

The prostatic venous plexus

63
Q

With which venous plexus does the prostatic venous plexus communicate on its posterior side?

A

Drains into the internal iliac vein which connects with the vertebral venous plexus

64
Q

What is the clinical significance of the prostatic venous plexus connecting with the vertebral venous plexus?

A

Hypothesised to be the route for metastasis of prostate cancer to bone

65
Q

What forms the somatic nerve supply of the reproductive organs?

A

1) Ilioinguinal nerve

2) Genitofemeral nerve

66
Q

What does the ilioinguinal nerve originate from?

67
Q

What does the genitofemoral nerve originate from?

68
Q

What does the ilioinguinal supply?

A

Supply skin at the root of the penis in the male and the labia in the female

69
Q

Where does the ilioinguinal nerve enter the inguinal canal?

A

The superficial inguinal ring

70
Q

Where does the genitofemoral nerve enter the inguinal canal?

A

Deep inguinal ring

71
Q

What structure(s) in the male are supplied by the genital branch of the genito-femoral nerve?

A

Sensation to upper anterior thigh, skin of scrotum in males and mons pubis in females

72
Q

What is the clinical significance of the genital branch of the Genito-femoral nerve?

A

Hypoesthesia over the anterior thigh below the inguinal ligament

73
Q

What does the pudendal nerve supply?

A

Innervate the skin and the muscles of the perineum

74
Q

What is the nerve supply of the pudendal nerve?

A

S2, S3 and S4

75
Q

Where does the pudendal nerve arise from?

A

The sacral plexus

76
Q

The course of the pudendal nerve follows what?

A

The pudendal nerve follows the course of the pudendal artery

Travels from pelvis to perineum, via the gluteal region

77
Q

Which nerve is targeted for nerve block during childbirth? Which landmark do you use?

A

A pudendal nerve block can be administered trans-vaginally using the ischial spine as a bony landmark

78
Q

Sympathetic fibres from L1, L2 via the hypogastric plexus supply what?

A

Vas deferens, seminal vesicles, prostate and epididymis in the male

79
Q

Sympathetic fibres from the pelvic and ovarian plexus and parasympathetic nerve fibres from the pelvic splanchnic nerves (S2, S3 and S4) supply what?

A

The female genital tract

80
Q

Parasympathetic fibres from S2, S3, S4 via the hypogastric plexus supply what in both males and females?

A

Innervate the erectile tissue in both male and female

81
Q

What are the erectile structures in males?

A

1) Corpora cavernosa of the penis become engorged with arterial blood, tumescence, during erection
2) Lesser so the corpus spongiosum of the penis

82
Q

What are the erectile structures in females?

A

1) Corpora cavernosa, positioned to the left and right of the vaginal oriface (vestibular bulbs)
2) The clitoris

83
Q

After rectal surgery, why are some men unable to ejaculate?

A

Retrograde ejaculation can occur when damage to the muscles or nerves that controls the muscles of the bladder

Damage to autonomic nerve plexus

84
Q

What are the four primary nodes present in the pelvis receiving the lymphatic drainage of the pelvic organs?

A

1) External iliac lymph nodes
2) Internal iliac lymph nodes
3) Sacral lymph nodes
4) Common iliac lymph nodes

85
Q

What does the external iliac lymph nodes drain?

A

Pelvic viscera, inguinal

86
Q

What does the internal iliac lymph nodes drain?

A

Gluteal region, deep perineum and inferior pelvic viscera

87
Q

What does the sacral lymph nodes drain?

A

Postero-inferior pelvic viscera

88
Q

What does the common iliac lymph nodes drain?

A

Drainage from the three main groups: external, internal and sacral lymph nodes

89
Q

The male reproductive organs can be grouped into 3 categories, which are?

A

1) The external genitalia.
2) The gonads, where gametes or sex cells are produced, also the site for the production of important sex hormones.
3) The tube system for conveying the sperm and ovum enabling them to unite with resultant zygote being implanted.
4) The accessory glands which support the gametes and lubricate the copulatory organs.

90
Q

The male internal reproductive organs include what?

A 
> Testis 
> Ductus deferens or Vas deferens
> Seminal glands 
> Prostate 
> Epididymis 
> Bulbourethral glands
91
Q

What is the purpose of the testis being located outside the abdominopelvic cavity?

A

The maintain the temperature of the testis 1oC lower than the core body temperature which is necessary for the survival of sperm

92
Q

Migration of the testes from the abdominal cavity during development leads to which structure being produced?

A

The inguinal canal

93
Q

What are the main contents of the spermatic cord?

A

1) Vas deferens
2) Genito-femoral nerve
3) Testicular (gonadal) artery
4) Pampiniform plexus (venous) which empties into the gonadal vein

94
Q

The ovoid testes are suspended by what in the scrotum?

A

The spermatic cords

95
Q

What is the tough outer fibrous layer of the testis?

A

Tunica albuginea

96
Q

What is the sac covering the testis?

A

Tunica vaginalis

97
Q

What are the two layers of the tunica vaginalis ?

A

1) Parietal (lines scrotal cavity)

2) Visceral layers (Overlies the tunica albuginea)

98
Q

What material is present between the two layers (parietal and visceral layers) of the tunica vaginalis? What is its role?

A

Thin (Serous) fluid layer to reduce the friction between the testis and the scrotum

99
Q

What is a hydrocele?

A

A collection of serous fluid in a part of the tunica vaginalis

100
Q

What is a haematocele?

A

Testicular injury, leading to rupture of one of the vessels of the tunica

101
Q

At which vertebral level do the testicular arteries arise from the abdominal aorta?

102
Q

The testicular arteries pass retroperitoneally and cross which two important structures?

A

1) Ureters

2) External iliac arteries

103
Q

What is the term for the 8-12 anatomising veins associated with the testis?

A

The pampiniform (venous) plexus

104
Q

What is the function of the pampiniform plexus?

A

Other than venous return, temperature regulation of the testis

105
Q

Into which vein does the right testicular vein drain into?

A

Inferior vena cava

106
Q

Into which vein does the left testicular vein drain into?

A

Left renal vein

107
Q

What is a varicocele?

A

Enlargement of the veins in the scrotum

108
Q

Which two groups of lymph nodes receive lymph from the testis?

A

1) Para-aortic lymph nodes

2) Pre-aortic lymph nodes

109
Q

Where does the vas deferent start?

A

From the tail of the epididymis

110
Q

Where does the vas deferent terminate?

A

It terminates by joining the duct of the seminal gland to form the ejaculatory duct

111
Q

What secretions are produced by the seminal vesicles? pH?

A

Produce 60% of semen:

  • Sugar (fructose)
  • Proteins
  • Prostaglandins
  • Clotting factors

Slightly alkaline

112
Q

What secretions are produced by the prostate? pH?

A

Produces 30% of semen

Slightly acidic

113
Q

Why might an enlarged prostate gland cause retention of urine?

A

Puts pressure on the urethra

114
Q

What is the clinical significance of drainage from the prostatic venous plexus?

A

Drains into the internal iliac vein which connects with the vertebral venous plexus, this is hypothesised to be a route for bone metastasis of prostatic cancer

115
Q

What are the bulbourethral (cowper’s) glands?

A

These are small, paired structures located in the urogenital diaphragm which empty into the penile/spongy urethra

116
Q

What secretions are produced by the bulbourethral (cowper’s) glands?

A

Pre-ejaculate (Cowper’s fluid)

117
Q

What are the lymphatic drainage of the prostate?

A

Internal iliac and sacral node groups

118
Q

What are the lymphatic drainage of the seminal vesicle?

A

External and internal iliac lymph nodes

119
Q

What are the lymphatic drainage of the scrotum?

A

Superficial inguinal lymph nodes

120
Q

What are the lymphatic drainage of the penis?

A

Deep inguinal nodes

Year 3 Anatomy - Reproductive (2 decks)

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