Quick SUGER anatomy Flashcards
how does the inguinal canal travel?
medially and inferiorly
from transversalis fascia to external oblique superficially and medially
rings of inguinal canal
deep inguinal ring to superficial inguinal ring
contents of inguinal canal in females
round ligament of uterus
ilioinguinal nerve
genital branch of the genitofemoral nerve
contents of inguinal canal in males
spermatic cord
2 nerves
- genital branch of the genitofemoral nerve
- sympathetic fibres
3 arteries
- testicular
- cremasteric
- artery to the vas deferens
3 fascial layers
- external spermastic fascia from external oblique aponeurosis
- cremaster muscle and fascia from internal oblique
- internal spermastic fascia from transversalis fascia
4 other structures
- pampiniform venous plexus
- lymphatics
- vas deferens
- processus vaginalis
and ilioinguinal nerve
indirect inguinal hernia
contents of abdomen forces through deep inguinal ring into canal
more common
direct inguinal hernia
contents forced through posterior wall
thin scrotal muscle
dartos
what also surrounds the testes?
tunica vaginalis
as well as 3 usual layers
epididymis
coiled tube lying along the posterior border of each testis
sperm stored here
where is sperm made and stored?
made in testes and stored in epididymis
what does the vas deferens carry?
sperm from epididymis
where does venous blood from the testes and epididymis enter?
pampiniform venous plexus which forms the testicular vein
right testicular vein enters the IVC
left enters left renal vein
cylinders of penile erectile tissue
two dorsal corpora cavernosa
one ventral corpus spongiosum
what is the glans
end of penis
expansion of corpus spongiosum
penile fascia
buck’s fascia
deep fascia of the penis
where does the penile urethra lie?
within corpus spongiosum
opening of urethra
external urethral meatus
arterial supply to penis
penile arteries from internal pudendal from internal iliac
nerve supply to penis
S2-4
sympathetic - dorsal nerve of the penis from pudendal
parasympathetic - erection - peri-prostatic nerve plexus
which tissue erects penis and how
corpus cavernosa
arterial blood flow increases
function of corpus spongiosum
prevent urethra from being compresses during erection so ejaculation can occur
arterial supply to adrenal glands
superior, middle and inferior adrenal arteries
venous drainage of adrenal glands
right adrenal vein drains into IVC
left drains into left renal vein then IVC
what does the adrenal cortex produce
steroid hormones
cortisol
aldosterne
testosterone
what does adrenal medulla produce
adrenaline
layers outside kidney, deep to superficial
perinephric fat, renal fascia, paranephric fat
renal arterial supply and venous drainage
arterial supply - right and left renal arteries drom abdominal aorta
venous drainage - right and left renal veins drain into IVC
renal sinus
between minor calyces
kidney stone pain
T12 to L2
where are kidney stones likely?
PUJ
pelvic brim
VUJ
muscles of the posterior abdominal wall
psoas and quadratus lumborum
lumbar plexus
L1-L4
and T12 contricutes
on posterior abdominal wall and thigh
branches of lumbar plexus
iliohypogastric and ilioinguinal nerves
genitofermoral nerve
lateral femoral cutaneous nerve
femoral nerve
obturator nerve
where does the abdominal aorta descend?
left of midline
how does aorta terminate?
L4
bifurcates into left and right common liliac arteries
paired branches of abdominal aorta
renal
adrenal
gonadal
lumbar
what forms IVC
union of left and right common iliac veins at L5
where does IVC ascend?
right of midline
which bones form the hip bone
ilium, ischium, pubis
joints of hip
hip joint - femur and acetabulum of pelvis
sacroiliac joint - sacrum and ilium
pubic symphisis
lumbosacral - 5th lumbar vertebrae and sacrum with an intervertebral disc between
sacrococcygeal joint - sacrum and coccyx
pelvic landmarks
iliac crest - lumbar punctures
intercristal line
intertubecular line
iliac tubercle - most lateral part, divides suprapubic and umbilical regions
pubic tubercle - most medial parts of pubic bone
midinguinal point - mid point btween ASIS to pubic symphysis
Mc Burneys point - 2/3 from umbilicus to ASIS
ASIS - most anterior part
AIIS
superior pubic ramis
inferior pubic ramus
acetabulum
where does the inguinal ligament run from?
ASIS to pubic tubercle
where is femoral artery palpable?
mid inguinal point
male vs female pelvis
female
- wider circular pelvic inlet vs hear shaped in males
- obtuse angle formed by inferior pubic rami in females, acute in males
- wider and shorter sacrum in females
blood supply to bladder
vesical arteries in both sexes
prostate and seminal vesicles in males
nerves of sacral plexus
sciatic - L4-S3 - supplies lower limb
pudendal nerve - S2-4 - major nerve of perineum
superior and inferior gluteal nerves - gluteal region
pelvic splanchnic nerves - pelvic viscera
function of pelvic floor muscles
prevent inferior herniation
urine and faeces continence
increase intra-abdominal pressure
two muscles of pelvic floor
levator ani - split into 3 paired muscles
- puborectalis for micturition and defacation, most anterior levator ani
- pubococcygeus
- iliococcygeus which actually attaches to spines of ischium not ilium
coccygeus
innervation of levator ani
S2-4
perineum
between the medial surfaces of the thighs
diamond shaped
2 triangles
triangles of perineum
anal and urogenital
anal is posterior
layers of urogenital triangle
skin
perineal fascia
superficial perineal pouch
perineal membrane
deep perineal pouch
what is the superficial perineal pouch
potential space containing erectile tissues of penis or clitoris
and 3 muscles
- ischiocavernosus
- bulbospongiosus
- superficial transverse perineal muscles
what supports the attachments of ischiocavernosus and bulbospongiosus?
perineal membrane
what is the deep perineal pouch?
potential space between the perineal membrane and pelvic floor muscles
contains external urethral sphincter
what sits between the two perineal triangles and what is its function?
perineal body
attachment for almost all perineal and pelvic floor muscles
what does the superficial perineal pouch contain?
erectile tissue that forms the clitoris or penis - corpora cavernosa
parts of the cropora cavernosa attached to the ischial ramus
crura
crura of the clitoris
crura of the penis
where does the corpus spongiosum sit?
midline
bulb of the penis
part of the corpus spongiosum sitting on the perineal membrane
what tissue forms bulb of the vestibule?
corpus spongiosum
also called bulb of the clitoris
function of ischiocavernosus muscles
cover corpora cavernosa
stabilise erect penis and clitoris
function of bulbospongiosus muscle
cover corpora spongiosum
in males, maintains erection and squeezes remaining semen or urine
in females, maintains clitoral erection
arterial supply of perineeum
internal pudendal artery
perineum nerve
pudendal
S2-S4
how do the internal pudendal artery and pudendal nerve enter the perineum?
greater and lesser sciatic foramina of the pelvis
seminal vesicle
secrete seminal fluid - thick alkaline fluid
how does vas deferens terminate?
joins duct of seminal vesicle to form ejaculatory duct
prostate
lies against neck of bladder
pierced by urethra and ejaculatory ducts
secretions of the prostate are added to the seminal fluid
parts of uterus
fundus, body, cervix
where does the blastocyst implant?
endometrium of uterus body
broad ligament
pouch of peritoneum adhering to itself at the sides of the uterus to form the broad ligament
space behind the uterus but anterior to the rectum
rectouterine pouch
pouch of Douglas
deepest part of peritoneal cavity
internal os
communication between the cervix and uterine cavity
external os
communication between the cervix and vagina
vaginal fornices
protrusion of the cervix into the vagina
where does fertilisation occur?
fallopian tubes/ uterine tubes
fallopian tube anatomy
10cm
near broad ligament
funnel shaped infundibulum laterally
free edge of infundibulum is broken up into fibriae which drape over ovary
ovaries
attached to broad ligament by mesovarium
frequently lie in ovarian fossa
- angle between internal and external iliac arteries
where does the vagina terminate?
introitus
space between the labia minora
how much of the vagina lies in the perineum and pelvic cavity?
upper 2/3 in pelvic cavity
lower 1/3 in perineum
blood supply of most pelvic organs
internal iliac artery
vulva
collective name for external female genitalia
vulval blood supply
internal pudendal arteries
branches of internal iliac arteries
innevration of erectile tissues
parasympathetic
innervation of vulva
4 nerve
- genital branch of genitofemoral
- ilioinguinal
- pudendal
- posterior cutaneous nerve of the thigh
mons pubis
mound of fatty tissue in front of the pubic symphisis
hairy
labia majora
hair breaing folds of skin meeting at the mons pubis anteriorly
labia minora
hairless
medial to labia majora
fuse anteriorly to form the hood of the clitoris
form the boundaries of the vestibule
what tissues form clitoris
corpora cavernosa
corpus spongiosum
vestibule
area between labia minora
contains vaginal opening, urinary meatus and vestibular glands
urinary meatus
urethral opening
posterior to clitoris, anterior to vagina
vestibular glands
greater
- Bartholin’s glands
- posterior to vaginal opening
- secrete lubricant during arousal
lesser
- Skene’s glands
- lie near urethral opening
- maybe lubricate vaginal opening or urethra
- maybe antimicrobial
arteries and veins of urinary bladder
vesical arteries
vesical veins
both from internal iliac!
how much urine can bladder store?
400-600ml
where do ureters enter bladder?
trigone at an angle
folds of mucosa in bladder
rugae
which muscle forcibly expels urine?
detrusor
internal urethral sphincter
smooth muscle
involuntary
external urethral sphincter
skeletal muscle
volunary
just after prostate in males
deep perineal pouch of females
somatic innervation of urinary bladder and urethral sphincters
pudendal nerve S2-4
sympathetic innervation of urinary bladder and urethral sphincters
sympathetic chain
relaxation of detrusor and contraction of internal urethral sphincter
parasympathetic innervation of urinary bladder and urethral sphincters
pelvic splanchnics
S2-S4
contraction of detrusor, relaxation of internal urethral sphincter
micturition occurs
bladder stretch reflex
sacral micturition centre in sacral spinal cord
bladder filling detected and relayed here
bladder contraction stimulated
inhibited by cerebral cortex in adults
consider a lesion above or below the sacral level
above
- not aware of filling
- cannot contract external sphincters
- incontinence, bladder automatically empties as it fills
below
- reflex still functional
- reflex disrupted
- internal sphincter permanently contracted
- pressure in bladder eventually overcomes internal sphincter
overflow incontinence or urinary retention
flexures of rectum
sacral and anorectal
anal sphincters
involuntary smooth muscle internal
voluntary external skeletal muscle
pectinate line
dentate line
divides superior and inferior anal canal
superior
- endoderm
- hindgut
- superior rectal artery from inferior mesenteric artery
- portal system towards liver
- columnar epithelium
- internal voluntary sphincter - sympathetic trunk and pelvic splancnics
inferior
- ectoderm
- middle and inferior rectal arteries from internal iliac
- drained systemically
- stratified squamous
- external voluntary sphincter - pudendal nerve
haemorrhoids
painless above the pectinate line
painful below
