Repro Flashcards
Locate on pelvis
- sacral promontory
- ala of the sacrum
- arcuate line of the ilium
- pecten pubis
- pubic tubercle
- pubic crest
- pubic symphysis
What structures make up the pelvis outlet?
Inferior margin of pubic symphysis
Inferior pubic rami
Sacrotuberous ligament
Tip of coccyx
What areas form the true and false pelvis?
Everything above pelvic inlet = false
Everything below = true
How do the pelvises of males compare to females?
False pelvis is deeper
True pelvis is narrower/deeper
Inlet heart shaped (vs larger and round)
Smaller pelvic outlet
Acute subpubic angle
Obturator foramen rounder (vs triangular/oval)
Actebulum faces laterally (vs anteriorly)
Which muscle occupies the lateral pelvic wall?
Obturator internus
What muscle occupies the posterior pelvic wall?
Piriformis
Which nerve structure lies next to the muscle that forms the posterior wall?
Sacral plexus
What muscles form the pelvic floor?
Levator Ani - largest component
- pubococcygeus
- puborectalis
- iliococcygeus
Coccygeus
Fascia coverings of muscle
What are the perineal and anococcygeal bodies?
Perineal body joins the pelvic floor to the perineum
Anococcygeal body - Extends from the cocccyx to the anus and is a fibrous tissue where levator ani muscles meet
What are the functions of the pelvic diaphragm?
Urinary/faecal continence
Supports abdominal viscera
Resists increases in pelvis/abdominal pressure
What is the innervation of the pelvic diaphragm/floor?
Levator Ani - Pudendal (S2-4)
Coccygeus - S4,S5
What is a cystocoele and a rectocoele?
Bladder/rectum bulging into vaginal wall
Why may an episiotomy minimise long-term damage?
Why is a mediolateral preferred to a midline?
Decreases uncontrolled tearing of perineum/muscles
Mediolateral has less risk of rectal herniation
What structures might you palpate during a rectal examination in males and/or females?
Both
- sacrum/coccyx
- ischial spines/tuberosities
Males
- Prostate
Females
- Cervix
What is the blood supply to the pelvis?
Mostly branches of internal iliac
- inc. pelvic organs, perineum, gluteal region
Except
- tesis
- ovary
- upper rectum
What are the significant arteries of the pelvis? What structures do they supply? (And what are they branches of?)
- *Superior and inferior vesicle** > bladder, seminal gland, prostate (sup from umbilical, inf from internal iliac)
- *Uterine artery** > uterus/uterine tube (from internal iliac)
- *Gonadal** > testis/ovaries (abdom aorta)
- *Superior rectal** > proximal rectum (inf. mesenteric)
- *Middle and inferior rectal** > distal rectum (internal iliac)
- *Vaginal** > vagina, lower bladder (from uterine artery)
- *Internal pudendal** > perineum (internal iliac)
- *Obturator** > thigh adductors (internal iliac)
What are the significant veins of the pelvis?
Internal iliac veins
Superior rectal veins
Median sacral vein
Gonadal veins
Internal vertebral venous plexus
Which part of the rectum drains into the portal circulation? Which drain into the systemic circulation?
Superior (rectal vein) to portal
Middle/inferior to systemic
Why mighte haemorrhoids be associated with liver cirrhosis?
Can be caused by portal hypertension
With which venous plexus does the prostatic venous plexus communicate on its posterior side? What is the clinical significance?
Internal vertebral
Cancer commonly spreads from this way from prostate to vertebral bodies
Where does the ilioinguinal nerve originate and what is its path?
Where does the genitofemoral nerve originate and what is its path?
Originates from L1
Enters the inguinal canal at superficial ring to supply skin at the root of the penis in male/labia in female
Genitofemoral at L1-2, enters at deep inguinal ring
What structures in the male are supplied by the genital branch of the genito-femoral nerve?
Anterior Scrotum and cremaster muscle
What is the nerve supply of the skin and muscles of the perineum? What are the segmental roots?
Pudendal nerve
S2-4
Why is the route of the pudendal nerve clinically relevant?
What bony landmarks are relevant?
Bilateral pudendal nerve block during childbirth, particularly instrument-assisted
Ischial spines used as landmarks
What are the autonomic components of the pelvic nerve supply? What do they supply?
Sympathetic fibres from L1,2 supply vas deferens, seminal vesicles, prostate, epididymis, via hypogastric plexus
Sympathetic fibres from pelvic and ovarian plexuses and parasympathetic nerve fibres from the pelvic splanchnic nerves (S2-4) supply the female genital tract
Parasympathetic fibres from S2-4 supply erectile tissues in men and women, via hypogastric plexus
What muscles serve as the erectile tissue?
Crura (men and women)
> corpora cavernosa
Bulb > corpus spongiosum
After rectal surgery, why are some men unable to ejaculate?
Injury to hypogastric plexus
What are the different groups of lymph nodes in the pelvis? Where does each drain?
External iliac
- inguinal nodes, external genitalia, vagina, and cervix
Internal iliac
- gluteal region, deep perineum, inferior pelvic viscera
Sacral
- inferior rectum, inferior vagina, posteroinferior pelvis
Common iliac
- receives from the three other groups
What are the male internal reproductive organs?
Testis
Ductus/vas deferens
Seminal glands
Prostate
Epididymis
Bulbourethral glands
What are the main contents of the spermatic cord?
Blood vessels
- pampiniform plexus
- testicular artery
- cremasteric artery
- deferential artery
Nerves
- genital branch of genitofemoral
- autonomic nerves
Other structures
- vas deferens
- lymph vessels
What is the tough outer fibrous layer of the testis?
Tunica albuginea
What is the peritoneal sac covering the testis? What is its structure?
Tunica vaginalis
Visceral and parietal layers
What is present between the tunica vaginalis layers?
Fluid
What is a hydrocoele and haematocoele in the context of the tunica vaginalis?
Collection of fluid (hydro) or blood (haemato) between layers of tunica vaginalis
What is the blood supply to the testis?
At what vertebral level does it arise and from where?
Testicular arteries
L2 from abdominal aorta
What is the route of the testicular arteries?
Travel retroperitoneally and cross the ureter and external iliac artery before travelling through inguinal canal
What is the term used for the 8-12 anastomosing veins associated with the testis?
What is their function?
Where do they drain?
Pampiniform plexus
Cools blood entering the scrotum
R testicular vein drains into IVC
L drains into left renal vein
What is a varicocoele?
Enlarged/varicose pampiniform plexus
Which two lymph node groups receive lymph from the testis?
Lumbar and para-aortic
The vas deferens and the duct of the seminal gland join to make what?
The ejaculatory duct
What secretions are produced by the seminal vesicles?
Produce/store fluid for semen
- thick alkaline fluid
What secretions are produced by the prostate?
Fluid of citric acid and proteolytic enzymes
What is the clinical significance of drainage fromt he prostatic venous plexus?
Prostate cancer can spread to vertebrae
What are the bulbourethral/cowper’s glands?
Small structures located in the urogenital diaphragm
In response to sexual stimulation prior to ejaculation, the Cowper’s glands begin producing an alkaline mucous secretion known as pre-ejaculate which neutralizes acidic urine that may still be present in the urethra while also lubricating the urethra and external urethral orifice to protect sperm from mechanical damage during ejaculation.
What is the lymphatic draiange of each of these organs?
- prostate
- seminal vesicle
- scrotum
- penis
Prostate - internal iliac/sacral nodes
Seminal vesicles - internal iliac
Scrotum - superficial inguinal
Penis - Internal iliac (body) and superficial inguinal lymph (skin)
What are the histological features of the testis (seminiferous tubules)?
Convoluted tubules sectioned in various planes
4-8 layers of cells
Spermatozoa in lumen
Leydig cells in the interstitial space
What are the histological features of the prostate?
Serous alveoli with infolding epithelium
Trabeculae of muscular stroma
Amorphous eosinophilic masses, called corpora amylacea, in the alveoli in older men
What are the histological features of the seminal vesicles?
No sperm in lumen
Highly recessed and irregular lumen forming crypts and cavities giving a honey-combed appearance
Well developed muscular externa
What are the histological features of the vas deferens?
Lumen stellate in shape
A thick walled muscular tube
Epithelial lining and its supporting lamina propria are thrown into longitudinal folds
What are the organs of the female reproductive system?
Uterus
Fallopian tubes
Vagina
Ovaries
What three structures constitute the birth canal?
Cervix
Vagina
Uterus
What are the three layers of hte uterus?
Perimetrium
Myometrium
Endometrium
What area of the uterine body does the lower segment develop from? When a caesarean delivery is done which part of the uterus is opened to deliver the baby?
Area between the cervix and uterus develops into the lower segment.
During caeserean, the uterus is opened at the lower segment with a transverse incision for delivery of the baby
What is the normal position of the uterus?
Anteverted with fundus anteflexed
What could happen if the uterus is very retroverted and retroflexed?
Uterine prolapse
Before surgical management of miscarriage, why might it be important to know whether the uterus is anteverted or retroverted?
Minimises risk of perofration with instruments
What are the three groups of ligaments in the female reproductive tract?
Broad ligament
Uterine ligaments
Ovarian ligaments
What is the broad ligament attached to? What does it contain?
Attached to the uterus, fallopian tubes and ovaries
Contains ovarian and uterine arteries
Also contains other ligaments
- Ovarian ligament
- Round ligament of uterus
- Suspensory ligament of ovary
What are the ovarian-associated ligaments? Where do they attach? Do they contain anything?
Ovarian ligament
- inferior of ovary to the side of the uterus, below origin of fallopian tubes
Suspensory ligament of ovary
- extends outwards from the ovary to the lateral abdominal wall
- contains ovarian artery, ovarian vein, ovarian nerve plexus and lymphatics
What are the uterus-associated ligaments? Where do they attach?
Round ligament
- originates at uterine horns, attaches to the labia majora, passing through inguinal canal
Cardinal Ligaments
- also known as the lateral/transverse cervical ligament
- arise from side of the cervix and lateral fornix. Extensive attachment on the lateral pelvic wall
Pubocervical Ligaments
Uterosacral Ligaments
Apart from the ligaments, what other structure in the pelvis is an important support of the uterus?
Pelvic floor muscles
What are the sections of the fallopian tubes?
Which part is longest/widest
Where does fertilisation occur?
Infundibulum
Ampulla - longest/widest - site of fertilisation
Isthmus
Intramural or uterine
What is a cornual ectopic?
Implanted at the end of the uterine tube but not properly in the uterine cavity, or in the rudimentary horns
What two major vessels supply the gonads/genitalia?
The gonadal and internial iliac arteries
At what level do the gonadal arteries originate?
L2
Which vessels do the gonadal veins drain into?
Left > left renal vein
Right > IVC
At what level does the uterine artery cross the ureter?
Level of ischial spine at the junction of cervix and lateral part of fornix of vagina
Lymph from the labia and the distal part of the vagina drain into which group of lymph nodes?
Which group receives lymph from the ovary?
Superficial inguinal
Ovary > lumbar
Where does each of these parts of the uterus drain lymph to?
- fundus/upper uterine body
- rest of uterine body
- uterine cervix and upper vagina
- lower vagina
Fundus/upper
- pre-aortic
Uterine body
- external iliac
Cervix/Upper vagina
- internal iliac/sacral
Lower vagina
- superficial inguinal
How many lobes make up the breast?
Where is the breast located?
[what a stupid question]
15-25 lobes
Extends vertically from 2nd to 6th rib and horizontally from lateral sternum to anterior axillary line
The deep surface of the breast is related to which muscles?
Pec major
Serratus anterior
Pec minor
What is the arterial supply of the breast?
Branches from subclavian and axillary arteries
Lateral thoracic > lateral mammary branches
Internal thoracic > medial mammary branches
What are the main groups of lymph nodes draining the breast tissue?
Axillary lymph nodes
Parasternal
Supraclavicular
Which group of lymph nodes first receives lymph from the lateral part (quadrant) of the breast tissue?
Pectoral (anterior lymph nodes)
What does the placenta develop from?
Develops from the trophoblast following implantation of the blasocyst into the uterine endometrium
List 4 functions of the placenta
Gaseous exchange
Nutrient/waste exchange
Protection/immunity
Endocrine/hormonal functions
When does the placenta physiologically separate from the uterine wall?
Third stage of labour after delivery of foetus
How many umbilical arteries are in the umbilical cord?
What is the function of these in the foetal circulation?
How many veins are there?
2 arteries
- takes deoxygenated blood from foetus to placenta
1 vein
What does the umbilical vein persist as?
The round ligament
What makes up the rest of the umbilical cord?
Wharton’s jelly
What are the boundaries of the male perineum?
External genitalie (urethra, scrotum, penis)
Perineal muscles
Anal canal
What are the boundaries of the female perineum?
Female external genitalia
Perineal muscles
Anal canal
Which triangle lies inferior to the pubic symphysis?
Urogenital
Which triangle lies anterioinferior to the coccyx?
Anal triangle
What is the name given to the thin sheet of deep fascia that stretches between right and left sides of the pubic arch, below the pubic symphysis?
Perineal membrane
What are the muscles of the perineum?
External anal sphincter
Superficial transverse perineal muscle
Bulbospongiosus
Ischiocavernosus
Deep transverse perineal muscle
External urethral sphincter
What is the innervation of each perineal muscle, and their actions?
External anal sphincter
- prevents faeces, also supports/fixes perineal body
Bulbospongiosus
- supports/fixes perineal body, compresses bulb of penis, acts as ‘vaginal sphincter’
Ischiocavernosus
- maintains erection of penis by obstructing outflow
Superficial/deep transverse perineal
- supports/fixes perineal body, resists increased abdominal pressure
External urethral sphincter
- compresses urethra to maintain continence
All innervated by branches of pudendal
What is the perineal body?
Irregular fibromuscular mass
Central attachment for perineal muscles
Which muscles converge towards the perineal body?
Levator ani
Bulbospongiosus
Superficial/deep transverse perineal
External anal sphincter
External urethral sphincter
What are the superficial/deep perineal pouches?
The external and internal urethral sphincters are each found in which of the pouches?
Fascia-limited, potential spaces traversed by the urethra
External urethra in Deep perineal space
Internal in subperitoneal space
Where do the superficial and deep perineal pouches lie?
Superficial
- lies antero-inferior to the urogenital membrane and surrounds external genitalia
Deep
- surrounds the deep transverse perineal muscle
What are the three parts of the male urethra?
Prostatic
Membranous
Spongy
What are the widest and narrowest parts of the male urethra?
Prostatic - widest
- where urinary and reproductive tracts meet
Membranous - narrowest
- surrounded by external urethral sphincter
What is the purpose of the ischio-anal (ischio-rectal) fossae?
Lie inferior to the pelvic floor and lateral to anal canal
- allow the anal canal to expand during defaecation
What is the major content of the ischio-anal fossae and why is it often a site of abscess formation?
Contains fat
- can swell/burst
Which structures are present in the neurovascular bundle that enters the ischio-anal fossae through the lesser sciatic foramen?
Internal Pudendal Artery and Vein
Pudendal nerve
What structure does the neurovasculature from the ischio-anal canal supply?
Vasculature to/from perineum
Innervates perineal structures
