Repro Flashcards by Kerrie McNulty

What are general features of the breast?

Modified and highly specialised sweat glands

No special capsule or sheath

Both males and females

Well developed in females

Breast size and shape result from genetic, racial and dietary factors

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What is the breast location?

Extends vertically from the 2nd to 6th rib

Transversely from sternal edge to midaxillary line

Lies on deep pectoral fascia

Axillary tail (of spence) or process; small part may extend towards axillary fossa

Retromammary space helps some degree of movement

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What are the breast relations?

2/3rd of breast rests on pectoralis fascia covering pectoralis major

1/3rd rests on fascia covering serratus anterior

Firmly attached to dermis by suspensory ligament of cooper; helps support lobules of the gland

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What are structures of the breast?

Nipple; prominence
Areola; pigmented area around nipple

Each breast contains 15-20 lobules of glandular tissue (parenchyma))

Each lobule is drained by a lactiferous duct; opens independently on the nipple

Each duct has a dilated portion; lactiferous sinus

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Describe the nipple

No fat or hair

Contains collagenous dense connective tissue, elastic fibres and bands of smooth muscle

Tips are fissures with lactiferous ducts opening into them

Position; variable or 4th intercostal space

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Describe the areola

Skin covering nipple and areola contains numerous sweat and sebaceous glands

Enlarge during pregnancy

Oily materia secreted by sebaceous gland provides a protective lubricant for nipple and areola

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What are the breast quadrants?

Used for anatomical location and description of pathology

Superolateral
Superomedial
Inferolateral
Inferomedial

Axillary tail is an extension in the superolateral quadrant

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Describe the male breast

Rudimentary throughout life

Formed by small ducts without lobules or alveoli

Little supporting fibroadipose tissue

Temporary enlargement in newborn and during puberty

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Describe the development of the breast

Mammary crests/ridges appear during 4th week

These extend from axillary to inguinal region

Crests usually disappear except in pectoral region

Primary mammary buds - secondary buds - lactiferous ducts and their branches

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What are breast related conditions?

Gynecomastia; postnatal development of rudimentary lactiferous ducts in males, during midpuberty ~2/3 males develop varying degrees of hyperplasia of breast

Supernumerary breast and nipples

polymastia; extra breast
poluthelia; extra nipple

Athelia or amastia is absence of nipple or breast

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Describe the blood supply of the breast

Branches of axilary artery, internal thoracic and some intercostal

thoraco-acromial artery
lateral thoracic artery
internal mammary (thoracic) artery

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Describe the nerves of the breast

Anterior and lateral cutaneous branches of 4th - 6th intercostal nerves

They convey sensory fibres to skin of breast

Also carry sympathetic fibres to blood vessels and to smooth muscle around nipple

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Describe the lymphatic drainage of the breast

Great clinical significance due to mets

Breast lymphatics branch extensively and do not contain valves

Most lymph (>75%) from lateral quadrants -> axillary lymph nodes

Some lymph may drain directly to supraclavicular/infraclavicular or inferior cervical nodes

Lymph from medial quadrants - parasternal or to opposite breast

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What is the role of sentinel node biopsy and how is it carried out?

First draining node

Lymphatic mapping and staging of patients

A radiolabelled colloid used to locate sentinel node

At time of surgery a blue dye is injected

Combination of radioisotope and dye provides most accurate means

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Describe the soft tissue of the breast

Made up of lobes which contain a network of glandular tissue consisting of branching ducts and secretory lobules

Terminal duct lobulr unit is the functional secretory component

Connective tissue stroma surrounding lobules; dense and fibrocollagenous

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What lines the ducts and acini of the breast?

Epithelial cells and myoepithelial cells

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What are age related pre-pubertal changes in the breast?

Neonatal breast contain lactiferous ducts but no alveoli

Until puberty, little branching of ducts occurs

Slight breast enlargement reflects growth of fibrous stroma and fat

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What are age related pubertal changes in the breast?

Branching of lactiferous ducts

Solid sphenoidal masses of granular polyhedral cells (alveoli)

Accumulation of lipids in adipocytes

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What are age related post-menopausal changes in the breast?

Progressive atrophy of lobules and ducts

Fatty replacement of glandular tissue

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Describe changes in the breast during pregnancy

Enlarged lobules

Acini dilated

Epithelium vary from cuboidal to low columnar

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Describe the lactating breast

Acini distended with milk

Thin septa between lobules

At higher magnification; acini with eosinophilic material containing clear vacuoles

Milk production; suckling (neurohormonal) prolactin and oxytocin

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What are diagnostic investigation methods for the breast?

Imaging; mammography and US

Fine needle aspiration cytology

Core biopsy

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Describe breast cancer commonality

20% of all cancers in women

Commonest cause of death in women 35-55

In UK any woman has 1 in 9 chance of developing breast cancer

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What are some benign breast tumours?

Fibroadenomas
Duct papillomas
Adenomas
Connective tissue tumours

Paget’s disease of the nipple

erosion of nipple resembling eczema
associated with ductal or invasive carcinoma

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What are the boundaries of the pelvic outlet? (inferior pelvic aperture)

- Coccyx - Ischial tuberosities - Sacrotuberous ligament - Pubic symphysis

What type of joint is the sacroiliac joint?

Synovial plane

What type of joint is the pubic symphysis?

Secondary cartilaginous

Where does the piriformis muscle lie?

Most posterior pelvic wall muscle Passes through greater sciatic foramen to upper part of greater trochanter

What is the innervation of the piriformis muscle?

Ventral rami of S1 and S2

What is the function of the piriformis muscle?

External rotation hip Abduction of hip

Where does the obturator internus lie?

Lateral pelvic cavity wall Wraps out and inserts on posterior aspect of femur

What is the innervation of the obturator internus?

Obturator internus nerve (L5-S2)

What is the function of the obturator internus?

External rotation Stabilises head of femur in socket

What do the sacrospinous ligaments connect?

The sacrum to the ischial spines

What do the sacrotuberous ligaments connect?

The sacrum to the ischial tuberosities

What are the levator ani muscles?

From anterior to posterior Puborectalis Pubococcygeus Iliococcygeus (beside other two)

What is the most inferior pelvic floor muscle?

Ischiocavernosus

What nerve/roots innervate the levator ani muscles?

Branches of pudendal nerve (S2,3,4) and anterior rami S4

What nerve roots innervate the coccygeus?

anterior rami S4 and 5

What is a cystocoele?

prolapsed bladder woman's bladder bulges into her vagina

What is a rectocoele?

Condition in which wall separating rectum from vagina weakens causing vaginal wall to bulge

Where do the superior and inferior vesical arteries originate and what do they supply?

Internal Iliac Artery Bladder, seminal gland and prostate in males

Where does the uterine artery originate and what does it supply?

Internal Iliac Artery Uterus

Where do the gonadal (testicular or ovarian) arteries originate and what do they supply?

Abdominal aorta (below renal arteries) Testis or Ovary

Where does the superior rectal artery originate and what does it supply?

internal Iliac Upper 1/3 rectum

Where do the middle and inferior rectal arteries originate and what do they supply?

Internal iliac Lower 2/3 rectum

Where does the vaginal artery originate and what does it supply?

Uterine artery vagina and base of bladder

Where does the internal pudendal artery originate and what does it supply?

Internal iliac Main artery to perineum

Where does the obturator artery originate and what does it supply?

internal iliac Ileum, pelvic muscles, head of femur, muscles and skin of middle thigh

What rectal veins are part of the systemic circulation?

lower and middle rectal veins

What does the prostatic venous plexus communicate with posteriorly?

vertebral venous plexus

What nerves make up the somatic component of the repro neural supply?

Ilioinguinal Genito-femoral Pudendal

Describe the ilioinguinal nerve

Root origin: L1 Enters pelvis via superficial inguinal ring Supplies; skin at root of penis, labia

Describe the genito-femoral nerve

Root origin; L1/L2 Enters pelvis via deep inguinal ring Supplies; cremaster muscle, spermatic cord, anterior scrotal skin, labia majora and round ligament of uterus

Describe the pudendal nerve

Root origin; S2-S4 Passes between piriformis and coccygeus, exits pelvis through lower part greater sciatic foramen then re-enters through lesser sciatic foramen Supplies; skin and muscles of perineum, 3 branches dorsal clitoral, perineal, rectal

What makes up the sympathetic component of the repro neural supply?

L1/2 via hypogastric plexus Supplies vas deferens, seminal vesicles, prostate and epididymis

What makes up the parasympathetic component of the repro neuro system?

S2/3/4 via hypogastric plexus Supplies erectile tissues in male and female

What are the main lymph nodes draining the pelvis?

External iliac nodes Internal iliac nodes Sacral nodes Common Iliac nodes

What do the external iliac lymph nodes drain?

Prostate, bladder, membranous urethra, cervix, upper vagina

What dot he internal iliac lymph nodes drain?

Gluteal region, deep perineum, inferior pelvic viscera

What do the sacral lymph nodes drain?

Posterior inferior pelvic viscera

What do the common iliac lymph nodes drain?

The three other groups of pelvic lymph nodes - external iliac - internal iliac - sacral

What do the bulbourethral glands do?

Add fluid to semen during ejaculation Alkaline fluid

What do the vas deferens do?

Transports mature sperm to urethra

What does the prostate do?

Secrete prostatic fluid (component of semen)

What are the layers of the inguinal canal?

From external to internal - skin - dartos muscle - 3 fascia layers - cavity of tunica vaginalis - epididymis and testis

What are the main contents of the spermatic cord?

Vas deferens Blood vessels Nerves Lymphatics

What is the tunica albuginea?

Layer covering the testis; tough, fibrous layer

What are the two layers of the tunica vaginalis and what material is present between them?

Visceral and parietal thin fluid layer; reduces friction between testes and scrotum

What vertebral level do testicular arteries arise from aorta?

What structures do the testicular arteries cross?

Ureter | Genito-femoral nerve

What is the term for the anastomosing veins associated with testis?

8-12 veins Pampiniform plexus

What is the function of the pampiniform plexus?

Temperature regulation Countercurrent heat exchanger with nearby arteries

Into which veins do the testicular veins drain?

Right testicular vein --> IVC Left testicular vein --> left renal vein

What is varicoele?

Distended testicular veins (pampiniform plexus)

Which lymph nodes receive lymph from testes?

Lateral aortic/lumbar Pre-aortic This is due to testes arising from abdominal region and migrating downward during development

What do the seminal vesicles produce?

Semenogelin; makes semen sticky, protein

What lymph nodes drain the prostate?

Internal iliac (primarily) and sacral nodes

What lymph nodes drain the seminal vesicles?

Internal and external iliac nodes

What lymph nodes drain the scrotum?

Inguinal lymph nodes

What lymph nodes drain the penis?

Inguinal lymph nodes

What is the innervation of the external anal sphincter?

Inferior anal nerve

Which nerve network lies on piriformis muscle?

Sacral plexus

What are functions of the pelvic floor?

Support pelvic viscera Continence Urine and faeces passage

What is the perineal body?

Central tendon of perineum

What is the annococcygeal body?

fibrous median raphe in floor of pelvis extending coccyx --> margin of anus

How may an episiotomy prevent long term damage?

Prevent rupture of tissues

Which parts of the rectum drain into the portal circulation?

upper third

Describe neural supply of female genital tract

Symp nerve fibres from pelvic and ovarian plexuses and parasymp nerve fibres from pelvic splanchnic nerves (S2, 3 and 4)

What are the male repro organs?

``` Testis Vas deferens Seminal glands Prostate Epididymis Bulbourethral glands ```

What part of the urethra does the prostate surround?

Prostatic urethra

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

Bone mets in prostate cancer

What are histological features of testis?

- convoluted tubules - 4-8 layers of cells - spermatazoa in lumen - leydig cells in interstitium

What are histological features of prostate?

- serous alveoli with infolding epithelium - trabeculae of muscular stroma - amorphous eosinophilic masses, called corpora amylacea

What are histological features of seminal vesicle?

- no sperm in lumen - highly recessed and irreg lumen forming crypts and cavities - honeycomb appearance - well-developed muscular externa

What are histological features of vas deferens?

- lumen stellate in shape - thick walled muscular tube - epithelial lining and supporting lamina propria are thrown into longitudinal folds

What are the three structures of the birth canal?

Vagina Cervix Uterus

What are the three layers of the uterus?

Endometrium (inner layer) Myometrium (middle layer, thickest) Perimetrium (outer layer, serous)

What area of the uterine body does the lower segment develop from in pregnancy?

Isthmus

What is the normal position of the uterus?

Anteflexed | Anteverted

What are the fornices of the vagina?

Superior portions extending into recesses created by vaginal portion of cervix

Through which vaginal fornix can you access the rectouterine pouch?

posterior fornix

What are the ligaments anchoring the uterus and cervix in place?

Ligament of ovary Suspensory ligament of ovary Round ligament of uterus Broad ligament

Which ligament is called the cardinal ligament of the uterus?

lateral cervical ligament

Apart from pelvic fascia, what other structure in the pelvis is also an important support of the uterus?

muscles of pelvic floor

What are the parts of the uterine tube?

Infundibulum Fimbria Ampulla Intramural/uterine part (isthmus)

What part of uterine tube is longest and widest?

Ampulla

Which part of uterine tube does fertilisation occur in?

Ampulla

What is a cornual ectopic pregnancy?

Rare form of ectopic where implantation occurs in a cavity of a rudimentary horn of uterus

What are the ligaments associated with the ovary?

From uterus to ovary; ovarian ligament | Ovary to lateral pelvic wall; suspensory ligament of ovary

At what vertebral level do gonadal arteries originate?

Describe the route of the ovarian artery

descends within the suspensory ligament to supply the ovaries via broad ligament

Where does the uterine artery cross over the ureter?

Level of ischial spine

Which group of lymph nodes drain the labia and distal vagina?

External iliac

Which group of lymph nodes drain the ovaries?

Para-aortic

What lymph nodes drain the fundus and upper uterine body?

para-aortic lymph nodes

What lymph nodes drain most of uterine body?

external iliac

What lymph nodes drain uterine cervix and upper vagina?

Internal iliac and sacral

What lymph nodes drain lower vagina?

superficial inguinal

Which part of male urethra is widest and most dilatable?

Prostatic

Which part of male urethra is narrowest and longest?

Spongy

Which part of male urethra is shortest?

Membranous Surrounded by external urethral sphincter