Repro Anatomy Flashcards
name the labelled parts of the pelvis
What is the true pelvis?
true pelvis is the area between the pelvic inlet, and the pelvic outlet
what is the landmark which separates the true pelvis from the false pelvis?
The pelvic inlet separates the true and false pelvis
Name the labelled parts of the pelvis
What type of joint is the sacroiliac joint?
Synovial plane
What type of joint is the pubic symphysis?
Secondary cartilaginous
Describe how a male and female’s FALSE pelvis structure differs
Female false pelvis = shallow
male false pelvis = deep
Describe how a male and female’s TRUE pelvis structure differs
Female true pelvis = wide and shallow
male false pelvis = narrow and deep
Describe how a male and female’s pelvic inlet differs
Female pelvic inlet = oval and rounded
Male false pelvis = heart shaped
Describe how a male and female’s pelvic outlet structure differs
Female pelvic outlet = comparatively large
Male pelvic outlet = comparatively small
Describe the difference between the suprapubic angle of a male and female
Female = obtuse (greater than 90)
Male = acute (less than 90)
Identify which pelvis is male and which is female
What is the narrowest diameter of the pelvic INLET in females?
13cm
What is the narrowest diameter of the pelvic OUTLET in females?
11cm
Name the muscles of the pelvis labelled
which muscle makes up the posterior wall of the pelvis?
Piriformis
Which nerve plexus sits on piriformis?
The sacral plexus
Which muscle does the sacral plexus sit on?
Piriformis
Name the muscles
Name the muscles
What is the perineal body?
a fibromuscular node lying in the midline of the perineum.
What is the function of the perineal body?
provides an anchor point for several of the muscles within the perineum
What is the anococcygeal body?
A ligament which runs between the coccyx and the rectum
Which muscles does the anococcygeal ligament/body run between?
It runs between the two walls of the levator ani muscle
What are the two muscles which make up the pelvic floor?
coccygeus and levator ani
What are two functions of the pelvic diaphragm?
Continence (urine and faeces)
Support for the abdominal viscera including the rectum
What nerves innervate the muscles of the pelvic floor? (Levator ani and coccygeus)
Pudendal nerves (S2, 3, 4) and anterior rami of S4
What are the roots of the pudendal nerve?
S2, 3, 4
What is a cystocele?
the bladder and vaginal wall fall into the vaginal canal.
What is a rectocele?
the front wall of the rectum sags and bulges into the vagina
Why are episiotomies performed?
To prevent a midline tear (a midline tear will damage the perineal body)
Name the labelled branches of the internal iliac artery
Which arteries supply the bladder, seminal gland and prostate?
Superior and inferior vesical (branch of anterior division of internal iliac artery)
Which artery supplies the uterus?
Uterine artery (branch of anterior division of internal iliac)
Which artery supplies the ovaries/testes?
Gonadal artery (ovarian or testicular) - branch of abdominal aorta
Which artery supplies the superior 2/3rds of the rectum?
Inferior Mesenteric Artery
Which artery supplies the inferior 1/3rd of the rectum?
the middle and inferior rectal arteries (branches of the internal iliac)
Which artery supplies the vagina and the base of the bladder?
The vaginal artery (branch of the uterine artery)
What is the main artery to the perineum?
The internal pudendal artery (brach of anterior division of internal iliac artery)
What organs are supplied by the superior and inferior vesicle arteries?
The bladder, seminal gland and prostate
Which organ is supplied by the uterine artery?
Uterus
Which organs are supplied by the gonadal arteries?
Ovaries (ovarian artery) and testes (testicular artery)
Which organ is supplied by the Inferior Mesenteric artery?
superior 2/3rds of the rectum
Which organ is supplied by the middle and inferior rectal artery?
The inferior 1/3rd of the rectum
Which parts of the rectum drain into the portal circulation?
the upper 1/3rds (via the superior rectal vein)
Which part of the rectum drains into the systemic circulation?
The lower 2/3rds via the the middle and inferior rectal veins
With which venous plexus does the prostatic venous plexus communicate with on its posterior side?
The internal vertebral venous plexus
Why is prostate cancer so often associated with spinal metastases?
Because the prostatic venous plexus communicates with the internal vertebral venous plexus
What is the nerve root of the ilioinguinal nerve?
L1
What does the ilioinguinal nerve supply?
Skin at the root of the penis in males
Labia in females
Where does the ilioinguinal nerve enter the inguinal canal?
At the superficial inguinal ring
What is the root value of the genitofemoral nerve
L1-2
What does the genital branch of the genitofemoral nerve supply?
Cremaster muscle and anterior scrotal skin
Which reflex can be used to assess for testicular torsion?
The cremaster reflex
Which nerve plexus gives of the pudendal nerve?
Sacral plexus
What does the pudendal nerve innervate?
Skin and muscles of the perineum
What is the root value of the pudendal nerve?
S2-4
What kind of nerve block is used in instrumental deliveries?
Pudendal nerve block
What bony landmarks are used when performing a pudendal nerve block?
The ischial spines
Where does the autonomic nerve supply to the pelvis originate from?
The hypogastric plexus
Where do sympathetic fibres supplying the pelvis originate from (remember autonomic supply comes from the hypogastric plexus so it must come from somewhere in there!)
Sympathetic = L1 and L2 via hypogastric nerve
Which male and female reproductive organs have sympathetic supply?
Male - vas deferent, seminal vesicles, prostate and epididymis
Females = Ovaries, uterus, Fallopian tubes and vagina
Where do parasympathetic nerve fibres which supply the pelvis originate from?
Pelvic splanchnic nerves (S2-4)
After rectal surgery, why are some men unable to ejaculate?
Damage to the parasympathetic pelvic splanchnic nerves
What is drained by the external iliac lymph nodes?
Urinary bladder
prostate
membranous urethra
Cervix
Upper part of vagina
What is drained by the internal iliac lymph nodes?
Gluteal region
Deep perineum
Pelvic viscera
What is drained by the sacral lymph nodes?
Posteroinferior pelvic viscera
sacrum
Which lymph nodes drain the urinary bladder, prostate, membranous urethra, cervix and upper part of vagina?
External iliac lymph nodes
Which lymph nodes drain the gluteal region, deep perineum and inferior pelvic viscera?
Internal iliac lymph nodes
Which lymph nodes drain the posterior inferior pelvic viscera and the sacrum?
Sacral lymph nodes
Which lymph nodes drain the ovaries?
ovaries are drained via:
- the ovarian ligament (to lymph nodes in the obturator fossa and the internal iliac region)
- the suspensory ligament (towards para-aortic and paracaval lymph nodes)
Which lymph nodes drain the uterus?
Primarily the obturator lymph nodes
Which lymph nodes drain the testes?
Para-aortic lymph nodes (Of the structures comprising the male external genitalia, the testes are the only ones that do not drain to the inguinal lymph nodes)
Name the bony landmarks that create the boundaries of the perineum
What is the name of the orange triangle?
The urogenital triangle
What is the name given to the green triangle?
The anal triangle
A thin sheet of fascia stretches between the right and left sides of the pubic arch, below the pubic symphysis. What is the name of this fascia?
the pubocervical fascia
What is the function of the external anal sphincter?
Voluntary control of defecation
What is the nerve supply of the external and internal anal sphincters?
Pudendal nerve S2-4
What is the function of the superficial transverse perineal muscle?
Stabilises the perineal body
What is the nerve supply of the superficial and deep perineal muscles?
Pudendal nerve (S2-4)
What is the function of the deep transverse perineal muscle?
Fixes the perineal body
Expels semen and the last drops of urine
What is the function and the nerve supply of the external urethral sphincter?
Compresses the urethra to maintain urinary continence
Supplied by pudendal nerve S2-4
What is the function of the bulbospongiosus muscle in the male?
helps to empty the penile urethra in urination and ejaculation
What is the function of bulbospongiosum in females?
clitoral erection, contractions of orgasm and closing of the vagina
What nerve supplies the bulbospngiosum muscle in males and females?
Pudendal nerve S2-4
What is the function of ischiocavernosum in males?
Compresses the penile crus which provides extra rigidity to the erect penis
What is the function of ischiocavernosus in the female?
Tenses the vagina during orgasm
What nerve supplies ischiocavernosus in males and females?
Pudendal nerve (S2-4)
Name the two layers of fascia which make up the pelvic diaphragm
Superior and inferior pelvic fascia
Which structures pierce the pelvic diaphragm?
Vagina, urethra, rectum
Label the following diagram
Name the three parts of the male urethra
Prostatic
Membranous
Spongy (longest
Which part of the male urethra is the widest?
Prostatic part
Which part of the male urethra is the narrowest part?
Membranous part
What is the end of the penis called?
Glans penis
Label the diagram below
What is the name given to the fascial layer which covers the corpus callous?
Tunica albuginea
What structure surrounds the penile urethra?
Corpus spongiosum
Sensory innervation of the penis is through which nerve?
The Doral penile nerve (branch of pudendal S2-4)
Where is the internal urethral sphincter located?
In the neck of the bladder
Is the internal urethral sphincter voluntary or involuntary?
Involuntary
What is the innervation of the internal urethral sphincter?
Sympathetic T11-L2
Parasympathetic S2-4
Where is the external urethral sphincter found in males?
In the membranous urethra just below the prostate
Where is the external urethral sphincter found in females?
Distally and inferiorly to the bladder neck between the vaginal orifice and clitoris
Is the external urethral sphincter voluntary or involuntary?
Voluntary
What is the innervation of the external urethral sphincter?
Deep branch of perineal nerve (of pudendal nerve) (S2-S4)
Label the internal and external urinary sphincters in the male
Label the internal and external urinary sphincters in the female
Which urinary sphincter is voluntary and which is involuntary?
Internal = involuntary
External = voluntary
Name the contents of the vulva (9)
- labia majora
- labia minora
- clitoris
- vulva vestibule
- urethra
- vaginal opening
- Mons pubis (fat pad)
- Bartholian’s glands
Name the nerve and artery that supply the vulva and all of the structures contained within it
Pudendal nerve and internal pudendal artery
What is contained within the vulval vestibule?
urethra and vagina (enclosed by the labia minora)
Which Male tissue is the clitoris equivalent to?
The corpus cavernosum
Name the sphincters in control of defecation
Internal and external anal sphincters
Which anal sphincter is voluntary?
External
Which anal sphincter is involuntary?
Internal
What is the function of the fat filled ischia-anal fossae?
Allow the anal canal to expand during defication
Label the diagram
Which vessels and nerves travel through the lesser sciatic foramen?
Pudendal artery, nerve and vein
What three structures constitute the birth canal?
Vagina, cervix & vulva
Label the structures
Label the structures
What are the three layers of the uterus?
Perimetrium (outer), myometrium & endometrium (inner)
When a caesarean delivery is done which part of the uterus is opened to deliver the baby?
Lower
Which angle is the angle of flexion and which is the angle of version
How is the normal position of the uterus described?
Anteverted and ante flexed
what is the normal angle of ante version?
What is the normal angle of anteflexion?
170
What is the name given to describe a uterus that flexes backwards instead of forwards over the bladder?
Retroverted uterus
How many vaginal fornices are there?
4 (anterior, posterior and 2x lateral)
What is the name given to the space which lies between the rectum and the uterus?
rectouterine pouch/pouch of Douglas
What is the name given to the space between the bladder and the uterus?
Vesicouterine pouch
Through which vaginal fornix you can access the rectouterine pouch?
The posterior fornix
What structures does the ovarian ligament connect
Ovarian ligament= connects ovary to uterus
What structures does the suspensory ligament of the ovary connect?
Suspensory ligament of the ovary = ovary to pelvic wall
What structures does the round ligament attach?
round ligament = sides of the uterus to the mons pubis
What structures does the broad ligament attach?
Uterus to lateral pelvic wall
Which ligament travels within the broad ligament?
The round ligament
Which ligament is sometimes referred to as the cardinal ligament?
The cervical ligament
Which structures does the cardinal ligament attach?
Lateral aspect of cervix and lateral vagina to the lateral pelvic walls
Name the parts of the uterine tube
In which part of the uterine tube does fertilisation occur?
In the ampulla
What is an ectopic pregnancy?
A pregnancy occurring outside of the uterus
What is a corneal ectopic?
A pregnancy in the uterine horn (where the Fallopian tube and the uterus meet)
Name the two ligaments which support the ovaries
ovarian ligament (1)
Suspensory ligament of the ovary (2)
What is the name of the artery that supplies the ovary?
Ovarian artery
do the ovarian arteries originate from?
L2 on the abdominal aorta
which ligament carries the ovarian arteries to the ovaries?
The suspensory ligament of the ovary
blood vessel does the ovarian artery anastomose with?
The uterine artery
Where do the right and left ovarian veins drain into?
RIKL
Right = IVC
Left = Left renal vein (kidney)
Where does the uterine artery branch from?
The internal iliac artery
Which structure passes under the uterine artery?
The ureter (water under the bridge)
Which lymph nodes drain the ovary?
Pre-aortic nodes
Which lymph nodes drain the uterine body?
Pre-aortic
Which lymph nodes drain the cervix and upper vagina?
Internal iliac and sacral lymph nodes
Which lymph nodes drain the lower vagina?
Superficial inguinal lymph nodes
What are the bony relations associated with the breast
2nd - 6th rib
lateral border of the sternum- midaxillary line
Which muscles lie deep to the breast?
Pectoralis major, pectorals minor and serrates anterior
Which arteries supply the breast?
Lateral thoracic artery (branch of axillary)
Medial mammary (branch of subclavian)
The veins have the same names
Name the 4 groups of lymph nodes which drain the breasts
- Apical lymph nodes
- central lymph nodes
- Pectoral lymph nodes
- Internal thoracic lymph nodes
Which group of lymph nodes drains the lateral quadrant of the breast?
axillary
Identify the tissue
breast (before pregnancy)
Identify the tissue
Breast (during pregnancy)
Identify the tissue
breast (lactating)
Identify the tissue
Uterus (proliferative stage)
Identify the tissue
Uterus (secretory phase)
Identify the structure
Fallopian tube
Which surface of the placenta is shown here?
Foetal surface
Which surface of the placenta is shown here?
Maternal surface
List 4 functions of the placenta
Gas exchange
Nutrient exchange
Immunity transmission (from mother to baby)
Produces HCG
At which stage of labour does the uterus separate from the uterine wall?
The third stage of labour
Identify the tissue
Umbilical cord
What do the letters in the image represent?
A= Artery
V= vein
W = Wharton’s jelly
The umbilical artery carries oxygenated/deoxygenated blood
Deoxygenated blood (from foetus to mother)
The umbilical vein carries oxygenated/deoxygenated blood?
Oxygenated (from mother to foetus)
What structure (ligament) does the umbilical vein persist as in adult?
Round ligament of liver (also called ligamentum teres)
the round ligament forms the EDGE of the falciform ligament
Label the following diagram
What is the name of the canal that the testis passes through during development?
The inguinal canal
What is the name of the structure that pulls the testes down through the abdomen during growth and development?
The gubernaculum
From outside to inside, list the layers of skinned fascia surrounding the testes
Skin
Dartos muscle
external fascia
internal fascia
Tunica vaginalis (parietal layer)
Cavity of tunica vaginalis
Tunica vaginalis (visceral layer)
Tunica albuginea
testes
Name the inguinal rings
What is contained within the spermatic cord? (8)
- Testicular artery (branch of aorta)
- Cremasteric artery and vein (supplies cremasteric muscle and fascia)
- Artery to the vas deferens (branch of the inferior vesicle artery, which arises from the internal iliac.)
- Pampiniform plexus of testicular veins – drains venous blood from the testes into the testicular vein.
- Genital branch of the genitofemoral nerve – supplies the cremaster muscle and autonomic nerves
- Vas deferens
- Processus vaginalis – projection of peritoneum that forms the pathway of descent for the testes during embryonic development. In the adult, it is fused shut.
- Lymph vessels – these drain into the para-aortic nodes, located in the lumbar region.
What is the tough outer fibrous layer of the testis called?
Tunica albuginea
What is the arterial supply of the testes?
testicular artery
Where do the testicular arteries arise from?
Abdominal aorta at L2
Which structures do the testicular arteries cross?
Genitofemoral nerve and ureter
What is the term used for the 8-12 anastomosing veins associated with the testis?
Pampiniform plexus of the testes
What is the function of the pampiniform plexus?
Drains the testes and helps in temperature regulation
Explain the venous drainage of the left and right testes
RIKL
Right = IVC (via right pampiniform plexus)
Left = left renal vein (via the left pampiniform plexus)
What is a varicocele?
Large tortuous veins in the pampiniform plexus
What is the main cause of varicocele?
Defective valves in the scrotum
Which lymph nodes drain the prostate?
Internal iliac and sacral lymph nodes
Which lymph nodes drain the seminal vesicles?
Internal and external iliac nodes
Which lymph nodes drain the scrotum?
Superficial inguinal lymph nodes
Which lymph nodes drain the penis?
superficial inguinal
lateral sacral
hypogastric
What is the function of the epididymis?
Stores sperm
What is the function of the vas deferent?
takes sperm from the epididymis to the ejaculatory duct
What is produced by the seminal vesicles?
Alkaline component of semen
contains fructose (energy for sperm), prostaglandins (helps with sperm mobility), and proteins
What does the prostate produce?
Liquid component of semen
citric acid, proteolytic enzymes, clotting enzymes
Why does an enlarged prostate cause issues with urinary retention?
the prostate surrounds the prostatic urethra therefore if it enlarges it compresses the urethra
Why do patients with prostate cancer often present with spinal mets?
Because the prostatic venous plexus anastomoses with the internal venous vertebral plexus
What is the arrow pointing to?
The bulbourethral glands/ Cowper’s glands
What secretions are produced by Cowper’s glands?
Clear, colourless, mucoid secretions which are released prior to ejaculation
What is the function of the secretions from Cowper’s glands?
Designed to neutralise the male urethra to protect sperm cells
lubricates the penis
helps neutralise the vagina (some of the cowper’s gland secretions are also added to seminal fluid)
What is this?
Vas deferens
What is this?
Seminal vesicle
What is this?
Epididymis
What is this?
Testes
What is this?
Prostate
During which week of development do mammary crests form?
4th week
How many lobes make up a breast?
15-25
Breasts are highly modified sweat glands- true or false?
True
What is the name of the duct that drains the breast?
Lactiferous duct
What is the name of the ligament that anchors the breast to the dermis?
Suspensory ligament of Cooper
What is the nerve supply of the breast?
anterior and lateral cutaneous branches of the 4th-6th intercostal nerves
Which cells produce sperm?
Germ cells
What is the function of sertoli cells?
Produce inhibit and support sperm producing cells
Which structures produce:
A) Liquid component of semen
B) Mucoid component of semen
C) Alkaline component of semen
?
A) Liquid component = Prostate
B) Mucoid component = Cowper’s glands
C) Alkaline component = seminal vesicles
What is the function of the rate testes?
Move sperm from testes to epididymis via ciliary action
What type of epithelium lines the seminal vesicle?
Pseudostratified columnar
What kind of epithelium lines the ductus deferens?
Pseudostratified columnar
Which structures come together to form the ejaculatory duct?
Vas deferens and seminal vesicle
Which two structures help to control the temperature of the testes?
Dartos muscle and cremaster muscle
How does the cremaster muscle help with thermoregulation?
darts expands or contracts to wrinkle the scrotal skin (changes surface area)
Explain how the cremaster muscle helps with thermoregulation of the testes
Contracts and brings the testes closer to the body for warmth and relaxs allowing the testes to drop away from the body when they need to cool
Which nerve innervates the cremaster muscle?
Genitofemoral (genital branch)
How many bulbs of corpus spongiosum are found in males and females?
One in males
Two in females
What do leading cells produce?
Testosterone
Where can leydig cells be found?
In the interstitum between semineferous tubules in the testes
In the female, there is a vesicuouterine pouch and a rectouterine pouch. what is the name of the pouch found in men?
Vesicorectal pouch
What is the round ligament the uterus a remnant of?
The ovarian gubernaculum
Which ligaments travel through the broad ligament
Round and ovarian
What kind of epithelium lines the prostate?
Simple cuboidal
Which muscle forms the posteriolateral wall of the pelvis?
Piriformis
Which muscle forms the anterior lateral wall of the pelvis?
Obturator interns
Name the structures
Name the structures
Name the structures
What is the embryological origin of the reproductive system?
The mesonephros (one of the 3 primitive kidneys)
How does the reproductive tract know if is male or female?
The Y chromosome codes for an SRY gene which causes the production of testis determining factor
What is the embryological origin of the vas deferens and the seminal vesicle?
mesonephric duct
What is the embryological origin of the Fallopian tube, uterus, cervix & upper vagina?
Paramesonephric duct
What is the prostate an outgrowth of?
The urethra
What is this?
Complete duplication of the uterus (caused by an abnormality in the paramesonephric duct during development)
What is this called?
Septate uterus (caused by a problem with the paramesonephric duct during development)
What is this called?
Bicornate uterus (caused by a problem with the paramesonephric duct during development)
What is this?
Arcuate uterus (caused by a problem with the paramesonephric duct during development)