Reproductive Anatomy Flashcards
1
Q
Name the structures that define the superior pelvic aperture
A
- Sacral promontory
- Ala of the sacrum
- Arcurate line of the ilium
- Pecten pubis (ridge on the superior rams of the pubic bone)
- Pubic tubercle
- Pubic crest
- Pubic symphysis
2
Q
What is the sexual diamorphism of the greater pelvis?
A
Females have a shallow greater pelvis
Males have a deep greater pelvis
3
Q
What is the sexual diamorphism of the lesser pelvis?
A
Females have a wide lesser pelvis
Males have a narrow lesser pelvis
4
Q
What shape is the pelvic inlet in both sexes?
A
Females have an oval/rounded shaped pelvic inlet
Males have a heart shaped one
5
Q
What is the difference in relative size of the pelvic outlet between the two sexes?
A
Female relatively large
Male relatively smaller
6
Q
What is the sexual diamorphism of the suprapubic angle?
A
Female - Obtuse: greater than 90 degrees
Male - Acute: less than 90 degrees
7
Q
What is the difference in shape of the obturator foramen in men and women?
A
Female - oval
Male - round
8
Q
What is the sexual diamorphism of the relative size of the acetabulum?
A
Female relatively small
Male relatively large
9
Q
What are the two types of joints found in the pelvis?
A
Planar synovial e.g. sacroiliac joint
Pubic symphysis e.g. secondary cartilaginous
10
Q
What is the pelvic brim?
A
The edge of the superior pelvic aperture - anything superior to this point is known as the greater (false) pelvis and inferior to this point, the lesser (true) pelvis
11
Q
Why is the greater pelvis known as the false pelvis?
A
Contains the inferior part of the peritoneal cavity (i.e. intestines and other abdominal organs)
12
Q
Why is the lesser pelvis known as the true pelvis?
A
Contains true pelvic organs (i.e. reproductive systems)
13
Q
What walls does the pelvic cavity have?
A
Antero-inferior wall, two lateral walls and a posterior wall
14
Q
What is the antero-inferior wall made of?
A
Bodies and rami of the pubic bones and the pubic symphysis
15
Q
What is the lateral walls made of?
A
Obturator internus and the piriformis muscles
16
Q
What is the posterior wall made of?
A
Coccygeus muscle
17
Q
What is the pelvic floor?
A
Funnel-shaped ‘hammock’ of muscles and fascia that separates the pelvic cavity from the perineum, inferior to which the genitalia and anus sit
18
Q
How does the pelvic floor allow for defaection and urination?
A
Hiatuses for the anal and urethral canal
19
Q
Between anal and urethral hiatuses lies a fibrous node of connective tissue known as what?
A
Perineal body
20
Q
What are the functions of the pelvic floor?
A
- Support of abdomen-pelvic viscera
- Resistance to increases in intra-pelvic/abdominal pressure
- Urinary and faecal incontinence
21
Q
What are the muscles of the pelvic floor?
A
- Levator ani muscles
- Coccygeus muscle
- Fascia covering the muscles
22
Q
What muscles form the elevator ani muscles?
A
Puborectalis, pubococcygeus and the iliococcygeus
23
Q
How does the puborectalis maintain continence?
A
Originates at the pubic bone and form muscular slings around the anal canal and urethra respectively
24
Q
What is the only true levator muscle of the levator ani muscles?
A
Iliococcygeus - elevating the pelvic floor and ano-rectal canal
25
How is the levator ani muscle innervated?
Pudendal nerve (roots S2, S3, S4)
26
Describe the course of the coccygeus muscle
Originates from the ischial spines and runs posteriorly attaching to the lateral aspect of the sacrum and coccyx along the sacrospinous ligament
27
What is the blood supply to the pelvis?
Branches of the internal iliac artery supply everything except for the testes/ovaries (gonadal artery) and the upper rectum (superior rectal artery from the Inferior Mesenteric Artery)
28
What structures do the superior and inferior vesicle arteries supply?
Bladder, seminal glands, prostate
29
What structures do the uterine arteries supply?
Uterus, ovaries, Fallopian tubes
30
From where do the gonadal arteries arise?
Abdomain aorta
31
From where do the middle and inferior rectal arteries arise?
Internal iliac a.
32
What structures does the vaginal artery supply?
Vagina/base of bladder
33
What is the vaginal artery a branch of?
Uterine artery
34
What is the main artery to the perineum?
Internal pudendal artery
35
What does the obturator artery supply?
Thigh adductors
36
Five different veins drain the pelvis; name them.
1. Internal iliac veins
2. Superior rectal veins
3. Median sacral veins
4. Gonadal veins
5. Internal vertebral arteries (Batson's plexus)
37
What veins do the rectal veins drain into? Think about types of venous drainage
Superior - portal circulation
| Middle and inferior - systemic circulation
38
What is the clinical significance of the rectal veins?
Suppositories bypass portal circulation, potentially giving better bioavailability
39
What is the significance of the prostatic venous plexus?
Freely communicates with Batson's plexus; significant in metastasis of cancers
40
What are the four components of innervation to he pelvis?
- Ilioinguinal nerve
- Genitofemoral nerve
- Pudendal nerve
- Autonomic components
41
Describe the ilioinguinal nerve
Originate from L1 and enters the inguinal canal at the superficial ring to supply the skin at the root of the penis and labia
42
Describe the genitofemoral nerve
Originates from L1-L2 and enters at the deep inguinal ring, supplying the cremaster muscle and is tested via the cremasteric reflex
43
Describe the pudendal nerve
Arises form the sacral plexus (L4-S4) and follows the course of the pudendal artery to innervate the sin and the muscles of the perineum
44
What bony landmark is used to locate the pudendal nerve or nerve block during forceps delivery?
Ischial spine
45
What effect do symapthetic fibres have in the pelvis?
From L1-L2, via the hypogastric plexus supply the vas deferens, vesicles and epididymis
Fibres from the pelvic and ovarian plexuses and parasympathetic nerve fibres from the pelvic splanchnic (S2-S4) nerve supply the female genital tract
46
What effect doe parasymptahtic fibres have in the pelvis?
Fibres from S2-S4 form the hypogastric plexus innervate the erectile tissue
47
How many lymph node groups are there in the pelvis
Four primary
48
What are the groups of lymph nodes in the pelvis called?
Extrernal iliac
Internal iliac
Sacral
Common iliac
49
What structures are drained by the external iliac nodes?
External genitalia, rectal viscera, abdominal wall (inferior to umbilicus)
50
What structures are drained by the internal iliac nodes?
Gluteal region, deep perineum and inferior pelvic viscera
51
What structures are drained by the sacral nodes?
Pelvic, perineal nad gluteal regions
52
What structures are drained by the common iliac nodes?
Receive drainage from the other groups of lymph nodes in the pelvis and lower limbs
53
Reproductive organs can be classified into four categories in males; what are they?
- External genitalia
- Gonads
- Tubal systems
- Accessory glands
54
What are the male reproductive organs?
Testes, ductus deferens/vas deferens, seminal glands, prostate, epididymis, bulbourethral glands
55
What is the function of the counter-current heat exchange system in the testes?
Testes optimal temperature is two degrees below core body temperature. the testicular artery is surrounded by the pampiniferous venous network to draw out heat
56
What are the fascial coverings of the testes?
1. Skin
2. Dartos muscles and superficial fascia
3. External spermatic fascia
4. Cremasteric fascia
5. Internal spermatic fascia
57
Describe the structure of the testes
Tough fibrous outer layer called tunica albugeniea
Tunica vaginalis is a peritoneal sac covering the testes. It has two layers: visceral and parietal and between them exists serous fluid
58
What spinal level do the testicular arteries arise?
L1/L2
59
What is the peritonisation fo the testicular arteries?
Retroperitoneal
60
What structures do the testicular arteries cross before entering the inguinal canal?
Psoas major and IVC
61
What is the pampiniferous venous plexus?
A network of 8-12 anastomosing veins surrounding the testicular artery in the scrotum that are important in the heat transfer
62
Where do the testicular veins drain into?
Left - Left Renal Vein
| Right - Inferior Vena Cava
63
What two groups of lymph nodes drain the testes?
Para-aortic and inguinal nodes
64
What is the vas deferens?
Muscular tube which arises from the caudal epididymis and enters the pelvis over the external iliac vessels
65
Where does the vas deferens terminate?
Joining the duct of the seminal gland to forth ejaculatory process
66
What are seminal glands?
Paired structures on the posterior aspect of the bladder
67
What is the funciton of the seminal glands?
Secrete a thick, yellow, alkaline fluid which comprises of protein, sugar and semen
68
Where is the prostate anchored?
To the inferior neck of the bladder and surrounds the prostatic urethra
69
What does the prostate secrete?
A thick milky and slightly acidic fluid
70
What are the bulbourethral glands (also known as Cowper's glands)?
Small, paired structures located in the urogenital diaphragm which empty in to the penile/spongy urethra
71
What lymph node group drains the prostate?
Internal iliac and sacral
72
What lymph node group drains the seminal glands?
Internal and eternal iliac nodes
73
What lymph node group drains the scrotum?
Superficial inguinal nodes
74
What lymph node group drains the penis?
Superficial inguinal nodes
75
What are the histological features of a testis sample?
Convoluted tubules in various planes
4-8 layers of celss
Spermatozoa in the lumen
Leydig cells in the interstitium
76
What are the histological features of a prostate sample?
Serous alveoli with infolding epithelium
Trabeculae of muscular stroma
Amorphous eosinophilic masses called corpora amylacae in the alveoli in older men
77
What are the histological features of a seminal vesicle sample?
No sperm in lumen
Highly recessed and irregular lumen forming crypts and cavities giving a honey-combed appearance
Well-developed muscular externa
78
What are the histological features of a ductus deferens sample?
Lumen stellate in shape
A thick walled muscular tube
Epithelial lining and its supporting lamina propriety are thrown into longitudinal folds
79
What reproductive organs comprise the female reproductive system?
Uterus, ovaries, fallopian tubes, vagina
80
What comprises the birth canal?
Vagina, cervix and vulva
81
What are the three layers f the uterus?
Perimetrium, myometrium, endometrium
82
As pregnancy advances, the uterus has what two sections?
Upper and a lower
83
What is the normal position of the uterus?
Anteverted and antiflexed
84
What is anteversion?
Refers to the positions of the uterus in which its long axis is bent forward on the long axis of the vagina
85
What is anteflexion?
Refers to the position in which the long axis of the body of the uterus is bent forward along the axis of the vagina at the internal os
86
What are the fornices of the vagina?
Superior portions of the vagia extending into recesses
87
Why is the posterior fornix clinically relevant?
It is an important surgical route into the rectouterine pouch and can be a common site of metastasis
88
What is the main ligamentous support of the uterus?
Cardinal ligament (lateral cervical ligament)
89
Apart from the pelvic fascia, what other structure provides important support of the uterus?
Bladder
90
What are the sections of the Fallopian tube called?
Starting at the ovarian end:
Fimbriae
Infundibulum
Ampulla
Isthmus
91
The ovary is held in place by which two ligaments?
Suspensory ligament - from ovary to pelvic wall
| Ovarian ligament - from uterus to ovary
92
The ovarian ligament is covered by what flat ligament?
Broad ligament
93
What two major branches of the abdominal aorta supply the gonads and genitalia?
Internal iliac and Gonadal arteries
94
Where do the gonadal arteries originate?
L2 level
95
In females, the ovarian artery descends within what structure and freely communicates with what other major pelvic artery?
Suspensory ligament; uterine artery
96
Where does the uterine artery cross over the ureter?
Lower level of the ischial spine at the junction of the cervix and lateral part of the fornix of the vagina
97
Lymph from the labia and distal vagina drain into which nodes?
Deep inguinal and external iliac nodes
98
Lymphatic drainage of the ovaries is achieved by what nodes?
Para-aortic
99
Describe the lymphatic drainage of the uterus
Fundus and upper part - para-aortic
Body - internal iliac
Uterine cervix - internal iliac and sacral
100
Describe the structure of the breast
Each breast contains 15-25 lobes with tubule-acinar glands (parenchyma) and stroma (connective tissue)
101
Describe the position of the breasts anatomically
Extend vertically from the 1st to the 6/7th rib and horizontally from the lateral border of the sternum to the mid-axillary line
102
What are the deep surface relations of the breast?
Pec. major, serrates ant., intercostal muscles, rectus abdomens, external oblique
103
What arteries supply the breast?
Branches of the subclavian/axillary (internal and lateral thoracic arteries)
104
What lymph groups drain the breast?
Lateral quadrants - axillary nodes
Medial quadrants - parasternal nodes
Superior quadrants - supraclavicular nodes
105
What is the clinical significance about lymph drainage of the breast?
Lymph from the medial side of one breast can drain into nodes on the medial side of the contralateral breast - thus providing a route for infection/cancer
106
What are the three distinct phases of uterine histology?
Proliferative and secretory and menses
107
What hormone facilitates the proliferative phase of the uterus; what are its features histologically?
Follicle Stimulating Hormone (oestrogen for vascularisation)
Thick endometrium, renewed connective tissue, glandular structure and ehlicrine arteries
108
What hormone facilities the secretory phage and what are its features?
Luteinising Hormone
Cork-screw endometrial glands, filled with glycogen
109
What hormones are responsible for the beginning of menses?
Decreasing levels of Luteinising Hormone and progesterone
110
What feature are histologically recognisable in menses?
Lumen, degeneration of the endometrium and ears of blood leakage as spiral arterioles degenerate
111
What ype of organ is the placenta?
Foetomaternal (common to both the foetus and the mother)
112
What embryological structure does the placenta develop from?
The placenta develops from the trophoblast following implantation of the blastocyst
113
What are the features of the maternal side of the placenta?
Rough and spongy
114
What are the features of the foetal side of the placenta?
Smooth and bears the attachment of the umbilical cord
115
What are the four main functions of the placenta?
Gaseous exchange
Excretion of waste
Immunity
Endocrine
116
Describe the structure of the umbilical cord
Two umbilical arteires, one vein, one allantoic duct and surrounded by Wharton's jelly
117
What type of blood do the umbilical arteries and vein transmit?
Vein - oxygenated
| Arteries - deoxygenated
118
Where does the perineum lie?
Inferior to the pelvic diaphragm
119
What are the structures of the perineum?
Exrtenal genitalia, perineal muscles, anal canal
120
The perineum is divided into what two triangles? What demarcates these?
Urogenital triangle and the anal triangle; the imaginary line between the two ischial tuberosities
121
What are the four main muscles of the perineum?
External anal sphincter
Transverse perineal muscles
Bulbospongiosus
Ischiocavernosus
122
What are the action and innervation of the external anal sphincter?
Continence (faecal); branch of the pedundal nerve
123
What are the action and innervation of the bulbospongiosus?
Males: empties urethra
| Female: clenches vagina; pudendal nerve
124
What are the action and innervation of the ischiocavernosus?
Assists bulbospongiosus; pudendal nerve
125
What are the action and innervation of the superficial and deep transverse perineal muscle
Fixation of the perineal body; pudendal nerve
126
What are the action and innervation of the external urethral sphincter?
Continence (urinary); pudendal nerve
127
What is the perineal body?
The raphe of fibromuscle which denotes the boundary between the anal and urogenital triangle
128
Which muscles converge towards the perineal body?
External anal sphincter, bulbospongiosus, elevator ani, transverse perineal
129
What are the perineal pouches?
Superficial and deep perineal pouches are fascia-limited, potential spaces traversed by the urethra
130
What is the clinical significance of the perineal pouches?
They can become infiltrated following traumatic surgical injury of the urethra
131
What urethral sphincter is found in the deep perineal pouch?
Internal
132
What urethral sphincter is found in the superficial perineal pouch?
External
133
How does the superficial perineal pouch relate to the urogenital membrane?
Antero-inferior and surround the external genitalia
134
How does the deep perineal pouch relate to the perineal muscle?
Surrounds it
135
What are the three main parts of the urethra?
Prostatic, membranous, spongy
136
Which is the widest part of the urethra? Which is the narrowest?
Prostatic; membranous
137
What is the function of the ischio-anal fossa?
Allows room for the anal canal to expand during defaecation
138
What characteristic of the ischia-anal fossa makes it susceptible to pathology? What lifestyle can predispose you to this?
Fatty tissue is susceptible to abscess and can result in fistulae; sedentary lifestyle
139
What neurovascular bundle enters the ischio-anal fossa?
The pudendal nerve and vessels (artery and vein)
140
What foramen does the pudendal bundle enter the ischia-anal fossa through?
Lesser sciatic foramen
141
What structures do the pudendal neurovasculature supply?
Sensory external genitals and motor supply to the pelvic muscles
