reproductive tracts plenary Flashcards
what do you call the cartilage that fused up until late teenage years in the pelvis between the ischium, ileum and pubic, found in the acetabulum/forming the acetabulum
triradiate cartilage
how can the triradiate cartilage affect what you see on a pelvis scan
you can mistake an unfused triradiate cartilage in a teen for example as a fracture
describe how you’d tell the difference between man and woman in a pelvic xray
pelvic angle of male is more V shaped, females is more U shaped
Males = narrow shape
female = wider shape
wings of iliac is more flared in women and less flared in males
wider birthing canal hence perturding sacrum in females
what are the 4 different female pelvic shapes and how can u differentiate them
- gynecoid (round/circular birthing canal)
- platypelloid (rugby ball shape birthing canal)
- android ( heart shaped canal_
- anthropoid ( egg shape canal)
due to the shape of the pelvis, what does this indicate about fractures is can have
due to the shape of the pelvis, if there is one fracture, there is likely to be another
- breaks in at least 2 places
The pelvic ligaments are so strong that the pelvis will fracture before the ligaments will break.
what is the pelvic girdle
The ring formed by the pelvic bones and ligaments, particularly the sacroiliac ligament and pubic symphysis
due to pregnancy, what changes do the ligament of the pelvis girdle undergo and how
the ligaments of the pelvic girdle become more elastic due to increased levels of hormones in preparation for the birth.
what causes pelvic girdle pain during pregnancy
unborn baby also puts a lot of uneven pressure on the girdle
the perineum is the a posterior/under diamond shape between the ischial tuberrosities, what 2 sections can we divide the peritoneum into
- imaginary line draw through the peritoneum at the level of the ischial tuberosity
- the anterior triangle is the urogenital
- the posterior triangle is the anal
what is the name of the membrane in the peritoneum and what area does this cover
- peritoneal membrane
- it ONLY covers the urogenital triangle
what does the peritoneal membrane attach to?
external genitals
what do you call the space between the perineal membrane and the perineal floor muscles
deep peritoneal pouch
what is found between the peritoneal membrane and the skin
superficial peritoneal pouch
what is the perineal body?
- fibromuscular mass that provides an attachment site for many peritoneal muscles
(when snipped in child birth, can cause weak pelvic floor muscles)
what is a lithotomy position
- supine frog legged position patients do on bed as we examine their reproductive areas
where is sperm produced
testies
where does sperm mature
epididymis
what muscular tube connects to the epididymis and why does it need to be muscular
- ductus deferens
- it is muscular to undergo peristalsis (squeeze sperm to move up in the tube)
what is found within the spermatic cord
- ductus deferens
- lymphatic vessels
- testicular artery and vein
which canal does the ductus deferens pass through to get to the posterior section of the bladder where the seminal visible is
- inguinal canal
what part of the male reproductive system sits at the back of the bladder
seminal vesicle
what is the function of the seminal vesicle
- provides majority volume of the ejaculate
- fructose for energy
- prosto glands which suppress the immune system of females
- clotting factors so the ejaulate clots in the vagine
what duct is formed as a result of the joining between the seminal vesicle and ductus deference and where does this happen
ejaculatory duct
- occurs within the prostate
what does the ejaculatory duct join with in the prostate
it joins with the urethra coming from the bladder
what is the function of the prostate
- ## add proteolytic enzymes to ejaculate (break down protein)
why is proteolytic enzymes added into ejaculate by the prostate
- prevent the ejaculate from clotting until it is outside the penis
what 4 areas can the prostate be split into
looking at it from a sagittal view
- central zone ( upper side left/ posterior )
- transitional zone (upper middle)
- anterior zone (upper side right)
- peripheral zone (across entire bottom)
which zone of the prostate is most likely for cancer to originate and what makes it easier to find
- peripheral zone
- being at the bottom makes it easier to palpate
where is the external urethral sphincter found
- beneath the prostate
- in the perineal pouch
where is the bulbourethral gland found
in the external urethral sphincter
what is the purpose of the bulbourethral gland
- joins with the urethra and provides lubication for sperm motility
- pre-ejaculate
- alkaline fluid
why is it necessary for the release of alkaline fluid by the bulbourethral gland
as u urinate, the urethra becomes acidic and you dont want the acid to kill the sperm
what part does the ejaculate or urine etc come out of
external urethral meatus
where do the testis develop / originate
abdomen
how does the testis descend from the abdomen into the scrotum (skin)
- gubernaculum (‘string’ attached to the testis) (ligament cord)
- pulls down on testis through inguinal canal along with its vasculature and into the scrotum
state the layers of the scrotum following the acronym
Some damn Englishman Called It The Testis
scrotum is formed from the layers of the abdomen
- scrotum
- dartos (fascia/muscle)
- external spermatic fascia
- cremaster
- internal spermatic fascia
- tunica vaginalis
- testis
what is the function of the cremaster
- muscle which can pull the testis back up closer to the body to regulate temperature/keep internal temperature warmer
what are the 2 different types of tissue that attache from the peritoneum onto the penis
- corpus spongiosum (bulb of penis) (underside of penis)
- 2 sets of corpus cavernous ( crus of penis) (upper lateral)
during erection, why does the corpus spongiosum fill with less blood
- so it does not press against the urethra and prevent the ejaculate from leaving
what are the muscles lying on top of the corpus cavernous and corpus spongiosum (dont need to know)
- over the spongiosum= bulbospongiosus muscle
- over the cavernous= ischiocavernosus muscle
what is the purpose of bulbospongiosum and ischiocavernosus muscle
- support erection, ejaculation and urination
what do you call the external part of the end of the penis
glans penis
- has a corona (crown)
there are a lot of nerve endings in the glans penis (dont need to know)
what connects the glans penis to the foreskin / body of penis (DNTK)
frenulum
what is the line thats found from the scrotum up through the middle of the penis (DNTK)
raphe of penis
what vasculature is found in the corpus cavernous and why
- deep artery
- to provide blood (for erection)
from a cross section view of the penis, which side is ventral and which side is dorsal
top part = dorsal (as when erect faces the back)
bottom part = ventral (as when erect faces the front) (ventral = tummy)
what is the space between the rectum and bladder known as, what causes this
- rectovesical (males)/ retrouterine (females) pouch (also known as pouch of Douglas)
- formed by the peritoneal membrane
why is the rectovesical pouch clinically relevant
- if theres fluid in the abdomen e.g burst appendix, it can build up in the pouch
what is the most anterior component in the female abdomen
- pubic symphisis
where is the external urethral sphincter found in females
in the deep perineal pouch
- beneath the bladder
what is the purpose of the vaginal wall to have rugae (bumpy edges)
- allows to expand
- increased surface area for microbiome
why is having microbiome important for the vagine
important for maintaining internal environment of vagine
what component is found connecting the uterus and vagine
cervix
what do you call the lateral spaces on either side of the cervix
fornix
what are the 3 layers of the uterus
- endometrium (layer that sheds)
- myometrium (majority muscle/bulk of uterus)
- perimetirum (part of peritoneum)
describe the features of the perimetirum
- serous layer
- secretes fluid that’ll lubricate the uterus
the uterus is anteverted, what does this mean and how is it different to retroverted
- anteverted = leaning forward (over top of bladder)
- retroverted = leaning back towards the rectum
why is the uterus in older women more retroverted
- ligaments that hold the uterus in place are more weaker
the uterus is ante flexed what does this mean and compare it to retroflexed
ante flexed = flexing forwards
retroflexed = flexing backwards
the Fallopian tubes extend from the uterus to the ovaries, what structure connects the Fallopian tubes to the ovaries
fimbriae
what is the function of fimbriae
- envelop eruption site
- encourage movement of oocyte into uterine tube where till travel down into the uterus
what do you call the space between the rectum and uterus
rectouterine pouch
what are the 6 ligaments of the uterus
- broad ligament
- round ligament
- cardinal
- ovarian
- uterosacral
- suspensory ligament of ovary
what does the broad ligament do
acts as mesentery for uterus / keeps it in place
what does the round ligament do
connects uterus to labia majora via inguinal canal to maintain its anteverted position
what does the cardinal ligament do
attaches cervix to pelvis
what does the ovarian ligament do
joins ovaries to uterus
what does the uterosacral ligament do
joins uterus to sacrum
what does the suspensory ligament do
attaches ovaries to pelvic wall and contains ovarian vein, artery and lymph
which uterine ligament causes pain during precnancy
round ligament as it passed through the inguinal canal
what does the crus of the clitoris attach to
glans of clitoris
bulb of vestibule and crus of clitoris make up the tissues of the external component of the vagine
what gland is located on the posterior part of the bulb of vestibule
greater vestibular (bartholin) gland
what is the purpose of the greater vestibular (bartholin) gland
secrete lubricating fluid onto vagina
what are the different cell types found between the uterus and vagina
uterus = columns cells
vagina = squamous cells
what is known as the transformation zone on a histology of the vagina/uterus
area where the cells are multipotent and deciding if they want to become columnar cells of uterus or squamous cells of vagina
in which area are you most likely to get HPV virus / cervical cancer and why
- in the transformation zone due to the multi potency of the cells
which artery supplies the reproductive organs in men
anterior division of the interior iliac artery
what organs do the inferior vesicle artery and vein supply in men
- prostate
- ductus defernes
- semicle vesicle
- bladder
what organs do the uterine and vaginal artery supply
- uterus and ovaries
the internal pudenal artery/vein is posterior to the uterine and vaginal artery, explain how the pudenal artery is structured
- exits the pelvis via the greater sciatic notch (passing above pelvic muscles)
- enters again via the less sciatic notch into the deep perineal pouch
what body part does the internal pudenal artery/vein supply
external genitalia
which nerve is found next to the internal pudenal artery/vein and hence follows the same structure
pudenal nerve
what is the purpose of the pudenal nerve
- ## sensation to external genitalia
where does the testicular artery and vein originate from
the abdominal aorta and inferior vena cava
- left testicular vein drains into the left renal vein
what do you call the vascular network on the testis
pampiform plexus
pampiform plexus goes through the inguinal canal joining to the testicular vein (men)
what does the vascular network travel through in women as the pampiform plexus does in the inguinal canal in men
through the suspensory ligament of the ovary
what lymph nodes drain the ovaries and testis
lumbar/aortic nodes
what lymph nodes drain the superficial genitalia
superficial inguinal lymph nodes
what lymph nodes drain the glans penis and clitoris
deep inguinal lymph node
what lymph nodes drain the more internal structures of the pelvis
internal and external iliac lymph nodes
The posterior superior iliac spine (PSIS) is located at S2, and can be the site of ‘sacral dimples’, where the skin is attached more tightly to the bone.
the ischium posteriorly, the ilium superiorly, and the pubis anteriorly
triradiate cartilage only seen in younger skeleton
name the 6 ligaments in the pelvis
- anterior and posterior sacroiliac ligament
- inguinal ligament
- sacrotuberous liagment
- sacrospinous ligament
- coccyx ligament
what do you call the membrane that covers the obtuator foramen
perineal membrane
the pelvic floor is a funnel-shaped group of what 2 muscles supporting the pelvic and abdominal viscera
- levator ani
- coccygeus
what is a hiatus in the pelvic floor
two gaps in the muscle sheet
what are the 2 hiatus in the pelvic floor and what passes through them
- anterior hiatus is called the [Urogenital] hiatus, through which the [Urethra] and the [Vagina] pass.
- posterior hiatus is called the [Rectal] hiatus, located posterior, through which the anal canal pass.
Name the attachment site of the bulbospongiosus muscle in males
perineal membrane
In births that are developing more quickly than the vagina can relax, or when the baby is larger, an episiotomy can be performed to direct any tearing tear away from the [Perineal body].
Prior to performing an episiotomy, the [Pudendal nerve] needs to be anaesthetised. This relieves pain in the perineum however not in the [Vagina] as the this is innervated by the [Inferior hypogastric plexus].
The [Ischial spine] nerve is used as a landmark to deliver the anaesthetic to the [Pudendal nerve] nerve
which nerve is connected to the vagina
inferior hypogastric nerve
which landmark is used to prescribe anaesthetic to the pudenal nerve
ischial spine
the hiatus in the pelvic floor needs to be filled to ensure the pelvic viscera down fall through the hole. So the perineal pouch sits directly inferior to it
remember that the names of the lymph nodes always follow the names of the corresponding artery
