SUGER Flashcards
where is the mid-inguinal point and what is significant about it
halfway between pubis symphysis and ASIS
can palpate femoral pulse
where is the mid-point of the inguinal ligament
halfway between pubic tubercle and ASIS
name the contents of the inguinal canal
- spermatic cord = males
- round ligament = females
- ilioinguinal nerve
- genital branch of genitofemoral nerve
what is a hernia
potrusion of organ/fascia through wall of cavity that normally contains it
what is an indirect hernia
peritoneal sac enters inguinal canal through deep inguinal ring
what is a direct hernia
peritoneal sac enters inguinal canal through posterior wall of inguinal canal
name the 3 fascial layers of the spermatic cord
- external spermatic fascia
- cremaster muscle and fascia
- internal spermatic fascia
name the contents of the spermatic cord
vas deferens
testicular artery
pampiniform plexus of veins/nerves/lymphatics
name the sac which surrounds the testes
tunica vaginalis
name the 3 arteries of the spermatic cord
- testicular artery
- artery of vas deferens
- cremastic artery
name the 3 veins of the spermatic cord
- testicular vein
- vein of vas deferens
- cremasteric vein
name the 3 nerves of the spermatic cord and what do they supply
- ilioinguinal = 1/3rd genital skin sensation
- genitofemoral = cremaster
- sympathetic = vas deferens/testicular pain
what vertebral level are the kindeys
T12 - L3
right slightly lower
describe the path of blood supply to the kidney
abdominal aorta to renal arteries = divide into interlobar arteries = divide into arcuate arteries = divide into interlobular arteries = divide into afferent arterioles
name the blood supply of the outer 2/3rd of the renal cortex
peritubular network supply nephrons and tubules
name the blood supply to the inner 1/3rd of renal cortex
vasa recta = long straight arteries
describe the venous drainage of the kidneys
renal veins leave hilum anterior to renal arteries
= directly to IVC
describe the ureter
25cm runs from kidneys to bladder
abdominal part/pelvic part
name the blood supply to the ureter
abdominal = renal artery and testicular/ovarian artery
pelvic part = sup/inf vesical arteries
where do sensory fibres from the ureter enter the spinal cord and what is the significance of this
T11 to L2 = referred pain
describe the inner wall of the bladder
has ruggae = can expand
trigone = smooth
name the specialised smooth muscle of the bladder
detrusor muscle
describe the internal sphincter of the bladder in males
circular smooth muscle fibres
autonomic control
describe the internal sphincter of the bladder in females
functional so no muscle present
formed by bladder neck and proximal urethra
describe the blood supply to the bladder
superior vesical branch of internal iliac vessels
males = inferior vesical artery as well
females = vaginal arteries as well
describe the venous drainage of the bladder
vesical venous plexus = empty into internal iliac veins
what nerve supplies sympathetic nerves to the bladder and what is its role
hypogastric T12-L2 = relaxation of detrusor muscles
what nerve supplies parasympathetic nerves to the bladder and what is its role
pelvic nerve S2-S4 = contraction of detrusor muscles
what nerve supplies somatic nerves to the bladder and what is its role
pudendal nerve S2-S4 = innervates external urethral sphincter = voluntary control over micturition
describe the parts of the male urethra
15-20cm long pre-prostatic prostatic = widest membranous = narrowest spongy
name the blood supply to each part of the male urethra
prostatic = inferior vesical artery membranous = bulbourethral artery spongy = branches of internal pudental artery
name the nerve supply of the male urethra
prostatic plexus = sympathetic/parasympathetic/visceral fibres
describe the female urethra
approx 4cm long
open directly onto perineum = vestibule
skenes glands = 2 mucous glands either side
name the blood supply and nerve supply to the female urethra
internal pudendal arteries
pudendal nerve
name the 5 muscles of the posterior abdominal wall
- iliacus
- psoas major
- psoas minor
- quadratus lumborum
- diaphragm
name the attachments, action and innervation of the quadratus lumborum
iliac crest to L1-L4 transverse processes
extension/lateral flexion of vertebral column
anterior rami of T12-L4
name the attachments, action and innervation of psoas major
transverse processes of T12-L5 to femur
flexion of thigh/ lateral flexion vertebral column
anterior rami of L1-L3
name the attachments, action and innervation of psoas minor
vertebral bodies T12-L1 to superior ramis of pubic bone
flexion of vertebral column
anterior rami of L1 spinal nerve
name the attachments, action and innervation of the iliacus
iliac fossa/AIIS to femur
flexion of thigh
femoral nerve L2-L4
what is the lumbar plexus and what is it formed by
network of nerve fibres that supplies the lower limb
formed by anterior rami of lumbar spinal nerves L1-L4, some of T12
what is the order of the nerves of the lumbar plexus from t12 to l4
iliohypogastric ilioinguinal lateral cutaneous femoral oburator
what does the iliohypogastric nerve innervate
posterolateral gluteal skin in pubic region
what does the ilioinguinal nerve innervate
skin on upper middle thigh
male = root of penis/scrotum
female = mons pubis/labia majora
what does the genitofemoral nerve innervate
cremaster muscle
what does the lateral cutaneous nerve innervate
anterior/lateral thigh down to knee
what does the obturator nerve innervate
skin over medial thigh
what does the femoral nerve innervate
skin of anterior thigh/medial leg
what epithelium is the ectocervix
stratified squamos non-keratinising epithelium
what epithelium is the endocervix
mucus secreting stratified simple columnar
describe an anteverted uterus
rotated forward towards anterior surface of body with respect to the vagina
describe an anteflexed uterus
flexed toward anterior surface of body with respect to the cervix
name the 3 layers of the uterus
peritoneum
myometrium
endometrium = deep stratum basalis and superficial stratum basalis
which layer undergoes hypertrophy and hyperplasua during pregnancy in order to expel the foetus at birth
myometrium
which layer proliferates in response to oestrogen and becomes secretory in response to progesterone and is shed in menstruation
superficial stratum functionalis
what is the role of the broad ligament
attaches sides of uterus to pelvis
what is the role of the round ligament
extend from uterine horns to labia majora via inguinal canal = maintains anteverted position
what is the role of the ovarian ligament
attaches ovaries to uterus
what is the role of the cardinal ligament
= base of broad ligament
attaches cervix to lateral pelvic walls
contains uterine artery and vein
what is the role of the uterosacral ligament
attaches cervix to sacrum
what supplies blood to the uterus
uterine artery from the internal iliac artery
what provides venous drainage from the uterus
plexus in broad ligament = drain into uterine veins
what provides sympathetic innervation to the uterus
uterovaginal plexus
what provides parasympathetic fibres of the uterus
pelvic splanchnic nerves S2-S4
what is the fornix
recess formed between margin of cervix and vagginal wall
anterior/posterior/2 x lateral
where is the uterine artery found
base of broad ligament in close relation to ureter
where is the vagina
upper 2/3rd in pelvic cavity
lower 1/3rd in perineum
how long is the vagina
9cm
name the 4 layers of the vagina
- stratified squamous epithelium
- elastic lamina propria
- fibromuscular layer
- adventitia
what is the role of the stratified squamous epithelium in the vagina
protection/lubrication by cervical mucus
what is the blood supply to the vagina
uterine/vaginal arteries
what is the venous drainage of the vagina
vaginal venous plexus to internal iliac veins
what is the nerve supply of the vagina
superior part = inferior fibres of uteroveginal plexus
inferior part = deep perineal nerve
name the layer that surrounds each cavernous body in the penis
tunica albuginea
what is the role of the suspensory ligament in the penis
connects erectile bodies to pubic symphysis
what is the role of the fundiform ligament in the penis
runs down from linea alba = surrounds penis and attaches it to pubic symphysis
describe the blood supply to the penis
internel iliac to internal pudendal artery to
- dorsal arteries of penis
- deep arteries of penis
- bulbourethral artery
what is the nerve supply to the penis
S2-S4 spinal cord segments/spinal ganglia
name the 3 zones of the prostate
central zone
transitional zone
peripheral zone
what is the role of the seminal vesicle
secrete thick alkaline fluid = forms bulk of seminal fluid
what innervates the prostate gland
inferior hypogastric plexus
how is the ejaculatory duct created
seminal vesical duct merges with vas deferens
what is benign prostatic hyperplasia
benign enlargement of the prostate
what is the pelvic floor formed from
levator ani and coccygeus
what innervates the levator ani muscles
branches of pudendal nerve S2-S4
what are the 3 roles of the pelvic floor muscles
- support of abdominopelvic viscera
- resistance to increases in intra-pelvic abdominal pressure
- urinary/faecal continence
what produces human chorionic gonadotrophin and what is its role
produced by trophoblasts
stimulate oestrogen and progesterone secretion
decreases as placenta grows
what produces prolactin and what is its role
produced by anteiror pituitary
increases cells that produce milk
prevents ovulation = not reliable
what produces relaxin and what is its role
produced by ovary and placenta
high in early pregnancy
limits uterine activity, softens cervix
what is the role of oestrogen in pregnancy
produced throughout pregnancy
regulates progesterone
prepares uterus for baby, breasts for lactation
what is the role of progesterone in pregnancy
prevents miscarriage
builds up endometrium for placental support
prevents contractions
what produces oxytocin and what is its role
produced by posterior pituitary gland
stimulates uterine contractions
triggers caring reproductive behaviours
synthetic drug used to induce labour
what produces prostoglandins and what is their role
produced by uterine tissue
initiates labour
what is parturition
birth process = successful transition form intra-uterine to extra-uterine life
what is cervical ripening
growth and remodelling of the cervix prior to labour
describe the events of prelabour 4 steps
- Stress = CRH release = ACTH release = cortisol release -= oestrogen release
- Oestrogen release = inhibits uterine progesterone release = uterine contractions
- Prostaglandins (PGF2a) and relaxin (from ovaries) relax walls of cervix = dilation
- Baby pushing onto cervix = oxytocin release = uterine contractions (positive FB)
what are the chemicals released from the foetus to signal labour
oxytocin
vasopressin
cytokines
what chemical is the maternal signal of labour
oxytocin
describe the 3 events of the active phase of labour
- stronger, higher frequency contractions
- full dilation resulting in foetal expulsion
- placental expulsion
when does the placenta begin developing and when has it implanted
at blastocyst implantation
11th day post ovulation
what does the placenta provide for the developing foetus
nutrition
gas exchange
waste removal
endocrine/immune support
what are the 3 main functions of the placenta
metabolism
transport
endocrine
what is synthesised in placental metabolism and what does it provide
glycogen
cholesterol
fatty acids
= provides nutrient and energy
what does the placenta transport
gases/nutrition water/glucose/vitamins hormones (steroid) electrolytes maternal antibodies waste products drugs and metabolites infectious agents
name 4 placental hormones
- hCG
- progesterone
- oestrogen
- relaxin
what is placenta accreta
doesnt adhere properly to wall of uterus
absence of decidua basalis
what is placenta praevia
placenta overlies internal os = abnormal bleeding = C section
describe the hormone changes at puberty
increase GnRH
increase FSH, LH, GH and sex steroids
what is the effect of FSH on the ovary
causes ovarian follicles to mature
leads to 1 dominant follicle developing
acts on granulosa cells = follicle secrete oestrogen
what is the effect of LH on the ovary
release of secondary oocyte from dominant follicle = fusion of follicular and ovarian membrane
acts on thecal cells = allow secrete oestrogen
what is the effect of oestrogen on the endometrium
proliferate
increase production of glands
synthesis of progesterone receptors on surface
what is the effect of progesterone on the endometrium
proliferate and change to secretory
bind to progesterone receptors
what is the effect of oestrogen on the cervix
secrete abundant and watery mucus before/during ovulation for best possible sperm entry
what is the effect of progesterone on the cervix
produce thick mucus secretions = act as plug prevent bacteria entry
when is inhibin secreted and what is its role
= inhibit FSH
increases during late follicular phase
remains high in luteal phase
decrease as corpus luteum regenerates
when must sperm enter the uterus for fertilisation to occur
5 days before/1 day after ovulation
how long can sperm survive
4-6 days
what is a renal corpuscle
whole unit of glomerular tuft and bowmans capsule
name the layers that fluid is filtered across in the kidney
- endothelial cells
- basement membrane/basal lamina = negatively charged
- between foot processes of podocytes
what are the 2 types of nephron and what are their proportions
15% = juxtamedullary = renal corpuscle in part of cortex closest to medulla 85% = cortical = renal corpuscle in outer cortex
what is the glomerular filtration rate
volume of fluid filtered from glomeruli into bowman’s space per unit time
what is the oncotic pressure in the bowman’s capsule
0
what is the calculation for GFR
filtration coefficient x glomerular capillary hydrostatic pressure - bowmans hydrostation pressure - osmotic/oncotic pressure of glomerular capillary
what is the average GFR for a 70kg person
125mil/min
what determines GFR
net filtration pressure
permeability of corpuscular membranes
surface area
what is osmolality
osmoles of solute per kg of solvent
what is osmolarity
osmoles of solute per litre of solution
what 2 things stimulate the release of renin
- reduced NaCl to DCT detected by macula densa cells
2. reduced perfusion pressure in kidney detected by baroreceptors in afferent arteriole
what cells release renin
granular cells of the juxtaglomerular apparatus
describe the RAAS system in 4 steps
- renin secreted
- cleaves angiotensinogen to angiotensin 1
- angiotensin 1 to angiotensin 2 by ACE
- angiotensin 2 stimulates release of aldosterone from adrenal medulla
where is angiotensin converting enzyme found (ACE)
epithelium of kidney/lungs
what are 5 effects of angiotensin 2
- aldosterone release
- vasoconstriction
- Na+ reabsorption in PCT
- thirst
- ADH release
what is the effect of aldosterone and where does it act
CD
increase ENaC channels = increase Na+ absorption increase K+ excretion
DCT
increase Na+ absorption
where is aldosterone secreted from
zona glomerulosa of adrenal gland
where is ADH made
hypothalamus
where is ADH secreted from
posterior pituitary
what regulates ADH secretion and why is it secreted
osmoreceptors in hypothalamus detect osmotic pressure of plasma = high osmolality = ADH released
what acts faster ADH or aldosterone and why
ADH is steroid so is faster than peptide hormone aldosterone
what is the effect on the kidneys of parathyroid hormone
increases Ca2+ reabsorption = decrease urinary Ca2+ levels
blocks phosphate reabsorption in PCT
where and why is parathyroid hormone released
released by parathyroid glands in response to decreased Ca2+
where is atrial natriuretic peptide synthesised and secreted
cardiac atria
what is the effect of atrial natriuretic peptide (3)
- inhibit Na+ reabsorption by blocking ENaCs in collecting duct + decrease Na+ reabsorption in DCT
- acts as renal vasodilator = increases GFR = increase Na+ excretion
- inhibits renin secretion = inhibit RAAS
where is erythropoietin (EPO) produced and what does it do
peritubular cells in interstitial space of renal cortex = stimulate bone marrow maturation of RBCs
when does EPO increase and decrease
increase = anaemia, altitude decrease = polythaemia, renal failure
name the 3 main hormones secreted by the adrenal cortex
- aldosterone
- cortisol
- corticosteroid
what layer of the adrenal cortex produces mineralcocorticoids
zona glomerulosa
what layer of the adrenal cortex produces glucorcorticoids e.g. cortisol (+ small amount androgens)
zona fasiculata
what layer of the adrenal cortex produces androgens (+ small amount cortisol)
zona reticularis
what is stress
a real/perceived threat to homeostasis
what is the normal function of cortisol
maintenance of homeostasis in absence of external stress
name 3 results of chronic stress
severe decrease:
- bone density
- immune function
- reproductive fertility
what is the main site for adrenaline synthsesis
adrenal medulla
describe the proportions of catecholamines released during fight or flight and their roles
adrenaline = 80% = vasoconstriction noradrenaline = 20% = vasodiltation
what do alpha receptors have a higher affinity for
noradrenaline
what do beta receptors have a higher affinity for
adrenaline
name 4 things that occur in a flight or fight response
- gluconeogenesis in liver/muscle
- lipolysis in adipose tissue
- tachycardia and cardiac contractility
- redistribution of circulating volume
whats the commonest urinary buffer
alkaline phosphate
what is titratable acidity
quantity of base needed to bring base to pH 7.4
= does not increase in response to acidosis
what is the equation for net acid excretion
titratable acidity + ammonium - HCO3-
name the physical changes of a male at puberty
- testicular enlargement
- body hair growth
- growth spurt
- spermatogenesis begins
- acne/body odour/mood changes
name the physical changes of a female at puberty
- breast development
- body hair
- growth spurt
- menarche
- acne/body odour/mood changes
what age for puberty in males
9-14
what age for puberty in females
8-14
what age for menopause
48-52
what are the short term signs of menopause (5)
- hot flushes/sweats/headaches
- irritability/lethargy/panic attack/depression
- shorter menstrual cycle
- altered blood loss
- dry skin
what are the long term signs of menopause (5)
- vaginal dryness
- decrease libido
- hair loss/thinning
- loss in compliance
- general aches and pains
what is responsible for people having darker skin
melanocytes producing more melanin
what is the normal skin pH
5.5
what is desquamation
mature corneocytes are shed from the surface of epithelium to make room for new cells in basal layer + degradation of extracellular corneo-desmosomes by proteases
what is the role of Vitamin D in the skin
essential in producing anti-microbial peptides = defend skin from bacteria/viruses
mneumonic for layers of epidermis
come lets get sun burned
where is vitamin D synthesised in the skin
stratum spinosum
what is the role of the lipid lamellae
keeps water inside skin cells
what causes red skin
dilation of blood vessels due to lymphocyte activity
what causes itchy skin
stimulation of nerves
what causes dry skin
skin cells leaking due to lymphocyte activity
what do irritants do to the skin
break down healthy skin
what do allergens do to the skin
trigger flare ups by penetrating into skin and causing reaction
how do allergens cause inflammation
penetrate into skin
met by lymphocytes
lymphocytes release chemicals which cause inflammation
what are the 3 signs of inflammation
red skin
dry skin
itchy skin
what is the function of the dermis
strength and elasticity
name the 2 layers of the dermis
papillary dermis
reticular dermis
where are sebaceous glands and sweat glands found in the skin
reticular dermis
what are the functions of the subcutaneous layer
insulation
energy store
shock absorbent
= LOTS OF ADIPOCYTES
what is glucogenesis
glycogen to glucose
what is glucogenolysis
glucose to glycogen
what is gluconeogenesis
amino acids/lactate to glucose
where is incretin secreted
endothelial cells of GI tract
what is renal clearance
volume of plasma from which a substance is completely removed
what increases GFR
afferent dilation
efferent constriction
what decreases GFR
afferent constriction
efferent dilation
what is autoregulation in the kidney
when high blood flow in afferent arteriole = walls stretch = smooth muscle contract = arteriolar constriction
how do macula densa cells stimualte the release of renin and what is this process called
macula densa detect NaCl = release prostaglandins = stimulate granular cells to releases renin
TUBULOGLOMERULAR FEEDBACK
what transporter is used in the ascending limb of the loop of henle
NKCC2 transporter
kidney response to respiratory acidosis
increase H+ secretion
increase bicarb production
increase ammonia secretion
kidney response to respiratory alkalosis
decrease H+ secretion
increase bicarb secretion
3 effects of ADH
- increase water permeability in DCT and CD = aquaporins
- increase urea permeability in collecting duct
- increase Na+ reabsorption in ascending limb
when is cortisol released and what is the action of cortisol
released in stress/low blood glucose
stimulate gluconeogenesis and fat/protein metabolism
5 layers of skin
- stratum corneum
- stratum lucidum
- stratum granulosum
- stratum spinsoum
- stratum basale
describe the papillary dermis
rete ridges
type 3 collagen
fibroblasts
describe the reticular dermis
type 1 collagen
well organised elastic fibres
describe the skin barrier
lipid lamellae above cells = corneocytes held together by corneodesmasomes
what hormones does the hypothalamus secrete (4)
- gonadotrophin releasing hormone
- growth hormone releasing hormone
- thyrotropin releasing hormone
- corticotropin releasing hormone
what hormones does the anterior pituitary secrete (6)
- follicle stimulating hormone and leutinising hormone
- growth hormone
- thyroid stimulating hormone
- Adrenocorticotrophic hormone
- prolactin
does the posterior pituitary secrete hormones
no just stores hypothalamic hormones
what hormones are released from the posterior pituitary
vasopressin
oxytocin
what cells are in islets of langerhans and what do they secrete
alpha = glucagon beta = insulin delta = somatostatin
what does insulin do
decrease hepatic gluconeogenesis
increase glucose storage
decrease lipolysis (= decreased ketogenesis)
what does glucagon do
increase gluconeogenesis
stimulate lipolysis = more ketogenesis
describe what happens when there is a high level of plasma glucose
high glucose
detected by Beta cells
insulin released
increase glucose uptake in muscles/fat
describe the mechanism of insulin release in 5 steps
- glucose into beta cell via GLUT 2
- glucokinase metabolise glucose = krebs and glycolysis producing ATP
- ATP close K+ channels = no efflux = depolarisation
- depolarisation = opens calcium channels = influx Ca2+
- allows exocytosis of insulin
what is the difference between endogenous and exogenous insulin
endogenous has C peptide attached
describe the mechanism of insulin action
- insulin binds to receptor on target cell
- increased exocytosis of GLUT 4 vesicles to cell membrane
- increase uptake glucose through GLUT 4
what is the role of incretins
pre-emptively amplifies the effect of insulin
what is the blood and nerve supply to the thyroid
superior and inferior thyroid artery
parasympathetic = vagus
what are the different cell types in the thyroid and what do they do
follicular cells = surround colloid, form follicles = produce T3/T4
C cells = parafollicular cells = produce calcitonin
describe the mechanism of thyroid hormone synthesis
- TSH released from anterior pituitary
- increase iodine uptake Na+/I symporter
- thyroglobulin iodinised = catalysed by thryoperoxidase
- thyroglobulin + tyrosine = thyroxine (T4)
what is T3
triiodothyronine = active hormone
what is T4
thyroxine - deiodinised in peripheral tissues to form T3
most common
how are T3/T4 carried in bloodstream
bound to albumin
name some changes in pregnancy
greater CO greater blood volume greater alveolar ventilation greater inspiratory volume decrease BP linea nigra striae gravidarum
name the 8 stages of fertilisation
- capacitation
- acrosome reaction
- syngamy
- cleavage
- compaction
- cavitation/expansion
- hatching
- implantation
where does spermiogenesis take place
seminiferous tubules by sertoli cells
what is the point of the blood testis barrier
- prevents chemicals from blood affecting seminiferous tubules
- helps retain luminal fluid
- proper conditions for cell development/differentiation
what is menopause
cessation of menstruation due to degradation of follicles = decrease oestrogen = increase FSH/LH