Y2: Repro Flashcards
Anatomy of Female Reproductive System by Georga Longhurst
Identify the featrues of the Female External Genitalia
Describe the anatomy of female external genitalia and features on clinical examination
Anatomy of Female Reproductive System by Georga Longhurst
What is FGM?
Describe the anatomy of female external genitalia and features on clinical examination
Complex, cultural and rational
4 different types
200m global, illegal UK
Issues w menstruation, urination, labour
??? Future reconstruction of vulva (not currently UK)
Anatomy of Female Reproductive System by Georga Longhurst
Identify features of the clitoris and greater vestibular glands
Describe the anatomy of female external genitalia and features on clinical examination
Anatomy of Female Reproductive System by Georga Longhurst
Identify features of the Vagina
*LOB: Describe the anatomy and relations of the ovary, uterine tubes, uterus, cervix and vagina, including their peritoneal coverings and related ligaments
Anatomy of Female Reproductive System by Georga Longhurst
Identify features of the Cervix
*LOB: Describe the anatomy and relations of the ovary, uterine tubes, uterus, cervix and vagina, including their peritoneal coverings and related ligaments
Anatomy of Female Reproductive System by Georga Longhurst
What is colposcopy
*LOB: Describe the anatomy of vulval cancer and the anatomy of colposcopy
- Procedure to view to investigate cervix
- Speculum inserted into vaginal cavity
- Colposcope (microscope with light
attached) used to look at cervix - Sample of tissue can be taken
- Cervical cancer associated with Human
papillomavirus (HPV)
View through speculum
Anatomy of Female Reproductive System by Georga Longhurst
Identify features of the Uterus
*LOB: Describe the anatomy and relations of the ovary, uterine tubes, uterus, cervix and vagina, including their peritoneal coverings and related ligaments
Hollow, pear-shaped muscular (smooth muscle) organ that protects and nourishes a developing foetus
Three layered wall
1. Perimetrium – outer serous wall covering the uterus
2. Myometrium – thick muscular layer, responsible for process of parturition
3. Endometrium – inner mucous layer; site of implantation; thickness changes through menstrual cycle
Anatomy of Female Reproductive System by Georga Longhurst
What is anteversion and flexion?
*LOB: Describe the anatomy and relations of the ovary, uterine tubes, uterus, cervix and vagina, including their peritoneal coverings and related ligaments
Anteflexion: The axis of the body of the uterus is bent forward with the long axis of the cervix
Anteversion: The axis of the of the cervix is bent forward on the long axis of the vagina
Anatomy of Female Reproductive System by Georga Longhurst
What is retrovesion and flexion?
*LOB: Describe the anatomy and relations of the ovary, uterine tubes, uterus, cervix and vagina, including their peritoneal coverings and related ligaments
Retroflexion: The axis of the body of the uterus is
bent backwards with the long axis of the cervix
Retroversion: The axis of the of the cervix is bent
backwards on the long axis of the vagina
Anatomy of Female Reproductive System by Georga Longhurst
Identify features of the Uterine tubes
*LOB: Describe the anatomy and relations of the ovary, uterine tubes, uterus, cervix and vagina, including their peritoneal coverings and related ligaments
Passageway from ovaries to uterus (passage of ovum)
Inner wall contains cilia to propel ovum
Anatomy of Female Reproductive System by Georga Longhurst
Identify features of the Ovaries
*LOB: Describe the anatomy and relations of the ovary, uterine tubes, uterus, cervix and vagina, including their peritoneal coverings and related ligaments
Functions to produce oocytes and secrete hormones (oestrogen and progesterone)
Anatomy of Female Reproductive System by Georga Longhurst
What is the function of the ovaries?
*LOB: Describe the anatomy and relations of the ovary, uterine tubes, uterus, cervix and vagina, including their peritoneal coverings and related ligaments
Anatomy of Female Reproductive System by Georga Longhurst
What are the Ligaments of the ovary and Uterus
*LOB: Describe the anatomy and relations of the ovary, uterine tubes, uterus, cervix and vagina, including their peritoneal coverings and related ligaments
Ligament of Ovary connects ovary to uterus
Round ligament of the uterus Travels through inguinal canal and spreads into labia majora (foetal remanent of gubernaculum)
Suspensory ligament of ovary arrises from peritoneum (broad ligament) contains ovarian vessels
Anatomy of Female Reproductive System by Georga Longhurst
What are the peritoneal coverings?
*LOB: Describe the anatomy and relations of the ovary, uterine tubes, uterus, cervix and vagina, including their peritoneal coverings and related ligaments
Recouterine Pouch potental space b/n uterus and rectum
Vesicouterine pouch potential space b/n bladder and uterus
Mesovarium- double fold of broad ligament containing uterine tube (open laterally)
Mesometrium double fold of broad ligament containing round ligament and ligament of ovary
Anatomy of Female Reproductive System by Georga Longhurst
What changes occur to cervix in pregnancy?
*LOB: Describe the changes that occur in the uterus and cervix with pregnancy
- Internal os closes off
- Production of mucus plug
- Prevents microbes traveling into amniotic sac
Anatomy of Female Reproductive System by Georga Longhurst
What changes occur to uterus in pregnancy?
*LOB: Describe the changes that occur in the uterus and cervix with pregnancy
- Expands in size significantly
- By 12 weeks, the fundus rises out of the abdomen and by 40 weeks it reaches the level of the xiphoid process
- Walls become thinner and nearly membranous
Anatomy of Female Reproductive System by Georga Longhurst
What changes occur to cervix in labour?
*LOB: Describe the changes that occur in the uterus and cervix with pregnancy
Dramatic remodeling (collagen realignment) to allow for
passage of fetus
* Softening
* Ripening
* Dilatation (approx. 10cm)
* Postpartum restoration
Anatomy of Female Reproductive System by Georga Longhurst
What changes occur to uterus in labour?
*LOB: Describe the changes that occur in the uterus and cervix with pregnancy
- Uterine myometrium becomes more excitable
- first irregular contractions but become more regular and expulsive -positive feedback loop
Anatomy of Female Reproductive System by Georga Longhurst
What are the thickenings of the endopelvic fascia?
*LOB: Describe the anatomy and relations of the ovary, uterine tubes, uterus, cervix and vagina, including their peritoneal coverings and related ligaments
Uterosacral passive uterus and cervix support
Cardinal attaches from lat pelvic wall to uterus cervix and vagina, passive support of uterus and cervix, anchor sutures in surgery
Pubocervical fascia prevents bladder herniating into vagina
CLINICAL: weakening and damage results in prolapse
Anatomy of Female Reproductive System by Georga Longhurst
What is the arterial supply?
*LOB: Describe the origin, course and relations of the ovarian, uterine and vaginal vessels
Ovarian artery From abdo aorta, runs in suspensory lig
Uterine artery from Ant Internal Iliac, crosses ureter, anastamoses w ovarian artery
Vaginal artery branch from uterine artery of Ant interal illiac
Anatomy of Female Reproductive System by Georga Longhurst
What is the nerve supply?
*LOB: Describe the origin, course and distribution of the pudendal nerves and the sites of pudendal nerve block
Sympathetic
* from symp chain
Sacral splanchnic L1-L2/3
* Sympathetic to viscera and vessels in pelvis
* Contract internal urethral and anal sphincter
* Secretion from reproductive glands
Pelvic splanchnic nerve (S2 – S4)
* Parasympathetic to viscera and vessels in pelvis
* Erection
* Contraction of detrusor muscle in bladder
* Inhibit contraction of internal urethral and anal sphincter
Inferior hypogastric plexus
n/a
Pudendal nerve (S2 - S4)
* Motor and sensory to perineum
* Think pleasure
Anatomy of Female Reproductive System by Georga Longhurst
What is the lymphatics/
*LOB: Describe the lymphatic drainage of the pelvic and perineal organs
Pelvic Viscera drains to int ext iliac nodes, to pre-aortic nodes
Ovaries, tubes, upper uterus follows ovarian vessels, aortic/lumbar nodes
Perineum clitoris and lab maj = superificial inguinal, glans clitoris, lab min, distal vagina = deep inguinal
Anatomy of Male Reproductive
Label the Anatomy
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
Anatomy of Male Reproductive
Scrotum
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
A cutaneous sac consisting of
* Skin
* Dartos fascia (wrinkles to help reduce heat loss)
* Male gonads are externalised from the
abdominopelvic cavity
* Optimum temperature for spermatogenesis 2 – 3
degrees lower than body cavity
* Contains the left and right testes and spermatic cord separated by a septum
* Scrotal raphe
External marking of the internal septum of the scrotum which divides the scrotum into left and right sides
Anatomy of Male Reproductive
Testes
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
Paired ovid shaped gonads that are suspended in the scrotum by the spermatic cord
* Produces spermatozoa (seminiferous tubules) and androgens (Leydig cells)
* Surrounded by thick capsule (tunica albuginea) and multiple musculofascial layers
* These layers are related to the development of the testis
Anatomy of Male Reproductive
Gonadal development
*LOB: Describe the structure and course of the spermatic cord and ductus (vas) deferens
Gonads (testis or ovary) originally develop in the abdomen (close to the posterior abdominal wall).
* Descend inferiorly towards labioscrotal swelling
* Testis travel into scrotum, by traversing through and picking up layers of the abdominal wall.
* Ovaries remain in pelvis
Anatomy of Male Reproductive
Decent of Testes
*LOB: Describe the structure and course of the spermatic cord and ductus (vas) deferens
1) Gubernaculum Cord like structure guides gonad towards labioscrotal swelling from posterior abdo wall
2) Precessus Vaginalis Invagination of partial peritoneum- creates tubular extention of peritoneal cavity for testis and neurovasculature herniate through INGUINAL CANAL ORIGIN
3) Testis and spermatic cord now
surrounded by musculofascial layers and rocess vaginalis obliterates ~6mo but paten (open) around testis and epididymis as the tunica vaginalis (sac)
Anatomy of Male Reproductive
Label the layers of Testis and Spermatic cord
*LOB: Describe the structure and course of the spermatic cord and ductus (vas) deferens
1) External Spermatic Fascia
2) Cremasteric muscle and Fascia
3) Internal Spermatic Faschia
4) Partial layer of tunica vaginalis
5) Cavity of tunica vaginalis
6) Visceral layer of tunic vaginalis
7) Tunica Albuginea
Anatomy of Male Reproductive
CLINICAL: Hydrocoele
*LOB: Describe the structure and course of the spermatic cord and ductus (vas) deferens
Excess serous fluid
* Located in spermatic cord:
* Excess fluid in a persistent Processus vaginalis
* Located in testis: Increase fluid secretion from visceral layer of tunica vaginalis
* Clinical examination: Trans-illumination positive
* Light signs through excess serous fluid
Anatomy of Male Reproductive
Layers of the Testis
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
Some Dumb Englishman Called It the Testis
Skin of Scrotum
Dartos (superficial) Fascia
External spermatic fascia
Cremaster Fascia
Internal spermatic fascia
Tunica (parietal)
Tunica (visceral)
Anatomy of Male Reproductive
Epididymus
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
- Receives spermatozoa from testes
- Elongated (comma shaped) structures
- Formed of a long-coiled tube
- Functions to stores and mature spermatozoa
- Spermatozoa passes to the vas / ductus deferens which is part of the spermatic cord
Anatomy of Male Reproductive
Spermatic Cord
*LOB: Describe the structure and course of the spermatic cord and ductus (vas) deferens
Anatomy of Male Reproductive
Testicular Torsion
*LOB: Describe the significance of the vascular supply of the testis in relation to torsion and varicocele and the lymphatic drainage in relation to tumour spread
Twisting of testis and spermatic cord
* Cuts of blood supply: Ischemia
* 5-star medical emergency
* Treatment
* Manual rotation
* Surgical rotation – attaching testicle to scrotum
* 6 hours – 90% chance saving testis
* 24 hours – 0%
Anatomy of Male Reproductive
Varicocele
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
Bag of worms’ appearance
* Pampiniform plexus becomes dilated and tortuous
* More common on the left side
* Due to higher venous pressure
* Left testicular vein drains into left renal vein at a right angle, causing turbulent flow
Anatomy of Male Reproductive
Vas Ductus Deferens
*LOB: Describe the significance of the vascular supply of the testis in relation to torsion and varicocele and the lymphatic drainage in relation to tumour spread
Water under the bridge
- Receives mature sperm from the tail of the epididymis
- Passes in the spermatic cord
- Passes through abdominal wall (inguinal canal) to enter
pelvic cavity - Passes over the roof of the bladder
- Ampulla of vas deferens Joins duct of seminal vesicles
Anatomy of Male Reproductive
Accessory Reproductive Glands
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
Anatomy of Male Reproductive
Ejaculatory Duct
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
Duct of seminal vesicle joins ampulla of ductus / vas deferens to form ejaculatory duct
* Ejaculatory duct transports semen into the prostatic urethra
Anatomy of Male Reproductive
Prostate (gross anatomy)
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
Anatomy of Male Reproductive
The prostate
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
Anatomy of Male Reproductive
Zones of the prostate
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
Anatomy of Male Reproductive
Puboprostatic ligament
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
Anatomy of Male Reproductive
Bulbourethral
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
Membranous Urethra
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
Anatomy of Male Reproductive
Urethra recap
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
Anatomy of Male Reproductive
Penis
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
Anatomy of Male Reproductive
Penis MSK
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
Fundiform Lig
Suspensory Lig
Ischiocavernosus M
Bulbospongiosus M
Anatomy of Male Reproductive
Compare Penis and Clitoris
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
Anatomy of Male Reproductive
Erection, Emission and Ejaculation
Describe the innervation of and mechanisms involved in the erection of cavernous tissue and in emission and ejaculation
Anatomy of Male Reproductive
Blood Supply of Pelvis
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
Anatomy of Male Reproductive
Course of Pudendal Neurovascular Bundle
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
Anatomy of Male Reproductive
Nerves of the Pelvis
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
Anatomy of Male Reproductive
Lymphatics of Pelvis and Perineum
*LOB: Describe the anatomy, neurovasculature and lymphatic drainage of the scrotum, testis and epididymis, penis, prostate and seminal vesicles, and their features on clinical examination
Greater Pelvis
Lesser Pelvis
Sex Difference
Pelvic Floor
Perineum
Superficial Perineal Pouch
Perineal Body
Ischioanal Fossa
Course of Pudendal Neurovascular Bundle
Pudendal Nerve Block
