Card Set Information
Last lecture and a half
What does the urtethra pierce when entering the outside world?
the UG diaphragm
: here it is surrounded by urethral sphincter
Under voluntary control through the somatic nervous system
WHat divides the greater and lesser pelvis?
The pelvic brim
what is the pelvic floor formed by?
pelvic floor muscles- diaphragm- LA mm
What marks the pelvic brim?
top of S1 and the pubic symphesis
What is on the floor of the pelvis?
- perineum lies within the flor
- diamond shaped between the pubic symphesis and coccyx
- this forms the anal and urogenital triangles
Male bits and pieces
What are the contents of the lesser pelvis of a female?
- peritoneal reflections over the UG system- bladder, uterus, vagina, rectum
- recto- uterine space (space behind vagina and infront of the rectum)
- uterus on top of the bladder
- vagina, uterus and ligs can be palpated vis rectum
What is the broad ligament?
- two layers of peritoneum sandwiched together outside the uterus
- round ligament runs through anterior part of broad ligament
- suspensory ligaments of ovary contains ovarian vessels
What are the structures that support the uterus?
- part of the broad ligament
- round ligament of the uterus
- - ligaments around the cervix
What is the position of the uterus normally?
What are the ligaments around the cervix?
- cardinal ligament (transverse cervical)- at the base of the broad ligament- contains uterine artery and vein
- uterosacral ligament- from sacrum to uterus
- pubocervical- from the side of the cervix to the pubic symphosis
what are the components of the broad ligament?
Mesometrium - the mesentery of the uterus; the largest portion of the broad ligament
Mesosalpinx - the mesentery of the Fallopian tube
Mesovarium - the mesentery of the ovaries.
What is the male equivalent of the round ligament of the uterus?
Note/ decent of gonads explains termination of round lig in labia majoria
What is the blood supply of the female pelvis?
- branches of the internal iliac crest
What are the three division of the internal iliac artery?
What artery supplies the ureter?
- uterine artery
Where does the pudendal artery supply blood to?
- provides blood to the external genitalia
Where does the gluteal division of the internal iliac artery supply blood to?
Superior and inferior branches:
- superior- largest branch, supplies glutes, piriformis etc
- inferior- (sciatic art), buttocks and back thigh
What does the pelvic arteries supply?
- organs of the pelvis
Ovarian artery connects with?
Note/ during perganacy uterine artery pulse can be felt thru the vagina
What does the ovary artery supply?
- ureter (ovary art turns into uterine art)
Where are the ext nodes of the lymphatic system?
- sit near the pelvic brim near common and external iliacas
- they drain lower limb and genitals (superficial and deep)
What are the two groups of nodes?
- external nodes
- internal nodes
What are the internal nodes and where are they situated?
- drain pelvic floor and viscera
What lymphatic node does the ovaries drain into?
-para- aortic node near renal arteries
what lymphatic node do the fundus of uterus drain into?
- para- aortic node
What lymphnode does the body of uterus drain into?
- generally to internal iliac node, some to superficial inguinal
what lymphnode does the cervix drain into?
- internal iliac nodes
- also deep sacral nodes
Pelvis inlet and outlet
Inlet- is the pelvic brim
outlet- between ischial spine
Male genital/ UG system
- peritoneal reflections over male system
- retropubic space- access to male UG system
What sphincter is voluntary and involuntary of the bladder?
- internal urethral sphincter is involuntary- primary mm in control of the exit of urine- smooth mm
- external urethral sphincteris- located at the bladder's distal inferior end in females and inferior to the prostate in males- skeletal mm- voluntary
- female ext sphincter not very strong
Urethra in males
- longer than female
- surrounded by lobes of prostate
- prostate lobes develop as diverticula from prostatic urethra
- medial lobe (surrounds urethra) prone to BHP (begins at 45 yrs and by age 80- 80% of men have BPH)- hypertrophy
What are the layers of the perineum?
- superficial perineal space (three muscles and root of penis)- outside
- Inferior fascia of UG diaphragm (aka perineal membrane)
- UG diaphragm- sphincter urethral and transverse perinel mm, bulbourethral glands. Vol sphincter
- Superior fascia of UG diaphragm
-Levator ani- three mm- puborectalis, pubococcygeous, iliococygeous
What mm is responsible for the bend in rectum?
- pouch that develops from ant abdominal wall
- testis have superior retroperitoneal orgin
- drags layers with it and these form various coverings (tunics) or spermatic cord and testies
- vessels, nerves and vas within fascia that surrounds spermatic cord
WHat is the anatomical position for the penis
Anatomy of the penis
- 3 cylinders of erectile tissue
- two corpora cavernosum- crus attached to pubic arch
- corpora spongeosum expands to form glans and transmits urine and ejaculate
- each cylinder is surrounded by elastic sheath
- three cylinders invested by deep fascia of penis
- suspensory and fundiform ligament suspend penis
- when errect the ANS controls
- when errect, stays errect by the compression of the vein
What is the blood supply of the penis?
- two arteries
: dorsal and deep arteries of penis
- most venous drainage into dorsal vein of penis
- peritoneal reflects over female UG system
- recto- urterine space
- uterus bent anteriorly over bladder (antiverted/antiflexed)
- vaginal fornices- intercourse
What are the parts of the external female genitalia?
- located in perineum
- the vulva
- labia majora (outer hair)
- labia minora
- vestibule or urogenital sinus-between labia minora
- urethal orifice
- has 3 layers of erectile tissue- but one uretral tube in the middle
- fibromscular tube- from vestible to uterus
- for elimination of menstrual fluids
- recieves penis during sexual intercourse and holds sperm
- forms birth canal for expulsion of fetus
- fornices (singular fornix)
- interesting wall- four layers
What are the four layers of the vagina?
- lamina propria
- adventitial (nerves and skeletal mm)
What are the layers of perioneum in a female?
- three mm, root of clitoris, bulb of vestibule, greater vestibular gland
- inferior fascia of UG diaphragm (perineal membrane)
- UG diaphragm- sphincter urethral & deep transverse perinel mm
- Levator ani
Male and female structures
WHat supplies most of the peritoneum?
- pudendal artery
What nerve innervates the perineum?
branches of pudendal nerve supplies most. S 2-4
What is the sexual response mediated by?
- sexual response mediated by coordinated activity of autonomic and somatic NS in both genders
WHat are the autonomic effects of the sexual function?
- vascular dilation- causes penile or clitoral erection (parasympathetic)
- stimulation of prostatic or vaginal secretions
- smooth mm contractioon of vas deferns in ejaculation (sympatheitc) and rhythmic vaginal contractions during orgasm
- contraction of somatic pelvic mm (BS and IC) during orgasm
WHat are the four nerve pathways of the sexual act?
- sensory afferents
- somatic (voluntary) efferents
- sympthetic and para efferents
What is sexual function usually driven by?
- psychic and reflex mechanisms that generate sexual sensations
- erection- emission- ejaculation- resolution.
physiology of sexual function
- reflexs arcs throughthe spinal cord important
- both motor and sensory nerve fibres involved
- dual projections from thoracolumbar (T10-L2) and lumbosacral (S2-S4) segments in splanchnic nerves and autonomic plexi
- sexual responses are mediated by the coordinated activity of somatic (sensory and motor), sympathetic, parasympathetic divisions of the nervous systems (four pathways)
Somatic afferent branch involved in sexual sensations?
- glans richly inervated in both genders
- afferents travel in pundenal nerve (S2,3,4), sacral plexus, sacral cord then up to somatosensory cortex
- labia, scrotum, and anal perineal region stimulation adds to sexual sensation
Visceral afferent for sexual sensations
- sexual sensations also originate in internal structures
- urethral, bladder, prosate, testes, seminal vesicles and vas deferens
- inflammation and aphrodisiac drugs can lead to sexual sensation by their action inside the above organs